The Human Spirit as an Organ

Brain-Lightbulb1-214x300May 23rd, 2014 – Santa Barbara, California: another day, another shooting rampage, a few more souls lost to mental illness. More calls for gun control. More calls for funding of public health programs. More wringing of our hands and gnashing of our teeth where as a society we wrestle with what we can do to prevent disturbed individuals like Elliot Rodger from senselessly taking the lives of others.

I’d like to take a pragmatic approach to what we might do, starting with gun control.

As we saw recently, opponents of gun control are very effective politically at making impassioned arguments that owning a gun is the manifestation of a God-given right to defend personal self and property against threats from others – and most particularly in the minds of some political activists  (i.e., the Tea Party), the government. And they have huge lobbying strength.

Now I feel I have to share, that even for those most zealous gun enthusiasts with huge caches of automatic weapons I truly don’t understand how they would expect to defend their neighborhood against an AH-64 Apache helicopter should there ever be a military-supported government coup. Can’t you see it? A long row of sixty-something Harley riders with ammo strips strapped over their shoulders, long grey hair flowing from under their skull n bones bandanas. Waving their AK-40’s wildly as they fall like dominoes. Sort of like us fifty-something’s having to get under our desks in grade school during the 60s to rehearse protecting ourselves against a nuclear attack. But I digress.

Humor aside,  I think it’s important in this discussion to understand that gun ownership is a culturally ingrained part of wide swaths of our society. Unless that changes gun control legislation and regulations will have about as much success in the 21st century that Prohibition had against controlling alcohol production and consumption in the early 20th century. And perhaps there is a measure of truth in recognizing that in both instances the policy focus is misplaced by not recognizing the ultimate responsibility of acts committed under the influence or with a weapon (or both) lies with the individual, not the bottle or the gun.

So ruling out much hope for gun control as a viable approach to prevent these types of tragedies we next turn to doubling down on promoting policies that will expand access to mental health services.  But what if rather than spending more money to treat mental illness and its symptoms as distinct and separate from physiological well being we instead doubled down on efforts to understand how critically important it is to treat mind and body together.

I realize there are earnest efforts all across the country to integrate physical and mental health and move toward holistic well being. But from what I have seen those efforts are mostly incremental in nature and not going to create the transformational shift in health practitioners’ approach that can ultimately have the type of impact on mental illness we seek.

I think what is required is a paradigm shift in thinking about where and how mental health integrates with the overall health and wellness of the individual. We need to begin recognizing that mental well-being is a spiritual reality that, while ultimately the manifestation of physiological attributes, exists independent of those attributes.

And in this way it is just as much a vital organ as is the heart, the brain and so on. And that leads me to believe we should be thinking of human mentality as an organ. Just as our physical organs are necessary to provide human cells with basic needs to sustain life, we are learning more every day how important our human mentality is to cellular health.

I believe if we can broadly achieve this vantage it would change the way we approach research, the way health practitioners integrate awareness of mental health into diagnoses and treatments, the way we approach and treat symptoms of mental illness – and it would change the way we view mental health policy.

Your thoughts?

Cheers,
  Sparky

Senate Leadership Reprised

It is admittedly difficult to rail against the travesties of political injustice in modern American democracy without quickly feeling your feet go out from under you in a wave of self-conscious hypocrisy. But after the blatant expression of individual cowardice that took place in the US Senate yesterday I am left wondering whether that inane and inept institution has outlived its useful purpose of balancing the interests of national majorities against those of individual states.

According to an ABC Washington Post-ABC News Poll, over 90% of Americans are in favor of universal background checks as a prerequisite to gun ownership (as are 85% of NRA households by the way). That was still not quite enough to convince more than 46% of the US Senate to accept the will of the American majority over the metaphorical bags of gold being dangled in front of them by the NRA (or rather, being taken away).

I’m not going to beleaguer Pub visitors with a diatribe on the pure idiocy of turning a blind eye to even legitimately considering what was a common sense and widely accepted gun control policy measure. I rather refer you to former Representative Gabrielle Giffords’ editorial in the New York Times, A Senate in the Gun Lobby’s Grips.

I have long held that the political realities are such that we can expect no change until being elected becomes more like being chosen to serve jury duty than winning the lottery. The addiction to political power in this country is now so strong that with few exceptions elected officials have become whores to the status, fame and fortune attendant to public office. They achieve through Congress that which they would never be able to achieve through any other legal means of personal industry.

And the greatest irony I find in this is mockery of democracy is that those who most ardently oppose any encumbrance upon gun acquisition and ownership do so under the auspices of individual rights and liberties. I wonder whether they really trust a sitting body of government to protect those rights and liberties when that body has clearly and blatantly demonstrated its ability to ignore the will of a strong majority in favor of the political influence bought and paid for by business interests. Be careful what what you wish for Daniel Boone . . .

Cheers,
 
Sparky

Gun Control and the ACA

imageThis is the second occasion I have had in the past four months to correct a news piece that has appeared on the Breitbart web site regarding the Affordable Care Act.  Last November, I shared my disagreement with Dr. Susan Berry’s fallacious interpretation of a Journal of American Medical Association article on knee replacements under the Affordable Care Act.

Interestingly, that post – Death Panels Just Won’t Die – remains the most popular PolicyPub article landed upon.  Visitors come to it by using search engines and wanting to learn more about “Obamacare and knee replacements.” But today I am writing about Awr Hawkins’ piece from January 9, Obamacare Amendment Forbids Gun and Ammo Registration.

A good friend brought this to my attention via  forwarded e-mail. As with many topics of this type, the news gets passed around in emails, blogs and web sites and then reproduced, repurposed and morphed into all varieties of content (just as I am doing here).  As I did in my post on death panels referenced above, however, I will try again to be diligent here in providing to readers original source content, so that you can do your own research – and thinking.  I wish Mr. Hawkins had gone to such effort.  Here is what he wrote:

“Good news — it has become known that hidden deep within the massive 2800-page bill called Obamacare there is a Senate Amendment protecting the right to keep and bear arms.

It seems that in their haste to cram socialized medicine down the throats of the American people, then-Speaker Nancy Pelosi (D-CA) and Barack Obama overlooked Senate amendment 3276, Sec. 2716, part c.

According to reports, that amendment says the government cannot use doctors to collect ‘any information relating to the lawful ownership or possession of a firearm or ammunition.’

CNN is calling it ‘a gift to the nation’s powerful gun lobby.’

And according to Senate Majority Leader Harry Reid (D-NV), that’s exactly right. He says he added the provision in order to keep the NRA from getting involved in the legislative fight over Obamacare, which was so ubiquitous in 2010.”

In his piece, Hawkins references an article produced by HotAir.com, which, in turn, references a video report produced by CNN on the subject that Hawkins’ references in his article (following, so far?).  What the original reporting claims is that Title X, Sec. 2716, Subsection C was a, “little known” piece of the Affordable Care Act that was unwittingly passed in support of the gun ownership lobby by lawmakers whom many would assume are gun control advocates.  In particular, Harry Reid.

As the CNN piece points out, however, up until very recently, Harry Reid has been a rather reliable gun rights advocate.  More importantly, as Ed Morrissey writes on the HotAir site, “this isn’t that much of a bar on Congressional action. What can be done in this manner can be undone in the same manner.”

Even beyond Mr. Morrissey’s interpretation, however, what the above referenced section does is make it explicit the ACA does not empower the Federal government (primarily under the Secretary of the Department of Health and Human Services) with the right to collect, analyze and/or report data and information on gun ownership.  And it was rather widely understood at the time (sorry conspiracy theorists) that in order to achieve some measure of political support of the ACA by the Gun Lobby, this section was intended to provide assurance the ACA was not granting new Federal powers.

That is not the same thing as saying such powers have been henceforth forbidden or cannot be achieved through other means (i.e., through future legislation).  In other words, if Congress were to advance gun control legislation currently under consideration that requires stricter registration, tracking and reporting of gun ownership, there is nothing in the ACA that would conflict with that legislation.

President Obama recently issued 23 executive actions on gun control.  One of these is to, “clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes." This has also been unfortunately interpreted by some media sources as a new Federal requirement that doctors are being required to act as deputies in ferreting out individuals at risk of committing gun violence.

In any event, while speaking on gun control during last week’s State of the Union, the President noted that, “each of these [gun control] proposals deserves a vote in Congress.  If you want to vote no, that’s your choice. But these proposals deserve a vote. Because in the two months since Newtown, more than a thousand birthdays, graduations and anniversaries have been stolen from our lives by a bullet from a gun."

What I believe this to mean is the President does not have the votes in Congress to pass any meaningful gun control legislation at this time.  But he is seeking to gain some measure of political capital by getting those opposed on record.

This is a very difficult ball of public policy yarn: wrapped in together you have healthcare delivery policy, mental health policy and gun ownership/gun control policy.  It requires serious efforts in research, understanding and debate.  It requires, wherever possible, a clear articulation of the known facts.  Although my readership is paltry compared to what Breitbart controls, I hope my efforts here will combat this latest demonstration of reporting laziness, manifested in unhelpful misinformation.

Cheers,
  Sparky

Blog post picture courtesy of www.sodahead.com

Mental Health Realities

As mentioned here before, WordPress allows me to track blog visits based upon search strings that were used to refer visitors to the PolicyPub.  I have noted recently a prevalence of searches on Mental Health, likely owing to the national discussion and debate on Gun Control now taking place in lieu of the Sandy Hook Elementary shooting in December.

I recently wrote a post (Obama’s Opportunity Missed) explaining why I feel the President missed a golden opportunity to raise the level of social awareness and consciousness concerning the difficult and growing challenges that mental and behavioral health present to our society.  As a follow up to that, I wanted to share with Pub visitors information that was recently presented by Pamela Hyde, the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), at the Third Annual Public Health Law Research Meeting in New Orleans on January 18th.

According to Ms. Hyde, “people are just beginning to wake up to the knowledge that behavioral health issues are so common . . . “ yet among the eight million people worldwide in the past year who had a mental illness or substance abuse disorder, only 6.9% received treatment.  She added that, “the country has to spend as much time helping children develop their emotional skills as they do their soccer skills.” 

Links to Ms. Hyde’s slide presentation, data cites, and meeting Q&A can be found at the bottom of this post.  Provided below are a few snippets taken directly from her presentation that I found particularly impactful.

Prevalence & Incidence
Approximately one-half of all Americans will meet criteria for mental illness at some point in their lives

Mental and Substance Use Disorders rank among the top 5 diagnoses associated with 30-day readmissions, accounting for about one in five of all Medicaid readmissions (12.4 percent for Mental Disorders and 9.3 percent for Substance Use Disorders)

Comorbidity
7% of the adult population (34 million people), have co-morbid mental and physical conditions within a given year

Co-morbid depression or anxiety increases physical and mental health care expenditures

Impact on Physical Health
24 percent of pediatric primary care office visits and ¼ of all adult stays in community hospitals involve Mental or Substance Use Disorders

Adults who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of hypertension, asthma, diabetes, heart disease, and stroke

Cost of Care
Average monthly expenditure for a person with a chronic disease and depression is $560 dollars more than for a person without depression

General medical costs were 40% higher for people treated with bipolar disorder than those without it

Perception of Value
Mental illnesses account for 15.4% of total burden of disease, yet mental health expenditures in the U.S. account for only 6.2%

The public is less willing to pay to avoid mental illnesses compared to paying for treatment of medical conditions

Top reasons for not receiving treatment include:
     • Inability to afford care (50.1%)
     • Problem can be handled without care (28.8%)
     • Not knowing where to go for care (16.2%)
     • Not having the time (15.1%)

The SAMHSA Web site referenced above includes a large knowledgebase of useful, understandable resources and information on mental/behavioral health and substance abuse.  If you are interested in learning more about the very difficult public policy issues surrounding Mental Health, I invite you to check it out.

Cheers,
  Sparky

Link to Slides: Click …
                                    

Link to Q&A: Click …
                                   

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