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Q&A: DeWine’s Mental Health Proposals After The Dayton Shooting

During a vigil for the victims from the recent mass shooting in Dayton, Gov. Mike DeWine's remarks were drowned out by those in the crowd imploring him to  "do something." And he has started to do something, rolling out a 17-point plan to reduce gun violence. Several parts of his plan address mental health. Morning Edition host Amy Eddings discussed these proposals recently with ideastream's Anne Glausser.

What did the governor propose?

There are four proposals that specifically have to do with mental health. There's one around early intervention: this is money that's already in the budget, $675 million, that will fund wrap-around services for schools to address students' social and emotional issues.

So this isn't anything new. This is already planned, and it's just highlighting the fact that he did this.

There's the telemedicine proposal, which is also already in the budget but he's highlighting the efforts. The Ohio Department of Medicaid is investing $15 million in telehealth mental health services for kids to increase access to care for those who face barriers like transportation or nearby providers. The medicaid program already has telemedicine mental health services, so this would really be an expansion of these services. Additionally, in July, the Ohio medicaid program lifted their restrictions related to providing telehealth care so providers face fewer hurdles to setting up these kind of services (which was flagged to me as a big issue from University Hospitals psychiatrist Dr. Patrick Runnels). 

Another proposal was this idea of identifying risk factors and connecting people with resources. I spoke with Tracy Plouck, the former head of the Ohio Department of Mental Health and Addiction Services under Gov. John  Kasich and now an Executive in Residence at Ohio University, and she said that this kind of outreach about how to identify warning signs of a mental illness and know where to go for help is good but isn't really a sea change. 

But this fourth proposal would be a sea change if it passes the legislature, according to Plouck and others. DeWine is proposing to increase access to inpatient psychiatric care by revamping where the courts place people who are deemed not competent to stand trial for misdemeanor offenses. According to UH's Runnels, this is an evidence-based practice nationally that improves outcomes. 

Plouck explains it like this: "If someone goes into a CVS pharmacy and steals some toiletry items, they might be picked up for that property crime and they might be exhibiting signs of mental illness. A judge could place them into a state hospital today for their competency restoration and they might be there for 90 days. They may not have any signs that they are planning to harm themselves or harm anyone else."

So the whole idea behind this legislative change is to have that "restoration to competency" happen in a community setting, freeing up psych beds for those who really need them. Runnels said he thinks this is a good idea but also points out that some counties are already doing something similar within our current legal system through court mental health dockets. So he's curious to see what needs to happen in the legislature to further this kind of community-based mental health work.

How are other people in the mental health field feeling overall about these proposals?

It's kind of a two-parted response really: excitement that mental health is getting attention and that these kind of proposals are going to strengthen the overall health and well-being of Ohioans, but there's also concern about the stigma caused when associating mental health issues with mass shootings.

Tom Royer, president and CEO of the social and mental health services provider Beech Brook, said DeWine's mental health proposals are a step in the right direction, but says "one thing I would hope though is that the governor would come out and make clear that the proposal, while it addresses mental illness, it can lead to further stigmatizing folks who have mental illness and could eventually prevent people from seeking help when they need it."

So DeWine is seeing a connection between mental illness and mass shootings. But what do we know about that connection?

The folks I spoke with said that mental health is part of the issue at hand when it comes to mass shootings, but there are other risk factors at play. A new report from the advocacy organization National Council for Behavioral Health says "people with serious mental illness are responsible for less than 4 percent of all violence and less than a third of mass violence," according to their press release.

"Hatred, bigotry, impulsivity, and an interest in harming others: these are not necessarily a diagnosable mental illness," said Plouck.

The bottom line for Plouck is it's about showing kindness and compassion for those that have been traumatized by the shooting, and for those who are experiencing trauma every day in their lives. Addressing trauma matters, she says, and everyone has a role: schools, police, courts, jails, governments, health care, and nonprofits.

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