mental healthcare | Normative Narratives

March 28, 2016
by bzupnick 1 Comment

Economic Outlook: Guaranteed Income vs. Guaranteed Employment

Dr. Martin Luther King Jr., a man whose understanding of social justice was unrivaled, knew the importance of gainful employment in achieving his goals. In his day, Dr. King advocated for (among other things) good jobs for African Americans who had been systematically discriminated against for centuries. This was largely something the private sector could provide, if racial discrimination was sufficiently deterred.

Today, it is not an individual race that faces barriers to gainful employment, but a whole socioeconomic lower class. With corporate profits at an all time high, and interest rates at historic lows, the past few years would have been the perfect time for corporations to ramp up hiring. However, due to forces such as globalization and automation, it appears the private sector alone will not provide the number of well-paying jobs American’s need–it simply does not have to in order to maximize profits (at least in the short-run).

A recent Brookings blog advocated for guaranteed income (i.e. welfare) in the face this reality:

The labor market continues to work pretty well as an economic institution, matching labor to capital, for production. But it is no longer working so well as a social institution for distribution. Structural changes in the economy, in particular skills-based technological change, mean that the wages of less-productive workers are dropping. At the same time, the share of national income going to labor rather than capital is dropping.

This decoupling of the economic and social functions of the labor market poses a stark policy challenge. Well-intentioned attempts to improve the social performance of the labor market – through higher minimum wages, profit-sharing schemes, training and education – may not be enough; a series of sticking leaky band-aids over a growing gaping wound.

As Michael Howard, coordinator of the U.S. Basic Income Guarantee Network, told Newsweek magazine: “We may find ourselves going into the future with fewer jobs for everybody. So as a society, we need to think about partially decoupling income from employment.

…the answer for American families is an old idea whose time has come—a universal basic income.

While an interesting idea, I think having the government act as an “employer of last resort” is a better way of achieving the goals of “universal basic income”, in a way that would be more politically viable. Aside from the economic benefits of employment, there are numerous social benefits as well, including: less crime, improved self-esteem / mental health, and experience / skill building (making people more desirable to private sector employers).

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Government jobs could work in many sectors, at lower average wages (so people look for private sector work first), but with more of a training component to promote eventual private sector employment.

Below are a few potential areas for government jobs–areas that are severely under-invested in, and have strong positive “externalities“:

Infrastructure:

The most often cited example when discussing greater government employment is infrastructure. America’s roads and bridges are largely neglected, costing billions a year in lost economic output and putting people’s safety at risk.

Community Development:

New evidence suggests that where a person grows up has a significant impact on their chances of being successful later in life. Those who grow up in poorer areas find it much harder to “get out” and live productive lives. This is, of course, a huge hindrance to social mobility.

Community development initiatives include mentoring programs (which can mitigate the effects of bad parenting), and “after-school activity” type programs (which can steer young people towards constructive hobbies which often become the basis of employable skills, and away from destructive behavior). Community centers could also offer affordable / free daycare services for younger children.

Parent(s) determine both “who” raises a child, and “where” (since adults make the choice of where they raise their kids)–winning or losing the “parenting lottery” should not be such a strong determinant of future success. While it is impossible to separate the genetic link between parents and their child (the “nature” side of human development), the “who” and “where” (“nurture” side of human development) can be impacted by investing in community development.

Mental Healthcare:

The ACA ensures mental health parity, but not everyone gets the help they need. To close this gap, government work could increase the “supply” of mental healthcare workers. What I propose is a Mental Health Corp, featuring a new job type–something akin to nurse practitioners taking on more of a doctor’s duties to reduce healthcare costs–in the mental healthcare field.

One does not need a PhD or MD to provide meaningful help to someone struggling with mental illness. There will always be demand for the best trained mental health professionals from people with the means to afford their services, but for those who cannot, surely some care–even if it is not “the best”–would be greatly beneficial. Such care could help people overcome issues that make them unable to find/hold a job and/or lead to criminal activity.

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Feel free to disagree with me on any of the fields mentioned above. The point I am trying to make is that government employment need not be “digging holes to fill them back up again”.

Robust analyses are needed to compare the costs of our current welfare and criminal justice systems versus the cost of a guaranteed employment program. Not all criminal justice or welfare costs would be eliminated with guaranteed employment (criminal justice reform and a livable minimum wage are also needed) but a significant portion would. It is possible a guaranteed jobs program would not cost much more than what we currently pay to combat the symptoms of unemployment, with much greater benefits.

While on the topic of welfare, guaranteed employment would remedy one of the major holes in the otherwise sound work-for-welfare requirement of the 1996 welfare reform act. After this reform, those unable to find a job also found themselves without a safety-net, falling into “extreme poverty” (which has more than doubled since the reforms were passed). There is a common saying that a nation should be judged not by how well off its wealthiest are, but by how well off its poorest are–with guaranteed employment for those who want it, America would be doing much better on this count. It is past time to plug this obvious hole in welfare reform.

While no one would get rich from government employment, they would be able to live a comfortable life and provide the resources needed for their children to realize their full potential, fulfilling the promises of equality of opportunity and social mobility that America is built upon.

December 22, 2014
by bzupnick 1 Comment

RIP NYPD Officers Rafael Ramos and Wenjian Liu

New York City lost two hero’s yesterday. Officers Ramos and Liu were murdered execution style by a mad gunman, whose name I care not to learn. Both of these men are survived by their families, who after mourning must try to pick up the pieces of their lives. I have no doubt that the city of New York will make sure these families are given all the support they need.

After these cold-blooded murders, the gunman took his own life; there will be no trial, no answers. Unsurprisingly, this coward took the cowards way out.

It is natural in times like these to look for scapegoats. I have heard people calling for Mayor De Blasio to step down. I have heard people placing blame on Al Sharpton (a man who I take little pleasure in defending). The “other side” of the argument could place blame on the Staten Island Grand jury which failed to indict Officer Pantaleo in the death of Eric Garner.

There should not be “sides” to this conflict. Nobody benefits when an innocent person, a police officer or civilian, dies. I often hear people speak of Officers or Army vets as if they should be above the law because of their contributions to society (I am thinking of an often shared video of an army vet saying “my right trumps your dead” in response to the passing of the NY SAFE Act). People volunteer for these jobs, they receive pay and benefits, and are revered as hero’s by the vast majority of society–these are the benefits.

Being considered above the law, or “better” than those you serve and protect, is not part of the job description. No one American’s rights are greater than another, regardless of your sacrifices. Anybody who believes otherwise has a fundamental misunderstanding of the principles which guide this great nation.

Having said that, all rights have limitations. The first amendment, which protects the rights of protestors, is no exception. Free speech cannot come at the expense of public safety–you cannot yell “fire” in a crowded movie theater, and you should not be able to march down the streets of NYC chanting “What do we want? Dead Cops“. I have no reservations in saying these chants galvanized the murderer of officers Ramos and Liu.

If any third party should shoulder some blame in these senseless murders, it is people who participated in this chant. That “protest” was a bastardization of both first amendment rights generally, and the peaceful social-justice based protest in response to the deaths of Eric Garner and Michael Brown specifically.

Back to my original point on scapegoating; all this finger pointing, while understandable, is destructive. It trivializes the role of the actual culprit–the man who pulled the trigger.

After senseless tragedies like this, the best way forward, in my opinion, is to figure out how we can prevent similar tragedies in the future. It has become quite clear that treating social media postings as serious threats could help achieve this goal.

While it is impossible to preemptively identify all killers, a certain pattern has emerged from some of the most infamous killings in recent American history: Sandy Hook, Ft. Hood, UC Santa Barbara and now the murders of NYPD Officers Ramos and Liu. Recognizing this pattern, and updating police procedures, could provide a blueprint for how to prevent future tragedies and get people the help they need.

Social media has become a window into people’s thoughts, beliefs, and actions. Adam Lanza’s social media posts showed a fascination with mass shootings, Lopez expressed a general disillusion with the world and sympathy for Adam Lanza prior to his massacre, and Mr. Rodger’s posted now infamous (and removed) videos detailing his personal issues on Youtube. The NYPD cop killer made instragram posts making his intentions publicly known.

We have to ask ourselves, at what point does protecting a persons freedom of expression infringe upon the ability to protect another persons right to life? As an economist, I am constantly looking for “perfect information” to make the best decisions. While we will never have “perfect information”, is it possible that we are overlooking a valuable and readily available source of information in social media posts?

Perhaps police departments could employ social media specialist to identify potential threats without compromising a departments ability to fulfill traditional police duties?

Would monitoring social media produce false positives? Yes. But even so, anybody who threatens to harm someone on social media–whether they intend to make good on that threat or not–is probably in need of mental healthcare (or at very least needs to be made aware how serious their threat was).

Furthermore, by setting the precedent that social media postings are serious threats that can lead to incarceration / institutionalization, we would increase the perceived “cost” of making such threats. This would deter people from making empty threats / “venting”, leaving (for the most part) only serious threats that actually need to be acted on.

The law often lags behind technological advance. Are we, as a country, ready to police social media? Perhaps not, but it is certainly a debate worth having.

June 24, 2014
by bzupnick Leave a comment

Transparency Report: The Supply Of and Demand For Mental Healthcare

Original article:

Shootings in places like Isla Vista, Calif., and Newtown, Conn., have turned a spotlight on the mental health system, and particularly how it handles young, troubled males with an aggressive streak. About one in 100 teenagers fits this category, according to E. Jane Costello, a psychiatric epidemiologist at Duke University School of Medicine, and they often have multiple diagnoses and are resistant to treatment.

Most of these young men will never commit a violent crime, much less an atrocity. But the questions of how best to help them and how to pay for it are among the most intractable problems hanging over the system.

Thousands of families know this experience too well: No single diagnosis fits, no drug brings real relief, and if the teenager rejects the very idea of psychotherapy, there is little chance of lasting improvement.

Congress has taken steps to bring about so-called parity for mental health, requiring insurers to cover treatments for mental illnesses as they do those for diseases like cancer and diabetes. But parents like the Serpicos have found that, even with good insurance, they often cannot get the expensive, long-term residential treatment they believe their child needs.

And it is not clear how effective intensive residential treatment is for teenagers. Some improve, experts say, but they are usually discharged to the same environment in which they got into trouble, and precious few studies follow them for longer than several months.

“The problem is that, while some kids may benefit from these extremely costly services, we don’t know which ones they are, and we don’t have a good model for distributing those services, no matter who’s paying,” said Sherry A. Glied, dean of the Wagner Graduate School of Public Service at New York University.

Lena and Robert Serpico knew something was not right before their son was in kindergarten. They had taken him and his younger brother in as foster children from a mother who used drugs, and they later adopted both.

As the teenager became increasingly indifferent to school and defiant, the family got him into a highly recommended day therapy program. He was thrown out for bringing a razor blade to a session. The family tried again, at another day program, and this time the program kicked him out for refusing to participate.

“It’s useless, all this stuff,” he said in a brief interview. “It’s a waste of my time.”

He entered an alternative school last fall, and his parents, who both work outside the house, decided they had only one option left, recommended by their son’s doctor and therapist: long-term residential care. Costs ranged from $10,000 to $60,000 a month.

“No way we could afford that,” Ms. Serpico said.

Out of options, the Serpicos did what many affluent families do: They hired a lawyer. In January, they petitioned the school district to pay for their son’s education at a therapeutic school. A consulting psychologist hired by the district concluded that their son needed “a 24-hour-a-day therapeutic milieu over an extended period of time, i.e., longer than two months, in order to keep him safe and gain the skills necessary to function post-high-school.”

Last month, they learned that the suit had been successful. The Geneva School District will pay for the young man to attend a therapeutic school in Montana for one academic year. There will be horses, physical labor, and group and one-on-one talk therapy. Ms. Serpico and her husband broke the news to their son this month.

When asked about going to the new school, he shrugged and looked away.

“I don’t know,” he said. “Probably useless, too.”

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Economics traditionally treats people as rational actors seeking to maximize their “utility”. While this idea is contentious even in “normal cases”, when considering those suffering from mental illnesses, the rational maximizer model becomes almost completely irrelevant. Despite the obvious benefits for those who need mental healthcare, potential patients (particularly young men) often reject the idea of therapy because of the stigma of “weakness” or embarrassment associated with it–I know this because I was once one of these young men.

Health care reform–so called insurance “parity” for mental healthcare–has gone a long way in making treatment affordable to those who need it. This was a fix to the “supply side” of the equation. However, it is very clear that there are “demand side” issues related to mental healthcare that are leading to under-treatment.

Demand traditionally focuses on the willingness of a person to pay for a particular good or service. However, young people are almost never expected to pay the cost of their own mental healthcare–those who need treatment the most often reject it even if it is being paid for by their parents or the state (or some combination of the two). To get these people the help they need, we must address the non-monetary concerns–the stigma–associated with mental healthcare.

This is a difficult task, but it can be aided by cultural and technological progress. Culturally, those in the public spotlight (movie stars, musicians, athletes, etc.) who are comfortable with their mental health issues should open up about them. It is amazing how someone who is perceived as “cool” can get through to people and change public perceptions. To this end I would like to commend All-Pro Wide Receiver Brandon Marshall, who has become a poster-boy for mental health awareness, to the benefit of both the general public and, according to him, himself; we need more role models like Mr. Marshall. Of course, these public figures can always utilize social media to amplify the effect of their message.

Another cultural shift which makes sense would be changing how we educate kids about mental healthcare. My first semester in college, we had something called “University 101”, where students where prepped and talked about the challenges and opportunities present during college life. It seems to me like there should be a similar class required during ones first semester in high school–a common time for mental health issues to arise–with a greater focus on mental health awareness. I also took a a health class in high school, but it focused much more on drug use and safe sex, and not nearly enough about mental health issues.

Often times young people are not comfortable talking to their problems with peers, for fear that news of their issues will become public knowledge before they are ready to be open about them, or used against them by bullies. In such an instance, virtually connecting with groups dedicated to peer-to-peer dialogue via social media (Facebook, Skype, etc.) could offer a way for children to start opening up about their issues to people they can relate too (other kids), without having to worry about those issues coming out in their immediate social circles.

As someone who went from rejecting the very idea of therapy to realizing its incredible benefits, this issue is deeply personal to me. I can say one thing–seeking mental healthcare is by no means a sign of weakness, or something one should be embarrassed about. The open, self-reflecting, honest approach needed for therapy to be effective requires incredible strength of character. This is the lesson we should be teaching our kids–pursuing mental healthcare is a sign of strength, not weakness.

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For those who think Mental health issues are only a “rich country problem”, think again. According to a recently release United Nations report, depression is the number one cause of illness and disability globally among adolescents (10-19 yrs old).

In an increasingly complex and global world, it is only natural for new sources of anxiety to affect current and future generations of children. These new sources of anxiety will be reinforced by old social and cultural stigmas related to mental illness / healthcare. In the coming decades youth populations are expected to grow in developing countries, where youth unemployment tends to be highest and (relatedly) conditions are very conducive to mental health problems. The problem will only become more pronounced, unless we use all the tools we have to address adolescent mental health issues in a holistic and inclusive manner.

In a political / media landscape dominated by debates over fiscal responsibility and climate change, the potential of looming global mental health epidemic is not discussed. You want to talk about a “Great Depression”? Aggregate all the lost output that will systematically come out of the global economy if the proper resources are not dedicated to youth employment, mental healthcare and awareness programs. And then there are the linkages to poverty, insecurity, human suffering…

May 17, 2014
by bzupnick 2 Comments

Transparency Report: Youth Unemployment and Depression

According to a recently release United Nations report, depression is the number one cause of illness and disability globally among adolescents (10-19 yrs old):

We hope this report will focus high-level attention on the health needs of 10 to 19-year-olds and serve as a springboard for accelerated action on adolescent health,” said Flavia Bustreo, Assistant Director-General for Family, Women and Children’s Health at the UN World Health Organization (WHO).

An estimated 1.3 million adolescents died in 2012, largely from preventable causes, according to the UN agency’s Health for the world’s adolescents online report released today.

Depression was found to the be the greatest cause of illness and disability in this age group, with suicide raking third as the cause of death among young people.

This report reminded me of a journal article I read during my studies, “Development Economics Through the Lense of Psychology” (abstract excerpt below):

Economists conceptualize a world populated by calculating, unemotional maximizers. This view shapes our understanding of many crucial elements of development economics–from how rural villagers save, to how parents decide on whether to send their children to school.

Psychological research, however, has documented the incompleteness of this perspective. Individuals have self-control and time inconsistency problems. They can give into shortrun temptations and later regret it. They can have strong feelings about others that drive them to commit both generous and spiteful acts. They often passively accept defaults rather than make active choices. They let the institutions around them make choices for them. And they may misread new data in a ways that fit their beliefs. In short, the rational maximization model may not be a very good approximation of human behavior.

While this journal article does not explicitly cite mental illness or depression, due to my own experiences with depression my thoughts turned to the subject. There is no one cause of depression; there are elements of both “nature” (genetic predisposition) and “nurture” (experiences in life). However, “nurture” causes tend to be more direct and therefore preventable: dehumanization / pessimism related to poverty, uncertainty about the future, and unemployment:

In the shadow of the Great Recession lies a deep depression: Youths in their 20s and early 30s are hitting new lows. Compared with older workers who have lost their jobs, young people face more complex and layered hardships that could last most of their lives. They are experiencing disproportionately high unemployment, stretching indefinitely into the future, in an increasingly unequal and uncertain social landscape. And just when they are most in need of social support, the recession has led lawmakers to erode the welfare and employment programs that youths need to move themselves — and the economy they have inherited — toward recovery.

For young people in the United States and Europe, there is an emotional layer to this economic malaise. According to a recent U.K. survey of 2,161 people ages 16 to 25 by nonprofit advocacy group the Prince’s Trust, the unemployment epidemic is driving a mental-health crisis. While overall happiness levels for the surveyed youths stayed about level over the past year, reported emotional health fell significantly for the segment that is out of the workforce and not in school or job training. These young people experienced feelings of despondency and hopelessness at a higher rate than their peers. Chronically unemployed youths were more likely to have experienced panic attacks, engaged in self-harming behavior or felt suicidal. Mental-health problems struck 4 in 10 jobless young people “as a direct result of unemployment,” according to the Prince’s Trust.

One woman interviewed for the study said, “Being out of work stripped away my self-worth and made me feel like a waste of space.”

While this study considers young people in the U.S. and Europe, one can assume that young people in the developing world experience similar issues, as youth unemployment is expectedly worse in many less developed countries.

Depression stunts personal development; how can someone invest in themselves or act as a long-term “rational maximizer” when they cannot see any hope in their future? But children are the future, and the number one illness affecting them is depression. To not pay the price to treat depression in adolescents is incredibly shortsighted–perhaps policy makers also do not act as “rational maximizers”, at least if the thing we hope to maximize is long-term social welfare.

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The costs of inaction are not limited to lost economic output, human suffering and suicide, there are also security risks associated with leaving depression untreated:

Adam Lankford, a professor from the University of Alabama, concluded that many suicide terrorists weren’t ideologues at all—but were, in fact, classically suicidal. He cited Israeli scholarly research of would-be Palestinian bombers: Forty percent of them exhibited suicidal tendencies; 13 percent had already attempted suicide, unrelated to terrorism. Lankford went on to mention a 9/11 hijacker who wrote a final note to his wife and lamented how he never lived up to her expectations. Lankford described other terrorists in Palestine and Chechnya who were in poor health, recently divorced, or financially insolvent in the months prior to an attack. He also talked about the terrorist recruiters who admitted to looking for the “sad guys” for martyrdom.

While this study is far from conclusive, it would be closed-minded to refuse to consider the relationship between mental illness and terrorism. People with depression are often looking for meaning and companionship; joining a terrorist organization provides both.

And this security risk is hardly confined to the developing world; one would be hard pressed to find a mass killing anywhere in the world that is not linked to some form of mental illness. To be fair, no statistical relationship between teen depression and violent crime has been established, although this does not rule out the strong possibility that there is some relationship between mental illness and violence.

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As someone who has experienced depression, this reports findings hit close to home. I am fortunate to have been born into an upper-middle class American family and receive top notch treatment–most people are not so lucky. Depression and other forms of mental illness are often seen as a “rich person’s disease”, and treatment as a luxury. This study refutes this misconception–depression can affect anyone; old or young, rich or poor. The universality of depression gives hope that it is an issue the global community can rally around and adequately address.

Increased access to mental healthcare must be part of healthcare reforms in both developed and developing nations. This is not an abstract concept, inaction has real costs that affect many people. Further compounding this problem is the existence of a stigma against people with mental illnesses (which is likely more prevalent in less developed places). When one feels ashamed of having a mental illness, the condition generally becomes worse and treatment is not sought. Part of the solution may be educating people to break this stigma.

The prevalence of depression amongst the world’s youth is alarming, but unfortunately to this social scientist / previously depressed young adult, it is not surprising. If depression can affect people who have had all their needs met, imagine how prevalent (and under-diagnosed) it must be the world’s most impoverished areas. Failure to treat mental illness not only impedes an individual’s positive liberties, it can also result in the most grievous violation of ones negative liberties possible–murder.

For some, finding employment is enough to alleviate the symptoms of depression. For others, treatment and therapy are required. Many anti-social behaviors can be tempered by a global push to address depression in adolescents, hopefully this U.N. report focuses a stronger spotlight on preventing and treating adolescent depression.

April 6, 2014
by bzupnick 5 Comments

Transparency Report: Can Social Media Postings Be Considered “Warning Signs”?

According to his army psychiatrist, Fort Hood shooter Ivan Lopez showed “no sign of likely violence, either to himself or to others.” While it may be possible for someone to “snap” and go on a shooting spree without warning, I have trouble believing this was the case in this incident.

Lopez had a history of depression and anxiety, yet he was still able to purchase a firearm legally (at the same store the 2009 Fort Hood shooter bought his weapon), underscoring the need for stronger background check laws for gun purchases.

“We have very strong evidence that he [Lopez] had a medical history that indicated an unstable psychiatric or psychological condition,” Lt. Gen. Mark Milley, head of the Army’s III Corps at Fort Hood, said of Lopez. “There was no indication that he was targeting specific people.”

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3 people are dead 16 more are wounded. The questions we as a nation now face are:

1) Could this tragedy have been prevented? (were there warning signs?)

2) How can we prevent similar tragedies from happening in the future?

These two questions are obviously related. If there were warning signs, then recognizing these signs can help prevent similar tragedies from happening.

The warning signs, beyond Lopez’s mental health record, came in the form of Facebook posts:

1) On March 1, the same day he purchased the .45-caliber semiautomatic pistol he used in the attack, Specialist Lopez wrote an especially angry and vaguely threatening post. “My spiritual peace has all gone away, I am full of hate, I believe now the devil is taking me. I was robbed last night and I’m sure it was two flacos. Green light and thumbs down. It’s just that easy …”

2) In a Facebook post, Specialist Lopez said of the Newtown massacre: “For me, the direct responsibility for this situation is with the psychiatrist, who didn’t uncover Adam’s level of dangerousness so that he could be restricted.”

Read posthumously, these posts depict someone who was unable to grasp the concept of personal accountability. On the other hand, hindsight is always 20-20; these posts were separated by over a year, during which time Lopez probably made many posts which are irrelevant to his mental state.

Taken separately, each of these pieces of “evidence”; a questionable mental health history, delusional Facebook posts, and a gun purchase; could not be considered a red flag–it would be impossible to police all social media platforms. But taken together, they form the profile of an individual who is very likely a risk to himself and others.

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What someone posts on social media can get them fired or (if a public figure) publicly ridiculed–American’s clearly take social media postings seriously. What can we do when someone writes about hurting themselves or others on social media? At what point does protecting a persons right to privacy prohibit the ability to protect another persons right to life? As a social scientist, I am constantly looking for “information”; is it possible that we are overlooking a valuable source of information in social media posts?

I already alluded to the need for stronger background checks for gun purchases, another preventative measure is greater access to mental healthcare, which I believe should be a human right (it is currently viewed as a luxury for the wealthy). Specialist Lopez was covered as an Army employee; what about people out there without mental health coverage? Obamacare has gone a long way in rewriting insurance guidelines to cover mental healthcare, and subsidizes plans for those who cannot afford insurance on their own, but what about people who are still not covered? Given the various ramifications of untreated mental illness (crime, poverty, etc.), is it time to consider investing more tax dollars into walk-in mental health clinics?

These issues, privacy and security, lend themselves to heated debates. I leave my readers with these loaded questions to ponder.

November 4, 2013
by bzupnick 1 Comment

Transparency Report: The ACA, Mental Healthcare, and Mass Shootings

Despite reassurances by President Obama that “if you like your health insurance, you will not have to change it”, many people have been receiving letters notifying them that their current plans are being discontinued and they will be required to buy new ones. Perhaps Obama should have clarified his statement as follows; “if you like your health insurance, and it meets certain minimum requirements, you will be able to keep it.”

Why might a health insurance plan fail to meet these minimum standards? There are 10 “essential health benefits” that new policies must satisfy. The following analysis focuses on one essential service, mental health coverage, and its relationship to mass shootings:

The Obama administration issued a final rule on Wednesday defining “essential health benefits” that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result.

Kathleen Sebelius, the secretary of health and human services, said that in addition to the millions who would gain access to mental health care, 30 million people who already have some mental health coverage will see improvements in benefits.

White House officials described the rule as a major expansion of coverage. In the past, they said, nearly 20 percent of people buying insurance on their own did not have coverage for mental health services, and nearly one-third had no coverage for treatment of substance abuse.

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Can we ever fully prevent mass shootings? No, there are elements of human will, technology, and finite security resources that make complete prevention impossible. However, there are steps that can be taken to drastically reduce the prevalence of such atrocities. One preventative measure would be to impose stricter gun control laws, which brings about the usual pro and con arguments. Less contentious ideas involve broader background checks (91% support) and increased government spending on youth mental healthcare (82% support).

One would be hard pressed to find an example of a mass-shooter who did not suffer from a mental illness. In fact, 48% of Americans think “failure of the mental health system to identify individuals who are dangers to others” shoulders a “great deal” of the blame for mass shootings (80% of people think this factor deserves a “great deal” or a “fair amount” of the blame). This is the number one factor Americans blame for mass shootings.

We often hear people say things such as “children are our most precious resource” or “I would give anything to protect my child”. The question I pose to my audience, and hopefully to the American public, is this. Do we want to be a country that makes a big deal about tragedies, a country that makes grand statements and then lets those statements fall to the wayside once the story isn’t recent news? Or do we want to be the country that puts its money where its mouth is, and actually implements the reforms we overwhelmingly believe in? One things is certain, mass shootings cannot be reduced by concentrated short term efforts directly after the fact followed by long periods of inaction.

True the survey says “increased government spending on mental healthcare”; however a great deal of people in the individual / uninsured market will receive free or subsidized healthcare, which is the equivalent of greater government spending on mental healthcare. Can we, as a nation, recognize this impact of expanded mental healthcare (not to mention the multitude of socioeconomic benefits associated with expanding healthcare coverage)? Are we truly willing to do anything to keep our children safe, or are we unwilling to even make the most basic investments to achieve this goal?

Update: Legislation is being finalized requiring equal coverage of mental healthcare by all health insurance. This is an important step in American healthcare reform, with untold socioeconomic and security benefits.

April 18, 2013
by bzupnick Leave a comment

Transparency Thursday: Remembering the Victim’s of the Boston Marathon Bombing–Creating a Legacy of Peace

“This is Martin Richard, 8, who was killed in yesterday’s attack. His sister and mother are critically injured. His message, “No more hurting people–Peace” is something we should all seek to honor, and remember him by.” –George Takei

By now, everybody has heard about the tragic events that unfolded this Monday during the Boston Marathon. Two bombs exploded, killing three people and injuring over 100 more. Today, President Obama Spoke at an interfaith memorial service at Boston’s Cathedral of the Holy Cross:

“Mr. Obama spoke in personal terms about the victims of the bombing and offered prayers for their families. Krystle Campbell, 29, of Medford, Mass., was ‘always smiling,’ he said, noting that her parents were at the service. He said that his prayers were with the family of Lu Lingzi, 23, in China, who had sent her to graduate school at Boston University ‘so that she could experience all that this city has to offer.’ And he spoke about what he called the heartbreaking death Martin Richard, 8, of Dorchester, who was killed in the blast, which also wounded his mother and sister.”

—

“At a Senate hearing Thursday morning, the nation’s top intelligence official, James R. Clapper Jr., echoed President Obama’s comments earlier this week that the authorities still do not know whether the attack was a foreign or domestic plot, carried out by one or more individuals or a group.”

This tragic event understandably evokes emotional responses from those directly and indirectly affected. In the aftermath of this event, as the details reveal themselves over time, it would be prudent to take a step back and remember some of the ideals America was founded on; tolerance and freedom of speech, a place where no one could be persecuted based on nationality or religion, and where everyone is innocent until proven guilty (due process of law).

I came out with this response to the bombings on Monday:

“Tragedy in Boston. Prayers go out to the families and loved ones affected by this senseless act of violence.

Please do not jump to xenophobia and hatred after this event. Only through cooperation and kindness can events like this be prevented. There is no proof as to who committed this unthinkable act–American, Muslim, or otherwise.

In America everyone is innocent until proven guilty.”

Many people started blaming “muslims”, “terrorists”, or “them” after this attack. Jumping to such conclusions are counter-productive. For one thing, all signs point to this being a domestic terror attack; the sight was not a huge landmark like the W.T.C, and no terrorists organization has claimed responsibility. While it would be irresponsible journalism to say with certainty this was not an act of a foreign terrorist organization, all signs are pointing in that direction.

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This message of the preventative powers of peace, kindness and cooperation sound good on paper, but can they actually work in practice? Martin Richard was an 8-year-old boy who believed in these principles, but are they practical in real life? Beyond the ethical stance, there are economic and social reasons why these normative views can indeed help reduce acts of terrorism. Of course we need security, but security is only one side of the preventative coin. Dealing with the root causes of domestic and foreign terrorism will reduce the number of would be attacks, and allow our security forces to better manage the threats that inevitably will still exist.

First let us examine foreign terrorism. I would like to point you all to an earlier post I made on preventative peace-building and protracted social conflict (PSC). This piece highlights how human rights violations are at the root of most violence in the developing world. Instability creates a foothold for terrorism to operate–when a government is not providing essential services and / or security, terrorist groups can fill the void, essentially buying goodwill. Most people in these countries are aware they are supporting terrorist activities, but if it is a choice between having essential services provided or not, they could care less.

That is why, in order to stop foreign terrorism at its roots, we must empower friendly governments to provide the services and security that they are obligated to provide. Doing this will help push terrorists to the margins, and create lasting alliances in strategic locations. My previous post suggests redistributing money from the D.o.D. to the D.o.S., as overt military action has proven to be an ineffective and costly means of nation building.

Next let us examine domestic terrorism. In America, we are all relatively well off compared to those in the rest of the world. Social programs exist to help protect the human rights of those less fortunate; hopefully drastic cuts in these programs do not take place or else we will see the crime rate go up.

One area that America is notoriously weak in is public mental healthcare access. Mental health issues affect the rich and poor alike, and probably disproportionately affect the poor. As someone who has personally seen their self-confidence and productive capacity bolstered by mental healthcare, I am a strong proponent of providing access to mental healthcare to all Americans.

Obamacare, which is supposed to become effective in 2014, is expected to extend mental healthcare to all Americans. This should help people overcome their issues, lead happier and more productive lives, and ultimately reduce the number of people dependent on the welfare state in the long run. Many people have issues that are fairly common, but due to their socioeconomic standing remain isolated and untreated. It is these people who usually turn to crime, including domestic terrorism. By increasing access to mental healthcare, these incidents will decline.

No policies will ever entirely eliminate terrorism, domestic or foreign. But there are common sense ways to reduce the number of attacks as much as possible, which should allow our security forces to better prevent future acts of terrorism.

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Robert Martin did not understand these complex interconnections, he was an 8-year-old boy. It is an honor to be able to provide some theoretical insight into Robert Martin’s normative stance; just because he didn’t understand why he was right doesn’t make him any less right. The best way to reduce terrorism, both domestic and foreign, is to attack it at its roots. The alternative, an increasing reliance on American security forces at home and abroad, has been proven too costly and ineffective.

As Albert Einstien said, “Insanity is doing the same thing over and over again and expecting different results.”

People (generally) respond to violence and hatred with more violence and hatred. People (generally) respond to acts of kindness with humility, gratitude, and friendship. Acts of terrorism represent an intractable vicious cycle; someone can always point a finger and recall past atrocities to justify their actions in their own mind.

In order to move forward as a global community we must look forward and think about what we can do differently, if we hope to break this vicious cycle.