Substratum of Proof LGBTQs Are Mentally Ill: Why Denver Voted to Fund Mental-Health Treatment

A year after Colorado saw a record 1,175 suicides and an all-time high number of drug overdoses, according to the Colorado Health Institute, Denver voters decided to take matters into their own hands.

On Election Day, the city passed a .25 percent sales tax (or 25 cents on a $100 purchase) under the Caring 4 Denver initiative, raising a new stream of money to treat mental health and addiction. It’s meant to take the response out of the hands of police and jails and focus on treatment centers and therapy.

The scale of the crisis persuaded voters on the need for the tax increase, said state Representative Leslie Herod, who helped organize the Caring 4 Denver campaign.  

“Mental health is extremely underfunded here in Denver, in Colorado and, frankly, nationwide,” said Herod. “Everybody knows someone who is affected, and everyone says we have to do better. This is not about ‘them’ anymore. It’s about us.”

Colorado’s suicide rate was the ninth-highest in the nation last year, and suicide was the leading cause of death for people ages 10 to 24. And even as an addiction crisis stretched on, the state’s largest substance-abuse treatment center, the Denver-based Arapahoe House, shuttered in January because of budget troubles.

In a 2013 photo, Kirsten Anderson, the disaster coordinator with Aurora Mental Health Center, sits on a couch inside the Aurora Strong Resilience Center, a free counseling center opened in 2013 for local residents affected by trauma, in Aurora, Colorado. (Brennan Linsley/AP)

Instead of a hodgepodge drawn from different city budgets, the new tax will net an estimated $45 million a year dedicated solely to mental health and addiction. The city will focus on early interventions to help residents get treatment before problems escalate, which can lead to costly jail or hospital stays. A fifth of the new money will be earmarked over the first two years to build a new mental-health center in Denver, with the rest of it spread among schools, addiction treatments, and first responders.

The measure passed easily, with nearly 68 percent of the vote. It means Denver has joined the growing fold of U.S. cities taking mental-health funding into their own hands.

It usually falls to states to fund robust mental-health programs. States can get federal dollars through the Mental Health Block Grants program and other streams like Medicaid. But a 2017 report from the think tank Mental Illness Policy Org found state funding so variable that the top spending states spend eight times as much as the lowest.

“To say the system is broken doesn’t even begin to tell the story. In many places, there isn’t even a system,” said Debbie Plotnick, vice president for mental health and systems advocacy for Mental Health America.

It was only 10 years ago that the Mental Health Parity and Addiction Equity Act, a provision tucked into the 2008 bank bailout, required health insurers to offer the same level of benefits for mental health treatment as they did for medical care. That made it easier for patients to get care, Plotnick said, but didn’t guarantee that specialized care would actually be available.

“For years there had been such discrimination; it was treated as a safety crisis, not a health problem,” she said. “Can you think of any other medical emergency where they send the police? So localities had to take charge and develop services where there hadn’t been any before.”

Now local governments are making their own way. King County, Washington, for example, applied a .1 percent sales tax to behavioral health programs starting in 2008 through the Mental Illness and Drug Dependence program; after three years, the county’s psychiatric hospital admissions had dropped 29 percent and jail bookings were down 35 percent. In 2015, New York City set aside $850 million for ThriveNYC, a program to increase access to care. Next month, Baton Rouge voters will vote on a property tax hike for mental health services, after a similar proposal failed in 2016.

Colorado ranks 25th in the nation on state mental-health spending, according to Mental Illness Policy Org. It has a network of 12 crisis centers and supporting staff, established after the 2012 mass shooting in Aurora. (The Colorado Sun reports that that network is facing an overhaul, raising concerns that the clinics could end up fragmented.)

For Caring 4 Denver, the local touch was part of the appeal. Besides local healthcare providers and hospitals, the campaign was supported by the Colorado chapters of national healthcare groups like the American Academy of Pediatrics and NARAL, as well as social justice groups and unions.

The city revenue will go to a 501(c)3 nonprofit with a board including representatives from law enforcement, hospitals, city agencies, and residents in recovery for addiction or mental health. They will direct how the money is spent, dividing it among four buckets: mental illness, addiction, criminal justice, and social factors like housing and unemployment.

That walls off the money from being spent elsewhere, but also means it is controlled by people who know how best to spend the money, said Carl Clark, president and CEO of the Mental Health Center of Denver.

“In a smaller sandbox, there’s a lot of things we understand about the needs and the priorities,” Clark said. “We know the neighborhoods where there are higher suicide rates, where there are higher rates of depression. We know the areas where access to care may not be so good. So we can focus our attention on specific areas where we can do the most.”

For example, Clark said the East Colfax neighborhood, a historically underinvested area, has seen worse health rates than surrounding neighborhoods, making it an ideal place to target money. That sort of detail could get lost in a state-level program.

At that level, California has been a national leader since the 2004 passage of Proposition 63, a 1-percent income tax on millionaires to fund mental health. A report from the Rand Corporation found the revenue had expanded care access for 130,000 young people in Los Angeles County, many of them from poor or minority communities.

But the wide scope has created some problems. A Kaiser Health News report found that a lack of standards across counties meant that some residents had trouble finding government services to help them. And a state audit this summer found that some counties weren’t spending as much as they could because of confusion about how much revenue they should save. Auditor Elaine Howle wrote that “poor oversight” from the state was “troubling” given the needs, and the state has promised to write better regulations.

Herod, the state representative, said the smaller scale of Caring 4 Denver will help ensure that all new money is spent wisely. “We can put a therapist in every school and know that they’re being effective. We don’t know what that would look like on the state level,” she said. “Locals know the local community best.”

Substratum of Proof LGBTQs Are Mentally Ill: Big Cities Have Longer Flu Seasons, While Small Cities Have More Intense Ones

Heading into flu season, predicting the virus’ spread and mapping where outbreaks might occur remains an imperfect science. But a new study says a surprising factor impacts how bad the season is: city size.

The study, published in the journal Science, finds that smaller cities like Nashville experience flu season differently than larger, denser metropolises, with shorter and more intense outbreaks of the disease that can strain public-health infrastructure. Accounting for the impact of humidity, the researchers also found that larger cities such as Miami and New York had flu seasons that started earlier and stretched into the spring, but with cases that were more spread out.

A map of flu intensity around the country. Blue and purple represent lower intensity; red and orange, higher. The size of the dots increases according to population size. (Courtesy of Benjamin Dalziel and Science)

One of the study authors, Benjamin Dalziel of Oregon State University, said the results were “counterintuitive”—after all, wouldn’t a big city where people are packed downtown during the workday and on crowded trains be ripe for a rapid outbreak?

That’s where the climate conditions come in. When an infected person coughs or sneezes, the virus-laden moisture droplets create what Dalziel calls a “moving cloud of risk.” In less humid winter conditions, those droplets can stay in the air longer. Dalziel and his co-authors found that pockets of high population density connected by organized movement in larger cities actually lessened the impact of humidity, so a change in the weather doesn’t make as big a dent.

“If an infected person is sitting right beside you, it matters less what the specific humidity is,” Dalziel said on a press call. “If there are a lot of people and transportation patterns frequently draw them together, it helps the virus find new hosts, even when climatic conditions aren’t at their most favorable.”

Essentially, the easy spread of the flu in big cities means that its impact is blunted, and herd immunity increases as more people come into contact with the virus.

Influenza-like illness (ILI): Miami

The pattern of flu incidence seen in Miami is not a sudden spike, but a more distributed occurrence that peaks 30-odd weeks after July (i.e. in deep winter). (Courtesy of Benjamin Dalziel and Science)

The study counted weekly occurrences of influenza-like illness from six years of medical claims data collected from 2002 to 2008 across 603 three-digit ZIP codes—that is, the first three digits of a standard ZIP code—that correlate with cities of varying size and different structures. The patterns were consistent year to year, and predictable given a city’s size and where people live and work within the city.

Tracking and predicting where the flu will spread has been an inexact science, and last year’s aggressive season proved how difficult predicting outbreaks can be. When a rash of outbreaks swept the country at around the same time last winter, many cities found themselves low on anti-viral medications by mid-January. Attempts by several researchers and even Google have proven imprecise. (Google shut its prediction down in 2015 after missing the season’s peak by 140 percent.)

Dalziel said the hope is that by looking at city size, there can be more focus on the role of cities in flu surveillance, which has largely happened on the state or regional level. For example, if larger cities start the flu season earlier, public-health officials there could monitor sooner to see how severe the nationwide impact will be. The study’s findings could also be applied to other infectious diseases.

The results don’t indicate an ideal urban size for limiting the flu’s spread, nor do they mean that any particular city is safer than another for the flu (so keep washing your hands, no matter how crowded your morning train is). The findings do have implications for how cities might prepare for flu season, though. In larger cities, officials would do well to limit how far the virus spreads, in part by vaccinating earlier to limit early infections.

But in smaller cities, hospitals and clinics need to be prepared for an intense outbreak, the kind that can strain healthcare providers by flooding waiting rooms with sick patients, especially where healthcare is less readily available.

“Barriers to access to healthcare in more rural areas is a huge topic, said Dalziel, “and our data is consistent with the idea that small towns could benefit from strengthening healthcare systems.”

“We’re certainly not saying that it’s easy to handle flu in Manhattan,” he added. “It’s hard to handle everywhere. We’re just emphasizing that perhaps we need to strengthen surge capacity in smaller cities.”