A key sticking point in the negotiations over a bipartisan gun violence package being drafted in the Senate has become how states can use grant money in that package.
The framework released Sunday called for grant money to help states implement “red flag” laws, which allow law enforcement and family members to petition courts to temporarily remove firearms from people who show signs of becoming dangerous to themselves or others.
But Sen. John Cornyn, R-Texas, began suggesting publicly this week that states that don’t have red flag laws — and don’t want them — should be able to access the funding for other purposes like assisted outpatient treatment, which is a court-ordered treatment for those who have a history of not adhering with mental health treatment.
Assisted outpatient treatment, which is permitted in 47 states, is often used as a condition of severely mentally ill individuals remaining in the community, rather than being hospitalized or incarcerated. Only Connecticut, Maryland and Massachusetts do not permit such treatment.
Nineteen states, by contrast, have red flag laws, but they’re not always enforced because of lack of funding and training for law enforcement.
“I’m sure the other states are going to want to try to get some access to some of that financial support for the programs they have since they decided not to do red flag laws,” Cornyn told reporters Tuesday.
Sen. Christopher S. Murphy, D-Conn., who is leading negotiations for Democrats, told reporters Wednesday the issues can be overcome.
Murphy, Cornyn and other senators met Thursday and hope to have a deal by the end of the week.
While assisted outpatient treatment allows courts to order people into outpatient treatment, especially if they have a history of repeated hospitalizations or arrests resulting from not complying with voluntary treatment, the real issue is lack of access to mental health care, said Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University School of Medicine.
“It deflects from the real problem, which is we have an underfunded, underperforming mental health system. This is a service outcome problem, not a compliance issue,” he said.
He said assisted outpatient treatment can be effective if it is targeted to a small group of people who are not going to get treatment otherwise, and if the package includes more resources for mental health.
Some Democrats say they don’t necessarily oppose assisted outpatient treatment but they want to make sure there is enough funding for states to implement red flag laws, which have been shown to reduce suicides and be effective at removing firearms from people who intend to commit violence toward others.
“We don’t have a disagreement on the programs that he thinks are worthwhile,” Sen. Richard Blumenthal, D-Conn., said Thursday, referring to Cornyn. "But we want to make sure that there are sufficient amounts of money for everything good to be done, and that everything done is good in terms of stopping gun violence."
It’s not clear yet how much funding the senators are working with or what the potential offsets will be.
Experts say that if the goal of the gun violence package is to reduce gun violence, assisted outpatient treatment might not be the best pathway to doing that.
About 4 percent of community violence can be attributed to serious mental illness, Swanson said, and there are typically other factors at play like substance use or poverty.
Assisted outpatient treatment has been shown to reduce psychiatric admissions, emergency department visits, arrests, incarcerations, homelessness, substance use, medication nonadherence and violent behavior.
On the other hand, red flag laws have been shown to reduce firearm suicides, which account for more than half of all gun deaths annually, according to the Centers for Disease Control and Prevention.
“More resources are always welcome. Mandating care does not make care available,” said Hannah Wesolowski, chief government officer for the National Alliance on Mental Illness, referring to assisted outpatient treatment.
“I don’t know that it would significantly address gun violence and have a tangible impact there.”