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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.

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