Another horrific mass murder takes place, this time in Orlando, Florida, and still, we have a Congress that continues to shuffle its feet on the topic of gun violence. For those in Congress who speak of "doing something now" to stem the tide of mass shootings, I have an idea for you – Reverse the nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence.
We as a nation of voters need to hold our representatives' feet to the fire on this issue. Over the past two years, we have seen a dramatic uptick in the political debate about mental health reform. The debate has at times blatantly, and other times, more subtly, made the connection between mental illness and violence. This connection continues to be made, in spite of the research showing that people with mental illness are far more likely to be victims than perpetrators of violent crime. Using the fear tactics inherent in connecting mental illness and violence while simultaneously blocking funding for research to understand better gun violence is not only disingenuous, it is unforgivable.
In June of last year, the House Appropriations Committee voted 19-32 against ranking member Rep. Nita Lowey's (D-N.Y.) proposed amendment to a bill that would fund health, education and labor programs in the next fiscal year. Representative Lowey's amendment would have reversed a nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Specifically, the amendment would have struck Section 216 from the bill (Section 216 prohibits funds from being used to advocate or promote gun control) and this section of text from the accompanying report(page 47-48):
Gun Research.—The Committee continues the general provision to prevent any funds provided from being spent on gun research, to include collecting data for potential future research, such as was proposed in the budget request for the National Violent Death Re- porting System. The Committee notes the budget request for Gun Violence Prevention Research is not funded and would be contrary to the prohibition. The Committee reminds CDC that the long- standing general provision’s intent is to protect rights granted by the Second Amendment. The restriction is to prevent activity that would undertake activities (to include data collection) for current or future research, including under the title ‘‘gun violence prevention’’, that could be used in any manner to result in a future policy, guidelines, or recommendations to limit access to guns, ammunition, or to create a list of gun owners.
For readers who have congressional representatives that continue to invoke a mental illness - violence connection, yet pride themselves on being forward thinking about mental health reform, time for a gut check.
Put on your advocacy hat, pick up the phone and call your representative's office. Ask them what they think about the wisdom of blocking a proposal that would have reversed a nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Ask them if they think this action falls in line with their publicly-held position on the connection between guns, violence and mental illness. Ask them, regardless of their position on gun violence and mental illness, if they think it would be a good idea to get a better handle on understanding the increasing gun violence in America. Ask them if they are committed to designing mental health legislation that incorporates sound research on gun violence. Remind them that the current mental health reform proposal in the House (H.R. 2646) “requires” family members of mentally ill individuals who have committed violent acts to be involved in decision-making around government grants focused on mental illness. Then ask them again, if they think it would be important to include sound research to understand gun violence in America better.
Hold your representative's feet to the fire on this issue, Network faithful. Over the past two years, we have seen a dramatic uptick in the political debate about mental health reform. The debate has at times blatantly, and other times, more subtly, made the connection between mental illness and violence. This connection continues to be made, in spite of the research showing that people with mental illness are far more likely to be victims than perpetrators of violent crime. Using the fear tactics inherent in connecting mental illness and violence while simultaneously blocking funding for research to understand better gun violence is not only disingenuous, it is unforgivable.
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Scott Bryant-Comstock President & CEO Children's Mental Health Network
The media coverage of this year's presidential election rages on. Meanwhile, meaningful mental-health reform legislation introduced in Congress has been relegated to the back burner. What was to be at the top of the 2016 House agenda, according to House Speaker Paul Ryan, has been pushed aside while Congress focuses on the politics of the election.
We have a presidential election every four years. We have a mental-health crisis in this country 365 days a year, every year. We only hear about the mass shootings that make the national news; yet tragedies involving untreated mental illness occur daily throughout this country and will continue to do so until Congress passes meaningful mental-health reform legislation.
Just this past February, it was reported that a father in Cape Coral was murdered and dismembered by his son who suffered from mental illness. The father's torso was found wrapped in a sheet in a wooded area behind their home. Body parts were found in a suitcase floating in a canal.
The father lived in fear of his son. Because the son did not meet the commitment criteria for involuntary hospitalization, the father was unable to get the treatment his son so desperately needed to prevent this gruesome tragedy.
Yes, this year's presidential election is important. So is mental-health reform. Seriously disturbed people struggling with mental illness need help now — not after the election — not next year. They need it now.
There have been multiple legislative proposals introduced in Congress to improve this country's broken mental-health treatment system. The strongest bill is from Rep. Tim Murphy, R-Penn., the "Helping Families in Mental Health Crisis Act," (H.R. 2646), which has 191 bipartisan co-sponsors — 138 Republicans and 53 Democrats.
This proposed legislation calls for a complete overhaul of the current federal system, refocusing resources on helping those with the most serious mental illnesses by getting them treatment before, during and after a psychiatric crisis. Individuals with serious mental illness such as schizophrenia and bipolar disorder can lose touch with reality. Many don't even know they're sick.
Among many important provisions, the Helping Families in Mental Health Crisis Act would reorganize the way the federal government funds mental-health services by identifying and prioritizing programs that have a proven track record of success.
This bill would provide funding to help states use assisted outpatient treatment, a lifesaving program for people who are too sick to maintain treatment themselves. It would increase the number of inpatient psychiatric beds and make adjustments to the Health Insurance Portability and Accountability Act that prevents doctors from giving families the most basic information about their mentally ill relatives' conditions.
Our current dysfunctional mental-health system abandons at-risk people to the devastating consequences of untreated mental illness. Mass shootings are on the rise. Suicide is the 10th-leading cause of death in the U.S. Untreated mental illness not only results in suicide and homicide, but in substance abuse, crime and homelessness.
Our failure to care for the mentally ill comes at a high cost — not just in economic terms but in wasted human potential. Yet with proper diagnosis and treatment, many patients are able to overcome mental illness, contribute to society and live normal and happy lives.
Mental illness is not something people choose. It's not a character flaw. It is a disease. It does not discriminate based on age, class or ethnicity. It affects all segments of society. According to the National Institute of Mental Health, the number of people with schizophrenia and severe bipolar disorder now tops 8 million adults in the U.S. Close to half of these people are going without treatment as families struggle to care for them.
As the mother of an adult son who suffered from severe bipolar disorder and took his life, I can personally attest to the fact that families for decades have had to watch their loved ones descend into "Code Red" territory because current laws do not allow them to push the "help" button until the person reaches the crisis stage. Only when an ill person becomes a danger, as determined by a judge at a commitment hearing, can this person be involuntarily hospitalized and treated.
Helping Families in Mental Health Crisis will mark a new era for mental-health care in this country. It will move mental-health care from crisis response and tragedy to recovery. Congress should move this comprehensive mental-health legislation forward now — not after this year's election.
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Dottie Pacharis is the author of "Mind on the Run — A Bipolar Chronicle." She divides her time between Fort Myers Beach, Florida, and West River, Maryland. Since her son’s battle with bipolar disorder, she has become an advocate for appropriate care for the mentally ill, especially family involvement in decisions about treatment. Dottie is the author of Mind on the Run – A Bipolar Chronicle, the story of a suicide that proper treatment would have prevented. She has been a featured speaker at various mental health organizations and has been published in the Wall Street Journal, Washington Times, Guardian UK, News-Press, Ground Report, and the Orlando Sentinel.
The month of June 2016 holds promise for being remembered as the time when “something” was done about mental health reform. The Senate is hard at work on crafting mental health legislation, and the House Energy and Commerce Committee has announced that Tim Murphy’s Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646) will rise again, apparently with a robust managers amendment to address some of the most problematic aspects of the bill.
One of the more ironic aspects of the protracted debate about what defines mental health reform is the discussion of Assisted Outpatient Treatment (AOT). Followers of congressional discussions of mental health reform will remember that since the early crafting of HR 3717, the precursor to the current HR 2646, AOT has been the tip of the spear for Tim Murphy’s campaign to get his bill passed.
Over the past few years, in stump speeches and editorials too numerous to count, the term AOT has become synonymous with mental health reform. Never mind the not insignificant fact that AOT is already on the books in 46 states or, even more telling, that I have yet to hear a politician articulate, with any sense of clarity or understanding, what is involved in the AOT process other than the civil commitment hearing component. Somehow, AOT has become the media darling for the “thing” that is going to prevent mass shootings and make us all safer from seriously mentally ill individuals determined to commit mass murder.
A few months ago I asked our research team to conduct an analysis of the news stories in support of HR 2646 listed on Representative Murphy’s website. Not surprisingly, the articles are filled with provocative and inflammatory language, graphic descriptions of violent incidents, and emotionally charged personal anecdotes. Headlines and articles contain references to "bloodiest rampages," "horror," "heinous crimes," "blood-curdling screams," "murderous assaults" and "apocalyptic assault." Authors have referred to seriously mentally ill individuals as "deranged," "frighteningly unstable," "shooters on the dishonor roll of evil," "a clear and severe risk to the public" and "a threat to society." Some headlines send the message that mental illness causes violence: "Floyd: Dallas police department attack highlights mental health needs," "New Mental Health Bill Could Prevent Mass Shootings," and "Efforts Underway To Prevent All Too Often Tragic Results Of Untreated Severe Mental Illness."
Despite the overwhelming statistics dispelling the idea that mentally ill individuals are inherently violent, the public buys into this notion in part because of the media's depiction of mental illness as a predicting factor of violent incidents such as mass shootings (Hoffner et al. 2015; Swanson et al. 2015).
Sadly, while many of the current 189 cosponsors of HR 2646 will admit that they understand that most seriously mentally ill are not violent, they continue to let the sensationalized misleading headlines in the media pairing violence and mental illness go unchallenged. The tacit approval of the guns, violence mental illness comparison is a disgrace, but then again, this is politics.
The AOT divide - advocate against advocate It is important to understand that the narrative about AOT that drove much of the discussion in Congress the past two years during hearings on the Helping Families in Mental Health Crisis Act was narrowly defined, focusing primarily on the civil commitment procedure in a courtroom. Justifying the need for AOT, architects of the various versions of the Murphy bill undertook a systematic campaign to eviscerate the peer support recovery movement and SAMHSA. Nowhere was this campaign more evident than in some of the hearings held by the House Committee on Energy and Commerce, Subcommittee on Health. Advocates supportive of the most intensive treatment end of the AOT spectrum railed against advocates supportive of the peer-to-peer support community seeking alternatives to AOT. Another sad tragedy caused by misguided politicians trying to move forward with an ill-defined bill at all costs.
The AOT pilot program was established by the Protecting Access to Medicare Act of 2014 (PAMA), Section 224, that was enacted into law on April 1, 2014 (Commonly known as the “Doc Fix” Bill). Rep. Tim Murphy (R-Pennsylvania) and Senator Debbie Stabenow (D-Michigan) are credited for getting the pilot program into the Doc Fix bill during the height of controversy around AOT being considered as part of HR 3717.
The description of the grant announcement includes language that states that "...grants will only be awarded to applicants operating in jurisdictions that have in place an existing, sufficient array of services for individuals with SMI such as Assertive Community Treatment (ACT), mobile crisis teams, supportive housing, supported employment, peer supports, case management, outpatient psychotherapy services, medication management, and trauma-informed care."
Mental health advocates need to seize on the language in the grant announcement that provides an opportunity for states and communities to put together applications that reflect the full breadth of what is required to make the AOT process work. I know this may seem difficult for anti-AOT advocates, but now is the time to get involved in the design and delivery of these pilot projects. Leaving it up to politicians to define what AOT is will result in more of what we are currently seeing – a gross lack of understanding of the importance of the recovery community in treating and supporting individuals with serious mental illness.
I encourage you to read our review of a community implementing AOT so that you can have a better understanding of what is required to make the process work. Also, take a look at Dr. Dennis Embry’s article on the science behind the AOT process. The recovery community must work in close collaboration with the treatment community if the precious federal dollars devoted to this effort are to have any chance of success. A winning proposal will honor both the need for high-intensity services along with the need for peer-to-peer supports that are designed for and by individuals with a history of mental illness.
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Scott Bryant-Comstock President & CEO Children's Mental Health Network
They come tumbling out, personal stories of having to relocate, to move on, cascades falling from websites and blogs into a growing pool of expat memoirs. The ones I have seen tend to praise the expatriate life, even though it is often made up of cycles of goodbyes, cycles of hellos, and lots and lots of starting over. Starting over with everything if they are the ones moving on; starting over with new friends and sometimes a whole new social circle, if they are the ones left behind. They tell of the challenges of life outside the home country, the comparisons to former homes, the accommodations to the new one, the languages and customs and food and expectations they need to adapt to, often over and over again every two or three years. They tell of the way coming home on furlough or summer vacation can be a welcome break, though just a temporary stay.
Sometimes they experience a reverse culture shock in returning to the familiar. They come home and they’ve changed, or home has changed -- they don’t know if they can slip back into the old identity like they can the old bathrobe, still hanging on its peg in a parent’s closet, their childhood bedrooms turned into guest rooms, and now they are the guests. Their friends and family might ask about their time overseas, but they have the feeling they don’t really want too many details. So they step gingerly around the questions, concerned they might sound like they are bragging about their international experience, concerned about seeming to lecture, worried that others might feel judged for their lack of worldly expertise, attuned more, sometimes, to the feelings of others than to their own. This is one of the things they’ve learned as expatriates, a sensitivity to how others might regard them, as foreigners.
They think they’ve prepared their children for this return as well. They believe they have immersed their children in their own home culture, so that it should be familiar, it should seem theirs. The children have heard the stories, myths and history growing up. They’ve learned the home language and celebrated the home holidays. They’ve been led to believe it is their culture, too, that despite their moves around the world, this is their real home and this is where they belong.
But their children experience a very different return because for them, it isn’t really coming home. It’s coming to their parents’ home. Home for these children, raised on the move, is not a place, it is a context. After the initial excitement -- similar to the way they feel at every move, in every new place -- they are anxious to leave again, dive back into the mobile stream. Because for them home, really, is the place where they swim with others like them, not rooted in a particular geography but floating among international, mobile communities.
Sometimes it is when the children finish their school years and are ready for college or the workforce that the strongest shocks are felt upon return. It is often at this time that the return is considered permanent. Their lives have reached the point where they can no longer trail their parents, and they must set off on their own.
Repatriation is foisted upon them. Sometimes it is when they turn eighteen and, as military kids, they are sent away from the bases where they lived, their resident privileges taken from them. Or they are no longer included in their parents’ embassy circles, or missionary communities, or the corporations with their social networks, or other groups living in expat bubbles.
Moving back for these kids can be overwhelming. They call it reentry, as though they are plunging back to earth from outer space. It can be the toughest move they’ve ever had to manage. Many struggle with feelings of invisibility -- they are used to being different, recognized as other outside their country of origin and bound to others like them. And here they are, apparently just like everyone else, except that they know they’re not. They’re expected to be native, but they feel more like immigrants. It’s a kind of isolation they have never known, it’s a different kind of move, and there is no community to relate to.
Some international organizations have begun to look more closely at reentry, and to provide the kind of support for returning families that they offer for those relocating overseas. Some colleges and universities have begun programs to identify and support these particular students. Skills assessment, career and personal counseling, academic and workplace adjustments, assistance in establishing new networks, all are helpful.
Above all, it is important to remember that reentry is another transition, and that these children, unlike their parents, are not moving back. They are moving on. Raised overseas, they are moving once again to a new environment, and this transition, like all the others, will have its rhythms and tides. They will be experiencing similar ups and downs and cycles of adjustment as they adapt to this, their new place. It is a profound change, this plunge into new waters, and the children, more than any others, need to be buoyed up till they learn, again, how to float, and then to swim.
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Nina Sichel is co-editor of the collections Writing Out of Limbo: International Childhoods, Global Nomads and Third Culture Kids (2011) and Unrooted Childhoods: Memoirs of Growing Up Global (2004). She leads memoir-writing workshops in the Washington, DC area and continues to collect stories and research about international and cross-cultural childhoods. For more information on TCKs, readers can visit her Facebook page, which includes links to articles of interest, book recommendations, and connection with other TCKs.
Law enforcement has found itself adrift within the “perfect storm” of public mistrust, increasingly violent encounters, and the one-dimensional social media soapbox. The struggle to maintain our bearing, for the purposes of establishing some semblance of order and trust amidst such disdain is taking its toll. The vast majority of law enforcement professionals are just that…professional. It is because of these professionals that I am honored to be a part of an internal system tasked with addressing the inherent exposure to trauma by officers experienced on all fronts; peer support.
As a trauma survivor of a deadly force encounter, I can attest to the need for peer support. At the time, no formalized peer support unit existed for me to utilize. However, friends and a strong wife (also in law enforcement) helped me to find my way again. It was during my shooting review board that a respected supervisor pulled me aside and assured me that I would recover and I would eventually use my personal experience to help others.
Challenge Accepted!!! The next few years were dedicated to obtaining the academic qualifications, certifications, and revisiting my experiences with the new eyes of a trauma-informed professional. I became a peer for several non-profit organizations and reached out to anyone I knew was involved in a critical incident. Unfortunately, my greatest opposition to providing help was the stigma associated with asking for it. It was clear, I needed to become a champion for change by sharing my uncensored experiences. I requested to teach a block of instruction for all new recruits titled, “Survival Mindset: Preparing for and Learning to Survive Trauma.” Pleasantly surprised, I was met with an overwhelming interest and acceptance of the concepts. A single class evolved into a sought-after presentation to surrounding police academies, and eventually around the country.
Too Much Success? Almost immediately, requests to speak with individual officers about finding help and resources began flooding in…it worked!!! I went into overdrive, seeking as many resources available for officers in crisis and vetting the efficacy. I recall a single month when I was helping several officers and began to feel the effects of their trauma. I began falling into the trap of helping beyond my ability. I wish I could say I noticed, but it was my wife who identified my declining mental health. I was becoming distant, fatigued, and frustrated that I was the only one doing anything (far from the truth)!!! I was regressing back to the damaged individual I fought so hard to fix. I had taken on the stress of the officers I was helping and I thought to myself…STOP!!!
Back on Track With the help of my wife and my own advice, I reached out for help. I opened up to my wife and I spoke to a close friend and licensed counselor. I needed to understand that desire to help is decidedly different than my ability. Saying “No,” while hard, is an integral part of peer support.
Healthy Peer Support Recently, I was working with a local fire department to establish a peer support unit and providing resiliency training. Something a battalion chief said to me stuck. He said, “We mandate Personal Protective Equipment (PPE) for our fire fighters…mental health PPE is just as important.”
We work in a time where peer support is a critical component of law enforcement, as important as our flashlight, handcuffs, weapon, or ballistic vest. Similarly, if we require our public safety personnel to maintain PPEs before going to work, law enforcement must ensure that peer support unit personnel are provided the proper mental health PPEs.
Resources There are numerous local and national support services for first responders. Resources that address suicide, substance abuse, grief, depression, vicarious traumatization, wellness, compassion fatigue…etc., are available. My humble suggestion is that we become students of our craft and never stop looking for the help that we will inevitably need. As a peer support unit director, the degree of help we provide is met with an equal responsibility to care for ourselves. To help others, we must recognize the need to help ourselves first.
Hey, guess what? It is Mental Health Awareness Month and Washington, DC is buzzing with advocates excited to meet with their congressional representatives to discuss meaningful mental health reform. For those advocates making the trek to DC, I am sure that on your list of questions for your congressional representative is something related to the need for improved services for LGBTQ individuals, right? I mean, we talk about the importance of addressing discrimination against the LGBTQ community all the time. The nation is abuzz with discussion about the rights of transgender individuals, who can use what bathroom, and whether or not a therapist should be obligated to see someone if they disagree with their sexual orientation. And of course, you are planning to speak to your congressional representative about LGBTQ equality... right?
Feeling a bit nervous about where to begin? Recent events in Congress are always a good conversation starter. Here is a good one for you to use, as it just took place yesterday.
During the House vote on H.R. 4974, the Military Construction and Veterans Affairs and Related Agencies Appropriations Act, Rep. Sean Patrick Maloney, D-N.Y. submitted an amendment aimed at upholding an executive order that bars discrimination against LGBT employees by federal contractors.
The vote tally at the end of expired time had the amendment passing, 217 - 206. Democrats cheered, but then slowly began to boo. Something was not right. The vote tally on the screen began to change, with the yae votes slowly decreasing and the nae votes increasing.
The rules of the House are that after the time expires, if a Representative wants to change his or her vote, they need to go to the well of the House Chamber and register their change with the Speaker. But no one was going to the well to change their vote, yet the votes were changing on the screen!
The room got louder and louder with shouts of protest as the tally on the screen showed mysterious vote changes taking place one by one, until the Speaker finally called it after the nays exceeded the yeas by one. The amendment was ultimately defeated 213-212.
Here is why this vote is important for children's mental health advocates If your congressional representative considers him or herself a champion of mental health reform, then at some point, you need to understand their position on the rights of the LGBTQ community - a community that is highly represented in mental health treatment, support and advocacy. If your congressional representative has voted to disallow basic equal rights protection for the LGBTQ community, you will want to ask them to help you understand the basis of their position, and how it reflects their commitment to comprehensive mental health reform.
Of the seven congressional representatives who switched their votes on the Maloney Amendment without following proper protocol, five are co-sponsors of H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015. H.R. 2646 is a bill that has generated much discussion in mental health advocacy circles over the past few years, and my guess is that many of the mental health advocates making Hill visits this month will be discussing H.R. 2646 with their elected congressional representatives.
Ask your congressional representative how he or she voted on the Maloney Amendment. If they voted no, ask them why, so you can better understand their thinking. Then ask them how they see the basic rights of the LGBTQ community being addressed in H.R. 2646. The ensuing conversation should provide opportunity for you to provide some perspective and possibly broaden the thinking of the individual entrusted to make decisions on behalf of the community in which you live.
Here are the five vote switchers on the Maloney Amendment who are also co-sponsors of H.R. 2646.
Morning Zen Guest Blog Post ~ Randi Carmen Schmidt ~
I grew up in a family that was long on challenges and short on money. To be frank, my parents were both alcoholics and had untreated mental health issues, and we didn’t have much money after my dad lost his job in the 1980’s and we moved to a small town in rural MN.
Because of where I have been, and what I have been through, however, I find that I am an eternal optimist when it comes to the resilience, strength and potential in children and youth who grow up in difficult situations, whether it is abuse, poverty, or drug and alcohol addicted parents. I am also an eternal optimist that there are adults in this country who want to see these children succeed and will help them achieve their potential. That is why I am very disappointed by what is going on in Congress right now. It seems that while some speak of wanting to help people in poverty and create opportunity in our nation, their actions leave something else to be desired when it comes to children, including low-income and poor children, or children suffering abuse or neglect.
In the past month, committees in the House of Representatives have three times had the opportunity to do right by children, but instead took steps to make their lives, and their climb to success, that much harder.
On March 14, the House Energy and Commerce Committee voted to make changes to the Children’s Health Insurance Program (CHIP), a program which provides low-income children health care. The Committee voted to scale back the federal matching rate states receive for helping low-income children get coverage, effectively making it harder and more costly for states to expand coverage to more children. It is estimated that this provision would result in countless low-income children nationwide losing coverage, or for those who don’t have coverage, prevent them from gaining it.
Then, two days later, on Wednesday, March 16, the House Ways and Means voted to eliminate the Social Services Block Grant program (SSBG). In FY 2013, 48 percent of the SSBG recipients, or 13.5 million, were children. SSBG funds vital programs important to babies, children, youth and families, including foster care, child abuse prevention services, and child protective services. It is estimated that millions of children will be impacted by the elimination of SSBG.
The Committee also voted to deny the Child Tax Credit (CTC), a tax credit which can help parents put food on the table, or pay the heating bill, rent or other basic necessities, to low-income working families with children who file their taxes with an Individual Tax Identification Number (or ITIN) rather than a Social Security number. It is estimated that this proposal would, “increase hardship and push several million low-income children and their parents into, or deeper into, poverty.” Three million children, 80% who are American citizens, are expected to be impacted by this proposal.
Now the House Education and Workforce Committee majority has released a bill that proposes to make it harder for schools to provide meals to hungry children in poor communities.
I can’t imagine what, if anything, abused and neglected children, children in need of health care or a hot lunch, or any child for that matter, did to upset members of Congress so much that they would want to make their challenging lives even harder. But, that is what these proposals would do. And it is troubling that some of the very same people in Congress who support these short-sighted and harmful proposals may play a part in creating a new agenda on poverty and opportunity, one which will more than likely impact some of these very same children.
The eternal optimist I am has to believe there is an alternative, that there is something better that our elected officials can and should be doing for children. And there is.
Our nation and its leaders, especially those that care about poverty and opportunity in our nation, can and must do better by children, particularly vulnerable children. The first step is making sure that none of these harmful proposals see the light of day again. The second is remembering the needs of children and youth in any public policy or budgetary discussion going forward, including the creation of a poverty and opportunity agenda.
For while there may be much for our nation to disagree on, I refuse to believe that how we treat the most vulnerable children in our nation is one of them.
IF you want to tell your members of Congress to support investing in our nation’s children and against proposals that will harm them, click here.
Randi Carmen Schmidt is the Executive Director of the Children’s Leadership Council. The Children's Leadership Council (CLC) is a nonpartisan coalition of children’s advocacy organizations. It is the only national children's coalition solely dedicated to supporting investments in our nation's children and youth, from birth to adulthood. Collectively, CLC's members have affiliates, partners and members in every state in the nation.
Have you ever been slapped in the face by someone’s prejudiced thinking about mental health needs? That’s called stigma. It first happened to me when my son was seven.
My son spent a lot of his 7th birthday party lying on the floor at Chuck E Cheese crying and saying, “I don’t deserve to live – I want to die.” Like his friends, he would race excitedly from game to game, then run back to me to say, “Guess what I won?” Then his mood would plummet and I’d see him drop to the floor, disconsolate. His friends would stop next to him and try to cheer him. Not long after, he had his first inpatient stay.
A year before, we had moved into a newly built housing tract. The school district was good, the neighborhoods were designed with curving streets and cul-de-sacs, which made them perfect for families with young children who rode their bikes and skateboards. All the houses around us seemed to be filled with kids the same ages as my two sons and they were soon traveling as a posse to one another’s houses to play with this game or try out that swing set. Families invited each other to parties and outdoor barbeques.
After my son’s hospitalization (which lasted nearly a month) he insisted on going to each of his friends’ houses to let them know he was home and available to play. I asked him what he was going to say. “They told me at the hospital that lots of kids go to the hospital to have an operation or because they are sick,” he said. “It’s just like that, except it’s your feelings. It’s okay to talk about it.” I felt that little clutch in my stomach that mothers get when they worry. But what did I know? This was a new world for us and if the “experts” told my son it was okay to talk about his hospitalization, then I was going to defer to them.
He set out on his neighborhood journey, going from house to house while I stood a little distance behind him. He did great, shaky a few times but was met with smiles and nods for the most part.
Not long after we got back home, I got a call from Denise’s mother. Denise was doted on by her parents and had been born some years after her older brother. They lived cater corner across from us and she played often with my son. Denise was perfectly dressed, her blonde hair done up in dozens of new ways each week. Denise’s mother was not all smiles and nods on the phone. She told me that although she felt sorry for my son, Denise was not allowed to ever play with him again. If he came to the door, he would be turned away. If he called, the phone would be hung up. If he was playing in their neighborhood group, Denise would not be allowed to join in. In fact, she added, she would appreciate it if I told him when he walked in front of their house to please use the sidewalk on the other side of the street. The rejection couldn’t have been more complete.
I told my son a gentler, highly-edited version of the conversation and it’s something he doesn’t remember today. But I do. My judgemental neighbor went from embracing we-are-all-raising-our-kids-together to making it very clear that there were two groups now, “us” and “them.”
Many people believe that there is less stigma today around mental illness, treatment and even psychiatric medications. They point to the growing number of stories that people like me tell of their own experiences, or that people with their own lived experiences relate. These stories don’t just provide a name and face, but details about what works and how it feels to experience the slings and arrows of a very tough mental health system. But an experience with in-your-face stigma changes you. You lose patience with slow change. You can’t go back to thinking that it’s lack of education or inherited attitudes. It’s more than that. Stigma is an ugly thing.
Researchers say stigma is a term “which has evaded a clear, operational definition.” It actually has three parts: lack of knowledge (ignorance), negative attitudes (prejudice) and excluding behaviors (discrimination). Like many others, my son and I have experienced all three.
Stigma is not just carelessly using words like crazy or psycho. It’s shunning like my son and my family experienced. One mom told me recently that her child was ostracized by her ex-husband’s entire family, who wished to hide her son’s mental health needs. It’s seeing your child shunted to the psych evaluation room from the emergency room as soon as they hear the mental health diagnosis. Another mom recently wrote, that even though her daughter overdosed on pills and was violently ill in the emergency room, “they stuck her in a psych room with a security guard” because they “thought she was faking it.” It’s being denied opportunities like the parent who told me she had to choose between a therapeutic school with a stripped down curriculum, or an academically challenging one with no therapeutic supports for her brilliant, beautiful daughter with extreme mood swings.
The hurt caused by an experience with stigma stays with you for a long time. You feel a little more mistrustful, a little more righteous anger and have warring impulses between disbelief and cynicism. I’m hurt, you feel; this is unjust, you think; this must stop, you realize. We need to keep telling those stories, we need to keep waging our awareness campaigns but we need something more. We need warriors.
Lisa Lambert is the executive director of Parent/Professional Advocacy League (PPAL) and a Children's Mental Health Network Advisory Council member. Lisa Lambert became involved in children’s mental health as an advocate for her young son in 1989 through the CASSP family network in California. After moving back to Massachusetts, she began supporting families whose children and youth had behavioral health needs. Her areas of expertise include mental health policy, systems advocacy and family-driven research.
This year marks a critical juncture for our country – one that presents both opportunities and challenges for health reform, and will determine whether or not we embrace the traditions of the past 150 years and move toward a more equitable, accessible, and patient-centered health system. What is most concerning today is that if we do not pay close attention to our history of comprehensive health reform, the remarkable gains we have fought so hard to attain over a century and a half, could be wiped out, moving us backwards in terms of health care coverage, access, delivery, and equity.
The Supreme Court, in its history, has never overturned a major health law, but we watched with bated breath whether the Court would do so this time around with the Affordable Care Act – a law more sweeping than previous health legislation and which incorporated broader civil rights protections. Fortunately the Supreme Court has so far followed contemporary precedent regarding health laws, but how could we be sure the Court wouldn’t do what a prior Court did in 1883 when it overturned the Civil Rights Act of 1875? In both instances when the Supreme Court ruled in favor of upholding the Affordable Care Act, the Court punted the demise of this law to the political process, arguing “[m]embers of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.”
Now with the Supreme Court settling the constitutionality of the Affordable Care Act, history affords us an opportunity to understand whether it is even possible six years after a major health law has been implemented to completely dismantle it via the political process. The answer is a resounding yes! Contrary to the belief held by many proponents of the ObamaCare law that Republicans are bluffing about their attempts to repeal the Affordable Care Act or that it could never happen at this point, that simply is not the case. 150 years ago, the Freedman’s Bureau Act was signed into law after the Civil War affording blacks and others access to health care across the country, especially in the South. However, seven years after this law was enacted, having survived every reauthorization, Congress decided to shut it down indefinitely – jeopardizing care to our nation’s most vulnerable people.
The Affordable Care Act is a test of whether we will go back 150 years to a time in our nation’s history when there was no appetite to implement a law overwhelmingly helping groups that were marginalized or uphold a law that would have elevated rights and protections for vulnerable populations. It is very clear that this is the first health reform statute in recent decades allowed to stand, but just like the Freedman’s Bureau, which lasted only seven years … if we are not careful, ObamaCare could see a similar fate.
I was quite hopeful that partisan political attacks on ObamaCare were subsiding when the Republican-led Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) one year ago, which reauthorized most of the programs that were in the Affordable Care Act. In fact, the MACRA legislation even expanded some of the ACA policies such as delivery and payment system reforms, making it in essence the health reform extension bill. However, the political backlash escalated again when the Supreme Court upheld ObamaCare once more last summer in 2015.
150 Years of ObamaCare explores the hidden backstory of the Affordable Care Act, shedding light on the creation and implementation of the greatest and most sweeping equalizer in the history of American health care. I wrote this untold story to draw back the curtains and offer an insider’s look into the crafting of the health reform law and provide an unprecedented review of the health equity movement past, present and future. I wanted to develop a resource highlighting the little known leadership efforts over the past 150 years to push for mental health reform, minority health reform, and universal health reform and how and why these efforts were successful this time around.
150 Years of ObamaCare highlights how and why the health reform law became the most inclusive law ever passed by Congress, not only in terms of its content, but in terms of the process - the stakeholders who were brought to the table, including racial and ethnic minorities, LGBT individuals, women, people with disabilities, and veterans. The book also highlights what we have left to do to ensure these reforms are not only implemented, but implemented in a manner that will greatly benefit all of our communities.
I wrote 150 Years of ObamaCare so that current and future generations of health equity advocates, students, and scholars can learn from our efforts, build upon our successes – understanding what strategies we employed and why, what challenges we faced internally and externally, and how we overcame them.
I also wrote this book to help leaders across our nation, whether in health care, public health, policy, and in other areas gain a better understanding of this landmark law – overcome some of the challenges it presents and leverage the numerous opportunities that are available.
Those who continue to oppose the Affordable Care Act would, undoubtedly, be on the wrong of side of history just like those 150 years ago who opposed and worked to effectively undermine a law intended to provide access to medical care to African Americans and other groups. 150 Years of ObamaCare highlights this historic inflection point, and what is at stake after November 2016.
Daniel E. Dawes is a healthcare attorney and the Executive Director of government relations, health policy, and external affairs at Morehouse School of Medicine. In addition to his executive role, Daniel is a director of health policy and a lecturer of health law and policy at the Satcher Health Leadership Institute and holds a faculty appointment in the Department of Community Health and Preventive Medicine. During the negotiations around health reform, he founded and chaired the National Working Group on Health Disparities and Health Reform, a working group of more than 300 national organizations and coalitions that worked to ensure that the health care reform law included health equity provisions to reduce disparities in health status and health care among vulnerable populations. In recognition of his efforts, he was one of 13 experts who were invited to serve on the Health Equity Leadership Commission, which provides guidance on implementing health reform to members of Congress, the Obama Administration, and officials at the Department of Health and Human Services. He is a frequent speaker and author of several publications on health reform and health equity. He is the author of the new book, 150 Years of ObamaCare(Johns Hopkins University Press).