Two years ago Sunday, a young man with a history of untreated mental illness shot his mother, then drove a short distance to a nearby elementary school. There, he killed 20 children and six educators before ending the senseless rampage by taking his own life.

The tragic events in Newtown, Connecticut, raised an alarm about the need to provide and expand mental health care in the U.S. However, the care here is little better than it was the day of the slayings. State-level mental health spending has stagnated, allowing gaps in services from recession-era budget cuts to remain unaddressed. Meanwhile, Maine – like many other states, as noted in a recent National Alliance on Mental Illness report – has settled for legislative “tinkering at the edges” on mental health, rather than sweeping reform.

Why has nothing changed? Because we haven’t changed. Awareness of the need to rebuild the nation’s mental health system is greatest after a high-profile tragedy like the one in Newtown, which feeds the idea that “they” – people with mental illness – pose a risk to “us” – the community.

This misperception not only vastly overstates the likelihood of violence by people with mental illness, who account for only 4 percent of the violence in the U.S., but also denies them their humanity, their place in the community. The mentally ill need and should get more help – offered out of concern for their well-being, not out of groundless fear.

NEEDY MAINERS WITHOUT OPTIONS

Chances are that most people reading this either have a mental illness or know someone who does. In any given year, mental illness affects one in four adults in the U.S. and up to one in five children. Those who aren’t treated face an array of grim consequences, ranging from decreased enjoyment of life, social isolation and a weakened immune system to homelessness, unemployment, arrest, incarceration, psychiatric admission and suicide.

But Mainers who need mental health services, either for themselves or for a loved one, quickly encounter roadblocks. Lack of money is the biggest and most obvious barrier.

Poverty is endemic in Maine, and more than a third of adults here who receive Medicaid have a diagnosable mental health condition. As the state-funded health insurance program has tightened its eligibility standards, however, thousands of young parents and childless adults have lost their health insurance and, with it, funding for counseling and prescription psychiatric medication.

It’s an appalling situation that’s unlikely to improve, since Gov. LePage has repeatedly rejected federal Medicaid expansion funds, leaving 70,000 residents without any mental health coverage. The governor – who touted his record on mental health care spending after Newtown – has taken a different path from that of his counterparts in 27 other states, who have demonstrated their commitment to helping people living with mental illness by accepting the money.

Some states have even been willing to try an experimental approach. Neighboring New Hampshire – another site of early and emphatic opposition to wider Medicaid eligibility – tweaked the proposal to make it more palatable to critics, eventually passing a bipartisan plan that calls for the state to get a federal waiver to use Medicaid dollars on private insurance for low-income residents.

BIG-PICTURE PERSPECTIVE LACKING

North of Augusta and in western and Down East Maine, another obstacle for Mainers with mental illness is the relative lack of mental health care providers – psychiatrists, clinical psychologists, social workers, marriage and family therapists and psychiatric nurse specialists.

Here again, other states have been willing to innovate. The new NAMI report praises Wisconsin for funding grants to encourage up to 12 psychiatrists to practice in rural areas that are underserved by mental health care providers. In Illinois and Kentucky, lawmakers have passed bills aimed at addressing the workforce shortage by allowing other types of providers to prescribe mental health medications.

Effective approaches to serving people with mental illness are developed based on who the clients are and what they need. In Maine, though, this key information is lacking.

For example, people without money for routine mental health care often seek services in a hospital ER. But NAMI Maine Executive Director Jenna Mehnert pointed out Thursday that there’s no one source of data, collected from every hospital in Maine, on these emergency patients – including basic information like their age, their gender and the reason why they’ve sought emergency services.

Similarly, nobody’s collected across-the-board statistics about people with severe mental illness in Maine’s criminal justice system, although anecdotal reports to NAMI Maine from law enforcement officials suggest that the unmet needs for care are great, said Mehnert.

The gathering of credible data is a behind-the-scenes but nonetheless critical part of providing health care. Otherwise, getting an overarching view of the state of public mental health – and developing meaningful ways to address gaps in services – will be difficult, if not impossible.

THE POWER OF BEST PRACTICES

Also missing in Maine, according to Mehnert, is a state-led effort to implement proven, efficient methods of serving those living with mental illness, including funds for training care providers in specific approaches to treatment targeted at particular groups.

A great deal of scientific evidence is available to support the use of some practices over others. Without support and direction from state health and human services officials, though, mental health professionals are less likely to incorporate these new ideas into their work with clients.

And when best practices aren’t implemented, the state – not to mention Maine taxpayers – loses out on possible cost savings. As NAMI said in a 2009 report on the state of the U.S. mental health care system, “In an environment of limited … resources, funding anything but the most effective services simply is not sustainable.”

We know more today than we ever have about how to recognize and treat mental illness. We know that the longer treatment is delayed, the harder an illness is to care for and the more severe it becomes. When we have this knowledge but don’t deploy it on behalf of the most vulnerable among us, we’ve failed them, and as a society, we’ve failed ourselves.