The Newly Elected 114th Congress: With the Republican Party having an outstanding election eve, the Grand Old Party controls both the U.S. House of Representatives and the U.S. Senate for the first time since 2006, when President George W. Bush occupied the White House. Their margin of victory in the House takes them close to surpassing their largest majority of the post-World War II era. Accordingly, one must expect an extensive public debate regarding the fundamental role of government in our society through a number of different venues, including whether Obamacare (or critical aspects of it) should be repealed. During my tenure on the U.S. Senate staff, Bob Ax, who worked for the federal Bureau of Prisons for 20 years and before that for the Trenton State Prison in New Jersey, was a frequent visitor, bringing his psychology interns to the Hill to get a firsthand glimpse of the public policy/political process. From his vantage point of retirement, he has been reflecting upon whether our current federal and state health care systems (including that of DoD and the VA) might undergo a significant privatization evolution in the foreseeable future – as he personally experienced with the prison system. And, if so, what might be the impact on quality of care and psychology.
"The private prison initiative began in America three decades ago and has grown exponentially since then. Since 2000, an increasing percentage of federal and state inmates have been housed in private facilities, even as the overall prison population plateaued and then dropped slightly. Privately owned or operated prisons now exist in many first-world countries. Notwithstanding numerous criticisms about their operations, private prisons are less accountable than those operated through the civil service. More information can be legally withheld as proprietary, a problem that led to Representative Sheila Jackson Lee introducing the Private Prison Information Act of 2011 as a corrective measure. The Act died in committee.
"Many of the immigrant detainee facilities around the country are privately owned and/or operated. Since 2009, the Department of Homeland Security's funding appropriations bills have included a provision mandating that 34,000 beds in these facilities be available each day, ensuring that tax-payer dollars continue to flow into the coffers of for-profit corporations. In 2013, Immigration and Customs Enforcement (ICE) detained almost 441,000 aliens. About half of these were housed in privately-owned or operated facilities.
"To ensure the continuity of the revenue streams, private prison corporations have contributed directly to political campaigns and otherwise funneled money to politicians to influence the passage of favorable legislation. They favor states with some of the toughest sentencing laws, particularly those that had enacted legislation to lengthen the sentence given to any offender who was convicted of a felony for the third time. Between 2000 and 2004, private-prison interests gave almost $2.1 million in 22 states that had a so-called 'three strikes law,' compared with $1.2 million in 22 states that did not pass such legislation. That is to say, they are actively engaged in the public policy/political process.
The underlying business model relies in part on monetizing inconvenient people: individuals whose behavior and/or status (e.g., as a person with serious and persistent mental illness, indigent, or a member of racial minority group) renders them disproportionately vulnerable to arrest and incarceration. More behavior criminalized means more prisoners and a greater return on investment. Tax dollars follow them out of the 'free world' community (where the funds might have been spent on schools, hospitals, or job programs) and into housing these men, women, and children in the criminal justice system. Private prisons seemed at first to be a necessary stop-gap solution to the burgeoning prison population in the 1980s and 1990s. Now they've become entrenched within the so-called prison-industrial complex.
"Under the best of circumstances, correctional health care, whether delivered through the private or public sector, is going to be problematic. On a day-to-day basis, treatment is inevitably a mission subordinated to safety and security concerns. Whereas health care providers are trained to consider individual differences, the criminal justice system emphasizes uniformity. Too often ignored as health care issues are the iatrogenic effects of incarceration, both on those incarcerated and on those impacted by extension: family members and communities.
"If we want healthier inmates, we should have fewer of them. Prevention is good health care, but bad business for a company that gets reimbursed for keeping prison cells full. The public needs to decide where it wants its tax dollars to go: toward healthier, stronger individuals, families and communities, or prisons and jails. We spent the last four decades tearing down psychiatric hospitals and building prisons. Now the discourse has begun to shift, with intimations of a move towards reducing incarceration. However, the incarceration rates – still near, if slightly below, record highs – reflect our abiding ambivalence toward prison reform, which would necessarily impact private prison companies" (Bob Ax).
The Long Term Policy Contributions of "Think Tanks": As those currently responsible for determining the role of government (i.e., our elected officials) engage in their ongoing debates, it is incumbent upon healthcare professionals and those of other disciplines to systematically bring to the nation's public consciousness agendas and concerns which should be addressed. To the extent to which the best of science informs this process, the nation will be well served. The Board on Children, Youth, and Families, directed by psychologist Kimber Bogard, of the Institute of Medicine (IOM) and the National Research Council recently released its report entitled Investing in the Health and Well-Being of Young Adults.
Young adulthood – ages approximately 18 to 26 – is a critical time in life. What happens during these years has profound and long-lasting implications for future employment and career paths and for their economic security, health, and well-being. Young adults are key contributors to the nation's workforce and military services and, since many are parents, to the healthy development and well-being of the next generation. In recent decades, the world has changed to place greater demands on young adults and provide less latitude for failure. The disruption and lengthening of established social and economic pathways into adulthood have presented more choices and opportunities for some young adults and more barriers for others. Providing educational, economic, social and health supports will help young adults assume adult roles, develop marketable skills, and adopt healthy lifelong habits that will benefit them, their children, and the nation. Despite popular attention to some of the special circumstances of young adults, however, they are too rarely treated as a distinct population in policy, program design, and research. Instead they are often grouped with adolescents or, more often, with all adults.
Focusing on the health and well-being of the current cohort of young adults is especially important because of the powerful (and perhaps transformative) economic and social forces now at work – the restructuring of the economy, widening inequality, a rapidly increasing "elder dependency ration" (i.e., the ratio of the population aged 65 and older to the working-age population). The future well-being of the nation rests on the investments made in all young adults today – particularly those whose background and characteristics put them at risk of experiencing the greatest struggles. Providing more of the educational, economic, social, and health supports they need will help ensure equal opportunity, erase disparities, and enable more young adults to successfully embrace adult roles as healthy workers, parents, and citizens.
The IOM report emphasized that: * Young adulthood is a critical developmental period; * The world has changed in ways that place greater demands on young adults; * Young adults today follow less predictable pathways than those in previous generations; * Inequality can be magnified during young adulthood; * Young adults are surprisingly unhealthy; And, * Supporting young adults will benefit society. Addressing the health status of young adults: Young adulthood is a critical period for protecting health, not just during the transitional years but over the life-course. Unfortunately, the dominant pattern among young adults today is declining health, seen most clearly in health behaviors and related health statuses. As adolescents age into their early and mid-20s, they are less likely to eat breakfast, exercise, and get regular physical and dental checkups, and more likely to eat fast food, contact sexually transmitted diseases, smoke cigarettes, use marijuana and hard drugs, and binge drink. In many areas of risky behavior, young adults show a worse health profile than both adolescents and older adults. For example, they are more likely to be injured or die in motor vehicle crashes and to have related hospitalizations and emergency room visits. Many risky behaviors peak, but it is also the time when involvement in risky behaviors begins to decline. It is a time of heightened psychological vulnerability and onset of serious mental health disorders, a problem compounded by failure to recognize illness or to seek treatment. Almost one-fifth of young adults had a mental illness in the past year and four percent had a serious mental illness. Yet, two-thirds of those with a mental illness and almost half of those with a serious mental illness did not receive treatment. Not surprisingly, the current generation of young adults appears to be in the forefront of the obesity epidemic and is more vulnerable than previous generations to obesity-related health problems consequences in later years.
The higher levels of poor health in young adulthood have important consequences for future health, educational attainment, and economic well-being. Rapid technological changes, economic challenges, and a prolonged transition to adulthood appear to be contributing to the health problems of young adults by increasing their stress and sedentary habits. Nevertheless, the report made it clear that it was not intended to imply the creation of an extensive set of new programs targeted only at young adults as this would have the potential to create new silos and concerns about lack of coordination across various ongoing programs. Rather the intent is to increase focus on how policies and programs are working for young adults. New policies, programs, and practices should be recommended only when the evidence indicates that young adults' specific needs are not being met. Three common themes emerged: 1.) Current policies and programs addressing this population too often are fragmented and uncoordinated. 2.) These policies and programs often are inadequately focused on the specific developmental needs of this population. And, 3.) The evidence base on interventions, policies, programs, and service designs that are effective for young adults is limited in most areas.
Retirement: "If you've been a workaholic, it's important to have plans for a 'new mission' in retirement to give your life focus and meaning. Otherwise, retirement can feel empty initially. There are unexpected disruptions, financial expenses or losses, deaths of significant friends and family. But most of those who functioned at a high level in their careers get through it with new activities and new values appropriate to the post-retirement phase of life" (Kris Ludwigsen). Oh, I Believe In Yesterday. Aloha,
Pat DeLeon, former APA President – Division 29 – November, 2014
