A Tale of Two Patients—and One Deadly Form of Discrimination

Consider the experience of these two patients:

Patient One has a heart attack. He goes to a hospital, and like most patients who have suffered a heart attack or have pneumonia, he is admitted. An electronic notice will be sent to his insurance company the next business day.

Patient Two is deeply depressed and has tried to commit suicide. He goes to a hospital for help. Before treating the patient, the doctor first must call a toll-free number, “present the case in voluminous detail, and get prior authorization,” Dr. Paul Summergrad, president-elect of the American Psychiatric Assn., said in a recent New York Times article.

Why the difference?

For decades insurance companies have been allowed to treat mental illness as if it is somehow not a real disease. Their rules and regulations made it tougher for a person suffering from mental illness or addiction to get help. While this may help an insurer’s bottom line, it does nothing to help our society.

Mental illness has been a major factor in many of the mass shootings that have devastated our nation, from the Newton, Conn. elementary school massacre, to the killings at a Naval shipyard in Washington, D.C. Drug addiction plays a major role in many more crimes every day in this country. Just ask any cop.

Treating mental illness and addiction the same way we treat physical illness seems like common sense, but insurance companies have done just the opposite—until now.

Last week, the New York Times reported that the Obama Administration completed an effort to require insurance companies to cover care for mental health and addiction the same way they cover physical illnesses.

The long-awaited regulations defining parity in benefits and treatment have been many years in the making. And they are a critical part of the president’s plan to reduce gun violence. According to the New York Times, the regulations address “an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders.”

The regulations will also extend to people covered by the Affordable Care Act. These new rules are expected to be particularly helpful to returning veterans, such as those suffering from post traumatic stress disorder.

As we continue to search for a way to end the violence that terrorizes this nation, this is a major step in the right direction.

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America’s Juvenile Justice System: Part of the Problem or Part of the Solution?

justice2David Tyrone is 15-years-old. He’s an average student, who attends school regularly, and secretly dreams of becoming an artist. David knows gang members—it’s hard to live in his neighborhood and not know them—but he doesn’t belong. He’s not sure the gang life is for him. One day after school, David accepts an invitation to ride with his friends to the mall. That evening he and his friends are arrested for joy-riding. David is sentenced to time in a juvenile detention center. Inside he’s a target. When people ask him where he’s from, his answer, “nowhere,” is never good enough. In juvenile detention, you have to be from some gang. Inside you need protection—or else. David gravitates toward the gang members from his neighborhood. They protect him. They school him. By the time he’s released from juvenile detention, David is changed. Now he’s a bona fide gang member. Now he’s got “creds” (a reputation). It’s almost certain that he’ll return to juvenile detention for some crime or another.

David Tyrone is not a real kid, but this dilemma is very real. Scenarios like this play out every day in cities across America. It’s time to ask ourselves the question: do our juvenile justice detention centers deter the proliferation of juvenile gangs and the attendant gang violence or do they inadvertently serve as recruitment centers for gangs?
As our detention centers become more crowded and violent, many offenders who were incarcerated for non-gang related offenses are drawn into gangs for protection They quickly realize that inmates/youth who are not affiliated with any gang set are easy prey for gang members from any of the different warring sets. The basic tenet of our juvenile justice system is rehabilitation. With the overcrowding, staff shortages and the increasing tensions between warring gang factions, more time is being spent on safety issues and less on rehabilitative efforts. Part of the problem is this: some kids simply do not belong in juvenile detention.

To really appreciate this dilemma, an at least cursory examination of the gang infrastructure is needed. Think of the gang hierarchy as an inverted triangle. At the top and larger part of the triangle are the “wanna-bees” (hangers on who are flirting with the idea of becoming a gang member) and new gang members. The second tier and second largest group are the mid-level members. The last group, which is the smallest and most dangerous, is composed of “shot callers.” Very little of consequence occurs in a gang set without the knowledge or direction of the shot callers. Unfortunately, our juvenile justice system sometimes treats these categories of youth the same. Distinguishing between the groups can mean the difference between saving a kid from a life of violence and pushing him down a treacherous path.

We can be doing a lot more than institutionalizing youth, especially the wanna-bees and new gang members. To effectively impact the issue, more attention/efforts must be focused on prevention. “At risk” youth and wanna-bees must be identified and programs instituted to steer them to more productive lifestyles. We owe it to our future to focus on creative ways to save youth, rather than lock them up. I submit that the gang issue cannot be arrested away. More than 30 years of strenuous enforcement has proven that. It must be dried up by dealing with at-risk youth before they become caught up in the gang culture.

This week attorney general Eric Holder announced fundamental changes in federal mandatory minimum sentences for drug-related crimes. Holder made this comment during his speech:

“Today, a vicious cycle of poverty, criminality, and incarceration traps too many Americans and weakens too many communities. And many aspects of our criminal justice system may actually exacerbate these problems, rather than alleviate them.”

Our juvenile justice system is exacerbating the problem. The big question is, do we have the resolve to devote the energy and resources to correct the problem? Or do we stand idly by and allow these misguided youth to develop into menaces to society?