System of Care Alumni Network Web Site: Where We’ve Been and Where We’re Going Now

Communities that have graduated from the Comprehensive Community Mental Health Services for Children and Their Families Program (also referred to as the Community Mental Health Initiative [CMHI]) grant program funded by the Child, Adolescent and Family Branch (CAFB) within the Substance Abuse and Mental Health Services Administration (SAMHSA) comprise a wealth of experience and knowledge regarding the development and implementation of their systems of care. Although “alumni” communities no longer receive federal funds from CMHI, they often wish to remain informed about systems of care and share their expertise and extensive experience to improve functioning in alumni and currently funded system of care communities.

The System of Care Alumni Network was formed to provide a forum for these communities to share information, connect with other system of care community members, and offer experience-based consultation and education to those interested in promoting the concept of systems of care. Since the creation of the Alumni Network in 2005, its members have participated in numerous system of care grantee conferences, collaborated with program partners on various projects, and compiled a diverse array of resources on the Alumni Network Web site. An initial Alumni Network effort was the development of a Peer Directory, including a description of each funded program and current contact information for individuals affiliated with the programs. The Director of the Alumni Network, Scott Bryant-Comstock, has facilitated these varied Alumni network activities and also serves as administrator of the Alumni Network Web site.

One of the most significant activities for the Alumni Network has been the development of the Alumni Network Web site (www.systemofcarealumni.org), initially launched in 2005. The Web site was designed as a resource by and for alumni, with the format and contents of the site being guided by the needs of individuals from alumni communities. The current version of the Web site was launched in December 2009. Throughout the development process, individuals from alumni and currently-funded system of care communities have provided feedback on the content and format of the Web site, resulting in a valuable networking tool for both alumni and currently funded system of care communities.

This report describes the history of the Alumni Network and the results of a recent evaluation of the Alumni Network Web site. It also presents some of the lessons learned throughout implementation of the Web site and next steps in the ongoing development of the Web site.

Evaluation of the Alumni Network Web Site

The National Evaluation Team completed three main activities during 2008 and 2009 to help inform the ongoing development of the Alumni Network Web site: two discussion groups; a series of review sessions; and compilation of quarterly Web site usage reports. In combination, these activities were aimed at addressing the following questions:

1. How many people are using the Web site and what are their usage patterns?
2. What are users’ perceptions of the utility and effectiveness of various aspects of the Web site?
3. How could the Web site be improved to better meet the needs of users?

Evaluation results indicate that, overall, discussion group and review session participants were enthused about the Web site. They offered many suggestions that were incorporated to further improve specific aspects of the site such as:

• Reorganize the homepage to make it less cluttered, more visually appealing, and easier to navigate
• Rework the main menu options to be more comprehensive and user-friendly, in part by grouping existing items in to fewer categories
• Provide links to existing resources like the CMHI Digital Library, the Technical Assistance Partnership, and www.grants.gov rather than duplicating their efforts

In addition, a quarterly report is produced to describe patterns of use of the Alumni Network Web site. The report contains information about the number of site visitors and registered members, number of page views, average number of pages viewed per visit, average visit duration, and sources of traffic to the Web site. This information is used continually to help guide continuous quality improvement (CQI) efforts for the future development and promotion of the Web site.

Three important lessons learned from hosting the Alumni Network Web site include:

• Staying Focused on the Intent of the Web Site—the Network is dedicated to meeting the needs and pursuing the priorities of system of care alumni.
• Letting Users Shape the Content of the Web Site—instead of a site administrator choosing what might be important, users themselves make the judgment by posting items.
• Promoting the Web Site—be creative in promoting a new resource like the Alumni Network Web site.

Next steps to enhance the Alumni Network Web site include:

• Maintaining the Uniqueness of the Web Site—by remaining focused on the intention for the site to serve as a resource by and for alumni.
• Highlighting Membership Benefits and Making It Easier to Join—by continuing to explore ways to encourage people to become members.
• Promoting the Web Site—by hosting graduation ceremonies and information tables at systems of care conferences, sending out periodic e-mail newsletters and announcements with direct links to the Web site, and having a link posted on other related Web sites.
• Collaborating with National Technical Assistance Providers—by continuing to consult with various national TA providers to identify potential services that could be provided through the Web site.

Soliciting Additional Feedback to Improve the Web Site—by using information from a variety of sources to inform future development of the Alumni Network Web site.

“By changing the mental health system for veterans, we will change it for all of us.”

He also said “acute episodic care for chronic illness doesn’t work” and long-term comprehensive support is needed.

On Friday, the Army Surgeon General’s special assistant for mental health, Elspeth Cameron Ritchie, M.D., and Ira Katz, M.D., deputy chief patient care services officer of the Department of Veterans Affairs, will participate in a NAMI Convention symposium asking whether the VA and Department of Defense can move forward together in reforming the system.

NAMI presented Kennedy, who is leaving Congress this year, with its highest honor, the Distinguished Service Award, for leading the charge in the House of Representatives for mental health insurance parity.

Parity was signed into law in 2008 and expanded in the recently enacted health care reform law.

Kennedy is the only current Member of Congress who has publicly talked about his living with bipolar depression.

“I’m not a hero because of my illness,” Kennedy told the convention. “I didn’t have a choice.”

“NAMI mission is providing hope and saving lives,” said NAMI Executive Director Michael Fitzpatrick.

“Patrick Kennedy’s long-time support for our cause have made him an invaluable, passionate advocate and champion loved by millions of individuals and families affected by mental illness.”

“He will be missed in the halls of Congress, but we know he will continue to make contributions as a private citizen.”

By SARAH KERSHAW

Published: March 29, 2010

Even without the new health care law, mental health advocates were getting ready to celebrate parity — a law requiring benefits for substance abuse and mental illnesses to be on par with benefits for medical illnesses.

But that law, passed in 2008 and taking full effect only this July, did not cover everyone with insurance, and it offered no help to the 32 million uninsured Americans.

Now mental health advocates are almost giddy. The law signed by President Obama last week expands parity to a much wider pool, making it possible for millions more people to get the same coverage for substance abuse and illnesses like bipolar disorder, major depression and schizophrenia as they would for, say, diabetes or cancer. There are no exact figures, but the mentally ill are more likely to be uninsured than the general population, advocates and researchers say.

“A lot of this still has to play out in terms of how parity works,” said Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness, or NAMI, an advocacy group. But the new law “can change the mental health system in America and really give families and individuals an opportunity to get a level of access to care we could only fantasize about before this became law,” he said.

Parity means that deductibles, co-payments and limits on the number of visits or days of coverage must be no more restrictive for coverage of mental illnesses and substance abuse than for coverage of medical and surgical treatments. If a plan provides for out-of-network medical benefits, it must provide out-of-network mental health benefits.

Under the new health law, employees of companies with 50 or fewer workers, whose employers were not required to comply with the existing parity law, would receive equal mental health benefits if their employers opt for the state-run exchange plans, available in 2014.

Peter Newbould, director of Congressional and political affairs at the American Psychological Association, which helped write parts of the legislation, said it was likely that the smaller companies would choose from the exchange programs, and that many may already be subject to state parity laws requiring the mental health benefits. He also said that the latest federal regulations on parity, released last month, left little wiggle room for other insurance companies to deny equal mental health benefits.

Still, in the state plans for purchase, the mental health benefits would be as generous, or as limited, as the plans are for medical health benefits. So those able to pay higher premiums are likely to get the best coverage on both fronts.

Besides increasing the number of people eligible for Medicaid, the new law requiresthat those in Medicaid managed-care plans be offered the same mental-health and substance-abuse benefits as medical and surgical benefits. Previously, only Medicaid-managed care plans provided that coverage.

The health care law is unlikely to affect most employees of large companies, already subject to state and federal parity requirements, although self-insured companies can opt out.

According to the National Institutes of Mental Health, one in four adults suffers from a diagnosable mental disorder in a given year, or about 58 million people. About 1 in 17 suffers from the most serious illnesses.

Fewer than half of those with mental disorders receive treatment, according to the Bazelon Center for Mental Health Law. An additional 22.2 million Americans need treatment for substance abuse or dependence, according to the latest data from the Department of Health and Human Services, from 2008.

Many of the changes affecting medical coverage, like the requirement that insurance companies provide coverage despite pre-existing conditions and the elimination of lifetime and annual limits on benefits, will have a big impact on people with mental illnesses.

Theresa Johnson, a nurse at an urban Connecticut hospital, knew that her daughter, Erica, would fall off the family’s plan with Anthem when she graduated from college last year. Ms. Johnson said she had tried to buy her daughter an individual plan with Anthem, but the company said her pre-existing mental illness, generalized anxiety disorder, made Erica “too high risk” and ineligible for coverage. (Her daughter’s pre-existing hypertension and hyperthyroidism did not make her ineligible, Ms. Johnson said she was told.)

Ms. Johnson decided to go with a Cobra option offered to children through her Anthem plan for up to three years after college graduation because she wanted to stay with Erica’s cardiologist and internist. That plan costs $605 a month, covering Erica’s therapy and the Lexapro she is taking for anxiety, and Erica is contributing $200, working three jobs. If Anthem had agreed to provide Erica with an individual insurance plan, the cost would have been roughly $250 a month, Ms. Johnson said.

“It really is discriminatory against people with mental health issues,” she said. “Being a nurse, it really kills me, it just kills me.”

Anthem declined to comment on the case because of privacy laws, but said in a statement that in some cases a pre-existing condition, or a combination of conditions, “may require us to decline coverage.”

Under the new health care law, dependent children can be covered under family plans until they are 26, effective in six months, though Ms. Johnson’s employer has announced that this will take effect for its insurance plans next January. And Erica, now 23, may face yet another period of uncertainty, because the protections for most people with pre-existing conditions do not take effect until 2014.

The new law provides for more training of what it refers to as “behavioral health workers,” but it is too soon to tell whether the mental health arena would face the kind of shortages predicted for primary care doctors, Mr. Newbould said. The law also includes a proposal to set up new nongovernmental research centers to investigate effective treatment for mental illnesses.

Because the law does not specifically define benefits, and many provisions will require many discussions on how to implement them, the devil may be in the details. “I think that’s a cliché we’re going to be hearing a lot,” Mr. Newbould said.

This article has been revised to reflect the following correction:

Correction: April 3, 2010

An article on Tuesday about mental health coverage under the new federal health care law, using information from the American Psychological Association, overstated one provision’s requirements for covering Medicaid recipients. Only those in Medicaid managed-care plans must be offered the same mental-health and substance-abuse benefits as medical and surgical benefits; the new law does not require all Medicaid coverage to include equal benefits.

Wednesday, April 14, 2010 | 12:03 p.m.

A federal class action lawsuit filed Tuesday night in U.S. District Court in Las Vegas accuses state and Clark County officials of overseeing a child welfare system that violates state and federal law.

The lawsuit, filed on behalf of 13 children by the National Center for Youth Law in Oakland, Calif., named as defendants Nevada Department of Health and Human Services Director Michael Willden, Nevada Division of Child and Family Services Administrator Diane Comeaux, Clark County Manager Virginia Valentine and Clark County Department of Family Services Director Tom Morton.

Those officials are accused of showing “deliberate indifference to the health and safety of the children [they are] obligated to protect.” In addition to seeking unspecified damages for the child plaintiffs, the lawsuit demands system improvements for several classes of children in foster care.

Clark County spokesman Erik Pappa said today: “We’re not commenting because we haven’t had a chance to review it.”

Department of Health and Human Services spokesman Ben Kieckhefer likewise said: “We haven’t been served yet and we can’t comment until we’ve had a chance to review it with our attorneys.”

The lawsuit alleges countless instances of blatant disregard of federal and state law, substandard judgment, neglect and active indifference on the part of child welfare officials and caseworkers. Those individuals were accused of perpetuating abuse by routinely denying foster children stability, health care, and, in many cases, even the most minimal level of safety. In fact, many children are taken from their homes only to be subjected to further abuse, including physical, sexual, or psychological abuse, while in the county’s custody, the lawsuit says.

In one cited example, defendants allegedly placed an infant and her older brother in a foster home where the baby was locked in a closet, and her brother was beaten when he tried to help her. Another plaintiff, now 17, has been in foster care for 15 years and has been shuttled through 40 placements.

The youth law center stated that since 2003, more than 10 studies and reports have documented the defendants’ failure to protect the health, safety and well being of child abuse victims and children in foster care.

Other law firms representing the plaintiffs include Morrison & Foerster LLP, an international, 1,000-lawyer firm with offices in 16 cities, including San Francisco, and Wolfenzon Schulman & Ryan, with offices in Las Vegas, Reno and San Diego.

The youth law center previously sued to reform the child welfare system in Nevada on behalf of different plaintiffs and a different class. The last suit, filed in 2006, was dismissed last year after the federal court declined to certify the class, and all the plaintiffs had either aged out of the system or been adopted.

The center is renewing its efforts for current and future foster care children who it says will continue to suffer until state and county child welfare officials make changes to ensure the safety and well-being of children in their custody.

“Our hope is that going forward, the county and state will commit its time and resources to addressing the needs of children in its care,” says youth law center attorney Bryn Martyna.

The law center said that many of the problems cited in its initial lawsuit persist or have worsened. A 2009 review of Nevada’s child welfare system by the U.S. Department of Health and Human Services found the state did not meet federal standards for child safety, staff and caregiver training, and children’s physical and mental health, among others.

Among the allegations in the lawsuit:

• Many caseworkers lack even the most rudimentary training, have no supervision, and carry exceedingly high caseloads, resulting in serious injury to children.

• Children are routinely denied mental health, medical, early intervention and special education services.

• Children as young as 7 are prescribed powerful psychotropic drugs, sometimes in combination, without adequate monitoring. Most of the drugs are not approved for use in children. One child named in the suit was twice hospitalized in the ICU for near organ failure due to an overdose of such drugs.

• Caseworkers regularly fail to visit children in their placements.

• Supervisors and caseworkers often “turn a deaf ear” to reports of abuse and neglect in foster care, allowing children to endure further abuse.

• Children sent to out-of-state placements are essentially written off by defendants, who fail to evaluate or monitor such placements, allowing children to suffer further abuse and neglect.

The lawsuit is also demanding that the state and county agencies develop case plans that contain the information foster parents need to properly care for the children in their care, provide representatives for children in court as required under both Nevada and federal law, and provide early intervention services for foster children.

“If defendants’ unconstitutional and unlawful actions and omissions are not halted, many more children will be harmed,” said youth law center attorney Bill Grimm, lead counsel on the case. “And another generation of children will suffer untold misery in the form of abuse, instability and absence of a loving family. Some will suffer irreparable injury or even death, and others will leave the foster care system ill-prepared to live healthy, independent, and productive lives.”

The state of Mississippi is facing a federal lawsuit alleging its failure to provide community-based mental health services to its children is denying them access to care and increasing their odds of being institutionalized.

The Southern Poverty Law Center Mississippi Youth Justice Project , the Bazelon Center for Mental Health Law and local civil rights attorney Rob McDuff are suing the state in an effort to improve the mental health system for children, according to a news release from the Youth Justice Project.

The state, according to the lawsuit filed today in U.S. District Court in Jackson, fails to invest in community-based services and instead pumps the bulk of its resources into ineffective, expensive institutions. In doing so, it violates both the Americans with Disabilities Act and the Medicaid Act, said Vanessa Carroll, staff attorney for the Mississippi Youth Justice Project.

State officials were not immediately available for comment on the lawsuit.

The lawsuit alleges the state fails to meet the needs of children in two fundamental ways.

First, the state discriminates against children with mental illness by separating them from their families and communities and forcing them to cycle through psychiatric institutions that fail to provide adequate services, the news release states. Second, the state fails to provide federally mandated and medically necessary home- and community-based mental health services, according to the news release.

A statement from the Youth Justice Project reads: “Mississippi’s mental health system is defined by an over-reliance on institutions where hundreds of children with behavioral and emotional disorders cycle repeatedly through hospitals, emergency rooms, acute care facilities and residential centers. When children leave these facilities, they rarely receive necessary follow-up treatment.”

© 2010 The Clarion-Ledger

Social deprivation-a lack of access to social and material resources-is known to be associated with a syndrome of poor growth in children, according to background information in the article. “Several subtypes have been described, though all share two characteristics: otherwise unexplained growth failure occurring in association with socially stressful conditions and significant catch-up when a child’s caregiving environment improves,” the authors write.

Dana E. Johnson, M.D., Ph.D., of University of Minnesota, Minneapolis, and colleagues studied 136 healthy institutionalized infants (average age 21 months) from six orphanages in Bucharest, Romania. Of these, half were randomly assigned to remain in their facilities and half were assigned to a foster care program. Their growth rates and measures of intelligence over time were assessed and they were compared with each other and with a group of 72 never-institutionalized children at 30, 42 and 54 months of age. Caregiving environments were evaluated by analyzing and coding 90-minute videotapes of the children interacting with their preferred caregivers.

At the beginning of the study, institutionalized children displayed compromised growth and development, with more severe deficits among those who were born weighing less than 2,500 grams (approximately 5.5 pounds). Children assigned to foster care showed rapid increases in height and weight (but not head circumference), so that by 12 months 100 percent of them were in the normal range for height, 90 percent were in the normal range for weight and 94 percent were in the normal range of weight for height.

Caregiving quality was a predictor of this catch-up growth. “Components of the caregiving-quality score positively correlated with catch-up included sensitivity (child-centered, contingent responses) and positive regard for the child (acceptance, respect and warmth, including expressions of physical affection),” the authors write.

Children whose height caught up to normal levels also appeared to improve their cognitive (thinking, learning and memory) abilities. “Each incremental increase of one in standardized height scores between baseline and 42 months was associated with a mean [average] increase of 12.6 points in verbal IQ,” the authors write.

“The significance of these findings extends beyond the millions of children worldwide within institutional or conventional foster care to the hundreds of millions of impoverished children who have stunted growth and/or do not meet their developmental potential and are living within families,” the authors conclude. “Psychosocial deprivation within any caregiving environment during early life is as detrimental as malnutrition and must be viewed with as much concern as any severely debilitating childhood disease.”

Arch Pediatr Adolesc Med. 2010;164[6]:(doi:10.1001/archpediatrics.2010.56).

Source
Archives of Pediatrics & Adolescent Medicine

The current conflicts in Iraq and Afghanistan have resulted in extended and repeated combat-related deployments of U.S. military service members. While much has been reported about the problems, both physical and psychological, many bring back with them, new research out of UCLA shows that the family back home can have issues as well.

The suddenly single parents left at home and their children must quickly adjust to altered family roles and the stress of having a loved one in a distant and dangerous land, in addition to dealing with potential psychological or physical health problems the active-duty parent may have upon their return.

Reporting in the April edition of the Journal of the American Academy of Child and Adolescent Psychiatry, UCLA assistant professor of psychiatry Dr. Patricia Lester and her colleagues found that it is the number and length of repeated deployments that cause higher levels of anxiety in children and that this anxiety persists even after the deployed parent returns home.

Second, they found that the level of anxiety children experience can be predicted by the amount of psychological distress shown by both the active-duty parent and the at-home parent.

Lester and her colleagues studied 171 families in which either the mother or father was on active duty, currently deployed or recently returned from serving in Iraq or Afghanistan. Of the sample, the active-duty parent had, on average, been deployed more than twice and had been away from home for 16 months.

The researchers found that approximately one-third of the children in these families had increased symptoms of anxiety. Strikingly, the anxiety remained even after the deployed parent returned home.

“It’s known that, in general, a child’s level of distress is linked to parental distress,” Lester said. “Here, we found that approximately one-third of the at-home parents and almost 40 percent of the recently returned deployed parents showed elevations in anxiety and depression.

“We also found that the at-home parent showed higher levels of anxiety when their spouse was deployed. But the two key markers for anxiety in the child were the distress levels of both parents and the number of months a parent had been deployed during the child’s lifetime.”

Interestingly, the study suggests that school-aged boys and girls behave differently during and after a parent’s deployment. Girls showed an increase in acting out and disruptive behavior when the parent was deployed, while boys appeared to have more difficulties after the deployed parent returned.

“For the boys, this may be related to reduced autonomy and increased structure in the family life upon the return of the deployed parent,” Lester said.

Notably, the children also showed indices of resilience, and their experiences of other types of emotional and behavioral problems were comparable to what is seen normally within any general community of kids.

Lester noted that the military demographic in the U.S. has changed in the past several decades to include a much larger proportion of service members with families. She said planning is needed for extended military operations to take into account the impact on family members.

“These findings suggest that there is a cumulative wear and tear upon the military family from multiple deployments during wartime,” she said.

Lester and her colleagues have developed a program to help such military families. Called FOCUS (Families OverComing Under Stress), the program provides both parents and children customized training that addresses the impact of wartime deployment on families and helps them learn very specific communication and problem-solving skills to address these challenges.

Other authors on the study included Dorie Glover, Catherine Mogil, William Saltzman, Robert Pynoos and Katherine Wilt of UCLA; Kris Peterson and Larry Knauss of the Madigan Army Medical Center; James Reeves of the Naval Medical Center San Diego; Naihua Duan of Columbia University; and William Beardslee of Children’s Hospital Boston and Harvard Medical School.

The study was supported by a grant from the National Institute for Child and Human Development. The authors express no conflicts of interest.

Source:
Mark Wheeler
University of California – Los Angeles

It is now widely understood that most adult and adolescent mental illness begins in childhood. And evidence shows that early mental health problems can seriously impact on life chances (5). In contrast, positive mental health is associated with good educational outcomes, productivity and strong relationships.

The Children and Young People’s Mental Health Coalition will seek to influence policy and practice on a range of issues and in the first year will focus on four streams:

1. The Early Years – to include equipping parents with the knowledge and tools to improve their children’s mental wellbeing as well as their own.

2. Building Emotional Resilience – to resource children with self awareness and resilience to meet the challenges of growing up and enjoy good mental health.

3. Reaching Adulthood – to ensure adequate provision of care and flexible services for those entering into and adjusting to adulthood.

4. Seldom Heard Voices – to ensure that minority groups are able to access good quality support from services.

The coalition’s core members are Action for Children, Children England, Family Action, the Mental Health Foundation, Mind, the National Children’s Bureau, Place2Be, Right Here, Rethink, The Prince’s Trust, YoungMinds, Young Scotland in Mind, Youth Access, Youth Action and YouthNet.

Chair of the Coalition and Chief Executive of Young Minds Sarah Brennan said:

The launch of the Children and Young People’s Mental Health Coalition represents the opportunity to bring together a range of high profile organisations to lobby and campaign for much needed improvements in the provision of mental health services, and for greater recognition of the vital importance of children’s wellbeing and good mental health. I am delighted to be chairing the coalition and for YoungMinds to be taking part in the potential influencing power of this partnership.

Dr Cathy Street, Young People’s Research and Development Lead at Rethink, said:

Rethink is very please to be part of the new Coalition and supports its focus on how we can create flexible services for young people up to the age of 25. These need to be responsive to their many varied needs. We are aware of much progress in mental health service deliver but also through our Uthink programmes for young people, know that many still struggle to get help when they need it. We hope that the collective voice of the different organisations within the Coalition, and their strong links with many young people in both statutory and voluntary sectors, will provide an impetus for improving this situation.

Barbara Rayment, Director at Youth Access, said:

There remain considerable challenges for national policy in meeting the mental health needs of young people. Despite the gaps and the challenges of funding, the voluntary sector has developed proven service models for reaching out effectively to this group. Youth Access is delighted to be working with the Coalition to bring a stronger voice to creating change in the way we deliver services to young people in the future.

Lucie Russel, Director of Campaigns, Policy and Participation at YoungMinds, said:

Young people’s mental health is the elephant in the room. Thousands of young people are suffering in silence and the launch of the Children and young People’s Mental Health Coalition provides a much needed platform to campaign on behalf of these young people and to raise awareness of the vital importance of good mental health for all children and young people.

The coalition has recruited Sarah-Jane James as policy officer and Kim Penketh as participation co-ordinator. The initiative has been funded by the Zurich Community Trust. A grant of £135,000 will finance the three-year campaign strategy and Zurich employees will have opportunities to contribute their business skills.

Head of Zurich’s Community Trust, Pam Webb, explained:

Our partnership with the Mental Health Foundation to host the Coalition supports our desire to focus on the early intervention and prevention of mental health issues as part of the Trust’s £1.2 million Young People’s Mental health programme.” She added: “In so doing, we hope that by getting one strong united voice from charities that it will lead to changes in policy and services which will improve the emotional wellbeing of children and young people with mental health issues.

References

1) Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and young people in Great Britain 2004. London: Palgrave. See http://www.statistics.gov.uk/

2) Office for National Statistics (2004). Census 2001: national report for England and Wales. London: Office for National Statistics.

3) Adult Psychiatric Morbidity in England, 2007: Results of a household survey, The NHS Information Centre, 2009

4) Mental Health Foundation (2006). Truth hurts: report of the National Inquiry into self-harm among young people. London: Mental Health Foundation

5) Colman, I., Murray, J., Abbott, R., Maughan, B., Kuh, D., Croudace, T. & Jones, P. (2009) Outcomes of conduct problems in adolescence: forty-year follow-up of a national cohort. British Medical Journal 338: a2981.

Source
MIND

In assessing the long and fraught process that brought the once-endangered bill to passage, party faithful have taken inspiration from the great triumphs of the past — Franklin Delano Roosevelt’s “Second New Deal’’ of 1935, which brought Social Security and a host of other measures, and Lyndon Johnson’s Great Society programs of 1965, which broke the political logjam that had long frustrated federal action on education and health insurance. But that history is is also a measure of how difficult it is to enact social reform legislation at this particular moment in American politics.

When Roosevelt and Johnson wanted to get their legislative agendas moving, each could depend on something that seems both anachronistic and undemocratic today — entrenched congressional committee chairmen who could move things forward, or halt them in their tracks.

The days are long behind us when Roosevelt’s success in getting his New Deal measures enacted hinged on the long-serving Southern chairmen — their tenure in office assured by disfranchisement of black voters — or when the powerful, and fickle, Ways and Means Chair Wilbur Mills could singlehandedly frustrate the desire of multiple presidents for Medicare. That era was interred in the 1960s and ’70s when political activists successfully pushed for procedural reforms that transformed Congress into the modern cacophony of perspectives and political posturing we see today.

If members of Congress are more independent, voters are too. Just a short time ago, the conventional wisdom among historians was that blocks of voters remained loyal to one party for long periods of time, with periodic realignments that could make possible such policy innovations as the New Deal. Today, however, many voters now affiliate themselves with neither party and seem up for grabs.

What seemed to be the greatest challenge for supporters of the health care bill, however, was mobilizing voices outside the Beltway to push things forward. By contrast, when Roosevelt proposed his ambitious 1935 program, everyone knew that political alternatives had been bubbling up all over the country, some idealistic, others demagogic. They ranged from the novelist Upton Sinclair’s End Poverty in California program, which scandalized the Democratic Party, to Huey Long’s Share Our Wealth Society, which grew out of his flamboyant political power in Louisiana.

Thirty years later, Johnson’s reform mandate was cemented not by political rivals, but by social movements outside of Washington that seemed to link Johnson’s success with his ability to get progressive measures through Congress. Johnson’s basic problem was that he took office with no electoral mandate at all. He worried intensely about it, and solved the problem by tying himself to the mantle of his assassinated predecessor.

Johnson pledged to get Kennedy’s stalled civil rights legislation through Congress. That tied Johnson, in turn, to a civil rights movement whose demonstrations had pushed Kennedy to propose the legislation, and in particular to Martin Luther King, Jr. Johnson could formulate his ambitious 1965 social program only with the added confidence, political clout and electoral mandate that flowed from his ability to enact the legislation that civil rights activists had placed on the nation’s agenda.

In recent weeks, the Obama administration seemed to recognize this problem and sought to mobilize supporters around the country, after months in which that kind of improvisational, decentralized energy seemed more in possession of the opponents of social reform legislation than of its supporters.

To the extent that the legislative triumphs of the New Deal and Great Society are held up as inspirational examples in assessing what the Obama administration has achieved, one should also remember the structural advantages that Roosevelt and Johnson had in putting their programs through, and the help that they received, willing and unwilling, from political and social movement leaders who were beyond their control.

When the definitive history of this political moment is finally written years from now, the ability of the administration, and its opponents, to foster innovation in an age of political constraint will surely be one of the central stories.

Kenneth W. Mack is a professor at Harvard Law School.

Original post here

By Kenneth W. Mack