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The latest mass shooting has prompted Congress to talk about mental health again, in addition to gun control. Almost all of the recent mass killers have shown signs of mental illness: Navy Yard shooter Aaron Alexis was reportedly hearing voices prior to his rampage. Adam Lanza's mother tried to commit him to a mental institution before Sandy Hook. Before the mass shooting at Virginia Tech in 2007, there was a failed attempt to involuntarily commit the perpetrator, Seung-Hui Cho. Would stricter mental health background checks or a reformed mental health system have prevented these tragedies? Maybe. Members of Congress are now discussing a few options, but the proposals are struggling to attract much support.

How did the our mental health system get to this place? Over the past two decades, budget cuts have resulted in fewer state hospitals and less access to mental health care. This is part of a century-long shift from inpatient psychiatric care to the primarily outpatient care that's offered now. Some think that this deinstitutionalization has gone too far, and that "we’re protecting civil liberties [of patients] at the expense of health and safety," as Doris A. Fuller, executive director of the Treatment Advocacy Center, told The Washington Post. Money-wise, the Great Recession placed extra constraints on state budgets — states cut $1.8 billion in mental health care funding between 2009 and 2011 (Alaska, South Carolina, Arizona and D.C. made the most significant cuts). Compared to other nations, however, the U.S. still spends a fair amount on mental health — a little less than Australia, a little more than France. 

And now there is little momentum to fix the system. The gun lobby is split over whether to support mental health initiatives — some, like the NRA's executive vice president Wayne Lapierre, say they do. Others are worried mental health initiatives will open the door to gun control, as The New York Times' Jeremy W. Peters reports. And gun control advocates, especially Senate Majority Leader Harry Reid, are worried mental health initiatives will divert Congress away from making stricter gun laws. So what are lawmakers proposing?

Mental health background checks for gun purchases

Who's proposing it: Republican Sen. Tom Coburn, but he's all but given up. Currently, federal law only bans those who've been involuntarily committed to a mental institution from buying guns. Coburn proposed stricter background checks this year, but the legislation fell apart. He told The New York Times, "It's all politics."

Some states, however, have updated their laws with stricter background checks. After Newtown, New York passed a law with a provision that requires mental health professionals to report dangerous patients to local officials. The officials, if they agree with the assessment, can then confiscate patients' guns and revoke their gun licenses. Connecticut also passed legislation that requires hospitals to report those who've voluntarily committed themselves for psychiatric treatment. Those patients are then banned from buying guns for six months.

Florida and California have similar laws.

Could it pass? Not likely. The idea will have to be picked up by others in Congress and given new life. One note of encouragement is that the NRA supported Florida's legislation.

Some are also hesitant about this kind of legislation because of privacy implications. Since there's been no consensus as to who exactly qualifies as "dangerous," Garance Franke-Ruta at The Atlantic writes that there are "privacy and stigmatization issues involved in cataloging harmless people who suffer from common mental illnesses in order to label them as potential threats in a federal government database."

Teacher training about mental illness

Who's proposing it: Republican Sen. Kelly Ayotte and Democratic Sen. Mark Begich wrote to the Senate on Wednesday insisting there be no delay in addressing "clear connection between recent mass shootings and mental illness." Ayotte and Begich are attempting to revive stalled legislation that would "establish programs to train teachers to recognize the signs of mental illness and how to defuse potentially violent situations."

It should be noted: Both Ayotte and Begich opposed the assault weapons ban that failed in April. 

Could it pass? Again, not likely. The Times reports that Reid is hesitant to pursue any mental health legislation in the Senate before addressing gun control. 

More care and services for the mentally ill 

Who's proposing it: Democratic Sen. Debbie Stabenow is now reviving her Excellency in Mental Health Care Act, which aims to increase access to psychiatric services. Among other things, it would establish 24-hour crisis care at community health centers.

Could it pass? No. Reid says there aren't enough votes. 

The National Alliance of Mental Health, however, says there is already a helpful law in place: the Affordable Care Act. NAMH's director of communication Katrina Gay tells US News and World Report , "the implementation of the ACA is critically important to helping people who are living with mental health conditions have more access." According to the Substance Abuse and Mental Health Services Administration, 

Obamacare will mean 2.6 million Americans with mental illness or substance abuse will be eligible to enroll for health care within the new insurance market places opening up on Oct. 1, and 2.7 million will be eligible for mental health care through the expansion of Medicaid.

Gay says, "I don't know if Congress quite connects the dots between ACA and mental health care." Of course, a significant number of people in Congress are making a last-ditch effort to defund Obamacare before the insurance exchanges go into effect on October 1.

It's only been a few days since the Navy Yard shooting, but as of right now, it doesn't look like Congress will do much about mental health.

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