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Report: Mental health care gaps in Indian Country

BILLINGS, Mont. (AP) — A new U.S. government report highlights serious gaps in mental health care for many American Indians and Alaska Natives, groups that suffer from problems including a teenage suicide rate more than twice the national average.

One in five hospitals and clinics in Indian Country provide no mental health services, according to the Inspector General’s Office of the Department of Health and Human Services.

Only half provide drug therapy treatments, and at dozens of facilities some drug treatments are handled by non-licensed social workers, counselors and nurses.

The inspector general’s report covers a government health system that serves almost 2 million people, belonging to more than 500 tribes scattered across 35 states. It was released Friday by Montana U.S. Sen. Max Baucus.

The Democrat in 2008 had requested an investigation into problems with mental health care on reservations, which often are set in remote areas with struggling economies and where health care services of any sort are often in short supply.

“The demand for mental health services outstrips capacity at some IHS (Indian Health Service) and tribal facilities,” the report’s authors wrote, adding that American Indians and Native Alaskans “rank first among ethnic groups as likely to suffer mental health disorders such as anxiety and depression.”

The consequences of those problems came into dramatic focus over the last two years on Montana’s Fort Peck reservation. Five suicides and 20 attempts in one year at the rural reservation’s Poplar Middle School prompted tribal leaders last year to declare a crisis and the government to dispatch an emergency team from the U.S. Public Health Service.

At least two more teenagers have killed themselves since and dozens of other children across the reservation have tried.

The inspector general’s report says drug and alcohol abuse, depression, and unemployment also drive the need for better access to mental health services.

Some changes have been made since Baucus first called for the investigation, including new programs promoting the use of telemedicine, in which doctors can speak with patients remotely.

“In Montana, we’ve seen all too well the tragedies that result when folks don’t get the mental health care they need,” Baucus said in a statement. “It’s clear from this study that more needs to be done, and my staff and I will continue working with Indian Health Service and folks on the ground in Montana.”

The inspector general’s office called for the Indian Health Service to further expand the use of telemedicine and also link up with non-native mental health care providers.

An Indian Health Services spokeswoman said no one from the agency was available late Friday to comment on the report. But in an August letter to the Inspector General Daniel Levinson, IHS director Yvette Roubideaux said she agreed with the recommendations and would work to put them into practice.

Military retirees to pay higher health premiums

WASHINGTON (AP) — Military retirees will pay slightly more for their health care starting Saturday, and more cost increases are on the way.

Premiums haven’t been raised since 1994 and still will be just a fraction of what civilians pay. Under a change announced by the Defense Department on Thursday, individuals who enroll in the retiree program as of Saturday will pay $260 annually, up from $230, and it will be $520 annually for a family, up from $460.

Retirees already in the program will not see any increase until next year because they have already paid for this year. But “modest annual increases” are planned in the future, Cynthia Smith, a Pentagon spokeswoman, said.

Active duty service members get free health care and that will remain the same. But other personnel changes unpopular with service member may be in the offing due to U.S. budget problems, including changes to the system for retirement pay, which is under study.

Military health costs have ballooned since 2001, and increases announced Thursday were approved in February by former Defense Secretary Robert Gates, who said he was trying to get spending under control. The decades-old health program, known as TRICARE, provides health coverage to some 10 million active duty personnel, retirees, reservists and their families. Its costs have jumped from $19 billion in 2001 to $53 billion, according to estimates from earlier this year.

“We are committed to offering the best possible health care system for our entire military family,” Dr. Jonathan Woodson, the assistant defense secretary for health affairs, said in a statement Thursday. “This modest annual fee increase allows us to responsibly manage our costs in line with other secretary of defense initiatives announced earlier this year.”

Officials have tried previously to raise premiums but were met with resistance from veterans’ groups as well as lawmakers loathe to tamper with benefits of men and women in uniform who have sacrificed for the nation. But the nation’s budget and debt crises have changed that.

Gates particularly singled out working-age retirees — those in their 40s who retired after 20 years in the military and can go on to second careers, meaning they are likely to be able to afford a small increase, he said.

That retirement system is also under a magnifying glass. A Pentagon advisory panel in July created an uproar among troops and retirees by suggesting it should be scrapped and replaced with a 401K-style savings plan. Though the report was preliminary, advisory and nonbinding, Defense Secretary Leon Panetta took pains to put out a statement saying he believed any changes to retirement pay should exempt current troops and retirees.

But Panetta also said the system needed to be looked at, and other defense officials have said everything is on the table as the Pentagon looks for savings.

Panetta also agreed with the advisory group that the retirement system is unfair in that it pays lifetime benefits at about half of base pay, starting immediately when a person retires with 20 years of service, but it pays nothing for those who stay in uniform for 10, 15 or even 19 years.


TRICARE health program

Retirement report

Health Minister Lesley Griffiths makes the case for NHS reform

Health Minister Lesley Griffiths outlines her priorities for the NHS in Wales

ON JULY 5, 1948, the National Health Service was born and healthcare became free to all.

I think it would be fair to say that many people can’t remember life without an NHS. We have little idea of the unfairness and inequality that existed in healthcare before it came into being.

Before the NHS existed, life was, in some instances, a lottery. If you were poor you couldn’t afford even the most basic treatments. You simply had to put up with whatever illnesses came your way.

Someone who worked in the NHS for more than 20 years, I have seen what the founding principles of free healthcare mean in practice to patients and their loved ones.

Now, as Health Minister, I want to make clear the NHS in Wales will not deviate from those founding principles.

I believe in a high-quality NHS, delivered by the public sector, free for all – no ifs, no buts, no maybes.

While I’m Minister, the NHS will continue to offer high-quality services, including free prescriptions and increasingly fair health outcomes for all.

Fairer outcomes can come about through society itself being fairer and by using policy to give people a better chance in life.

Where a person lives or their social circumstances should not lead to a lesser quality of life and a premature death.

While the principles that underpin our NHS remain as relevant today as they did when it was formed, that does not mean the way the NHS works cannot change.

Striving for progress and excellence means change must occur in order for improvements to take place. To argue otherwise is disingenuous.

The current Welsh Government was elected on a manifesto that contained bold policies to improve and modernise the NHS.

I believe in strong public services that place public interest above private profit, with quality services for all.

Working with the NHS, we have now put improving health and preventing avoidable illness at the heart of the planning process.

We should have high expectations of the services provided. We have brought together all the NHS in new streamlined health boards, which are responsible for the health of local populations, working with local authorities and supported by Public Health Wales.

They plan and develop services without the threat of market-driven healthcare and privatisation, which exists in England.

Creating the new bodies was the first step. The next will be a shift to an NHS based on personal health outcomes rather than performance targets, with careful financial management and high standards of care across Wales.

To achieve this, the NHS needs to start measuring and reporting clearly what health outcomes it achieves.

We have a plan that sets out a measure of healthy life expectancy for Wales and we will use this to focus our actions.

Using outcomes and indicators intelligently will help guide the NHS into strong partnerships with local government and the third sector in a combined effort to tackle inequities in health.

Fairness is about distribution and I want the NHS to consciously look at who gets what outcomes.

People have different needs and should be treated accordingly. I want every NHS encounter to count as a health promotion opportunity. This means the NHS needs to learn how to deal with every individual in a unique way.

Over the next five years there will be major changes which will transform the NHS in Wales.

We must allow changes that make services safer, more sustainable and more effective to take place. They must also be fair.

Bringing about these changes will not be easy for the dedicated staff, nor, in some instances, for patients.

On a personal level, I know the changes will not be a walk in the park politically.

There will be difficult decisions to be made by health boards that I may ultimately have to consider.

Despite whatever political flak lies ahead, I will not shirk from the work ahead because I know change is necessary and in some cases long overdue.