There was a great thunderclap of consensus in the days following the 12/14 attack on Sandy Hook School that something has to change. The crime, which left 20 first graders and six school personnel dead, was so shocking and so wrong that the calls for action were immediate and widely supported across even the yawning political divide in this country. The inquiries into what and how much change would be possible began quickly, and soon focused on three areas: gun control, school safety, and mental health.
Of the three issues, gun control has moved the fastest and has drawn the most attention. Because of its political nature and its apparent dependency on swaying opinions rather than ascertaining facts, the gun control issue is likely to be the first to be addressed on the state and federal level, one way or the other. (New York State has already enacted stricter gun laws.) And last week, the state’s Sandy Hook Advisory Commission learned from a panel of architects that while some improvements are possible, hardening school facilities against threats will never offer absolute protection. Change is likely to be measured and incremental in both these areas.
In the calculus of causes and effects of the 12/14 tragedy, guns played a deadly role in amplifying the overwhelming effects of the crime. Mental illness, on the other hand, has taken its place on the causal side of the equation, even though the exact nature of Adam Lanza’s mental problems has yet to be defined. Attacking the root cause of gun violence has been given special emphasis on both sides of the gun debate. But the need for early intervention in mental illness that poses a threat to individuals and the public at large, though widely acknowledged, is likely to prove the biggest challenge to those calling for change. Just ask parents currently struggling to get mental health services for their children.
Under our current patchwork system of services and insurance coverage, parents are often left to themselves to navigate a complicated and frustrating “fail first” system of mental health care required by private insurers. Even when the best course of treatment — say hospitalization or residential care — is obvious to health care providers, patients are required by insurers to “fail” at less intensive (and less expensive) levels of care, before moving on and on to higher levels of care at which they must also fail before accessing the treatment they needed from the beginning. This may take months, years, or it may never happen at all. Many services offered in the community or at home are not covered by private insurance, and some residential services do not accept private insurance. The process is full of dead ends, which raise the risks of devastating consequences at every turn.
A key battle in changing the status quo will be to provide better and more comprehensive support for families trying to navigate the labyrinthine mental health care system. They need access to information and resources. They need better coordination of school, state, and private services so the system is less trial and error and more trial and treatment.