3/14/2022
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Wall St Journal
Spokesman-Review
Spokane mayor’s task force takes aim at city’s mental health challenges
KHQ
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Wall St Journal
Our care for the mentally ill focuses on the relief of symptoms, and few patients receive the treatment they need.
By Sally SatelMarch 13, 2022 5:31 pm ET
Thomas Insel in 2013, testifying in the Senate as director of the National Institute of Mental Health.
Photo: Cliff Owen/ASSOCIATED PRESS
A psychiatrist and neuroscientist who headed the National Institute of Mental Health in 2002-15 and has since returned to the private sector, Dr. Insel is well-positioned to answer the question. In “Healing,” he outlines the treatments that currently exist, describes the obstacles that many people face, and shows how care programs might be designed to work better. The core of his argument is quickly grasped: “We’re not taking advantage of the science we have.”
Dr. Insel starts his analysis with two contrasting scenarios. Young Roger was once a neighbor of his: During Roger’s last year of high school he began hearing “alien voices.” A doctor prescribed crucial medication, but Roger stopped taking it. He became so agitated that his father had to call 911, and the police were dispatched. Hospital beds were scarce, and state law made it impossible to commit Roger to involuntary care. Psychotic and unable to care for himself, Roger ended up homeless.
Dr. Insel met Brandon at a mental-health fundraiser several years ago and learned about his history. In his late teens, Brandon had become increasingly irrational. Unlike Roger, though, he was able to embark upon a continuous and coordinated long-term plan that addressed every area of vulnerability. There was medication for his delusions and coaching for his social skills. He received employment support. Brandon, Dr. Insel says, shows what can go right. Roger’s story, a far more common one, reflects the “crisis of care.”
The statistics are depressing. Only about 16% of people with severe mental illness are receiving even “minimally acceptable” treatment. Many of the others land in jail cells or squalid street encampments, or languish in back bedrooms. Psychiatrists are heavily concentrated in high-income urban areas, with half of all U.S. counties having no psychiatrists at all. Paying for treatment can be a challenge, too: Almost 60% of psychiatrists don’t accept Medicaid, and 45% don’t accept private insurance. There are only 12.6 public hospital beds for mentally ill patients per 100,000, a quarter of what analysts estimate we need.
These stark deficiencies move Dr. Insel to investigate programs that, in their creativity and effectiveness, are worth imitating. Roger’s father, as we remember, had become so frightened of his troubled son that, like other parents in such circumstances, he ended up turning to the police. In Maricopa County, Ariz., by contrast, parents (or any concerned person) can call a special toll-free number. A dispatcher deploys a van with a mobile crisis team, including a psychiatric nurse.
The University of Washington in Seattle has perfected so-called collaborative care. A staff member is assigned to focus on “the people who may not be asking for help or might be falling through the cracks,” as the program’s director puts it. “This person’s job is to integrate medications and psychotherapy with programs aimed at meeting social needs.” In Britain, the Improving Access to Psychological Therapies program has trained more than 7,000 therapists; they provide help for anxiety and depression to nearly 600,000 patients each year, as Dr. Insel reports.
Dr. Insel emphasizes that well-designed programs for recovery should aim at “finding connection, sanctuary, and meaning not defined or delimited by mental illness.” Ideal long-term care, after initial contact, would include the sustained attention of a team, including a social worker and an occupational therapist. One goal would be to help the patient navigate a return to school or work, thus avoiding isolation and self-destructive rumination.
Because Dr. Insel is such an understated writer, it is easy to miss the audacity to be found in “Healing.” He confesses to having long “misunderstood the problem” of treating mental illness—as did most of the profession he helped to lead for two decades. “While we studied the risk factors for suicide, the death rate had climbed 33%,” he writes. “While we identified the neuroanatomy of addiction, overdose deaths had increased threefold. While we mapped the genes for schizophrenia, people with the disease were still chronically unemployed and dying 20 years early.”
The reality of this failure dawned on him a few years ago during a public lecture in Portland, Ore. He was clicking through a PowerPoint presentation highlighting the achievements of his scientists at the National Institute of Mental Health: high-resolution scans showing brain changes in people with depression and abnormal branching in the neuronal cells of children with schizophrenia.
The first question came from an exasperated father in the audience. He said that his schizophrenic son had been in and out of hospitals, had attempted suicide several times, and was now homeless. What, the man wanted to know, were all those great lab discoveries doing for his child? “My mouth suddenly felt dry,” Dr. Insel writes. “But in that moment, I knew he was right.” Nothing in the lab per se was addressing the “urgency or magnitude of the suffering.”
Dr. Insel has made the most of the revelation, traveling widely to identify the crisis of care and look for solutions. “Healing” is the product of this odyssey—and a compelling summary of all that he learned along the way.
Dr. Satel is a senior fellow at the American Enterprise Institute and a visiting professor at the Columbia University’s Vagelos College of Physicians and Surgeons.
Fentanyl’s spread and the pandemic’s destabilizing effects have accelerated fatal drug overdoses in Black communities
By Jon Kamp and Julie Wernau | Photographs by Asa Featherstone, IV for The Wall Street Journal
March 13, 2022 9:00 am ET
The fatal overdose rate among Black people surpassed that for white people in the first year of the pandemic, as an increasingly lethal drug supply and Covid-19’s destabilizing effects exacted a heavy toll on vulnerable communities in the U.S.
The proliferation of the potent opioid fentanyl, and a pandemic that has added hazards for people who use drugs, are driving new records in U.S. overdose deaths, and Black communities have been hit especially hard. Black people often have uneven access to healthcare including effective drug treatment, putting them at high risk, researchers and public-health experts say.
The most recent full-year of federal data, through 2020, shows the rate of drug deaths among Black people eclipsed the rate in the white population for the first time since 1999, researchers at the University of California, Los Angeles recently demonstrated.
The gap in overdose rates between the Black and white populations was narrowing before the pandemic. Iris Lattimore lost her 35-year old son, Corey Rucker, to a fatal overdose in late 2017. Her older son, Greg Wiley, overdosed and died at age 41, in July 2020. She said assistance and messaging around the crisis seemed aimed at white people rather than her community.
“We’ve been fighting this for a long time,” said Ms. Lattimore, 61 years old.
Family photos of Iris Lattimore’s sons, Corey Rucker and Gregory Wiley.
Iris Lattimore shares a family photo taken when her sons were young.
There were more than 15,200 overdoses among Black people in 2020, more than double the number from four years earlier, according to data the UCLA researchers published in March in the medical journal JAMA Psychiatry. The toll represents nearly 37 drug overdose deaths per 100,000 Black people that year, the UCLA researchers found, trailing only the death rate in the significantly smaller American Indian or Alaska Native population.
“The Black death rate rose much faster than the white death rate,” said Helena Hansen, co-author of the new paper and professor of psychiatry at UCLA’s David Geffen School of Medicine.
The researchers said the findings demonstrate the need to close gaps in access to treatment and harm-reduction services, which are meant to make drug use less risky, among other steps. They said ending routine incarceration of drug users could help prevent fatal overdoses among people after they leave prison.
In Boston, opioid-related overdoses in the Black population doubled to 82 in 2020 versus the prior year, while opioid deaths in the city’s larger white population increased 16% to 101. The city has stepped up efforts to bring mobile harm-reduction services to Black communities, said Bisola Ojikutu, executive director of the Boston Public Health Commission. This includes distribution of the overdose-reversal drug naloxone and other services like syringe exchanges and testing for HIV and other health issues.
“We have to go where people are,” Dr. Ojikutu said.
The increase in overdoses among Black people comes as fentanyl, a synthetic opioid up to 50 times as powerful as heroin, continues to pour into the U.S. There are legitimate forms of fentanyl used to treat pain, but the main version wreaking havoc in the U.S. is illicitly made by Mexican cartels and smuggled into the U.S., federal authorities say.
Fentanyl was a major driver when drug overdose deaths jumped roughly 30% to about 92,000 in 2020, the most recent federal count for that year shows. The scourge is getting worse: There were an estimated 104,288 overdose deaths in the 12-month period running through September, according to the most recent preliminary data from the Centers for Disease Control and Prevention.
Use of stimulant drugs like cocaine among Black people may also be exposing some to fentanyl, which sometimes contaminates other drug supplies, health experts say. A recent paper published in the American Journal of Epidemiology found Black Americans had a sharper increase in combined stimulant and opioid deaths than did white people between 2007 and 2019, especially in the eastern U.S.
Fatal overdoses among Black people more than doubled in a recent four-year period, largely due to illicit pills laced with fentanyl, such as these at a Sacramento, Calif., crime lab.
Photo: Andri Tambunan for The Wall Street Journal
Black people can also face higher hurdles to getting effective care for opioid use, doctors and public-health researchers say. Researchers at the University of Michigan examining outpatient visits for substance use in recent years found white patients were three to four times as likely as Black patients to receive buprenorphine, a prescription medication to treat opioid dependence that is more readily available to people with health insurance or the means to pay out of pocket.
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Health providers are more likely to direct Black patients to methadone, which is delivered by highly regulated opioid-treatment programs that often require daily visits to obtain the medication, researchers have found.
The history of Black Americans facing a higher rate of criminal penalties and incarceration for drug-related offenses than whites has also made some Black drug users reluctant to seek help, researchers and treatment specialists say.
“I would wait until I was almost dead to go to the hospital,” said Chetwyn “Arrow” Archer II, 62 years old and a former opioid user who is now a peer-support specialist with IDEA Exchange at the University of Miami, which provides harm-reduction services to drug users.
Ms. Lattimore’s eldest son, Greg, had a criminal record that made it challenging for him to find consistent work as an adult, she said. He appeared to be on the upswing in mid-2020, when he had found a new job at a factory and planned to marry his longtime fiancée. That July, the fiancée found Greg in the basement at their Columbus, Ohio, home, dead from an overdose.
Ms. Lattimore keeps a blanket she made with her two sons’ photos by her side. “Some days I look over at it and I say, ‘I can’t believe you guys left me,’ ” she said.
Iris Lattimore displayed the blanket with her sons' photos that she keeps close by, in her Ohio home.
Write to Jon Kamp at jon.kamp@wsj.com and Julie Wernau at Julie.Wernau@wsj.com
Laws on how much landlords can raise prices are debated in more than a dozen states
Will ParkerMarch 13, 2022 10:00 am ET
Affordable-housing activists rallied in February outside Tampa City Hall in Florida in support of rent stabilization.
Photo: Arielle Bader/Tampa Bay Times/Zuma Press
Lawmakers across the U.S. are looking to enact rent control, reviving measures largely shunned in recent years in an effort to curb the surge in home rental prices throughout the country.
These proposals, which would generally allow landlords to boost monthly rents by no more than 2% to 10%, are on the legislative agenda in more than a dozen states. Rental prices are up about 18% on average over the past two years, according to real-estate broker Redfin Corp. , hitting record levels across the U.S.
Large cities like Boston, affluent suburbs like Montclair, N.J., lower-income mobile-home communities in Colorado and fast-growing metros in Florida are among the places now considering rent control.
“Rents are exploding at a pace far faster than income,” said Stijn Van Nieuwerburgh, an economist and professor at Columbia Business School who researches rent control. “The problem is now as bad as it has ever been. And probably much worse.”
How California Is Redefining Rent Control
How California Is Redefining Rent Control
California’s sweeping new rent control law is meant to help alleviate pressures surrounding the affordable housing crisis. The result could mean laws like this start popping up all over the country.
Rising rents are a big contributor to the recent surge in inflation that is starting to weigh on the U.S. economy. Cost of shelter accounts for 40% of the core Consumer Price Index, CPI’s biggest component. Economists at the San Francisco Federal Reserve said in a February inflation forecast that rent increases “point to significant upside risks to the overall inflation outlook.”
Rent-control measures in the U.S. date to the years following the first and second World Wars, but the concept saw a major resurgence in the 1970s, a period marked by high inflation. Its resurgence was somewhat short-lived, and many lawmakers adopted the view that rent controls hurt housing markets more than they helped tenants, by discouraging new development and disincentivizing apartment maintenance.
More recently, some economists and politicians have reconsidered that thinking, pointing to rent control as one of the few ways to protect low-income renters, who often face the greatest hardships. In 2019, New York Congresswoman Alexandria Ocasio-Cortez proposed a national rent-control law. California and Oregon advanced rent-control bills the same year, now laws in both states.
Affordability problems deepened during the pandemic. Home prices hit record highs in most parts of the country, forcing tenants to keep paying ever-escalating rents.
Some cities are weighing more restrictive rent caps than previously considered. St. Paul, Minn., enacted last fall the only rent control in the Midwest, and now has one of the most stringent policies in the country. While many rent-control measures make exceptions for new buildings or vacant units, St. Paul’s law doesn’t.
St. Paul, Minn., recently approved rent controls.
Photo: Nicole Neri for The Wall Street Journal
In Santa Ana, Calif., local officials have gone beyond the state’s rent-control measure, which caps annual rent increases at 5% plus local inflation, to limit local rent increases to 3% at apartments built before 1995.
Those measures passed despite laws in both states that generally prevent local governments from writing their own rent rules. But in these cases, proponents found workarounds.
Other rent-control efforts will also have to navigate prohibitions, which still exist in more than two-dozen states. First-term Boston Mayor Michelle Wu, for example, campaigned on bringing rent control back to the city, and a poll shows a majority in the city would support it.
But local rent controls were banned there nearly three decades ago in a statewide referendum. Massachusetts Democrats are advancing a bill that would repeal that state ban, though Republican Gov. Charlie Baker has said he would probably not sign such a law.
Protesters in Chicago last year urged a lifting of a ban on rent control.
Photo: Max Herman/Zuma Press
In Florida, another state that pre-empts local rent controls, lawmakers in Miami and Tampa—where asking rents are up more than 30% over the past year—have discussed declaring housing emergencies to pass rent control.
The real-estate business successfully lobbied several states to write anti-rent control statutes decades ago, and the industry is active again. “We consider it an existential threat,” said Jim Lapides, a spokesman for the National Multifamily Housing Council, a landlord trade group.
Building owners continue to argue that rent control will stunt the supply of new housing and ultimately make the rental market worse for everyone. In St. Paul, for example, developers have temporarily placed more than a third of planned apartment units on hold due to concerns over the new law there, according to property management software firm RealPage, which compiled permit records and public reports and surveyed builders.
Some lawmakers, however, don’t see a better way to address the rising rent burden. Florida state Sen. Victor Torres, a Democrat representing parts of Greater Orlando, is proposing to overturn Florida’s rent-control ban. Mr. Torres said retail and hospitality workers in his district routinely face staggering increases on even the most modest one- and two-bedroom apartments.
“You renew your lease, and it says, well, we increase your lease by $500 a month,” he said. “Who can afford that?’’
In Colorado, State House Rep. Andrew Boesenecker aims to cap mobile-home lot rents by the greater of either 3% or the local inflation rate in any year. Mr. Boesenecker, whose district includes part of Fort Collins, said rent control isn’t enough to relieve the state’s housing problems. There is also a supply shortage, he said, but significant increases in rent for mobile-home lots necessitate a faster response.
“We’ve seen rent increases anywhere up to 50%,” Mr. Boesenecker said. “We have to do something to protect this affordable housing source.”
Write to Will Parker at will.parker@wsj.com
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Spokesman-Review
Spokane mayor’s task force takes aim at city’s mental health challenges
By Greg Mason
From Spokane Mayor Nadine Woodward’s perspective, the COVID-19 pandemic has put a spotlight on mental health challenges that aren’t going away anytime soon.
In an effort to work toward identifying and addressing those challenges in the local area, Woodward’s office has called together a coalition of around three dozen health care, education, youth services and government officials from across the region.
Woodwa rd , U.S. Rep. Cathy McMorris Rodgers and state Rep. Marcus Riccelli serve as honorary co-chairs for the task force, which met for the first time Friday morning. Other notable members include Spokane Public Schools Superintendent Adam Swinyard; Spokane County Commissioner Mary Kuney; American Indian Community Center Executive Director Linda Lauch and Dr. Frank Velázquez, health officer for the Spokane Regional Health District.
The mayor’s goals with the coalition include assessing and spreading awareness for available programs and resources, while she is keen to work toward removing stigmas associated with mental health.
“We’ve all been impacted in some way,” she said, “and I think if we can’t get to a point coming out of this pandemic where we can remove the stigma of mental health, I don’t know when we’ll ever be able to do that successfully.”
From there, Woodward said the group can look toward addressing any service gaps identified by the providers and mental health professionals on the task force.
Involved in these talks will be the $3 million in federal American Rescue Plan Act funding earmarked by the Spokane City Council for youth intervention and behavioral health services, Woodward said. The city council voted March 7 to approve that allocation within a $12.1 million portion of the $81 million in American Rescue Plan funds awarded to the city.
At the moment, the city is preparing to solicit formal proposals on how to spend any authorized American Rescue Plan funding.
“If we can identify what those needs are, and we know we have $3 million in funding, that might inform how we spend that money,” Woodward said.
Woodward said addressing mental health challenges that have emerged from the COVID-19 pandemic, particularly those faced by children, has become a priority for and her office this year through conversations with teachers, students superintendents and clinicians.
Spokane Public Schools, the city’s largest provider of youth outpatient mental health services, has more than 40 school counselors, school nursing support specialists and master’s level mental health therapists districtwide, Swinyard said.
“But a mental health crisis isn’t confined to certain hours in the day,” he said in a statement. “Resolving this community- wide challenge requires conversations with all partners at the table, committed to finding community- centered solutions.” Greg Mason can be reached at (509) 459-5047 or gregm@spokesman. com.
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KHQ
Courtesy of the City of Spokane
From the City of Spokane:
Spokane neighborhood beautification and cleanup efforts have received a boost.
The part of the City’s Neighborhood Clean-up Program in which residents can request a disposal pass to the Waste to Energy Facility at 2900 S. Geiger Blvd. has moved from a seasonal to year-round program or until funds are expended.
The passes, which cover up to $25 in tipping fees, are designed to help residents remove extra waste by distributing vouchers to the Waste to Energy facility. The program, which went digital in 2021, is a partnership between the Office of Neighborhood Services and Department of Solid Waste Collection.
Residents are responsible for any fees in excess of the $25 disposal pass. Passes have no cash value and can’t be carried over to additional vehicles or trips. Businesses, organizations and schools are not eligible.
Residents can visit https://my.spokanecity.org/neighborhoods/programs/clean-up/ to sign up. They will need to log in to their MySpokane account, the same as their utility billing account if they have one with the City, to request a pass starting March 1, 2022. The pass will be uploaded to your account, and residents will receive instructions via email on how to redeem the pass at the Waste to Energy facility.
If you don’t have access to a utility billing account, make an account at my.spokanecity.org/account. You can also call My Spokane at 311 or 509-755-CITY (2489) for assistance in setting up your account. A limited amount of paper passes are also available mid-March at your neighborhood COPS Shop.
Passes need to be applied for at least two weeks in advance of when the requester would want to use it as there is processing time.
The program collected 456.54 tons of waste in 2021, which equated to $58,407.52 in fees.
Combined loads can’t be separated by type in regard to fees. If you bring a combination of yard waste, recycling and garbage in one vehicle load, it will all be charged as general garbage.
Recycling (blue cart items) and household hazardous waste such as batteries, paint thinners and pesticides are accepted free of fees, but they must be hauled separately from garbage or “clean green” items to receive free disposal.
A complete list of what to bring and what not to bring is in the Solid Waste Disposal Guide. Electronics are not allowed.
Loads must be covered with a tarp or secured with a rope. Unsecured or uncovered loads will be charged a fee.
The disposal pass vouchers can only be used at the Waste to Energy Facility and are not eligible for use at county transfer stations.
The Waste to Energy Facility is open from 7:30 a.m. to 5 p.m. seven days a week, except on holidays.
The other part of the Neighborhood Clean-up Program, spring and fall curbside and roll-off events, start in April. For more information on those, contact your Neighborhood Council. Not sure which neighborhood you belong to? Visit spokaneneighborhoods.org.
The City resumed its optional curbside yard and food waste pickup service called Clean Green on Feb. 28 that features a 96-gallon green yard waste cart.
For more information about the Disposal Pass Program, contact Annica Eagle, Community Programs Coordinator, at aeagle@spokanecity.org.