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DAVID GREENE, HOST:

OK. As we just heard in Jeff's piece, members of the Newtown Advisory Commission don't know if Adam Lanza's mental health issues played a role in the attack at the school. Still, the massacre sparked a national conversation about mental health, with politicians promising more funding and new laws.

But what has actually changed? Jenny Gold has a look.

JENNY GOLD, BYLINE: Eighteen-year-old Rheanna Kathleen Morris has spent the past two years in and out of psychiatric units near her home in the Richmond, Va., suburbs.

RHEANNA KATHLEEN MORRIS: The end of my sophomore year, I was diagnosed with bipolar. I was put in the hospital after a suicide attempt, and that really started our foray into the mental health system.

GOLD: Her mother, Peggy Sinclair-Morris, is a former special ed teacher with a strong network of contacts. But even for this family with the know-how to work the system, it's been a constant challenge.

PEGGY SINCLAIR-MORRIS: It's scary. It's very fragmented. There's not a one-stop shop. You have to call people. You have to network. You have to find someone who might have had experience similar to yours. You just - you have to talk to people.

GOLD: From their perspective, not much has changed in the year since the shooting at Sandy Hook in Connecticut, and recent events in Virginia seem to support that. Just last month, State Sen. Creigh Deeds' 24-year-old son stabbed his father several times before killing himself. Austin Deeds had struggled with serious mental health problems, and was denied a bed in a psychiatric facility the day before. The rate of violent crimes among the mentally ill is very low, but Rheanna says the story hit home anyway.

MORRIS: I almost cried, actually. I was reading about it in the newspaper, and I thought: What if that had been me? I know I would never hurt my family, but if it had been me, you wouldn't hear about it all over the news, you know. Nothing would have happened.

GOLD: Virginia did boost its mental health funding after Sandy Hook, by about 5 percent. Thirty-five other states also increased funding. But that was a drop in the bucket after four years of recession-era cuts, says Sita Diehl with the National Alliance for Mental Illness, or NAMI.

SITA DIEHL: After these sorts of shootings, there's a lot of talk and a lot of policymakers saying we need to do something about the mental health system. But then when push comes to shove and the budget debates occur, mental health seems to lose out.

GOLD: Most of the additional funding was part of state bills that were already being considered, she says. The events at Sandy Hook gave legislators the push they needed to pass them. But still, Diehl says, that's a lot more than was done by federal legislators.

DIEHL: OK, I give the states a B-plus. I'm an A student, so, you know, I give the feds a C-minus, maybe a D. You know, a lot of talk, no action.

GOLD: Congress didn't pass mental health legislation following Sandy Hook, though several bills are still in the works. That sort of response doesn't come as a shock for Virginians, says Mira Signer, who runs NAMI's Virginia chapter. In 2007, the state was the site of the deadliest mass shooting in U.S. history - at Virginia Tech. It left 33 people dead at the hands of someone with a serious mental illness. The state added $42 million in new mental health funding. But then the recession hit and they cut almost all of it, says Signer.

MIRA SIGNER: And so we were kind of back to square one.

GOLD: Following the Creigh Deeds tragedy, Gov. Robert McDonnell pledged to add $38 million back into the system. Signer says this sort of roller coaster in funding is typical in mental health.

SIGNER: You know, I can look at reports and studies that were done like, 10, 15, 20 years ago; and I'm looking at the recommendations, and they're still true today. You know, you just need to slap another date on it. You - just needs to say 2013, 2014 - because they all say the same thing.

GOLD: The sort of tragedy-based conversation that happens in the wake of Virginia Tech or Sandy Hook or Aurora, Colo., just seems to fall away, she says; and it's not a mystery what the system needs: more services, more funding and stronger laws. She says the issue is getting it done before another tragedy strikes.

For NPR News, I'm Jenny Gold.

GREENE: Jenny is with Kaiser Health News, a nonprofit news service.

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