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Words matter when uttered or tweeted by the president of the United States. Lately, President Trump's words have scapegoated mentally ill Americans in the aftermath of massacres in El Paso and Dayton. He has suggested reverting to punitive, counter-productive policy of locking up people simply because they are ill.

At any given time, one in five adults has a diagnosable mental illness, yet fewer than half of us who are ill get treatment. If Trump's going to lock us all up, he is talking about millions of Americans.

Here is what the president said on Aug. 18: "I remember, growing up, we had mental institutions. A lot of them were closed. And all of those people were put out on the streets. And I said — even as a young guy, I said, 'How does that work?' That's not a good thing. And it's not a good thing. So I think the concept of mental institutions has to be looked at. ..."

"Mental illness and hatred pulls the trigger, not the gun," Trump said shortly after the Texas and Ohio shootings that killed 31 people. The president described the perpetrators as "a wicked man" and "another twisted monster."

In the 1950s, Montana State Hospital at Warm Springs hit a peak population of nearly 2,000 patients, including adults and children. That was before the introduction of effective psychiatric medication and modern behavioral therapies — when "patients" were basically warehoused for years, often for their entire lifetime at state-run institutions. Nationwide in 1955, more than 500,000 Americans were in government mental institutions, compared with about 70,000 in 1994, according to an Aug. 28 report by the PBS News Hour.

Today, Montana State Hospital has 270 licensed beds and doesn't admit children.

With the de-institutionalization of psychiatric patients in the '60s and '70s, most mental health care was supposed to be provided in the community, rather than in an institution or hospital. That model works great — so long as adequate community services are available to everyone who needs them when they need them. Funding has never been adequate. So, while many Americans do recover from serious mental illness, too many others struggle to get care and often wind up homeless or in jail, usually for minor offenses.

Care shortages

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Mental health care professionals have long been in short supply in rural states such as Montana. That shortage has grown more acute, prompting the launch of a psychiatric residency program at Billings Clinic, which will be a first for the state. Behavioral health providers constantly struggle to maintain services in the face of government budget cuts. People needing mental health care as well as those needing addiction treatment usually depend on publicly funded programs because their illnesses have caused them to lose their jobs. Most Americans get their health coverage through their employment. No job, no insurance. No health care, no prospect of getting a job.

A country's rate of gun ownership is a far better predictor of public mass shootings than indicators of mental illness, Adam Lankford, a University of Alabama criminologist who published a 2016 analysis of data from 171 countries, told The Associated Press.

"If mental illness were the driving factor, we would expect the countries with highest suicide rates to have higher rates of public mass shootings. That's not what we see," Lankford said. "The key of what's going on here is access to guns for people who are dangerous or disturbed."

Last month, the U.S. Secret Service released a report on mass public attacks in 2018, finding that "no single profile" can be used "to predict who will engage in targeted violence" and "mental illness, alone, is not a risk factor."

Toll of suicide

People with mental illness aren't responsible for the vast majority of mass shootings. Mental illness, however, is a key factor in most firearms deaths in Montana and in the United States because most firearms deaths are suicides. According to the Giffords Law Center in San Francisco, 36,000 Americans are killed by guns each year — an average of 100 per day — and 100,000 are shot and injured. Nearly two thirds of all gun deaths are gun suicides, and one third of gun deaths are gun homicides.

"In the U.S., it is easier to get a gun than it is to get mental health care," Angela Kimball, acting CEO for the National Alliance on Mental Illness said recently. "The president should be talking about better care and earlier access to intensive treatment, not revisiting the shameful institutions of our past."

Don't stigmatize mentally ill Americans, Mr. President. Help us get well in our own homes and communities.

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The Billings Gazette

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