Gun safety ‘wrapped in a mental health bill’: A look at health provisions in the new law

The gun safety law forged through tense bipartisan talks in the Senate last month has been heralded as the first federal legislation in 30 years to combat rising gun violence. But what often falls below the radar is the new law's focus on improving mental health services.

News coverage has largely centered on the law's provisions to enhance background checks for younger buyers, encourage states to implement their own "red flag laws," and close the "boyfriend loophole." Less attention has been paid to the mental health programs that most of the estimated $13 billion is earmarked for.

"It is kind of a gun safety bill wrapped in a mental health bill," said Jeffrey Swanson, a psychiatry professor at the Duke University School of Medicine who studies the intersection of gun violence and mental illness.

The pairing of these initiatives in the legislation spearheaded by a small group of senators after the May 24 school shooting in Uvalde, Texas, was a result of Republicans' insistence that any gun reform effort must also address mental health, even as Democrats disavowed a connection between the two concerns.

"We don’t think you can solve America’s gun violence epidemic through the prism of mental health. But if we have agreement between Democrats and Republicans to spend billions of additional dollars on mental health treatment, especially for vulnerable communities, let’s take that opportunity," said Sen. Chris Murphy (D-Conn.), a key negotiator, while laying out the bill's framework at a June 13 press conference.

While mental health advocates are happy Congress is authorizing new funds for their cause, they also expressed concern it would continue to perpetuate the idea that people with mental health disorders are largely responsible for gun violence, although research shows that's not the case. Only 3% to 5% of violent acts are committed by individuals with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. People living with mental illness are more likely to be victims of violence than are members of the general population.

"It is with very mixed emotions when we think about lumping these together," said Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness. "We need mental health investments, yet we know that mental health is not the direct cause of a person being violent."

A central question about this heightened level of investment is whether it can make a difference in the nation's struggle to combat gun violence. Here's a look at key mental health aspects in the new law.

What's in the legislation

The Congressional Budget Office estimated the new law's total cost at $13 billion, a large chunk of which will be used to increase funding to expand existing mental health and school safety services programs, including $1 billion over five years for two programs to boost the number of mental health counselors in schools.

Other allocations include:

• $80 million over four years for a pediatric mental health care access program, which allows pediatricians to provide mental health services via telehealth. An additional $60 million over four years is directed toward training primary care clinicians to provide mental health services to young people.
• $250 million over four years to increase the Community Mental Health Services block grants to states to help fill in blanks in a state's mental health system, such as creating care programs for adults and children with serious mental illnesses or emotional disturbances.
• $240 million over four years would be added to Project AWARE, which provides grants to mental and behavioral health organizations, community groups, and schools to raise students' awareness of and connect them to mental health services in schools.
• $150 million this year for the new 988 National Suicide Prevention Lifeline, which launches in mid-July.

The new law also provides up to $8.6 billion in funding over 10 years to support the build-out of certified community behavioral health clinics in every state in the U.S. These types of clinics, which already exist in 10 states as part of a pilot Medicaid program, are required to see people regardless of their insurance coverage and treat them for mental health or substance use issues. States would need to apply to participate in the program, which would begin in 2024.

While annual reports submitted to Congress about the pilot program show behavioral health outcomes varied by state, other data shows the clinics have saved money and scored well on such measures as getting patients to adhere to antidepressant medication or engage in alcohol-dependence treatment. However, a 2021 Government Accountability Office report found that the data on these clinics was incomplete, leading to difficulty in evaluating their effectiveness in improving behavioral health.

How useful are these mental health programs and when will they start?

It's hard to know how effective the new spending will be at improving mental health, said Marisa Domino, an economist and the director of the Center for Health Information and Research at Arizona State University, because not all the programs getting additional funding have been evaluated for effectiveness or are able to be evaluated.

"There are lots of little opportunities in this bill, but it's hard to tell as a whole" if it will be useful at improving mental health, said Domino.

Some of the funding will begin this year and continue for four or five years. Other spending streams may not start until 2024. That's typical since government funding must be planned years in advance. But it raises questions about how quickly mental health programs can be beefed up.

Still, advocates and researchers emphasized that more money going toward mental health will likely be beneficial since programs are severely underfunded across the U.S.

Will it stem gun violence?

It depends on how you define gun violence, said Swanson.

Over half of gun deaths in the U.S. are suicides, and it's possible this legislation will help to reduce those deaths.

The new law also provides funding for states, which can be used to implement red flag laws, which have been shown to reduce suicide rates. These types of laws, now on the books in 19 states and the District of Columbia, allow for family members, police, or doctors to petition a court to ask to temporarily remove guns for up to a year from people who they fear may be at risk of harming themselves or others.

For example, Swanson led a research project analyzing how a red-flag policy worked in Connecticut, where his team estimated that for every 10 to 20 guns removed, one suicide was prevented.

But experts acknowledge that the mental health spending may not do as much to stop the gun violence that's manifested through mass shootings, such as in Uvalde, at a supermarket in Buffalo, New York, in May, and during a Fourth of July parade in Highland Park, Illinois.

"The vast majority of people with mental illness are not violent," said Swanson.