Looking the Other Way: Mental Health in a Nation Fixated on Healthcare

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Last week, DC police forcefully entered a man’s home and fatally shot him, twice.  Jean Louis, a mentally ill 55-year-old, had resided in the same apartment for over thirty years.  His neighbors knew him to be alternately friendly and erratic, but on the day of his death, he had neither hurt anyone nor committed a crime.  In fact, he had been attempting to ward off mental health authorities, resisting residential treatment.  When police arrived on the scene, he allegedly used a self-sharpened screwdriver to keep them at bay, locking himself in his home and lunging forward when they broke through the door.  After killing Mr. Louis, police claimed that they feared he was armed, despite the fact that they crossed his threshold thinking he was unconscious. They found no weapons in the apartment.

The scene raises a number of deeply troubling issues.  Why was Mr. Louis’s patent disease left unmanaged for years?  Why was he killed, instead of treated for his illness, as he would have been if afflicted with cancer, diabetes, or heart failure?  Moreover, why is there no outrage?

Perhaps because the tragedy is, astoundingly, not astounding.  Mr. Louis’s death generated a measly two news clippings; his story is just one in a million.  In fact, most of the mentally ill are left without care.  Federal law prohibits hospitals from turning away patients in dire need, regardless of ability to pay.  Yet mentally ill patients who seek urgent care, but cannot afford admission into a private hospital, are often discharged after just a few days, even if they are a clear danger to themselves or others.  Emergency room doctors report that finding an open bed in a mental health unit is often impossible, leaving desperately ill patients to fend for themselves.  Prisons are home to three times as many mentally ill individuals as treatment facilities; many of these inmates cycle from jail cells to the streets and back again, without obtaining care.  Even our veterans suffering from crippling post-traumatic stress disorder are placed on waiting lists that do not turn over for months, and sometimes years.  In fact, the 9th Circuit recently concluded that the Dept. of Veterans Affairs’ “unchecked incompetence” is so severe as to violate the statutory and constitutional rights of these often suicidal patients. Read More

Posted in National Healthcare, Uncategorized; Tagged: , , , .


Promises of Progress from the High-Level AIDS Summit at UN

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At last week’s high-level United Nations AIDS review, world leaders adopted a Political Declaration that indeed included a commitment to having 15 million people on AIDS treatment by 2015, among other targets aimed at real progress. Along with the commitment on AIDS treatment, the other headline from the conference was the commitment to work towards eliminating vertical transmission by 2015.

Importantly, the Declaration also specifically addressed the need for enhanced prevention efforts among marginalized populations, including men who have sex with men and people who inject drugs. This was the first of a high-level UN declaration on HIV/AIDS explicitly mentioned men who have sex with men. The Declaration also set a target of reducing HIV transmission among people who inject drugs by 50% by 2015 — though some advocates were concerned about how the Declaration addressed this population, as UNAIDS has called for the elimination of this mode of transmission. More troubling, the Declaration only weakly called for countries to give “consideration to, as appropriate,” harm reduction programs, despite their proven effectiveness. The science is clear; the Declaration had no reason for being timid.

The Declaration also included other commitments that, if adhered to, will advance human rights of discriminated against groups, including helping to meet the needs of women and girls, and promoting their full enjoyment of human rights. And states committed “to national HIV and AIDS strategies that promote and protect human rights, including programmes aimed at eliminating stigma and discrimination against people living with and affected by HIV, including their families, including through sensitizing the police and judges, training health-care workers in non-discrimination, confidentiality and informed consent, supporting national human rights learning campaigns, legal literacy and legal services, as well as monitoring the impact of the legal environment on HIV prevention, treatment, care and support.” It is critical that these efforts encompass all marginalized populations at heightened risk of HIV infection.

The Declaration committed countries “to redouble efforts to strengthen health systems, including primary health care.” This is a necessary part of the expanded AIDS response.

The question now is whether the political will and funding will follow these commitments — which included increasing AIDS funding. If so, the world will have made real progress by 2015 in fighting AIDS and advancing human rights. If not, then the failure to keep the promises of 2011 will be another stain on the global conscience.

Posted in Global Health, Uncategorized, WHO; Tagged: , , .


The Future of Food Safety

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Food safety issues are once again in the news.  A large outbreak of E. coli O104:H4, centered in Germany, has sickened more than 3,000 people and killed 35.  After a lengthy investigation, German public health authorities believe the source of the E. coli to be bean and seed sprouts.

This recent outbreak highlights the need for strengthened national and international food safety regulation.  The United States took a large step toward improving food safety earlier this year by enacting the FDA Food Safety Modernization Act (FSMA). In a recent Commentary in the Journal of the American Medical Association, O’Neill Institute Faculty Director Larry Gostin and I addressed the improvements that the FSMA will bring to the U.S.’s food safety system.

As noted in the Commentary, food safety regulation is complex and improving safety requires efforts aimed at primary prevention, surveillance, and response.  The FSMA has been lauded for giving the FDA new mandatory recall authority for food, an enforcement tool it had lacked to date.  Though mandatory recall authority is an enormous boon for the FDA, the current crisis in Germany highlights the importance of a comprehensive “farm-to-table” food safety system.  Mandatory recalls can clearly only be applied when the source of the infection is known.  For this latest outbreak, identifying the source of the outbreak proved difficult.  By requiring producers to adopt preventive control plans and increasing inspections for production facilities, the FSMA moves the FDA toward a preventive approach to food safety. Read More

Posted in FDA, Uncategorized; Tagged: , , .


Launch of HealthLawandLigitation.com

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The National Health Law Program (NHeLP) and the O’Neill Institute are pleased to announce the launch of HealthLawandLitigation.com.

Since the enactment of the Patient Protection and Affordable Care Act (“ACA”), more than a dozen lawsuits have been filed in federal courts challenging the constitutionality of the law.  NHeLP and the O’Neill Institute have joined together to create a comprehensive clearinghouse of information about the litigation.  HealthLawandLitigation.com provides users with a schedule for all actions in all cases challenging the ACA; a compilation of briefs, motions, orders, and judgments as they are filed; notable Supreme Court precedents on the issues that are at the heart of the litigation; state ballot initiatives, legislation, and litigation related to the ACA; and legal and health policy scholarship pertaining to the litigation.

HealthLawandLitigation.com is meant as a practical resource for policymakers, practitioners, scholars, and for those interested in information about ongoing legislation, litigation, and scholarship relevant to the ACA.  NHeLP and the O’Neill Institute will ensure that the clearinghouse is kept regularly updated.  For additional information or questions, please contact nhelpdc@healthlaw.org or the oneillinstitute@law.georgetown.edu.

Posted in National Healthcare, Resources, Uncategorized; Tagged: , , , , , , , , .


World Health Assembly 2011 Outcomes and United Nations AIDS Review Preview

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Will the world’s premier health organization be able to reform itself to revive its global health leadership in the years ahead? Such was undoubtedly the question on the mind of health officials and civil society from around the world as they attended the 64th World Health Assembly (WHA) last month, the World Health Organization’s annual meeting of its governance body, comprised of all 193 of its Member States.

With WHO reform the marquee item on a crowded agenda that touched on many of the most pressing global health issues, this seemed destined to be a historic WHA.

And in some ways, it was – though at least in part, due to another issue. As the 2003 WHA secured its place in history by adopting the first global health treaty, the Framework Convention on Tobacco Control, and the 2005 WHA adopted the revised International Health Regulations, the 2011 WHA set the stage for greater international cooperation in responding to novel influenza viruses by adopting the Pandemic Influenza Preparedness Framework.

Pandemic Influenza Preparedness Framework

Despite being non-binding, and frankly underwhelming, it does for the first time set up a three-pronged global process of increase access of people in developing countries to vaccines and antiviral medication: 1) voluntary vaccine donations by vaccine manufacturers to a WHO stockpile to be used primarily in developing countries; 2) tiered pricing for vaccines and antivirals, and; 3) technology transfer for vaccines and antivirals. Manufacturers are also expected to contribute financially to support WHO’s global influenza surveillance and response system. Read More

Posted in Global Health, Uncategorized; Tagged: , , , , , , , , , , , , .


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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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