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UC Irvine aims to transform public health with record-breaking $200-million donation

Susan Samueli caught a cold while visiting France more than three decades ago. Instead of the usual medicines, a friend suggested aconite, a homeopathic remedy derived from a plant in the buttercup family.

She was cured — and became a lifelong advocate of homeopathy and other alternative healing methods to complement conventional medicine. Her husband, Henry — the billionaire co-founder of Broadcom, the Irvine semiconductor maker — says he was initially skeptical but found the integrative health approach helped him easily shake off colds and flus and kept their children healthy without antibiotics.

Now the couple’s passion for integrative health has led to the largest donation ever made to UC Irvine. On Monday, UC Irvine Chancellor Howard Gillman announced that the Samuelis have donated $200 million to launch what he billed as the nation’s first universitywide enterprise to embed integrative health approaches in research, teaching and patient care.

“The human body is a very complex and highly interconnected system. Therefore our healthcare needs to be looked at through a more holistic lens,” Henry Samueli, who also owns the Anaheim Ducks, said in remarks at UC Irvine. “Our genetics, our surrounding environment, our nutrition, our physical activity and our mental state all play critical roles in our well-being.”

The GOP Congress Is Rushing Wildly Ahead With A Huge Health Care Bill. Again.

Collins and Murkowski haven’t said how they’d vote, either. Both senators objected to the previous bills’ steep cuts to Medicaid, among other things, and Cassidy-Graham also slashes the budget for that program. Arguably more significantly, Collins and Murkowski oppose eliminating federal funding for Planned Parenthood, which this bill would do.

Article source: http://www.huffingtonpost.com/entry/gop-health-care-bill-again_us_59c022f6e4b0186c2205092f

Tillerson Says US May Close Cuba Embassy Over Health Attacks

A closing of the embassy, were it to occur, would be less a political statement than one of concern over the risks that employees face in Havana. The American Foreign Service Association reported this month that the symptoms among those affected included mild traumatic brain injury, permanent hearing loss, loss of balance, severe headaches and brain swelling.

While noting that Cuba is responsible for protecting the health of diplomats posted to the country, State Department officials have yet to suggest that the Cuban government was behind the attacks. The Associated Press reported this weekend that the initial reaction by the Cuban president, Raúl Castro, to the news — apparent concern, with none of the usual how-dare-you-accuse-us attitude — had caught American officials off guard.

The Cubans even offered to let the F.B.I. go to Havana and investigate, a rare level of openness that suggested to some American officials that the Cuban government was equally baffled about the cause. Victims told The A.P. how they walked in and out of what seemed like powerful beams of sound that hit only certain rooms or even only parts of rooms.

American officials have speculated that the problems may have resulted from some sort of sonic attack or perhaps a surveillance operation gone wrong. The attack may have been the work of a rogue government unit or another government like Russia. That a Canadian diplomat was also affected deepened the mystery. Relations between Canada and Cuba have long been warm.

While the Trump administration has moved to reinstate travel and commercial restrictions on Cuba, there has appeared to be little appetite to entirely undo measures that are broadly popular, including among Republicans. That is another reason the administration has reacted cautiously.

Still, the attacks have led to growing concern on Capitol Hill. On Friday, five Republican senators sent a letter to Mr. Tillerson asking that he expel all Cuban diplomats in the United States and, if Cuba does not take tangible action, close the American Embassy in Havana.

American and Cuban officials met in Washington that day as part of a continuing law enforcement dialogue, and the subject of the attacks was raised, according to the State Department.

“It is an aggressive investigation that continues, and we will continue doing this until we find out who or what is responsible for this,” Heather Nauert, the department’s spokeswoman, said on Thursday.


Continue reading the main story

Article source: https://www.nytimes.com/2017/09/17/us/politics/tillerson-cuba-embassy.html

After single payer failed, Vermont embarks on a big health care experiment

Doug Greenwood lifted his shirt to let his doctor probe his belly, scarred from past surgeries, for tender spots. Searing abdominal pain had landed Greenwood in the emergency room a few weeks earlier, and he’d come for a follow-up visit to Cold Hollow Family Practice, a big red barnlike building perched on the edge of town.

After the appointment was over and his blood was drawn, Greenwood stayed for an entirely different exam: of his life. Anne-Marie Lajoie, a nurse care coordinator, began to map out Greenwood’s financial resources, responsibilities, transportation options, food resources and social supports on a sheet of paper. A different picture began to emerge of the 58-year-old male patient recovering from diverticulitis: Greenwood had moved back home, without a car or steady work, to care for his mother, who suffered from dementia. He slept in a fishing shanty in the yard, with a baby monitor to keep tabs on his mother.

This more expansive checkup is part of a pioneering effort in this New England state to keep people healthy while simplifying the typical jumble of private and public insurers that pays for health care.

The underlying premise is simple: Reward doctors and hospitals financially when patients are healthy, not just when they come in sick.

It’s an idea that has been percolating through the health-care system in recent years, supported by the Affordable Care Act and changes to how Medicare pays for certain kinds of care, such as hip and knee replacements.

John Graves sits in his apartment in South Burlington, Vt. He lives at an apartment complex that is part of a program to provide housing for former homeless people, as well as help them enroll in health care and other programs. (Jacob Hannah/For The Washington Post)

But Vermont is setting an ambitious goal of taking its alternative payment model statewide and applying it to 70 percent of insured state residents by 2022 which — if it works — could eventually lead to fundamental changes in how Americans pay for health care.

“You make your margin off of keeping people healthier, instead of doing more operations. This drastically changes you, from wanting to do more of a certain kind of surgery to wanting to prevent them,” said Stephen Leffler, chief population health and quality officer of the University of Vermont Health Network.

Making lump sum payments, instead of paying for each X-ray or checkup, changes the financial incentives for doctors. For example, spurring the state’s largest hospital system to invest in housing. Or creating more roles like Lajoie’s, focused on diagnosing problems with housing, transportation, food and other services that affect people’s well-being.

Critics, however, worry that it will create a powerful tier of middlemen charged with administering health-care payments without sufficient oversight. Those middlemen are Accountable Care Organizations, networks of hospitals and doctors that work to coordinate care and can share in the rewards if providers are able to save health-care costs, but remain on the hook if costs run too high. In Vermont, the goal is to limit the growth in overall annual health care spending to 3.5 percent each year.

It will put a new burden on primary care doctors to keep people healthy — potentially punishing providers financially for patients’ deep-rooted habits and behaviors. And the core idea of increasing outreach to high-risk patients, though sensible on its surface, may not control health spending; one study found the approach was unlikely to yield net savings.

“I think this kind of model could be very good if it’s implemented the right way. There’s a big question on whether it will be implemented the right way,” said Amy Cooper, executive director of HealthFirst, an association of independent physicians in Vermont.

The current initiative is Vermont’s second attempt to revolutionize health care. It was the first state in the country to embrace a government-financed universal health-care system but abandoned the plan in late 2014 because of concerns over costs.

To hear Al Gobeille, a restaurateur turned Vermont human services secretary, tell it, paying for insurance coverage is just one of the big problems facing the American health-care system. The other, even more complicated one is reducing the underlying cost — and that is what Vermont is trying to tackle.

In 2015, a health insurance plan cost a family $24,000 in premiums, Gobeille said, and by 2025, that is projected to grow to $42,000.

“There’s going to be a calamity. No family is going to be able to afford that,” Gobeille said. “So it’s important to move to a system that aligns more closely to the growth of our economy.”

This year, 30,000 Medicaid patients — like Greenwood — have transitioned into the experimental model through a pilot run by the accountable care organization OneCare Vermont. The system uses software to flag people with complex medical needs and chronic health conditions and to coordinate care and support for those deemed at high risk. Instead of billing for each overnight stay or medical scan, hospitals receive an upfront monthly payment to manage the care for every patient assigned to them, and primary care practices receive payments to help with the outreach work.

“It’s creating a situation where the physicians and hospital leaders and other clinicians in Vermont feel like they have enough support and structure around them that they can fundamentally pursue changes in their clinical models and their business models,” said Andrew Garland, vice president of external affairs and client relations at BlueCross BlueShield of Vermont. “It has us all rowing in the same direction.”

Garland said BlueCross is in discussions to move a segment of its members — including individuals and small businesses who buy plans through its Affordable Care Act exchange — into the new payment model next year.

Other states are embarking on similar efforts to cut health-care spending, on both sides of the partisan divide.

Arkansas’ Medicaid program has collaborated with private insurers to shift payments around discrete “episodes of care” — such as asthma and congestive heart failure. “By having Medicaid and Blue Cross on the same page, we got the providers’ attention,” said William Golden, medical director of the medical services division at the Arkansas Department of Human Services.

In 2014, Maryland started giving hospitals an upfront budget for the year, to incentivize providers to keep patients healthy.

“The real magic here is when you get the payers — Medicare, Medicaid and the commercial payers, saying the same thing to the delivery system. Vermont is trying to do it one way . . . Arkansas is trying to do it with more coordination between Medicaid and Blue Cross,” said Christopher Koller, president of the Milbank Memorial Fund, a foundation focused on improving health. “States like Maryland, Vermont are really trying to get at the underlying cost.”

As Vermont retools how it pays for health care, the health system itself is already evolving — with an emphasis on services that fall far outside the traditional domain of medicine.

Vermont’s major hospital system has put up the money to allow community partners to buy and refurbish housing, building off earlier success of buying blocks of nights for temporary stays at a motel run by the Champlain Housing Trust. After three years, costs for hospital stays dropped by $1.6 million, accompanied by a large drop in readmissions.

That led the University of Vermont Medical Center to put up the cash this year to enable the housing trust to buy and convert a roadside motel in Burlington into a landing spot for patients who don’t need to be in a hospital, but don’t have a suitable place to return.

A hospital-owned family medicine practice in Colchester has set up “health-care share” day on Thursdays, when families can pick up a box of fresh vegetables prescribed by their family doctor.

Kari Potter, 34, said that the farm share has changed how her family eats. She makes all her own sauces, she said, loading a bag of veggies and two chickens into her car, and the weekly delivery has helped the kids learn to appreciate healthy snacks, even just thinly sliced cucumbers.

Most of these changes seem sensible, and they may even improve patient health. The question will be whether they save money in the long run. In Vermont, there are fears that only the biggest hospital systems that have the wiggle room to assume risk and sustain financial losses will survive.

It is also unclear how patients will react, as the pilot is expanded beyond Medicaid recipients.

During his appointment, Greenwood was firm that he had no real complaints about his life and didn’t think he needed any particular support.

“Any problems with depression or anxiety?” Lajoie asked. Greenwood said no and Lajoie gently tried to prod him for more information — “meaning you don’t have any sadness feelings?”

“No,” Greenwood said. “If I do, they ain’t bad.”

When she asked if his health ever got in the way of visiting friends, he chuckled.

“I don’t visit with friends,” Greenwood replied. “Just watch soap operas.”

Lajoie made notes to revisit his chewing tobacco habit and find out if he needed additional support in a month. The trick to this job is finding the ways that they can support people, which may not always be obvious — to the care coordinator or to the patient.

“We’re not here to judge them or anything. Sometimes we don’t understand what we can actually help them with,” Lajoie said. “It’s a learning thing, together.”

Article source: https://www.washingtonpost.com/business/economy/experimental-program-in-vermont-pays-doctors-to-keep-patients-healthy/2017/09/17/ddb47cfe-9320-11e7-aace-04b862b2b3f3_story.html

Yoga and Mental Health: How It Helps Depression and Four Other Conditions

Yoga can help quiet the mind, alleviating the worries and stress that plague our day-to-day lives. But the benefits can also extend to more serious psychological issues. 

In the U.S., nearly 1 in 5, or roughly 43 million Americans, suffer from a mental illness, including conditions like depression, anxiety, or schizophrenia. These individuals often experience difficulty getting the health care that they need, and available medications don’t always provide satisfactory effects. For this and other reasons, many individuals coping with mental health issues seek alternative approaches to healing, including yoga. 

Related: Too Much Stress? Former Surgeon General Says Doctors Need to Recognize America’s Mental Health Problem

Dorena Rode, a physiologist at UC Davis, has found help in yoga for her own mental health issues.  ”I understand the complexity of these situations and their devastating effects because I have overcome addiction, depression and [post traumatic stress disorder] in my own life. I practice yoga daily, teach others and have done so for decade,” she tells Newsweek.

Rode explains the results of yoga increase in a dose-dependent manner. The more you do, the greater the health benefits.

“I recommend people practice everyday for at least 15 minutes. A minimum of 3 to 5 times a week will still offer great benefit. If a person is under medical care, the appropriate level of practice for a person’s health condition should be made with their care provider,” says Rode.

A growing body of research suggests yoga does provide mental health benefits, from alleviating depression to PTSD

Depression

Yoga has been studied as an effective treatment for some types of depression. A series of studies from the Netherlands found yoga provided some benefit for people with chronic depression. In the first study, men and women who suffered from depression for an average of 11 years experienced a reduction in depression, anxiety, stress, and rumination after they took weekly 2.5-hour classes for nine weeks in conjunction with therapy and antidepressants. In the second study, depressed college students who practiced mindful yoga for 30 minutes with their instructor and then at home for eight days with an instructional video experienced a greater reduction in symptoms, even two months after, compared to another relaxation treatment.

Related: Mental Health: Can Ayahuasca, the ‘sacred plant’ of the Amazon, help addiction and depression?

Yoga offers the opportunity to release stress and tension by helping you shift your focus to the present and “connect to all of your holistic bodies, mind, body and soul,” says  Dr. Jodi Ashbrook, a teacher, author, and yoga instructor.

09_15_woman doing yoga_01 Yoga therapy can help ease symptoms of these common mental health conditions, from depression to PTSD. DON EMMERT/AFP/Getty Images

“By letting go of whatever negative energy is pulling you away from that intention, you can shift your perception that is typically feeling out of control to your ability to stay present and positive in the moment only to boost your mood,” Ashbrook tells Newsweek.

Anxiety

Yoga may also help ease symptoms of anxiety and depression. A 2016 study conducted at the University of Pennsylvania found people with major depressive disorder (MDD) who do not fully respond to medication, saw a decrease in depression and anxiety after practicing Sudarshan Kriya yoga (a cyclical controlled breathing practice), while those who took meds but did not practice yoga saw no changes. 

Erin Wiley, a clinical psychotherapist in Ohio, believes yoga helps calm the nervous system of patients with anxiety. “It teaches clients that they have control of their stress reaction, gives them a coping skill for when they are overwhelmed, gives them experience in practicing calming down which is helpful for times of distress,” Wiley tells Newsweek .

Eating Disorders

Yoga therapy can help patients with eating disorders change their attitude about their bodies. In a pilot study, researchers found those who participated in a yoga class designed to target eating disorder symptoms experienced a significantly lower negative effect before meals compared to the group that did not practice yoga. Those who had practiced yoga also reported feeling calm and in tune with their internal drives.

According to Wiley, yoga ”helps clients see their bodies as something they are working with rather than against, reminds clients that they have control and ownership over their bodies, helps clients see their bodies as assets, helps clients feel stronger.”

Related: Depression, Mental Health and the West: How the West’s Cultural Values Make People Unhappy

Psychiatric Disorders

A yoga therapy program could help as an accompaniment to the standard treatment of psychiatric disorders. A pilot study in The Journal of Alternative and Complementary Medicine found an eight-week yoga therapy program, which included postures, breathing exercises, and relaxation, led to schizophrenic patients showing a vast improvement in symptoms and a decrease in negative thoughts. Overall, it was found to bring significant symptomatic improvements and enhance their quality of life.

“Many centers treating people suffering from psychosis and schizophrenia have organized yoga classes in their centers for the patients. These class are well received by the patients,” says Wiley.

PTSD

Yoga is known to benefit the mind and body, which means it can potentially help with PTSD. A study in the Journal of Traumatic Stress found yoga improved the lives of women with PTSD when they took a 12-session, Kripalu-based (the philosophy that you should practice just as how you should live your life), “trauma-sensitive” yoga intervention (either once per week for 12-weeks or twice per week for 6-weeks). The researchers noted classes included both asana (movement) and breath exercises.

Wiley believes this approach can help patients learn the how to calm themselves down when distressed. “This leads to lower incidence of drug and alcohol abuse, or other self-medicating behaviors,” she says.

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Article source: http://www.newsweek.com/yoga-therapy-mental-health-mental-illness-depression-anxiety-eating-disorders-666220

Fire staff on long-term mental health leave up by 30%

Grenfell firefightersImage copyright
AFP

Image caption

A number of London firefighters had to take leave after Grenfell

The number of UK fire and rescue staff taking long-term sick leave due to mental illness has risen by nearly a third over the last six years, figures show.

In London, fire staff taking mental health leave has doubled since 2011-12.

Some 103 London fire staff have taken mental health leave this year, some after working at Grenfell Tower.

The Home Office said it was the responsibility of fire services to put wellbeing services in place.

Two-thirds of fire services provided data following a Freedom of Information request submitted by 5 live Investigates.

They reveal the number of firefighters and other staff taking long-term mental health leave rose from 600 to 780 over the last six years. At least 126 staff have left the service due to mental health issues since 2011.

The Scottish Fire and Rescue Service and Northern Ireland Fire and Rescue Service only provided comparable figures for one full year.

In 2016-17, 97 Scottish fire staff took long-term mental health sick leave while in Northern Ireland that figure was 111.

Image copyright
Andy Graham

Image caption

Andy Graham served as a firefighter for 30 years before retiring with PTSD

Andy Graham, 52, is a former firefighter, who served in the Greater Manchester Fire and Rescue Service. He has suffered from PTSD for the last 30 years.

Mr Graham, who has a son and a daughter, retired last year and now trains others in mental health first aid.

“When I started in the fire service in 1987 there was no proper debriefing system in place,” he explained.

“The first fatal incident I attended was a particularly traumatic suicide.

“Within a matter of weeks, I started suffering from nightmares and panic attacks, and it snowballed from there, after attending more fatal incidents.”

He said that he was afraid to go to bed at night because of the nightmares.

“It meant I started staying up late, drinking alcohol to help me sleep.

“Through the daytime, there would be triggers that would set me off having flashbacks and panic attacks. Those triggers were blue lights, sirens, loud bangs. Seeing certain situations being depicted on TV even would set me off.”

Suppressed issues

His son, John, was only five when his father had a breakdown.

“It’s horrible to bring it back, being so young and coming through the front door and seeing your dad lying on the couch with a blank look on his face, someone that you’re so used to being bubbly and happy, and he doesn’t even say hello to you.”

Andy explained that he tried to keep a lid on his issues for years.

“But they were always there, bubbling under the surface. When you’re in the fire service, you’re told that you’re the strong one, the one there to help others.

“So it goes really against the grain to be asking for help.

“I’ve been in therapy four times now, and I’m in a better place than I have been for 29 years.

“Fire services have better debriefing systems than they used to, but the support is not where it needs to be yet.”

Media captionFormer firefighter Andy talks about his mental health illness from the stress of work

Sean Starbuck, mental health lead for the Fire Brigades Union said: “The stigma attached to mental health needs to be consigned to the bins of history where it belongs. It’s not going to get there on its own.

“Fire services need to create an environment where firefighters feel able to disclose if they are suffering as a result of traumatic scenes they witness as part of the job.

“At the moment it appears many are unable to.”

Faye McGuinness, programme manager for mental health charity Mind’s Blue Light programme, said: “Our survey of over 1,600 staff and volunteers across emergency services shows nearly nine in 10 have experienced stress, low mood or poor mental health while working in their current role.

“A shocking one in four told us that they had contemplated taking their own lives.

“Not everyone involved in a traumatic event will develop post-traumatic stress disorder. It can take a long time – sometimes years – for symptoms to emerge.”

Fire service responsibility

A Home Office spokesperson said: “It is the responsibility of fire and rescue services to have wellbeing services in place that meet their workforce needs.

“The government has provided an additional £1.5m to pay for mental health support through Mind’s Blue Light Programme to ensure our emergency services workers have the counselling and emotional support they require.”

Ann Millington of the National Fire Chiefs Council (NFCC) said the increase could reflect a change in behaviour with more firefighters prepared to seek assistance. She said fire and rescue services had put a lot of work into ensuring help and support are available to staff and they were working hard to reduce the stigma around mental health issues.

She added: “The days following the Grenfell fire saw a lot of open discussion about support being made available to firefighters and firefighters openly discussing it. The fact that people were talking about it openly and willing to accept help is an encouraging sign for the wider fire sector.”

A spokesperson for the London Fire Brigade said: “The welfare of staff is of paramount importance to the brigade. Our counselling and wellbeing service provides accredited counselling to all staff to help with their psychological wellbeing.

“Firefighters can and do see some traumatising things and it is important to give them the support they need and for them to know that there are always people available to listen to them.

“Seeing an increase in the number of people coming forward because they need help is positive, as rather than suppressing their feelings, staff want to seek help and use the services available to them.”

The service says that of the 103 staff members identified in 5 live’s FOI figures, five were as a result of the Grenfell Tower disaster.

All of these staff members are continuing to receive occupational health and counselling support.


5 live Investigates: Firefighter Mental Health is broadcast on BBC Radio 5 live on Sunday, 17 September at 11:00 BST. If you missed it you can catch up on the iPlayer.

Is there something you want investigating? We want to hear from you.

Article source: http://www.bbc.com/news/uk-41164996

Meet the Twitter ‘mafia’ in health and fitness tech

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Twitter alums are taking over the health-technology sector.

A LinkedIn search revealed that more than 20 former Twitter employees are now at health, fitness and bio-tech start-ups. The vast majority of them joined or founded these companies in the past two years, in the midst of Twitter’s well-documented executive shakeup.

This list includes but is not limited to:

  • Former Twitter CEO Dick Costolo, who’s now running a fitness app called Chorus
  • Former Twitter industry manager Julie Martin, who’s now working with Costolo as head of partnerships at Chorus Fitness; and ex-Twitter senior product manager Erin Moore, now head of product at Chorus Fitness
  • Former Twitter data science leader Jesse Bridgewater, who’s now running the data science team at Livongo Health
  • Former Twitter media heads Katie Jacobs Stanton, who now runs marketing at a personal genetics company Color, and Ross Hoffman, now Headspace’s chief business officer
  • Former Twitter vice president of sales finance Jeff Dejelo, now running finance at Color
  • Former Twitter strategy and operations manager Linda Jiang, now consumer marketing at Color
  • Former Twitter vice presidents Elad Gil and Uthman Laraki, who co-founded Color Genomics
  • Former Twitter’s senior product director Baljeet Singh who’s now at chronic disease management start-up Livongo Health
  • Former Twitter vice president of engineering Nandini Ramani, now chief engineer at Outcome Health
  • Former Twitter mobile market manager Charles Wu, now director of product at Catalia Health
  • Former Twitter director of global operations Rita Garg, who left the company for a senior business development role at Zenefits
  • Former Twitter intern Ray Bradford, now is now the CEO of Spruce Health
  • Former Twitter account executive Rick Cerf, now a product manager at Grand Rounds Health
  • Former Twitter recruitment manager Mel Heydari, now director of talent at Proteus Health

What’s attracting all these Twitter alumni? Healthcare might be the fifth-largest industry in the U.S., but it’s highly-regulated, notoriously complex and the sales cycles are far slower than in other sectors.

In other words, there are far easier ways to make a buck.

‘Seeing an impact’

After leaving Twitter, Costolo got into the fitness-tech space for personal reasons. He’s a runner and Crossfit addict, and saw an opportunity to engage others in sports. But he had a few other ideas to explain the interest of so many fellow Twitter alums in health-tech.

“At Twitter, we were always mission-centric,” he said.

So it seemed logical to Costolo that his former colleagues would be attracted to companies with a strong mission.

“In Silicon Valley, we joke that every company thinks they’re changing the world,” he said. “But with health, you can see an immediate impact rather than needing to jump through verbal hoops to convince yourself.”

The other factor is the network effects. Just like the PayPal mafia, a group of high-profile former employees that chose to invest in each other, the Twitter alumni in health care are picking up the best and brightest from their former workplace.

Twitter’s former media chief Katie Jacobs Stanton served on the board of Color Genomics alongside fellow Twitter colleagues Elad Gil and Othman Laraki before making the decision to join full-time. She subsequently snapped up Linda Jiang and Jeff Dejelo, both from Twitter.

“Yes I do think there’s a network now,” she said. “But we also recognize that the (health) space is wide open and there’s so much opportunity.”

Baljeet Singh, who now works at a diabetes management start-up called Livongo Health, said he was shaped by the “rough patches” at Twitter. At times of intense scrutiny, he recalled that the all-hands meetings reminded him of the company’s mission. “It bound us together and got people fired up,” he said.

“I didn’t want to join a start-up that was doing things your parents used to do for you, like food delivery or laundry services,” Singh said. “I thought that tech could play a much bigger, and more socially impactful role in the world than that.”

Correction: An earlier version of this story misspelled Othman Laraki’s first name.

Stop dumping the mental-health crises on cops

On Thursday, the NYPD released bodycam footage of the Sept. 6 shooting death of Miguel Richards, an emotionally disturbed Bronx resident. As the first such incident recorded since officers began wearing bodycams, this tragedy has given civil-liberties advocates an opportunity to make more claims about cops’ allegedly excessive use of lethal force.

In truth, Richards’ death raises more questions about mental-illness policy than police work.

The NYPD has, in fact, been training officers to deal with these types of situations. But our expectations for the Crisis Intervention Team approach should be tempered by an acceptance of the fact that we shouldn’t make cops responsible for the failures of our mental-health-care system.

The NYPD launched its CIT program in 2015, and 5,600 cops have by now received the training. CIT teaches techniques patterned on those used in hostage negotiations.

Throughout the four-day course, cops learn about the history of mental illness in America and its varieties, symptoms and prospects for treatment, and they participate in scenarios with actors playing people in states of acute psychiatric crisis.

CIT has broad support. The 21st Century Cures Act, signed into law by President Barack Obama and developed in large measure by congressional Republicans, revised federal grant programs to allow funding for state and local CIT efforts. New York’s recently enacted budget increased funding for CIT.

In his classic study “Varieties of Police Behavior,” James Q. Wilson wrote: “The patrolman’s role is defined more by his responsibility for maintaining order than by his responsibility for enforcing the law” [emphasis from the original text]. For police, maintaining order in the streets has never been easy, and it has become tougher for two reasons.

First, tensions between police and the communities they patrol have deteriorated since the rise of Black Lives Matter. Attacks on cops are up. According to the National Law Enforcement Officers Memorial Fund, 64 police officers were shot and killed in 2016, compared with 41 in 2015.

Second, the US mental health-care system has become increasingly fragmented. Instead of caring for the mentally ill almost exclusively in psychiatric hospitals, as was generally done until the 1960s, governments at all levels now try to connect them with care in communities. This has proved easier said than done.

A striking indicator that “deinstitutionalization” has not lived up to its promise: the high rates of mental illness among our incarcerated population. Despite numbering less than one in 20 of the adult population, the seriously mentally ill constitute one in five jail and prison inmates.

Before the mentally ill wind up behind bars, their first point of contact with the criminal-justice system is with patrol officers. Last year, the NYPD responded to “emotionally disturbed person” calls at a rate of more than 400 per day.

Many calls for service concerning the mentally ill don’t involve any serious criminal activity. But even when a crime hasn’t occurred, the public — or whoever called 911 — expects the responding officers to address the immediate crisis.

CIT is thus a reasonable response to the reality that the mentally ill will likely remain heavily involved with the criminal-justice system for the time being.

Some form of CIT is in use in places where approximately half the US population lives, though the quality and nature of these programs varies. No definitive study of New York’s CIT initiative has been conducted yet.

For any department, it is difficult to quantify CIT’s success, because, as Sam Cochran, the leading expert on the training explains, “How do you prove [that] something doesn’t happen?”

Police shootings are rare events. CIT proponents cite studies that show how programs in other cities have reduced the “criminalization of mental illness” by lowering the number of “bookings” resulting from mental-health-crisis calls.

Still, patrol officers’ principal responsibility remains to maintain order — not to cure people with schizophrenia. That hundreds of these encounters are negotiated each day without resulting in a tabloid-worthy tragedy says a great deal about how effectively, even without CIT, the average NYPD patrol officer copes with mental-health crises.

CIT is a worthy program, but it can’t take the place of proper treatment. Its popularity shouldn’t divert resources or attention from genuine mental-health-care reform. A truly humane and effective mental-health-care system would have no need for something like CIT in the first place.

Stephen Eide is a senior fellow at the Manhattan Institute. Carolyn Gorman is the project manager for education policy and mental-illness policy at the MI. Adapted from City Journal.

Article source: http://nypost.com/2017/09/15/stop-dumping-the-mental-health-crises-on-cops/

Indian Health Service sets standards for patient wait times

The Indian Health Service has set standards for patient wait times more than a year after being criticized by a government watchdog for doing a poor job tracking them.

American Indians and Alaska Natives seeking appointments for routine or preventative care will be scheduled within 28 days and be seen in urgent care within 48 hours, on average, the agency recently announced. The standards are part of an effort to improve health care and have consistency within the agency that’s been labeled “high-risk” by the U.S. Government Accountability Office for inadequate oversight of its hospitals and clinics.

“Our aim is that patients receiving care in IHS direct-service facilities have access to timely, comprehensive and quality health care services to promote and maintain health, avoid preventable disease, manage disease, reduce unnecessary disability and premature death and achieve health equity,” IHS Chief Medical Officer Capt. Michael Toedt wrote in an email.

The standards in place since late August apply only to IHS facilities run by the federal government, and the IHS plans eventually to include emergency room visits and other services. Most Indian Health facilities are run by tribes or tribal entities under contract with IHS and can set their own standards.

The IHS said it worked with the U.S. Department of Veterans Affairs, another federal health care agency, on a patient management system that’s being phased out. But Toedt said the VA will support the system for several years while the IHS transitions to a new one.

The U.S. Government Accountability Office reported last year that patient wait times at IHS service areas were reviewed inconsistently or not at all, hindering the agency’s ability to tell whether it’s best serving its patients. Some Navajo Nation members, for example, waited four months to see a physician. Other tribal members in Billings, Montana, waited up to a month for a routine vision check, according to the report.

William Bear Shield, the tribal administrator for the Rosebud Sioux Tribe in South Dakota, said he understands the challenges IHS faces with recruitment and retention of providers but would like to see wait times in line with the private sector.

“If they’re saying that’s the norm, they’re probably right,” he said. “To me, it can be better.”

The IHS said it wants all patients to be seen in a timely manner, but the standards aren’t guaranteed. The wait times can change due to resources at hospitals and clinics, patient needs and emergency response without the patient being notified, the agency said.

U.S. Sen. Tom Udall of New Mexico highlighted the Albuquerque, New Mexico, service area in a hearing Wednesday on high-risk programs that serve Indian Country. He said wait times there are tracked electronically and patients are asked to fill out surveys about their experience.

“When promising innovations like that are being done at the local facility level, I’d like to ensure they get recognized and shared across the Indian health system,” Udall said in a statement.

Rear Adm. Michael Weahkee, acting director of IHS, said the agency will collect data on wait times to continually improve them and take action if they’re not met. The ability to measure and report the standards should be implemented by the end of the year, the agency said.

Article source: http://abcnews.go.com/Health/wireStory/indian-health-service-sets-standards-patient-wait-times-49883966

Trump calls single-payer ‘a curse’—here’s what data from other countries actually show

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Healthcare activists protest to stop the Republican health care bill at Russell Senate Office Building on Capitol Hill in Washington, July 17, 2017.

A group of 17 Senators led by Bernie Sanders (I-VT) introduced a bill calling for “Medicare for All” this week, a position supported by over 50 percent of Americans, according to an Economist/YouGuv poll from this year. With the Trump Administration and the Republicans in Congress opposed, it’s unlikely to advance, but top officials have nonetheless come out firmly against the idea.

That’s despite the fact that increased government involvement in health care around the world has actually been shown to both improve outcomes and bring down costs.

At her briefing on Wednesday, Press Secretary Sarah Huckabee Sanders said, “I can’t think of anything worse than having government more involved in your healthcare.”

And on Thursday, President Trump called the idea of single-payer health care “a curse on the U.S. and its people” and pledged to veto any version of the bill that reached his desk.

Trump has not been consistent on this point. As Twitter user Jordan Uhl pointed out, in President Trump’s 2000 book, “The America we deserve,” he strongly espoused the opposite opinion, writing, “We must have universal healthcare.”

Regardless, his administration’s current negativity isn’t supported by the data. Countries with some version of “Medicare for all,” single-payer or universal coverage all outperform the U.S. They deliver better results and do so at a lower cost.

According to a 2017 analysis of 11 rich, Western countries by the Commonwealth Fund, America comes in 11th.

In their report, the Fund writes: “We find that U.S. health care system performance ranks last among 11 high-income countries. … These results are troubling because the U.S. has the highest per capita health expenditures of any country and devotes a larger percentage of its GDP to health care than any other country.”

America’s dismal performance comes for a very specific reason, the Fund reports: The U.S. comes up short because “it is the only high-income country lacking universal health insurance coverage.”

A striking example is that American women have a mortality risk that’s three times higher than English women, according to an investigation by ProPublica and NPR. And, while labor and delivery is vastly safer in Liverpool than it is in Louisiana, it’s also vastly cheaper there.

In U.S. dollars, it costs $2,300 on average for a vaginal delivery or planned C-section in the U.K., or $3,400 for a more complicated procedure. By contrast, in America it costs more than 10 times as much — $30,000 for the former and $50,000 for the latter — all for worse outcomes.



This paramedic built a 7-figure company


In a viral Op-Ed for the Washington Post calling for single-payer, Dr. David A. Ansell writes that, under America’s current arrangement, citizens “die of poverty,” which is both needless and cruel. “Our current multi-payer for-profit health insurance system perpetuates premature death by putting many people at an extreme disadvantage when it comes to affording care,” he writes.

The U.S. could afford to make the switch.

“We pay enough in health-care taxes alone — that is, the government revenue that goes to Medicare, Medicaid, the VA, and a few other things — to cover a Canada-style Medicare-for-all system for the whole U.S., and then that much again in private money,” writes Ryan Cooper for the Week.

“In other words, if we could simply copy-paste Canada’s universal health-care system into America, taxes would actually go down.”



Canadians may pay more taxes than Americans, but here's what they get for their money


Ester Bloom

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