Franklin Cook of Watertown knows the issue of suicide among men all too well. In 1978, when Cook was 24, his father killed himself.
After that Cook struggled with addiction and found recovery, suffered from depression but got treatment, and built a career in suicide prevention and suicide grief support.
He knows many men struggle to seek help for mental illness.
More men than women die by suicide, and across the country middle-aged white men have the highest suicide rate of any age group.
“But the care-giving world also doesn’t market or doesn’t design programs specifically around our species, if you will,” Cook says. “[Some men] might not want to sit down face-to-face and talk to somebody for 55 minutes about their feelings. I’ve done that hundreds of times with a counselor, and it works for me, but it doesn’t work for all men.”
Now Cook is helping lead a Massachusetts suicide prevention campaign centered around a new website called MassMen.org. It was created by the Wellesley-based organization Screening for Mental Health, with funding from the state Department of Public Health.
On the site, people can complete an anonymous mental health screening in about two minutes to find out whether their feelings and behaviors are consistent with depression or another mental health disorder. They get results immediately and after the screening a “video doctor” does an interactive assessment.
“I’m concerned about your symptoms. I want to be sure you’re aware of the impact this can have on your health and well-being,” the video doctor, portrayed by an actor, says in one portion of the segment. “To help me understand how you feel about taking steps to feel less depressed, I have a question for you. On a scale of one to nine, how ready would you say you are to take steps to feel better?”
Candice Porter is executive director of Screening for Mental Health and a clinical social worker. She points out that while middle-aged men have the highest suicide rate, many of them may not be “moping around,” appearing overtly sad or depressed.‘Suicide: A Crisis In The Shadows’
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- Suicide Prevention Campaign Approaches Men ‘On Their Own Terms’
“They might mask their symptoms in a lot of ways that we’re not recognizing, and they’re not seeking the help,” Porter says. But she adds that even though the men might not seek counseling or treatment, many people who die by suicide visit their doctor for some physical ailment in the months leading up to their death.
“We do know that the primary care physicians are not asking the question, ‘How are you feeling? Are you depressed? Have you had thoughts of wanting to end your life?'” Porter explains. “So part of what we’re also trying to do is just increase awareness that these questions should be asked.”
The MassMen site also directs users to resources including mental health services in their communities.
Screening for Mental Health is sharing its online assessment tool for free with hospitals and community-based health providers, as well as workplaces.
And the nonprofit organization is trying another approach to target men: directing them to a website called ManTherapy, which is based in Colorado and used in that state’s suicide prevention efforts. The site features a mock therapist using exaggerated, sometimes raunchy humor that plays into stereotypes of masculinity.
“Most men think they shouldn’t share their feelings, emotions and personal problems with other men. They’re afraid of being made fun of or referred to as a girly man by their friends,” says the character, Dr. Rich Mahogany.
Cook acknowledges the site won’t appeal to everyone.
“And ManTherapy will be offensive, even, I think, to some,” Cook says. “The reason we decided to use it is that it is an innovative approach to really cracking open the door around approaching men on their own terms.”
After spreading word of the MassMen site with regional social media campaigns and billboards, organizers will collect data to find out if anonymous users have indeed found help for their mental illness or suicidal thoughts.
Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673).Related:
UPDATED March 26
The troubled payment formula for Medicare physicians is one step closer to repeal.
The House Thursday overwhelmingly passed legislation to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package.
According to a summary of the bill, unveiled by Republican and Democratic committee leaders earlier this week, the current system would be scrapped and replaced with payment increases for doctors for the next five years as Medicare transitions to a new system focused “on quality, value and accountability.”
There’s enough in the wide-ranging deal for both sides to love or hate.
Senate Democrats have pressed to add to the proposal four years of funding for an unrelated program, the Children’s Health Insurance Program, or CHIP. The House package extends CHIP for two years. In a statement Saturday, Senate Finance Democrats said they were “united by the necessity of extending CHIP funding for another four years” but others have suggested they may support the package.
Some senators have also raised concerns about asking Medicare beneficiaries to pay for more of their medical care, the impact of the package on women’s health services and cuts to Medicare providers.
In a letter to House members before Thursday’s vote, the seniors group AARP said the legislation places “unfair burdens on beneficiaries. AARP and other consumer and aging organizations remain concerned that beneficiaries account for the largest portion of budget offsets (roughly $35 billion) through greater out-of-pocket expenses” on top of higher Part B premiums that beneficiaries will pay to prevent the scheduled cut in Medicare physician payments.
Some Democratic allies said the CHIP disagreement should not undermine the proposal. After the House approved the SGR package by a vote of 392-37, Ron Pollack, executive director of the consumers group Families USA, urged the Senate to “adopt a CHIP funding bill as soon as possible. Families USA believes that a four-year extension is preferable to two years. We also know that time is of the essence, and it is crucial that the Senate act quickly.”
Some GOP conservatives and Democrats are unhappy that the package isn’t fully paid for, with policy changes governing Medicare beneficiaries and providers paying for only about $70 billion of the approximately $200 billion package. The Congressional Budget Office Wednesday said the bill would add $141 billion to the federal deficit.
For doctors, the package offers an end to a familiar but frustrating rite. Lawmakers have invariably deferred the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times. In a statement Sunday, the American Medical Association urged Congress “to seize the moment” to enact the changes.
Here are some answers to frequently asked questions about the proposal and the congressional ritual known as the doc fix.
Q: How did this become an issue?This KHN story can be republished for free (details).
Today’s problem is a result of efforts years ago to control federal spending – a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth, known as the “sustainable growth rate” (SGR). For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors were furious when their payments were reduced 4.8 percent. Every year since, Congress has staved off the scheduled cuts. But each deferral just increased the size of the fix needed the next time.
The Medicare Payment Advisory Commission (MedPAC), which advises Congress, says the SGR is “fundamentally flawed” and has called for its repeal. The SGR provides “no incentive for providers to restrain volume,” the agency said.
Q. Why haven’t lawmakers simply eliminated the formula before?
Money is the biggest problem. An earlier bipartisan, bicameral SGR overhaul plan produced jointly by three key congressional committees would cost $175 billion over the next decade, according to the Congressional Budget Office. While that’s far less than previous estimates for SGR repeal, it is difficult to find consensus on how to finance a fix.
For physicians, the prospect of facing big payment cuts is a source of mounting frustration. Some say the uncertainty has led them to quit the program, while others are threatening to do so. Still, defections have not been significant to date, according to MedPAC.
In a March 2014 report, the panel stated that beneficiaries’ access to physician services is “stable and similar to (or better than) access among privately insured individuals ages 50 to 64.” Those findings could change, however, if the full force of SGR cuts were ever implemented.
“The flawed Sustainable Growth Rate (SGR) formula and the cycle of patches to keep it from going into effect have created an unstable environment that hinders physicians’ ability to implement new models of care delivery that could improve care for patients,” said Dr. Robert M. Wah, president of the American Medical Association. “We support the policy to permanently eliminate the SGR and call on Congress to seize the moment and finally put in place reforms that will foster innovation and put us on a path towards a more sustainable Medicare program.”
Q: What are the options that Congress is looking at?
The House package would scrap the SGR and give doctors a 0.5 percent bump for each of the next five years as Medicare transitions to a payment system designed to reward physicians based on the quality of care provided, rather than the quantity of procedures performed, as the current payment formula does.
The measure, which builds upon last year’s legislation from the House Energy and Commerce and Ways and Means Committees and the Senate Finance Committee, would encourage better care coordination and chronic care management, ideas that experts have said are needed in the Medicare program. It would give a 5 percent payment bonus to providers who receive a “significant portion” of their revenue from an “alternative payment model” or patient-centered medical home. It would also allow broader use of Medicare data for “transparency and quality improvement” purposes.
“The SGR has generated repeated crises for nearly two decades,” Energy and Commerce Committee Chairman Fred Upton, R-Mich., one of the bill’s drafters, said in a statement. “We have a historic opportunity to finally move to a system that promotes quality over quantity and begins the important work of addressing Medicare’s structural issues.”
The package, which House Speaker John Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif., began negotiating weeks ago, also includes an additional $7.2 billion for community health centers over the next two years. NARAL Pro-Choice America denounced the deal because the health center funding would be subject to the Hyde Amendment, a common legislative provision that says federal money can be used for abortions only when a pregnancy is the result of rape, incest or to save the life of the mother.
In a letter to Democratic colleagues, Pelosi said the funding would occur “under the same terms that Members have previously supported and voted on almost every year since 1979.” In a statement, the National Association of Community Health Centers said the proposal “represents no change in current policy for Health Centers, and would not change anything about how Health Centers operate today.”
A summary of the House plan says the package also includes other health measures – known as extenders – that Congress has renewed each year during the SGR debate. The list includes funding for therapy services, ambulance services and rural hospitals, as well as continuing a program that allows low-income people to keep their Medicaid coverage as they transition into employment and earn more money. The deal also would permanently extend the Qualifying Individual, or QI program, which helps low-income seniors pay their Medicare premiums.
Q. What is the plan for CHIP?
The House plan would add two years of funding for CHIP, a federal-state program that provides insurance for low-income children whose families earned too much money to qualify for Medicaid. While the health law continues CHIP authorization through 2019, funding for the program has not been extended beyond the end of September.
The length of the proposed extension could cause strains with Senate Democrats beyond those on the Finance panel who have raised objections to the House package. Last month, the Senate Democratic caucus signed on to legislation from Sen. Sherrod Brown, D-Ohio, calling for a four-year extension of the current CHIP program.
Q: How would Congress pay for all of that?
The measure the House passed does not. That is a major departure from the GOP’s mantra that all legislation must be financed. Tired of the yearly SGR battle, veteran members in both chambers may be willing to repeal the SGR on the basis that it’s a budget gimmick – the cuts are never made – and therefore financing is unnecessary. But that strategy could run into stiff opposition from Republican lawmakers and some Democrats.
Most lawmakers feel the need to find financing for the Medicare extenders, the CHIP extension and any increase in physician payments over the current pay schedule. Those items account for about $70 billion of financing in the approximately $200 billion package.
Conservative groups are urging Republicans to fully finance any SGR repeal. “Americans didn’t hand Republicans a historic House majority to engage in more deficit spending and budget gimmickry,” Dan Holler, communications director for Heritage Action for America, said earlier this month.
Q. Will seniors and Medicare providers have to help pay for the plan?
Starting in 2018, wealthier Medicare beneficiaries (individuals with incomes between $133,500 to $214,000, with thresholds likely higher for couples) would pay more for their Medicare coverage, a provision impacting just 2 percent of beneficiaries, according to the summary.
Starting in 2020, “first-dollar” supplemental Medicare insurance known as “Medigap” would not be able to cover the Part B deductible for new beneficiaries, which is currently $147 per year but has increased in past years.
But the effect of that change may be mitigated, according to one analysis.
“Because Medigap policies would no longer pay the Part B deductible, Medigap premiums for the affected policies would go down. Most affected beneficiaries would come out ahead — the drop in their Medigap premiums would exceed the increase in their cost sharing for health services,” according to an analysis from the Center on Budget and Policy Priorities, a left-leaning think tank. “Some others would come out behind. In both cases, the effect would be small — generally no more than $100 a year.”
Experts contend that the “first-dollar” plans, which cover nearly all deductibles and co-payments, keep beneficiaries from being judicious when making medical decisions. According to lobbyists and aides, an earlier version of the “doc fix” legislation that negotiators considered would have prohibited “first dollar” plans from covering the first $250 in costs for new beneficiaries.
Post-acute providers, such as long-term care and inpatient rehabilitation hospitals, skilled nursing facilities and home health and hospice organizations, would help finance the repeal, receiving base pay increases of 1 percent in 2018, about half of what was previously expected.
Other changes include phasing in a one-time 3.2 percentage-point boost in the base payment rate for hospitals currently scheduled to take effect in fiscal 2018. The number of years of the phase-in isn’t specified in the bill summary.
Scheduled reductions in Medicaid “disproportionate share” payments to hospitals that care for large numbers of people who are uninsured or covered by Medicaid would be delayed by one year to fiscal 2018 but extended for an additional year to fiscal 2025.
Q. How quickly could the Senate act?
The wide margin of passage in the House, plus the Obama administration’s support of the measure, may put pressure on senators to pass the bill once they conclude work on the chamber’s fiscal 2016 budget resolution later Thursday or early Friday morning. But Senate Democrats and Republicans may want to offer amendments to the House bill, which could mean that the chamber does not resolve the SGR issue before the Senate’s two-week break, which is scheduled to begin March 30.
If the SGR issue can’t be resolved by March 31, Congress could pass a temporary patch as negotiations continue or ask the Centers for Medicare and Medicaid Services, which oversees Medicare, to hold the claims in order to avoid physicians seeing their payments cut 21 percent. However, Speaker Boehner has said the House will not consider a temporary patch before leaving for its break Thursday.
This article was updated to include House floor action on Thursday.
Starting in 2012, I have posted information about this award and have enjoyed following the nominees and winners. I look forward to seeing which titles are selected for this year’s award. The following is a guest post by Monique Fields, manager of communications at the University of Alabama School of Law.
The University of Alabama School of Law and the ABA Journal have announced the 2015 call for entries for the Harper Lee Prize for Legal Fiction. The prize is awarded annually to a published work of fiction that best illuminates the role of lawyers in society and their power to effect change. Only works published in 2014 qualify. The deadline for entries is March 31.
Five years ago, to commemorate the 50th anniversary of the publication of To Kill A Mockingbird and to honor former Alabama law student and author Harper Lee, the University of Alabama School of Law and the ABA Journal partnered to award the first Harper Lee Prize for Legal Fiction. Past winners were: The Fifth Witness by Michael Connelly, Havana Requiem by Paul Goldstein and Sycamore Row by John Grisham.
The 2015 prize will be awarded in Washington, D.C., on September 3, 2015, in conjunction with the Library of Congress National Book Festival, which will be held on Saturday, September 5, 2015, at the Walter E. Washington Convention Center in Washington, D.C. The winner will receive a signed copy of To Kill a Mockingbird.
For more information, visit harperleeprize.com or contact Monique Fields at email@example.com.
Individuals cannot privately own land in China but may obtain transferrable land-use rights for a number of years for a fee. Currently, the maximum term for urban land-use rights granted for residential purposes is 70 years. In addition, individuals can privately own residential houses and apartments on the land ("home ownership"), although not the land on which the buildings are situated. Both urban land-use rights and home ownership are subject to registration.
Visit http://www.loc.gov/law/help/real-property-law/china.php to read the entire report.
This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php. The Law Library of Congress produces reports for members of Congress and others. Learn more at http://blogs.loc.gov/law/2013/05/law-library-provides-global-legal-research/.
Freedom of peaceful assembly is a recognized right under international human rights law. This report provides a comparative review of one aspect of this right: whether advance notification or authorization is required for an assembly to take place under the law of France, Italy, Portugal, Spain, Sweden, the United Kingdom, and the United States. The report also reviews the relevant case law of the European Court of Human Rights.
Visit http://www.loc.gov/law/help/peaceful-assembly/index.php to read the entire report.
This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php.