Updated Feb 27, 2018

What Trump's call for "mental institutions" could actually achieve

President Trump has said the U.S. should bring back mental institutions. Photo: Chip Somodevilla/Getty Images

President Trump's call to bring back "mental institutions" isn't likely to catch on, but some experts hope it could be a springboard to addressing legitimate gaps in the mental-health system, including a lack of treatment options for low-income patients.

Why it matters: Most people who suffer from a mental illness aren't violent, but addressing the broader failings of the mental-health system could — in addition to improving millions of people's lives — also help prevent another mass shooter from falling through the cracks.

“In the old days, you would put him into a mental institution.  And we had them in New York, and our government started closing them because of cost.  And we're going to have to start talking about mental institutions."
— President Trump

Between the lines: "Thirty years ago, when you were talking about a mental institution, a state-run mental institution, you were generally talking about a place to warehouse people who we didn’t know what to do with or people we didn’t want to deal with," said Matt Salo of the National Association of Medicaid Directors.

  • “That’s not what anyone’s talking about," Salo added. "We’re not looking at a return to warehouses to just stick people with mental illness."

Yes, but: There are plenty of other ways to ensure that people with a mental illness get the care they need, experts said. One option would be to amend a federal policy that limits Medicaid coverage of inpatient mental-health treatment to facilities with fewer than 16 beds.

  • "Today, the reality is that we probably need more beds —the number of hospital beds we’ve got, short-term beds we've got, is inadequate," said Paul Gionfriddo, the CEO of Mental Health America.
  • There's plenty of capacity for "custodial care," Gionfriddo said — we've just moved it out of psychiatric hospitals and into jails and prisons. The shortage, he said, is in actual therapeutic care, most of which would be covered by Medicaid.
  • “We should have solved this problem 30 and 40 years ago, but the fed government got cute and decided to create mandates it wasn't going to fund," Gionfriddo said. “You've got a Medicaid program — fund it. You've got a special education program — fund it.”

What's next: The Energy and Commerce Committee is considering changing Medicaid's treatment caps in a bill to help address the opioid crisis. Lawmakers have pushed the idea before, but without success because of how much the Congressional Budget Office says it'd cost.

Go deeper

Centrist Democrats beseech 2020 candidates: "Stand up to Bernie" or Trump wins

Bernie Sanders rallies in Las Vegas, Nevada on Feb. 21. Photo: Mario Tama/Getty Images

Center-left think tank Third Way urgently called on the Democratic front-runners of the 2020 presidential election to challenge Sen. Bernie Sanders on the South Carolina debate stage on Feb. 25, in a memo provided to Axios' Mike Allen on Saturday.

What they're saying: "At the Las Vegas debate ... you declined to really challenge Senator Sanders. If you repeat this strategy at the South Carolina debate this week, you could hand the nomination to Sanders, likely dooming the Democratic Party — and the nation — to Trump and sweeping down-ballot Republican victories in November."

Situational awareness

Warren Buffett. Photo: Daniel Zuchnik/WireImage

Catch up on today's biggest news:

  1. Warren Buffett releases annual letter, reassures investors about future of Berkshire Hathaway
  2. Greyhound bars immigration sweeps
  3. U.S. military officially stops offensive operations in Afghanistan
  4. America's future looks a lot like Nevada
  5. Centrist Democrats beseech 2020 candidates: "Stand up to Bernie" or Trump wins

America's future looks a lot like Nevada

Illustration: Sarah Grillo/Axios

Today's Nevada caucus will foreshadow the future of American politics well beyond 2020.

Why it matters: The U.S. is in the midst of a demographic transformation, and the country's future looks a lot like Nevada's present. Today's results, in addition to shaping the 2020 race, will help tell us where politics is headed in a rapidly changing country.