Author: Lorraine Apolis

In the House: Military Hunger Prevention Act

On February 15, 2017, a bipartisan group of members in the House of Representatives introduced the Military Hunger Prevention Act, a bill that would help active-duty military members qualify for the Supplemental Nutrition Assistance Program (SNAP), more commonly known as food stamps. SNAP was implemented to address food insecurity and access to a sufficient quantity of affordable nutritious food. It was also designed to improve the long-term health and economic well-being of children.

Military members face unique financial challenges inherent to being active-duty, such as costs incurred from changes of station, deployment, and underemployment among military spouses. According to a survey conducted by Blue Star Families (a nonprofit that raises awareness of issues unique to military life) and the Institute for Veterans and Military Families (an interdisciplinary academic institute that publishes research on the social, economic, and policy issues that affect veterans and their families), 75% of active duty spouses reported that being a military spouse has had a negative impact on their ability to pursue employment.

Consequently, active-duty military members have reported facing food insecurity; some have indicated that they are seeking food assistance through a food bank or charitable organization. Yet, thousands of military members and their families are disqualified from SNAP because they receive a monthly Basic Allowance for Housing (BAH), which is then counted as part of their income when their eligibility for SNAP is determined. This is inconsistent with how other federal programs treat the BAH. For instance, the Internal Revenue Service (IRS) does not consider the BAH as earned income for purposes of assessing Earned Income Tax Credit. Nor is it accounted under the Health and Human Services’ Poverty Guidelines, which determines eligibility for other federal benefits programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) nor the Head Start Program.

It is also worth noting that SNAP is a federal entitlement program, which means that everyone who is eligible for the benefits will receive them. Receiving benefits will not be at the cost of another beneficiary.

The proposed Military Hunger Prevention Act intends to alleviate the food insecurity issue prevalent among active-duty military members who would otherwise qualify if it not for the current provisions under the Food and Nutrition Act of 2008 under 7 U.S.C. 2014(d). Thus, the Act would be an amendment excluding housing allowance “from any calculation of income, assets, or resources” when determining eligibility for any federal program issuing benefits in nutrition assistance.

According to Congresswoman Susan A. Davis, a senior member of the House Armed Services Committee, the Military Hunger Prevention Act would “make good on our national commitment to take care of all those who proudly serve in our armed forces.”

The Act is currently being reviewed by the Committee on House Armed Services and the Committee on House Agriculture.

Veteran Urgent Access to Mental Healthcare Act

On February 7, 2017, bipartisan members of the House of Representatives introduced the Veteran Urgent Access to Mental Healthcare Act to Congress. The current veterans’ bill under U.S. Code Title 38 only provides health care access to combat veterans who were discharged with an honorable status. The proposed bill purports to extend access to urgent mental health care services to combat veterans discharged from the military with a status that would have otherwise made them ineligible for them.

However, the bill is not without reservations. It still excludes veterans who did not deploy in combat or received a “dishonorable” or “bad conduct” discharge. However, it does extend access to noncombat veterans who were victims of sexual assault and battery and sexual harassment. In addition, the bill proposes access to health care services and to facilities outside of the Department of Defense (DOD) healthcare network in cases where the DOD mental health care professional advises or where service would not be economically feasible because of geographical inaccessibility. Still, pressing issues with regards to the number of available mental health providers and funding remain.

According to the Department of Veterans Affairs (VA), an average number of 20 veterans per day commit suicide. With the Veterans Urgent Access to Mental Healthcare Act, its sponsors are hoping to decrease the number of veteran suicides each year. If passed, the Act would require an independent report based on a study comparing the rate and methods of suicide among combat and noncombat veterans, and between those who have received mental heath care services from the Veterans Health Administration and those who have not.

Besides the significant number of suicides, the bill aims to address the controversies surrounding discharges that are “other than honorable.” Representative Mike Coffman, the bill’s principal sponsor and a combat veteran himself, questions “the nature of the discharges in the first place, and [is] exploring that” issue. In 2015, the National Public Radio reported from its study that about 22,000 Army veterans diagnosed with post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI) were discharged as less than honorable. As a combat veteran from two branches of the military, Representative Coffman believes that the stigma surrounding personality disorders has led to inappropriate disciplinary measures and consequently delayed access proper health care.

Last year, Representative Coffman proposed a similar bill. However, it did not pass the House. The previous bill purported to expand mental health care access to combat veterans that received dishonorable charges or bad conduct discharges; it did not gain much favor then. Now, with fourteen cosponsors, and the current VA Secretary David Shulkin’s assurance that there will be “greater accountability…improved access, responsiveness and expanded care options,” it is curious to see whether the bill will in fact help serve those who have served.




The Need for Mental Health Toolkit

In 2015, one out of every four reported fatal shootings by police involved a person with a mental illness. This figure does not include injurious but non-deadly shootings.

Perhaps one of the most high-profile of these cases is that of Charles Kinsey, a mental health caretaker that was shot by the police when he tried to help an autistic man that wandered off in the street. In July of this year, North Miami Police responded to a 911 call indicating that an armed man in the street was threatening to suicide. The police then instructed Kinsey and the man with autism to drop on the ground. When the man with autism did not comply, the police shot three times.

In more recent news, a New York Police Department sergeant fatally shot Deborah Danner, 66 years old, on October 16, 2016 in her apartment after she allegedly swung a baseball bat at him. According to Mayor Bill de Blasio, it was not the first time that the police responded to Ms. Danner’s home as a result of her behavior. Police had been dispatched to her apartment after a 911 call was placed detailing Ms. Danner’s erratic actions. This was one of more than 100,000 calls to the emergency call center about emotionally disturbed persons that the New York City police respond to every year. It was later determined that Ms. Danner diagnosed schizophrenic.

Police have been closely scrutinized lately amid a national debate about racially motivated use of deadly force. According to Lindsay Holmes, Deputy Healthy Living Editor of the Huffington Post, mental health “stigma” is a form of discrimination, and perhaps why many law enforcement officers do not know how to deal with mentally ill persons during an encounter.

What is being done about this? In 2015, New York City started providing its police officers advanced training on how to deal with people with mental illness. However, only about 4,400 of the 36,000 officers have been trained so far; the sergeant that fatally shot Ms. Danner had not.

In the District of Columbia, more than 650 Metropolitan Police Department officers are also crisis intervention officers. They receive several hours of training to better understand mental illness and how to better and safely respond to persons dealing with it. In surrounding areas, namely Montgomery County in Maryland, crisis intervention training is only voluntary and is offered four times a year. While more police departments are starting to implement crisis intervention programs, only about half of jurisdictions in America have some sort of program addressing mental health issues among police encounters.

Just last week on October 16, 2016 during the annual convention of the International Association of the Chiefs of Police, United States Attorney General Loretta Lynch announced that the Department of Justice would launch a mental health toolkit that would help police departments deal with crisis management involving the mentally ill. Secretary Hillary Clinton, Democratic presidential candidate, has promised to allocate $1 billion of her first federal budget to law, if elected.

Whether such resources and promises will significantly help train police officers nationwide how to deal with mentally ill persons more appropriately and decrease the number of preventable deaths is hopeful. Such better training will not only help mentally ill persons and the community at large – it will also help police officers themselves.

As the mother of Laval Hall, a schizophrenic young man fatally shot by the police, said, “I think the police officerstheir lives are changed forever when they take the life of somebody like this. They deserve a chance at knowing how to handle these situations and many of them are not given that chance by being given the proper training.

“Other Than Honorable” Health Care

United States Marine Corps veteran Carri Leigh Goodwin reported that she was raped twice while on active duty with the Marine Corps in 2007. No one was prosecuted. Shortly thereafter, Goodwin received an “other than honorable discharge.” In 2009, Goodwin died of acute alcohol poisoning.

Last August, the New York Times published a letter written by Goodwin’s father, also a U.S. Marine Corps veteran, where he described his daughter’s military sexual trauma and the impediments to veterans who need health benefits but received the same military discharge as his daughter.

According to a report published by the Harvard Law School Veterans’ Legal Clinic, more than 125,000 veterans, including 33,000 who served in combat, were discharged as “other than honorable” after September 11, 2011 up to 2013. This constitutes about seven percent of veterans, the highest rate of such discharges since World War II. Other than being denied access to the GI Bill or Yellow Ribbon educational benefits and employment opportunities, an “other than honorable” discharge means being denied access to vital health care services.

As defined under 38 U.S. Code 1720D, military sexual trauma, [MST], is “psychological trauma, which in the judgment of a Veterans Administration (VA) mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training.” According to the VA’s national screening program, 1 in 4 women and 1 in 100 men admit that they have experienced MST. These figures only constitute veterans that have actually sought health care from the VA.

Other than post-traumatic stress disorder, other diagnoses can result from MST. These include depression, mood disorders, and substance use disorders. The Department of Veterans Affairs has also published a list of signs that can determine whether someone has suffered from MST, including worsening work performance.

The VA said that it is committed to ensuring that veterans get the health care they need. Among various services, every VA heath care facility has an MST coordinator and all treatment for physical and mental health conditions that resulted from MST are free of charge. Still, in order to have access to such health care, a veteran must have an “honorable” discharge. While reports of sexual assault in the military have risen by approximately 88 percent between 2007 and 2013, some victims allege that they have faced retaliation for speaking out, namely and most notoriously, by receiving “bad papers”- a “dishonorable” or “other than honorable” discharge.

“Bad papers” are correlated to high rates of suicide. According to former Air Force Chief Prosecutor Colonel Don Christensen, some traumatized service members may take a bad discharge just to escape their perpetrator or because they think it would be easy to upgrade the discharge to an “honorable” one later. Between 2009 and 2012, the Board for Correction of Naval Records, who would have been the final decision-maker in Goodwin’s case, granted just one percent of “other than honorable discharge” upgrade requests. In 2014, Defense Secretary Hagel issued a guideline for review boards to favorably consider discharge upgrade requests for veterans suffering from PTSD. There was no specific mention regarding veterans that suffered personality disorders or MST.

In May 2016, Human Rights Watch recommended that Congress require the Department of Defense to expedite the review of sexual assault cases of veterans who believe they received a wrong type of discharge, and to have greater transparency to the public regarding decisions on such cases.

As for Mr. Goodwin, he wants his daughter’s honor restored. He wants the military to acknowledge that his daughter was the only one that acted honorably by actually reporting her assault.

Veterans Choice Act Needs to Get Its Act Together

In Spring 2016, a report from the Veterans Administration (VA) Office of the Inspector General revealed that 21 of 38 VA medical facilities investigated were using improper scheduling for appointments. This is similar to a practice uncovered two years prior. In 2014, forty veterans died while waiting to be treated by the VA. In an investigation that culminated in Phoenix, Arizona, it was discovered that VA medical facility staff created secret waitlists instead of entering veterans into the actual scheduling system, and thereby hid actual wait times. The scandal exposed a pattern of practice used in VA medical facilities nationwide.

In response to the scandal, Congress passed The Veterans Access, Choice and Accountability Act (“Veterans Choice”) in 2014, with hopes it would improve veterans’ access to and quality of healthcare. Essentially, the law requires the VA to authorize veterans registered in the VA health care system as of August 1, 2014 to receive non-VA care if they live more than forty miles from the nearest VA medical facility or if the treatment they need has a wait time of more than thirty days.

Most VA patients do not have war wounds; they have “worn-out knees and [backs] from lugging heavy gear up and down,” according to Irvin Bishop Small, who served in the U.S. Navy for ten years and lives forty-five miles from the nearest VA medical facility. The Veterans Choice program was created to help veterans like him. When the doctor prescribed physical therapy and acupuncture to Small, he reached out to the nearest Choice private medical facility. He was told he would get a call back, but it was him who ended up calling back, over and over again. Because of the lack of necessary treatment, Small’s chronic pain sometimes drove him into deep depression. Legislators that created the program now admit that thousands of veterans are in the same situation.

According to a June 2016 report released by the Commission on Care, the unit Congress charged with implementing the program, Veterans Choice is thoroughly flawed in its design and operation. The report showed some racial and ethnic health care disparities and private medical facilities refusing to treat veterans because of delayed reimbursements, if any at all. It also showed aggravated wait times in some VA medical facilities. Still, it has produced some positive results. A survey showed that 90 percent of veterans were satisfied with the appointments’ timeliness. Still, VA Secretary Robert A. MacDonald said that, “until all veterans say they are satisfied…nobody at VA will be satisfied.”

Meanwhile, presidential candidates are making promises to solve the problem. Republican Nominee Donald Trump pledged that he would expand the Veterans Choice program to allow veterans to choose their doctor and medical facility, regardless of whether they are affiliated with the VA. J. David Cox, president of the American Federation of Government Employees, and a spokesman for opposing candidate Hillary Clinton, disputes that Trump’s proposed plan would lead to the VA’s privatization and private corporations making profit off of veterans suffering.

Many oppose increasing privatization because they believe that VA staff, which are largely made up of veterans themselves, will understand veterans’ needs better than a private caretaker. Bill Breeden, a Vietnam veteran, said that veterans “talk the same language…same issues, [and are] concerned about veterans’ issues.” It is curious to see if promises will be fulfilled and whether this time, the VA will create a system that actually gives each veteran a choice.

Better Breastfeeding Laws for a New Normal

Malnutrition causes about one-third of deaths among children under five. More than half of these deaths are because of inappropriate feeding practices during the first year of life. As a way to improve young children’s health and nutrition, the World Health Organization (WHO) recommends that mothers breastfeed their children within the first hour of life. Evidence shows that exclusive breastfeeding for the first six months up to two years has the single largest impact on a child’s likelihood to survive and thrive.

In 1981, WHO adopted the International Code of Marketing of Breast-Milk Substitutes (the Code). The Code prohibits promotion of breast-milk substitutes including advertisements, gifts to health workers, and distribution of free samples. It also requires that breast-milk packages contain a message about the superiority of breast-feeding over formula. The Code does not absolutely prohibit breast-milk substitutes. WHO’s recently released resolution in June 2016 guides governments and companies on how to better handle breast-milk substitutes: “they should be readily available, but not promoted.” However, out of the 194 WHO member states, only 39 countries have laws executing all provisions of the Code; only six have allocated budget or funding for monitoring and enforcement.

The WHO, United Nations Children’s Fund (UNICEF), and the International Baby Food Action Network (IBFAN) say breast milk is safe, clean, and contains antibodies that help protect against many common childhood illnesses. Breastfed children perform better on intelligence tests, and are less likely to be overweight, obese, or diabetic. Mothers also benefit from reduced risks of breast and ovarian cancer. UNICEF Chief of Nutrition, Werner Schultink, emphasized that mothers should be aware of the “readily available means to protect the health and well-being of their children.”

According to the United Nations’ most recent report on nutrition, breastfeeding has the potential to save lives of more than 820,000 children and 20,000 women. Additionally, the global economy can gain up to $300 billion if every infant is exclusively breastfed for at least six months. Still, the more developed countries are plagued with breastfeeding controversies. In March, earlier this year, a woman in D.C. was fired for pumping breast-milk for her newborn child during her break at a desk job. A federal judge ruled in March that the D.C. police officer could sue the city. Also earlier this year, at the London Heathrow Airport, security threw out a mother’s two weeks worth of breast-milk. Several airports have long had equipment to securely check large amounts of liquid such as milk for young children.

Lancet, a UK medical journal, suggests some ways to improve protection and promotion of breastfeeding. Increased provisions for paid maternity leave and Affordable Care Act provision for protected nursing breaks and insurance coverage for breast pumps could increase breastfeeding by up to 25%. However, there is concern on whether breastfeeding can transmit infectious diseases such as the Ebola Virus and AIDS. Researchers from the University of Cambridge and Wellcome Trust Sanger Institute published case studies in the Virus Evolution journal, stating that a mother may have transmitted Ebola to her baby by breastfeeding. Previously, WHO advised that HIV-positive mothers to refrain from breastfeeding. However, on November 2009, WHO revised its recommendations. HIV-positive mothers risk less than 1% chance of transmission if they also take antiretroviral drugs throughout the period of breastfeeding.

Advocacy groups such as the United States Breastfeeding Committee are driving collaborative efforts for policy and practices that could protect and promote breastfeeding in the U.S. Still, the U.S. has yet to create laws that mirror the Code.