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By Alex Ruoff
Jan. 5 — Advocates for behavioral health providers applauded the Obama administration's new push to support mental health services and bolster the federal background check system for gun purchases, but some cautioned it will do little to stem violence.
Renee Binder, president of the American Psychiatric Association, said in a statement the changes would help curb gun violence. She said the APA would work with Congress to ensure that President Barack Obama's proposed $500 million increase in funding for mental health services would become a reality.
“Gun violence is a public health problem and needs to be addressed as such,” Binder said.
However, the head of Mental Health America, a consumer advocacy organization, told Bloomberg BNA that an effort to encourage more reporting of mental health data to the federal government's background check system for gun purchases may result in only a slight uptick in reporting.
Conservatives in Congress and right-wing policy analysts said the changes would do little to curb violence. Lawmakers vowed to fight the changes.
President Obama announced Jan. 5 a push to require all sellers of firearms to perform background checks on their customers and directed the Social Security Administration to begin the rulemaking process to include information in the background check system about beneficiaries who are prohibited from possessing a firearm for mental health reasons.
Obama also proposed $500 million in new federal funding for mental health services.
As part of that effort, the HHS Office for Civil Rights released a final rule Jan. 4 clarifying that certain health-care organizations and state agencies can report to the National Instant Criminal Background Check System (NICS) the identities of individuals who are subject to a federal “mental health prohibitor” that prevents them from possessing a firearm (02 HCDR, 1/5/16).
The new policy doesn't require physicians directly involved in patient care to report to the NICS, but would allow certain state health agencies with the authority to make adjudication or commitment decisions regarding mental health patients to report to the background check system without fear of violating the Health Insurance Portability and Accountability Act.
Local courts typically make the determination whether someone is capable of standing trial or not guilty of a crime by reason of insanity, which also deem an individual ineligible under federal law to purchase a firearm.
The OCR's final rule likely will affect only a few small psychiatric hospitals and public agencies, Paul Gionfriddo, president and chief executive officer for Mental Health America, told Bloomberg BNA Jan. 5. Most agencies that report to the NICS, such as court systems, aren't covered by HIPAA because they don't offer health-care services, he said.
The policy change was purposefully narrowly tailored to ensure that those voluntarily seeking mental health services wouldn't be reported to federal authorities, he said.
“The worry was that someone might end up on a list because they went to see a psychiatrist,” Gionfriddo said. “That wasn't really ever being considered but they clearly wanted to avoid making this too broad.”
With the change, the NICS system could see as much as 1,000 new records, he said.
Providers of mental health services don't want to report data about their patients to federal authorities for fear of discouraging someone from seeking treatment, Mark Covall, president and chief executive officer of the National Association of Psychiatric Health Systems, told Bloomberg BNA.
Republican lawmakers were critical of Obama's actions, particularly the request for funding to expand mental health services, which requires congressional approval.
“More money into our disastrously failed and antiquated system will only result in more lives lost,” Rep. Tim Murphy (R-Pa.), who has long pushed for reforms to mental health care, said in a statement.
Murphy introduced a bill (H.R. 2646) in 2015 that would alter HIPAA to give caregivers and families more access to patients' health information .
House Speaker Paul Ryan (R-Wis.), in a Jan. 5 statement, warned that the president's executive actions would be overturned if a Republican wins the presidential election in November.
The National Center for Policy Analysis, a conservative policy think tank, said in a statement that the changes Obama proposed “would do nothing to prevent gun violence” and would discourage some from seeking mental health services.
Obama, speaking at a press conference in Washington, said he'll immediately hire more Federal Bureau of Investigation employees to process background check applications and bolster the NICS.
He also touted the Department of Health and Human Service OCR change as a way to ensure that more mental health records will be submitted to the NICS.
However, state health agencies and mental health facilities have long complained that technology failures and privacy concerns have prevented them from reporting to the NICS, according to the OCR's final rule.
HIPAA doesn't require state agencies to report to the NICS the identities of individuals who are prohibited from purchasing firearms under either federal or state laws, the rule said. Additionally, HIPAA-covered entities may only use and disclose mental health data with an individual's express written authorization.
The NICS records are submitted voluntarily by local and state agencies as well as mental health institutions, psychiatrists, police departments and family members requesting placement of individuals into the system, Holly Henry, an FBI spokeswoman, told Bloomberg BNA in an e-mail.
The number of mental health records in the NICS grew by more than 2 million between 2011 and 2015, according to FBI data.
There are currently more than 4.25 million mental health records in the NICS, up from 1.8 million in 2011, according to the FBI.
The NICS can have multiple records for each person reported to the system, Henry said, meaning there are fewer than 4.25 million individuals banned from purchasing a firearm due to mental health reasons.
Mental health prohibitions are the eighth-most-common reason people have been denied by the NICS, according to the FBI. More than 21,000 background checks were denied under the “adjudicated mental health” category between November 1998 and December 2015.
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