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The national debate over gun violence has followed two themes. One involves gun control and the other involves mental health. Gun rights advocates have their reasons to talk about the mentally ill but they're not the only ones doing it here. President Obama yesterday spoke of addressing the nation's fragmented and poorest mental health system.
And reporter Sarah Varney found mental health advocates encouraged by the attention.
SARAH VARNEY, BYLINE: If the National Rifle Association's plan to curb violence was in part arming schools with guns, President Obama wants to arm them with something quite different: mental health training. The president's plan centered largely on training teachers and others who work with children to recognize mental illness as it's developing.
Dr. Paramjit Joshi is the incoming head of the American Academy of Child and Adolescent Psychiatry.
DR. PARAMJIT JOSHI: The fact remains that about 50 percent of lifetime mental illness starts before the age of 14.
VARNEY: Dr. Joshi says three out of four people with mental illness develop their affliction - including bi-polar disorder, depression, schizophrenia - by young adulthood, when the intricate structures of the brain are taking shape. But less than half receive treatment.
The president has called for a new initiative, which would need congressional approval that would provide mental health first aid training for teachers and set up a robust referral system for children with mental health and behavioral problems.
Mike Fitzpatrick, executive director of the National Alliance on Mental Illness, called the training critical.
MIKE FITZPATRICK: People say, oh, we saw the signs. But no one knows what the next steps are and that includes families and caregivers and teachers and resource officers. And so to go into the communities and offer training on what to look for, how to spot the signs of mental illness, and really, where do you go to get assistance - this in many ways would be a game changer.
VARNEY: President Obama's proposal also points out that a startling number of children have direct experience with gun violence: 22 percent of 14 to 17-year-olds in the U.S. have witnessed a shooting in their lifetime, and the plan calls on Congress to direct some $25 million to help traumatized students. A separate initiative would aim support at older teens and young adults in need of help, who can get lost in the tumble of college or a first job.
Dr. Joshi says all these efforts together recognize that children are developing in both body and mind.
JOSHI: I think this is really putting the focus on children's mental health as a child issue.
VARNEY: But mental health experts across the nation said in interviews that while it's critical to recognize the first signs of mental illness, it's just as important that children and their families have health insurance that guarantees them covered treatment. That problem was addressed, in part, five years ago when then-President George W. Bush signed a law requiring larger employers to offer mental health coverage that was on par with medical benefits.
But writing the regulations has proved difficult. There's been disagreement, for example, over a lifetime cap on the number of therapy visits for people with depression. In the meantime, those with mental illness have languished, their advocates say, under temporary rules that have barred patients from a full range of mental health services. That's set to change now.
One of the executive actions the president signed yesterday included a vow to issue final rules for the so-called Mental Health Parity Law in February.
CHUCK INGOGLIA: We're hoping that a final rule on parity will make it very clear about the scope of services that are offered.
VARNEY: Chuck Ingoglia, of the National Council for Community Behavioral Healthcare, says the rules will apply to nearly every type of insurance - from state Medicaid programs to employer coverage to individual health plans sold under the Affordable Care Act. Among the so-called essential benefits will be mental health care.
INGOGLIA: The whole intent of the parity law was that if you need mental health and addiction services, that it should be available to you.
VARNEY: Those rules won't require congressional approval, but much of the president's plan to improve mental health services - and his other proposals to require universal background checks for gun purchases, and to ban certain assault weapons and high-capacity magazines - will hinge on support from a Republican-led Congress that he has long had a contemptuous relationship with.
Still, the NRA and a number of Republicans have said they support addressing the nation's fractured mental health system, and advocates for the mentally ill say they anticipate far less political resistance. The total package of mental health proposals in the president's plan total some $155 million - million with an M, not billion - and the modest scale, those advocates say, might just be something everyone can agree on.
For NPR News, I'm Sarah Varney.
INSKEEP: She's a reporter with our partner Kaiser Health News, which is a non-profit news service.
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