Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Saturday, November 23, 2019

Republicans Were Rabid About Obama et al With Under1% of the Hard Evidence We Have On Trump And His Cronies

[Warning.  I've kept the kleenex box close today was the cold I thought had left a month ago, came roaring back.  If I were grading this post, I'd say it rambles, needs rearranging to make the flow work better, and doesn't really focus.  But I'm too drippy to revise it.  The basic theme is nothing you don't already know:  The Republicans have abandoned logic, principles, the constitution, and consistency, and the truth.  But if that sounds too repetitious and depressing, follow this link to a really cool rethinking of lined notebook paper.  And blogger wouldn't take < in the title, so I had to write 'under']]



From someone who has observed Jim Jordan for a while, we get this blistering commentary by retired Cleveland Plains Dealer editor, titled "Jim Jordan was imposed on us for egregiously partisan reasons. Now he’s afflicting the nation."[Link corrected]
In his Washington Post column of Nov. 14, Gerson showed his keen understanding of Jordan, describing him as “the Truly Trumpian Man – guided by bigotry, seized by conspiracy theories, dismissive of facts and truth, indifferent to ethics, contemptuous of institutional norms and ruthlessly dedicated to the success of a demagogue.”
And there are these hints that Nunes was part of the plot to get Zelensky to investigate Hunter Biden  "Giuliani associate willing to testify Rep. Nunes met with ex-Ukrainian official, attorney says"
The attorney for an indicted associate of President Donald Trump's personal lawyer says his client is willing to tell Congress that Rep. Devin Nunes, R-Calif., met with Ukraine's former top prosecutor about investigating the activities of Joe Biden and his son, Hunter Biden. . .
If true, the allegation would mean that Nunes — the chief defender of Trump as ranking member of the House Intelligence Committee, which has been holding impeachment hearings for several weeks — was himself involved in the very plot the committee is investigating. 
Yet the Republican Senate is quite likely to acquit Trump if the House turns over impeachment to them.  We hear stories how they are disgusted, but don't want to lose in the primaries where they face Trump cult members.  These are kids that fawn over the bully, lest he suddenly decide to attack them.  Just think about how he insulted the Republican candidates running against him in the primary - Rubio, Cruz, Graham, for instance - are now all his toadies.

But maybe the bully metaphors are the wrong ones.  From Machievelli on we've had variations of don't take on the king unless you're going to kill him.  And so Republicans are biding their time.

We get new stories like this daily.  Yet the Republicans are busy trying to deflect attention on Joe Biden's son, or lack of transparency, or too much transparency, or witch-hunts. or that impeachment is unconstitutional overturning of the election.

Remember how exercised they got over Bill Clinton talking to then Attorney General Loretta Lynch at the Phoenix airport?  Even Real Clear Politics, a right leaning web news aggregator, could only buttress the impropriety innuendos with 'strange':
"Strange. One can understand that Lynch needs to maintain that there was no conversation about Hillary’s email predicament — she’s repeated that enough times that there’s no going back. But if they didn’t have that to talk about, they didn’t have much else to say to one another. It would be one thing if theirs had been a random run-in. But do ex-presidents really just appear at the perfect time to talk to the perfect person who is perfectly positioned to make an imperfect situation go away? If the talk was really about nothing, why was Bill Clinton so eager to have it? So eager that he was at the airport in time to catch Lynch before she got off her plane; so eager that ascending the stairs to the airplane doorway, he had all but pushed past Lynch’s head of security. Strange indeed."
This is dated May 16, 2019 - they had three years to get more than innuendo.  Why didn't they interview the flight crew they said were present?  Because even if there was something there, the Hilary Clinton Email Servers, was only an issue because the Republicans (one can guess, with the support of the Russians) made it an issue.

Yet people who tried to make their careers on stories like this, see absolutely nothing wrong with the president shaking down Zelensky, or Sondland talking to the president on his personal cell phone in a restaurant in Kiev where people around them could listen in.



Now, let me say that  Lev Parnas, the convict who's offered to out Nunes is not someone I would trust on most things.  He certainly would know, but I don't know enough about his motivation.  Does he think Trump won't get around to pardoning him on time so he's making a deal with the whoever else could lighten his sentence?  If so, how can we trust him not to lie to save himself?  Or is he making an offer which will turn out to be fake to embarrass the Democrats and blow up their investigation?  Is he just signaling Trump or others by having his attorney make this offer?  If so what's he saying?  (I suspect that's not the case since all these folks seem to have pretty good access to the president.  But maybe that's only when they're making $100K donations.)


As I've said before, what we're seeing is how many people have never grown up, never gotten over their (probably parent induced) inferiority complexes.  Trump tells them their boorishness, misogyny, racism, homophobia, and xenophobia are all perfectly all right.  He tells them that in his words and in his actions

But it doesn't even matter.  There's already enough out there to impeach Trump 50 times.

Monday, November 04, 2019

Homelessness In Anchorage - Thoughts On What I've Been Told In OLE Class

I've been to five 75-minute classes on Homeless in Anchorage offered through OLÉ.  The class is facilitated by Nancy Burke, the Mayor's homelessness point person.  Friday's class was presented by Thea Agnew Bemben, M. A.,  who works for a consulting company on mental health.  She gave us the results of studies on ways to improve how the civilian and forensic (criminal) mental health population are served.


So after this much, here's my sense of things:


  1. Berkowitz's administration is better organized and on top of things than I thought
    1. At least in the data gathering aspects of homelessness
      1. They're part of a couple of national models for handling data and using the data to reduce homelessness
    2. Gathering data is important because it gives a picture of 
      1. how many homeless there are
      2. what categories the fit in
      3. what services they use
      4. how long they've been homeless
      5. best ways to use resources
  2. The Muni's data gathering system is up and running, though the sense I have is that it's a fairly recent phenomenon and it still has more to do
  3. Homelessness models identify three categories of homeless on a 1-10 scale
    1. 1-3 folks basically need help finding social services resources and can get themselves back into housing - these are people who have been housed and through an unexpected event (lost job, health emergency, etc) lost the ability to pay rent or mortgage
    2. 4-6 moderate problems,
    3. 7-10  problem homeless - mentally ill and or substance abusers that cost the city the most in police and health  and the most expensive to take care of
    4. The third category is about 50% of the homeless in Anchorage
  4. So, the most important way to deal with the 50% who have serious problems is to have better ways to deal with mental health in the community.  To increase the number of providers and beds available for the people with the most serious mental health problems
    1. Right now both on the civil side (hospital emergency rooms, API) and the forensic side (jai/prisons), we're failing woefully.  
      1. People get minimal treatment and sent back out onto the streets on the civil side.
      2. On the forensic side, people wait in jail until they  can be evaluated to see if they are fit to stand trial, if they aren't, they sit in jail.  They are off the streets, get fed, get some medical treatment, but not what they should get.  And they could be in jail for months before even going to trial.  
    2. A serious obstacle to enough beds is Medicaid rules that restrict payments to facilities with about 16 beds or less.  
  5. Despite all the Mayor's attention to homelessness, without improving mental health access early on, the part of the homeless problem people are most upset about isn't going to go away.  And getting money for improved mental health care for the indigent is going to be hard.
  6. The $40 million fund to help the homeless in Alaska will help
    1. The MOA is using several different national models - including Housing First - which seems to have an immediate effect on reducing lots of the other problems homeless people have.  And getting housing that's accompanied with social workers is an important factor. 
    2. There's concern that the State will cut funding because of this new source of financial help for the homeless.  
OK, that's my take on this off the top of my head after five classes.  There are two more 3 more classes, but I'll miss the last one.  


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The chart below comes from the Executive Summary of the Alaska Behavioral Health Systems Assessment commissioned by the Alaska Mental Health Trust with other health co-sponsors.  Thea Agnew Bembem - the presenter Friday - was part of the study team.  The Executive Summary is short and has good visuals.  I recommend a visit.  The whole study is much longer and requires a serious commitment.

I would point out the numbers and percentages of people with problems compared to the numbers and percentages of people who get help.  It's an impossible gap and probably explains not only a lot of our homelessness problems, but also accounts for dysfunctional families which create a population of kids with serious issues.  (The chart format is different in the original, but I think all the data are there.)

YOUTH
Grant Funds in State Fiscal Year 2013
Risk Behaviors 1                               page2image155785424page2image155785680page2image155786000page2image155786256page2image155786512page2image155786768page2image155787088page2image155787344page2image155787600
Approximately One in Five
4,641 traditional high school students had a moderate or high-risk behavior for substance use.
• The prevalence of this behavior was similar for male

and female students (20.3% compared to 16.4%)
Mental Health Issues 1, 2         page2image155787856page2image155788112page2image155788368page2image155788624page2image155788880page2image155789392page2image155789584page2image155789776
Approximately One in Four
7,214 traditional high school students experienced a mental health issue in the past year.
• The prevalence of mental health issues among female

students was higher than among male students (37.8%
compared to 19.4%)
Among 9 to 17 year olds, 5,550 (6%) were estimated to have had a serious emotional disturbance in the past year.
page2image155785168


Youth Clients Served 4     page2image155825472page2image155825728page2image155825984page2image155826304page2image155826560page2image155826816page2image155827072page2image155827392page2image155827648page2image155827904page2image155828160page2image155828416page2image155828672page2image155828928page2image155829184page2image155829696page2image155829888page2image155830080
Approximately One in Nine
12,147 unique youth clients were served with support from state Medicaid and/or behavioral health grant funds.
Breakdown of Youth Served
By diagnosis category:
• Substance Use Disorder: 1,324 (11%)
• Serious Emotional Disturbance: 9,350 (77%) • Mild or Moderate Mental Illness: 2,215 (18%) • Co-occurring Disorders: 482 (4%)
By gender:Male: 7,129 (59%) | Female: 5,018 (41%)


ADULTS
Total Prevalence 3         page2image155927632page2image155927888page2image155928144page2image155928464page2image155928720page2image155928976page2image155929232page2image155929552
Approximately One in Four
145,790 adults needed treatment for illicit drug or alcohol use and/or experienced a mental illness in the past year.
Alcohol & Illicit Drug Use 3    page2image155929808page2image155930064page2image155930320page2image155930576page2image155930832page2image155931088page2image155931344page2image155931856page2image155932048page2image155932240page2image155932496page2image155932752page2image155933008page2image155933264page2image155933520page2image155933776page2image155934032page2image155934288
Approximately One in Nine
62,815 adults needed treatment for an illicit drug or alcohol problem.
  • Estimated need for treatment among low income
    adults was higher than among adults above 138% of the
    federal poverty level (16.7% compared to 11.5%)
  • Estimated need for treatment among adult males
    was higher than among adult females (15.5% compared
    to 7.5%)
  • About one-third of those that needed treatment
    (22,990 adults) also experienced a mental illness in the past year
    Mental Illness 3                    page2image155934544page2image155934800page2image155935056page2image155935312page2image155935568page2image155931600page2image155936336page2image155936592page2image155936848page2image155937104
    Approximately One in Five   
    105,966 adults had a mental illness in the past year.
  • 61,176 adults (11.2%) had a mild mental illness, 23,487 adults (4.3%) had a moderate mental illness and 21,302
    (20%) had a serious mental illness
  • Estimated mental illness among low income adults was
    higher than among adults above 138% of the federal
    poverty level (23.8% compared to 19.4%)
  • Estimated mental illness among adult females was

higher than among adult males (24% compared to 15%)
Adult Clients Served 4              page2image155978176page2image155978432page2image155978688page2image155979008page2image155979264page2image155979520page2image155979776page2image155980096page2image155980352page2image155980608page2image155980864page2image155981120page2image155981376page2image155981632page2image155981888page2image155982400page2image155982592page2image155982784page2image155983040page2image155983296page2image155983552page2image155983808page2image155984064page2image155984320page2image155984576page2image155984832page2image155985088page2image155985344page2image155985600page2image155985856page2image155986112page2image155982144page2image155986880page2image155987136page2image155987392page2image155987648page2image155987904page2image155988160page2image155988416page2image155988672
Approximately One in Twenty
27,728 unique adult clients
were served with support from
state Medicaid and/or behavioral health grant funds.

Breakdown of Adults Served
By diagnosis category:
• Substance Use Disorder: 14,442 (52%)
• Serious Mental Illness: 16,841 (61%)
• Mild or Moderate Mental Illness: 2,061 (7%) • Co-occurring Disorders: 3,690 (13%)
By gender:Male: 11,480 (41%) | Female: 16,232 (59%)

Behavioral health services in Alaska are funded through a mix of Medicaid, state and federal grants, Indian Health Service Compact and other Tribal funds, private insurance, self-pay and uncompensated care so the utilization data analyzed tells only part of the story. Nonetheless, the report’s findings reinforce what we heard from stakeholders: the behavioral health needs of many Alaskans are going unmet resulting in higher costs and poorer health outcomes.