Tuberculosis – The Final Frontier: Pt. 1 “Global Growing Health Crisis”

Throughout time, mankind's ingenuity has
been breathtaking: We've discovered fire… Invented the wheel… Created the world wide web. Yet for centuries one tiny microorganism has defied us. I feel that Tuberculosis at present is like a time bomb… and it will blast anytime. Tuberculosis is one of the world's foremost infectious killers… infecting nine million new people every year. and now the bacterium is mutating into far deadly forms. You should be not just worried but very worried about drug resistant TB. There is as an estimated over 600,000
cases in the world and these cases are everywhere. They are in Europe, they're in Africa, they're in Asia they are on everybody's doorstep.

It is
everybody's problem now. Drug-resistant TB does not respond to
the first-line antibiotics used to treat standard TB. It's airbourne, infectious and spreading indiscriminately. We are now facing a major emergency with drug-resistant TB… with increasing numbers around the world. In all of our projects when we look we are finding patients in really large numbers. One infected person can spread TB to another 15 more person in the year so if we don't reduce multi-drug
resistant TB then there will be a lot of open cases and it will keep mounting up again more and more. Despite the growing global health threat, the response is shockingly inadequate. Today, barely one in twenty TB patients is
probably tested for drug resistance… and new tools for rapid diagnosis have yet
to reach many places. After recieving the report… that my daughter died on (MDRTB)… I nearly had a stroke. She was tested in time but I was told that the results would come after six weeks.

Six weeks came, two months came, three months came, four months came that time she was dead already. If maybe there was a way of getting the
treatment sooner she wouldn't die. For Briggitte's daughter the long
diagnosis period cost her life but not before the resistant strain of
TB had spread to her young son. Thankfully a new rapid diagnostic
test enabled Savouley to get the right treatment fast. Now he faces the next big challenge. As a medical doctor I find it extremely conflicting to put a patient on MDR-TB treatment. First of all the drugs are toxic They are minimally effective and they can cause long drawn-out suffering and lasting
side effects.

[The drugs make you very weak] [I can't even sit up for ten minutes, for two to three hours after i've taken them] [I always have to stay lying down. I can only spend an hour or two on my feet each day] After two years taking thousands of pills and receiving hundreds of injections patients have a paltry 50 percent
chance of cure. And with no formulations for children
available the situation is critical.

We are in a very terrible situation at the
moment. Only about one in five patients are estimated to get treatment, this is
woefully inadequate. Add to that the extortionate cost of the
drugs and grossly inadequate international
funding and it's clear we face an impending disaster. The Global Fund is the most important
international donor for TB providing around ninety percent of the
funding. In the last round actually TB was deprioritized and receive a smaller
share of funding and this undermines what we're trying to
do in the field and it sends a very bad negative
message about how important TB is as a priority.

The price of not acting is really too
frightening to comprehend. We need more research and development, we need more innovation
and we need better tools..

As found on YouTube

Essential Business English 2 — The Marketing Meeting

OK everyone, let's get started. As you know, the object of this meeting is to review our marketing strategy and come up with ideas for the next campaign. Sally would you like to get the ball rolling? Well, I think our current strategy is too focused on women in the 30 to 45 age range. We should be targeting our brand at a younger audience. I agree with Sally. Young people are increasingly interested in fashion. So what can we do to reach this target? Alan, do you have any suggestions? What about using social media? Our advertising is mainly based around traditional media such as print and television. Nobody under 25 reads newspapers anymore. I'm not so sure about that. Fashion magazines and supplements play an important role in our overall marketing mix. Yes, but we need to be using Twitter and Facebook too if we want to increase our market share among millennials. Can I make a suggestion? Of course, Kevin. Why don't we hire a social media manager? Someone who could connect with potential customers and promote the Chic Boutique brand online.

That's a good idea. It's certainly something we should consider. I'll bring it up at next week's board meeting. Right, I think we've covered everything. I'll send you a copy of the minutes tomorrow and we can start thinking about the agenda for the next meeting. Thank you, everyone..

As found on YouTube

Faith Communities, Veterans and Mental Health – Video #2 – “Trauma”

MAN: WELCOME
TO THE SECOND VIDEO IN A 4-PART SERIES
ON FAITH COMMUNITIES, VETERANS, AND MENTAL
HEALTH ISSUES. IN THIS VIDEO,
WE TURN OUR ATTENTION TO THE TOPIC OF TRAUMA AND SPECIFICALLY TO
WHAT IS OFTEN REFERRED TO AS POSTTRAUMATIC STRESS
DISORDER, OR PTSD. FOR OBVIOUS REASONS,
PTSD HAS BEEN UNDERSTOOD AS THE SIGNATURE PSYCHOLOGICAL
WOUND AMONG COMBAT VETERANS. HOWEVER, AS WE MENTIONED
IN THE FIRST VIDEO, MOST VETERANS DO NOT HAVE DIAGNOSABLE
MENTAL HEALTH PROBLEMS. SIMILARLY, HAVING
PARTICIPATED IN COMBAT DOES NOT NECESSITATE THAT ONE
WILL LATER SUFFER FROM PTSD. A VARIETY OF FACTORS
CAN DETERMINE THIS. ADDITIONALLY, MANY THINGS
BESIDES COMBAT CAN LEAD TO PTSD, MAKING EMOTIONAL PAIN
IN THE WAKE OF TRAUMA AN EXPERIENCE THAT FAR
TRANSCENDS JUST THE EXPERIENCE OF THOSE
WHO HAVE SERVED IN THE MILITARY. AS YOU WATCH THIS VIDEO,
WE INVITE YOU TO THINK ABOUT WAYS THAT YOUR COMMUNITY CAN CARE FOR THOSE WHO HAVE
EXPERIENCED TRAUMA– VETERANS OR OTHERWISE– AS WELL AS HOW PROVIDING
THIS KIND OF CARE MIGHT APPLY TO OTHER SORTS
OF EMOTIONAL, SOCIAL, AND PSYCHOLOGICAL CHALLENGES.

HELLO. I'M FATHER
BILL CANTRELL. IN THIS SECOND VIDEO, WE WILL
HEAR FROM A PSYCHIATRIST, A PASTOR, IMAM, AND RABBI, AS WELL AS FROM VETERANS
WHO HAVE HAD SOME DIFFICULTY IN REINTEGRATING
INTO THEIR FAITH COMMUNITIES AFTER HAVING TRAUMATIC
EXPERIENCES. WE WILL BEGIN SPEAKING ABOUT
THE ROLE OF FAITH COMMUNITIES AND SUPPORTING THOSE WHO HAVE
EXPERIENCED TRAUMA. THE INTENSITY OF SUPPORT
THAT TRAUMA DEMANDS CAN OFTEN EXCEED THE ABILITIES
AND AVAILABILITY OF CLERGY. HOW CAN YOU, AS A FAITHFUL
MEMBER OF YOUR COMMUNITY, SUPPORT THIS EFFORT? IN A MOMENT, YOU WILL HEAR
FROM MICHAEL YANDELL.

MICHAEL FACED SERIOUS CHALLENGES WHEN HE DETACHED
FROM MILITARY SERVICE AND HE FOUND RETURNING
TO HIS FAITH COMMUNITY TO BE MUCH MORE DIFFICULT
THAN HE EVER ANTICIPATED. YANDELL: BETWEEN MY RETURN
FROM IRAQ IN 2004 AND MY SEPARATION
FROM THE ARMY IN 2006, UH, I BECAME A VERY
UNSTABLE INDIVIDUAL. I BECAME A VERY ANXIOUS PERSON, A VERY, UH… MANIC PERSON,
AN ARGUMENTATIVE PERSON. AND THEN I WOULD BECOME
SILENT AND…

DEPRESSED, AND… THE COMMUNITY DIDN'T REALLY KNOW
HOW TO DEAL WITH THAT. AND I DON'T HOLD THAT
AGAINST THEM. I WAS EVENTUALLY ASKED
NOT TO COME BACK FOR A WHILE. UM… BECAUSE I WAS UNSTABLE. RETURNING FROM IRAQ,
DRINKING TOO MUCH, STRUGGLING WITH UNDIAGNOSED
MENTAL ILLNESS, AND THEN ATTEMPTING TO FIND
THE RIGHT… UH, COMBINATION OF
MEDICATE–MEDICATIONS TO TREAT THAT MENTAL ILLNESS
ONCE DIAGNOSED– HOW CAN ONE BE QUALIFIED TO SORT OF MEET THE NEEDS
OF SUCH AN INDIVIDUAL? THERE'S A–THERE'S
A LEGITIMATE QUESTION THAT I THINK MAKES CLERGY
HESITATE TO TALK TO VETERANS, ESPECIALLY VETERANS THEY KNOW
HAVE EXPERIENCED, UM, SOME DISTURBING COMBAT, AND IT'S A QUESTION OF,
"I HAVE NOTHING IN MY OWN LIFE "THAT MATCHES
THIS PERSON'S EXPERIENCE.

"HOW CAN I TALK TO THEM
ABOUT WAR? I'VE NOT EXPERIENCED IT." AND TO THAT QUESTION,
I JUST… HAVE COME TO DISCOVER
THAT TRAUMA CHANGES ANY SITUATION, AND IT CHANGES ANY RELATIONSHIP, AND THERE'S NO CLERGYPERSON
ON THE PLANET WHOSE EXPERIENCE MATCHES
THE TRAUMA OF THE PERSON… SHE'S SEEKING TO CARE FOR. A PERSON'S EXPERIENCE
IS HER OWN, AND THE QUALIFICATION
FOR BEING A GOOD… CARER FOR A SOUL ISN'T UNIFORMITY; IT'S… THE DESIRE TO LEARN SOMETHING ABOUT THAT PERSON. IT'S A DESIRE TO TRY TO SEE
THE WORLD THROUGH HER EYES AND TRY TO HELP HER RECKON
WITH HER OWN WORLD AND HER PLACE IN IT.

I THINK WE NEED TO EDUCATE
OUR COMMUNITIES ABOUT WHAT THE LEGACY
OF A TRAUMA IS– BOTH THE PERSONAL TRAUMA
AND THE COMMUNAL TRAUMA. AND, UM, UH, AND THEN ALSO TO
UNDERSTAND WHAT CAN RESTORE THE RUG THAT WAS PULLED OUT
FROM UNDER THEIR FEET. WHAT CAN RESTORE SOME KIND OF
BALANCE, SOME KIND OF MEANING, AND SOME KIND OF CONNECTION? UH, BECAUSE THAT'S
WHAT TRAUMA INTERRUPTS IS THE–THE NORMAL
NARRATIVE YOU HAVE THAT THINGS ARE GONNA BE OKAY– THAT IF I DO THIS,
THIS WILL HAPPEN.

IF I GET ON THE SUBWAY,
I'LL GET TO WORK. I THINK, ALSO, WE HAVE TO
RESPECT THE DIFFICULTY OF SURVIVORS OF TRAUMA
IN RETURNING TO THE STRUCTURES THAT THEY, UH–
THE RELIGIOUS INSTITUTIONS THAT THEY WERE PART OF. IT–IT'S NOT JUST ANGER AT GOD OR ANGER AT THE–
THE, UH, TRADITION. IT'S, UM–IT'S A REAL–
THEY'VE REALLY BEEN THRUST OUT OF A SECURE NARRATIVE. ONE COUPLE IN ONE OF
MY GROUPS SAY THAT THEY– THEY WERE ORTHODOX JEWS,
AND NOW THEY'RE FOOD JEWS. THE WAY THEY OBSERVE IS BY HOSTING HUGE MEALS
ON THE HOLIDAYS, AND THEY DON'T STEP FOOT
IN THE SYNAGOGUE SINCE THEIR SON DIED. AND THAT'S, UM–
THAT'S UNDERSTANDABLE. I THINK THE ONLY WAY
IT WILL CHANGE IS WHEN THE COMMUNITY
AND THE LITURGY AND–AND THE SERMONS ALL ADDRESS THE NEEDS OF BEREAVED,
UH, PEOPLE, IN–IN GROUPS, IN WORKSHOPS, WHATEVER,
AND SO THEIR NARRATIVE BECOMES A PART OF
THE COMMUNITY'S NARRATIVE.

AND I'M SURE THIS APPLIES
TO VETERANS, TOO– THAT–THAT, UM, THEIR NEED TO
BE–THEY NEED TO BE ACKNOWLEDGED FOR WHAT THEY'VE EXPERIENCED
AND–AND NOT JUST TOLERATED– RESPECTED FOR HAVING
A CERTAIN JOURNEY, UM, THAT OTHERS
MAY NOT KNOW VERY WELL. UM, UH, THE KEY TO VISITING
THE SICK IN OUR TRADITION, OR HELPING PEOPLE
WHO ARE SUFFERING, IS SHARING THE VULNERABILITY– NOT–NOT THE DIAGNOSIS
AND NOT THE EXPERIENCE, BUT THE VULNERABILITY
THAT WE ALL HAVE, UH, THAT, UH, YOU KNOW, "THERE
BUT BY THE GRACE OF GOD GO I." ALSO, UM, UH,
IRONICALLY ENOUGH, UM, YOU SHOULDN'T TREAT THEM AS PEOPLE WHO HAVE
BEEN THROUGH TRAUMA. YOU SHOULD TREAT THEM
AS FELLOW HUMAN BEINGS WHO HAVE THE SAME NEEDS
THAT YOU DO OF, UH, FELLOWSHIP,
OF, UM, INSPIRATION, UH, AND OF, UH, SECURITY.

ONE OF THE PARTICULAR, UH,
INSTANCES THAT COMES TO MIND OF TRAUMA IN RELATIONSHIP
TO A CONGREGATION, UH, OCCURRED A NUMBER OF YEARS
AGO WITH A FAMILY WHO, THROUGH A HORRIFIC
SET OF CIRCUMSTANCES, LOST THEIR DAUGHTER. THAT FAMILY CONTINUES
TO TELL THE STORY OF THE LOSS OF THEIR DAUGHTER AND HAS EVEN TAKEN THE TIME
TO DOCUMENT, IN A SMALL, PRIVATELY RELEASED,
UH, MONOGRAPH, UH, THE STORY OF TRAUMA
AND HEALING THROUGH THE BODY OF CHRIST. AND IN SOME WAYS,
WE'RE REAPING THE FRUIT OF THAT TERRIBLE THING
IN THAT, UM, SHE CAME TO PRESENT–SHE AND HER
HUSBAND BOTH CAME AND PRESENTED HER BOOK, AND, UM, SHE–
SHE SPOKE ABOUT GRIEF AND STAGES OF GRIEF AND HOW
HARD IT WAS ON THE MARRIAGE AND HOW IT WAS
FOR THE OTHER SIBLINGS, AND SHE DOCUMENTED HER STORY
IN A WAY, UM, THAT IS DIRECTLY, NOW,
HELPING A FAMILY, UH, WHOSE SON WAS KILLED
IN A CAR ACCIDENT LAST JUNE. SO SHE IS–SHE AND HER HUSBAND
MEET PRIVATELY WITH THIS COUPLE WHO HAS LOST A 25-YEAR-OLD SON, SO THE SUFFERERS BECOME
THE EXPERTS WHERE THERE IS MATURITY
AND GROWTH.

WHEN YOU LISTENED TO IRAQ
VETERAN MICHAEL YANDELL'S STORY OF REJECTION BY
HIS FAITH COMMUNITY, WHAT WERE YOU THINKING? HOW MIGHT YOU TALK WITH SOMEONE
ABOUT A TRAUMATIC EXPERIENCE EVEN IF YOU FIND IT DIFFICULT
TO RELATE? PASTOR POOLE
AND MARGARET FROTHINGHAM DESCRIBED A FAMILY
WHO EXPERIENCED TRAUMA FROM THE LOSS OF THEIR DAUGHTER. THIS HORRIFIC EVENT
TESTED THEM IN MANY WAYS AND HAS NOW EVOLVED INTO THE OFFERING
OF THEIR OWN EXPERIENCE IN THE SERVICE OF OTHERS WHO
GRIEVE THE DEATH OF A CHILD. THIS HARD-TO-IMAGINE TRAUMA
AND SENSE OF LOSS HAS GIVEN THEM AN UNDERSTANDING FROM THEIR OWN PAINFUL
EXPERIENCE, WHICH HAS PROVEN A GREAT COMFORT
AND ENCOURAGEMENT TO OTHERS. HOW MIGHT THIS
INFORM YOUR COMMUNITY ABOUT ITS INTERNAL RESOURCES
FOR THOSE WHO ENTER YOUR DOORS LOOKING FOR A WELCOMING
SPIRITUAL HOME? NOW WE'RE GOING TO HEAR
FROM MATT AND CALLIE BARR.

MATT SERVED MULTIPLE TOURS
WITH THE MARINE CORPS IN IRAQ. WHEN MATT AND CALLIE TRIED TO
RECONNECT TO A FAITH COMMUNITY UPON HIS RETURN FROM DEPLOYMENT,
THEY RAN INTO SOME CHALLENGES, AND THE UNADDRESSED LOSS THAT
HE EXPERIENCED DURING COMBAT CONTINUED TO LINGER. MATT: ALL THIS DEATH– YOU KNOW, WE LOST 20-SOME GUYS
IN MY FIRST DEPLOYMENT, AND, UM, YOU DON'T REALLY GET
TIME TO THINK ABOUT THAT.

WE NEVER WENT TO A FUNERAL.
WE NEVER HAD CLOSURE. WE NEVER SAW THEM BURIED AT HOME
WITH THEIR FAMILIES, YOU KNOW, AND SO, UH–SO
WE DIDN'T HAVE TIME, AND IT WASN'T–IT WASN'T LIKE
THEY WERE GONE. YOU KNOW– CALLIE: I DON'T THINK YOU EVER
REALLY HAD TIME TO– WELL, YOU DON'T HAVE
TIME TO GRIEVE, AND PART OF THAT IS BECAUSE
YOU'RE IN A COMBAT ZONE. MATT: YEAH.
CALLIE: THAT'S HOW YOU SURVIVE. YOU NEED TO GO ON
TO THE NEXT THING. YOU NEED TO FINISH YOUR MISSION.

MATT: SO–SO TO GO FROM, UM… JUST NONSTOP TRAINING, UH,
GOING FROM THE DEPLOYMENT, WE WENT RIGHT
INTO TRAINING AGAIN AND ON TO OUR NEXT DEPLOYMENT,
AND WE DIDN'T REALLY HAVE TIME TO PROCESS ALL THAT HAPPENED
ON OUR FIRST DEPLOYMENT. UH, I GOT A JOB OF, UH, PERSONAL SECURITY
FOR MY COMMANDING OFFICER, AND, UH, UH, SO DURING
DEPLOYMENT, HE WAS KILLED. UH, YOU KNOW, I FAILED, WHICH, YOU KNOW, AS MARINES,
YOU DON'T DO.

WE DON'T FAIL,
SO I'VE HAD PEOPLE TELL ME THERE'S NOTHING I COULD HAVE
DONE, AND THERE REALLY WASN'T. IT WAS IN THE MIDDLE
OF THE NIGHT, AND IT WAS PITCH-BLACK,
AND WE STEPPED ON AN IED, AND HE WAS–HE TOOK THE BLAST,
BASICALLY, AND I WAS JUST, YOU KNOW,
KNOCKED OUT, AND, UH… FINE. I WAS FINE. YOU KNOW, PHYSICALLY THERE
WAS NOTHING WRONG WITH ME. UM, SO I HATED GOD. I KNEW HE WAS THERE,
BUT I HATED HIM. CALLIE: AND THEN I THINK
YOU QUESTIONED, TOO, I MEAN, "WHY AM I STILL HERE?" MATT: YEAH.

CALLIE: RIGHT? "WHY,
IF I'M BELIEVING IN GOD, WHY IS HE SAVING ME BUT HE
DIDN'T SAVE THIS–" LIKE, YOUR COMMANDING OFFICER. MATT: A GREAT MAN. CALLIE: "THIS GREAT MAN
WHO WAS AN INSPIRING LEADER AND HAD CHILDREN?"
WHEN WE DIDN'T HAVE CHILDREN. AND SO YOU'RE–YOU'RE
QUESTIONING, WHAT IS MY VALUE? AND DOES GOD REALLY KNOW
WHAT HE'S DOING? MATT: YEAH.

SINCE THEN, WE'VE BEEN
TRYING TO FIND AND, UM, WE'VE BEEN TO A LOT
OF DIFFERENT CHURCHES, A LOT OF DIFFERENT PLACES
AND, YOU KNOW, UM, THE ONLY PLACE, REALLY,
THAT I'VE FOUND THAT I COULD SHARE MY STORY
WAS AT THE TBI CLINIC. WE HAD WAR GROUPS WHERE WE
BROUGHT IN, UM, YOU KNOW, OTHER WARRIORS THAT HAD
THE SAME EXPERIENCES. UH, THEY DID BRING
A CHAPLAIN IN THERE, UM, JUST TO SEE HOW, KIND OF,
WE'D GET A FEEL FOR, AND, UH, EVERYBODY REALLY
APPRECIATED HIS INPUT AND HIS INSIGHT AND, YOU KNOW,
UM, HIS UNDERSTANDING, AND, YOU KNOW, I THINK
FOR A CHAPLAIN, A PASTOR, YOU KNOW, CLERGYMEN, YOU KNOW–
THEY'RE THE EXPERTS.

THEY'RE THE EXPERTS–
THEY'RE SUPPOSED TO BE THE EXPERTS ON GOD, YOU KNOW? THAT'S WHAT I THINK OF
WHEN I THINK OF THEM. SO WHEN I GO TO THEM AND–
TO SHARE MY STORY, I–I FEEL LIKE I'M SHARING,
LIKE, WITH, UH, AN AMBASSADOR TO GOD, I WOULD SAY,
YOU KNOW? SO, YOU KNOW, I EXPECT THEM
TO, I GUESS, HAVE… YOU KNOW…
CALLIE: INSIGHT? MATT: YEAH. INSIGHT TO,
YOU KNOW, THE MAN HIMSELF
UPSTAIRS, I GUESS.

I DON'T KNOW. LIKE– YOU KNOW, I DON'T EXPECT TO BE,
LIKE, BLESSED AND, "OK, I FEEL CLEAN AND, YOU KNOW,
ALL MY SINS ARE FORGIVEN," BUT I FEEL LIKE, "OK,
I'M AT A GOOD PLACE," YOU KNOW. THE WEIGHT IS LIFTED OFF
A LITTLE BIT. THE BIGGEST THING THAT
I KNOW A LOT OF THESE GUYS THAT GO TO WAR STRUGGLE WITH
IS, YOU KNOW, "WILL GOD SAVE ME?
BECAUSE I'VE KILLED PEOPLE." LIKE, YOU KNOW, "I COMMITTED
THESE GREAT SINS, SO AM I GONNA BE SAVED?"
YOU KNOW.

AND SO THEY WANT TO STAY
AWAY FROM CHURCHES BECAUSE, YOU KNOW, I DON'T KNOW
THAT THERE IS A CHAPLAIN OR THERE IS SOMEBODY
THAT COULD SAY, "YES, YOU CAN BE SAVED
BECAUSE GOD WILL SAVE YOU," YOU KNOW, "BECAUSE YOU– EVEN THOUGH YOU DID
THIS GREAT, UH, SIN." UM… MAN: IN THE VIETNAM ERA,
UNFORTUNATELY, IN 1968, A NEW EDITION OF PSYCHIATRY'S
DIAGNOSTIC GUIDEBOOK WAS PUBLISHED–THE DSM, AND IT DIDN'T INCLUDE ANY
TRAUMA-RELATED DIAGNOSIS IN IT. IT WAS REALLY BAD TIMING
BECAUSE IT WAS RIGHT THEN THAT THE TET OFFENSIVE
WAS HAPPENING AND–AND AMERICAN
SERVICEMEMBERS WERE BEGINNING TO RETURN
IN LARGE NUMBERS FROM VIETNAM IN WHAT WAS AN INCREASINGLY
CHAOTIC WAR SITUATION. UH, AS IT HAPPENED, A MINORITY
OF THOSE RETURNING VETERANS, UH, BEGAN TO ORGANIZE IN WAYS
THAT WERE ACTUALLY OPPOSED TO THE VIETNAM WAR IN A GROUP CALLED VIETNAM
VETERANS AGAINST THE WAR.

THEY BEGAN TO ALLY
WITH SYMPATHETIC CLINICIANS WHO ALSO WERE OPPOSED
TO THE WAR, AND THEY BEGAN TO PARTICIPATE
IN WHAT THEY CALLED RAP GROUPS IN THE NEW YORK OFFICES OF VIETNAM VETERANS
AGAINST THE WAR, AND THERE WAS A SET OF
CLINICIANS NAMED CHAIM SHATAN AND ROBERT JAY LIFTON
WHO BEGAN TO MEET WITH THESE YOUNG
RETURNING VETERANS. A NUMBER OF WRITINGS
EMERGED FROM THAT, INCLUDING A POWERFUL
AND IMPORTANT OP-ED IN THE "NEW YORK TIMES"
BY DR. SHATAN ON MAY 6, 1972. IT WAS TITLED
"POST-VIETNAM SYNDROME." IT WAS AN OP-ED. IT WASN'T
A CLINICAL JOURNAL ARTICLE. BUT, UH, SHATAN DESCRIBED
A COUPLE OF VETERANS WHO EXPERIENCED WHAT WE WOULD
NOW DESCRIBE AS PTSD. THEY WERE–THEY WERE
SUSPICIOUS OF OTHERS. THEY WERE, YOU KNOW,
ALWAYS LOOKING AROUND, CHECKING SURROUNDINGS. AND HE SAID,
"WE MIGHT LABEL THIS "SOMETHING CALLED
POST-VIETNAM SYNDROME, AND HERE'S THE DIFFERENT SIGNS
OF POST-VIETNAM SYNDROME," AND WHAT SHATAN WROTE ABOUT
WAS THINGS LIKE, UM, FEELINGS OF ALIENATION, CONTINUED DOUBT ABOUT
ABILITY TO LOVE OTHERS, FEELINGS OF VICTIMIZATION, AND FEELINGS OF GUILT AND SHAME.

SHATAN SAID IN THIS OP-ED,
UH, SOMETIMES VETERANS WILL ASK, "CAN WE ATONE?
HOW DO WE TURN OFF THE GUILT?" THESE ARE PROFOUNDLY
MORAL QUESTIONS. NOW, THIS GOT A LOT
OF ATTENTION, AND PEOPLE BEGAN TO PAY
ATTENTION TO SHATAN AND–AND TO OTHERS,
AND THEY BEGAN TO SAY, "YOU KNOW, WE ACTUALLY
NEED SOMETHING "WITHIN PSYCHIATRY'S
DIAGNOSTIC GUIDEBOOK THAT REFLECTS THIS EXPERIENCE." SO THEY BEGAN TO TALK
TO THE PEOPLE WHO WERE IN CHARGE
OF THAT PROCESS, AND THE PROCESS TOOK
ALMOST 10 YEARS, AND WHAT EVENTUALLY CAME OUT,
IN 1980, WAS THE DIAGNOSIS OF PTSD, OR POSTTRAUMATIC
STRESS DISORDER.

NOW, IT'S UNFORTUNATE,
IN THAT CONTEXT, THAT WHEN PTSD CAME OUT
AS A DIAGNOSIS, IT–IT HAD LANGUAGE
THAT MOSTLY DESCRIBED PTSD AS A FEAR-BASED DISORDER, BUT WHAT'S INCREASINGLY BEING
RECOGNIZED IN OUR TIME IS THAT PTSD, THESE KINDS
OF RESPONSES, AREN'T ALWAYS MEDIATED
ONLY BY FEAR, ALTHOUGH THAT MIGHT
BE PART OF IT, BUT ARE ALSO MEDIATED
BY–BY OTHER KINDS OF EMOTIONS– BY ANGER, BY SADNESS, AND ESPECIALLY BY GUILT AND SHAME ABOUT THINGS THAT WERE DONE OR SEEN IN WAR THAT ARE HARD TO KNOW WHAT TO DEAL WITH
AS–ONCE RETURNING FROM WAR. "WHO HAVE I BECOME, HAVING DONE
CERTAIN THINGS IN COMBAT "OR HAVING PARTICIPATED
IN CERTAIN THINGS OR HAVING SEEN OTHER PEOPLE
DO CERTAIN KINDS OF THINGS?" AND THAT–THAT–THE TERM
FOR THAT IS INCREASINGLY "MORAL INJURY,"
BUT IT'S IMPORTANT THAT MORAL INJURY IS
NOT A NEW DISCOVERY. IT'S A REDISCOVERY OF
A VERY OLD REALIZATION THAT REALLY IS WITH US FROM THE VERY EARLIEST
DESCRIPTIONS OF COMBAT TRAUMA.

DR. WARREN KINGHORN SPEAKS
OF THE AFTERMATH OF THE VIETNAM WAR AND HOW MANY VETERANS ALLIED
WITH SYMPATHETIC CLINICIANS IN WHAT WERE CALLED RAP GROUPS. ONE OUTCOME WAS AN ARTICLE
ABOUT POST-VIETNAM SYNDROME. THE SIGNS AND SYMPTOMS
NOTED IN THE ARTICLE WERE FEELINGS OF ALIENATION, CONTINUED DOUBT ABOUT
THE ABILITY TO LOVE OTHERS, AND FEELINGS OF VICTIMIZATION,
GUILT, AND SHAME. CAN YOU THINK OF WAYS IN WHICH
A FAITH COMMUNITY MIGHT BE SUITED TO RESPOND
TO THESE SYMPTOMS? YOU ALSO HEARD
FROM MATT AND CALLIE.

MATT LOST
HIS COMMANDING OFFICER, WHO HE WAS ASSIGNED TO PROTECT. HE FELT RESPONSIBLE AND LIVES WITH THE BELIEF
THAT HE FAILED. WHAT WAYS MIGHT YOU
OFFER SUPPORT, AND WHAT MIGHT YOU WANT TO AVOID
IN OFFERING SUPPORT TO SOMEONE IN THESE
CIRCUMSTANCES? FAITH COMMUNITIES ARE IDEALLY
POSITIONED TO RESPOND AND MAKE MEANINGFUL
CONTRIBUTIONS TO THE HEALING
AND RECOVERY OF VETERANS CARRYING THE WOUNDS
OF MORAL INJURY. HOW MUCH ROOM DOES YOUR
COMMUNITY HAVE TO ALLOW THE WEIGHT OF
THIS BURDEN TO BE SHARED? DO YOU HAVE RESOURCES
TO PROVIDE VETERANS WITH SPIRITUAL CARE AND SUPPORT? IF SO, IN WHAT WAYS
CAN YOUR COMMUNITY MAKE SURE THESE RESOURCES
ARE AVAILABLE? THE PRESENCE OF A CARING
FAITH COMMUNITY CAN BE POWERFUL FOR SOMEONE
WHO HAS EXPERIENCED TRAUMA.

YET IT CAN BE HARD KNOWING EXACTLY THE RIGHT
WAY TO RESPOND. WE INVITE YOU TO THINK
ABOUT THE FOLLOWING QUESTIONS TO DISCERN DIFFERENT
POSSIBILITIES WITHIN AND OUTSIDE
YOUR COMMUNITY FOR PROVIDING CARE
TO THOSE IN NEED. CONSIDER AS A COMMUNITY, HOW DO WE OFFER HOPE TO PERSONS
WHO HAVE EXPERIENCED TRAUMA? WHAT ARE SOME OF THE RESOURCES
INHERENT IN OUR PRACTICES, BELIEFS, AND PROGRAMMATIC
SERVICES? SECONDLY, CONSIDER,
ARE THERE ANY ASPECTS OF WHAT WE DO AS A COMMUNITY THAT MAY CAUSE PERSONS WITH
TRAUMA OR MENTAL HEALTH PROBLEMS TO FEEL ALIENATED? WHAT ARE THOSE THINGS? IS IT POSSIBLE TO DO THINGS
DIFFERENTLY IN ANY WAY? FINALLY, CONSIDER…

WHAT LOCAL RESOURCES EXIST? WHO KNOWS ABOUT THESE RESOURCES? AND HOW CAN YOU CONNECT PEOPLE IN NEED TO MENTAL HEALTH SERVICES?.

As found on YouTube

20160420 Health 1

Quarter till 2:00. This is the Senate Committee on Health. Couple of real quick items. Item number six is going to be a consent item. That's SB 1100 Monning, Worker's Occupational Safety and Health Training. In educational programs, we have 15 items today, so we have a pretty packed schedule to go. Before we get started, I just have a real quick point of personal privilege. I've got some very good friends out here in the audience, that are here to visit. We have members from the California Optometric Association today here, it's their lobby day.

And of course, you know I'm an optometrist, and I've know many of these for many, many years and decades. So I'd like to welcome everybody from the California Optometric Association. >> Okay, looks like we've got our first item, is item number 3, that's Senator Hill. SB 994 Antimicrobial stewardship policies. As soon as we can establish a quorum we'll interrupt. But other than that, Senator Hill, welcome, good afternoon. >> Thank you Mr. Chair and Members. SB 994 would establish antibiotic stewardship policies in outpatient health settings. Something that is already required by law in hospitals and nursing homes. The bill addresses the problem of antibiotic resistant infections, which kills at least 23,000 Americans each year, in which the CDC has identified as the top public health threat.

Outpatient health settings are an important focus, because the majority of antibiotics are prescribed in those settings. And up to 50% of them are not needed, driving the development of this deadly public health problem. To address concerns from opposition and committee members, I circulated amendments yesterday and had intended to present them today. But after discussing them with everyone, it seems they don't fully address all of the concerns, so I will not be asking you to vote on them today. Instead I want to express my commitment to work with the California Medical Association to amend the bill, to require continuing medical education for physicians on this subject. The Medical Association approached my office late yesterday afternoon, and expressed their willingness to work with me on continuing education amendments instead of a stewardship policy. The hope is that continuing education would help promote better, more appropriate prescribing, helping to reduce the impacts of antibiotic resistance. And it's my goal to reduce the antibiotic in over-prescribing of those antibiotics in the office and outpatient setting. How we do that really isn't priority for me, how we get there isn't the concern.

If it were to be a stewardship program, a requirement is one thing. But if we can do it through continuing education, that would be a good thing as well. I'm not married to any one specific protocol, just as long as we at the end get the results that are necessary. So in closing, I'm asking you to vote on the bill in print with my commitment to amend it in appropriations, to remove the requirement for antibiotic stewardship. And instead require mandatory continuing education in antibiotic stewardship for physicians, as part of their ongoing continuing education. So I respectfully ask for an aye vote, members, thank you. >> Thank you. Do you have anyone that would like to speak in support of the measure? Any support? Any opposition? We have support? >> I'm Kelly Brooks with the County Health Executives Association of California. We represent the local public health departments across the state.

Public health officials in California, continue to be alarmed by the rise of antibiotic resistance. According to the CDC, at least 2 million Americans are infected with the antibiotic resistant infections resulting in at least 23,000 deaths each year. And we're pleased to be supporting this bill today. >> Thank you, anyone else? Please state your name and position. >> Thank you Mr. Chair and members, Megan Allred on behalf of the California Dental Association. Just wanted to officially remove our opposition per the author's commitment to take these amendments. We really appreciate his flexibility in working with us, and understanding of our concerns, as well as the committee's analysis, which I think did a good job of kind of outlining where we are on our data. And look forward to working with him as more data is available, but just wanted to let the committee know that we'll be removing opposition per the committed amendments.

>> Thank you. Anyone else in support? Opposition to the bill? I know we are taping. >> Alicia Sanchez with the California Medical Association. We are opposed to the bill in print. We are very appreciative of the analysis, and pointing out that guidelines for outpatient settings do not yet exist. And so it's very difficult to understand what exactly the requirements would be for the bill as it's drafted. We appreciate the author being willing to work with us on continuing education, and we'll see if we can get some place where we can all feel comfortable. Thank you.

>> Mr Chair and members, Tim Shannon, representing the California Orthopedic Association. When this bill was heard in the Business and Professions Committee, we pointed out that the main issue that's been raised about over-administration of antibiotics occurs in a primary care setting. Orthopedic surgeons follow CDC guidelines when administering antibiotics both before and after surgery, so we had some issues with the stewardship program, and asked to be amended out. I just wanted to go on the record and note that we just learned today about the continuing education approach, and that's troublesome as well when we have traditionally oppose mandatory continuing education. And particularly in the instance of orthopedic surgeons, where the administration of antibiotics follows very strict protocols, it would probably not be necessary.

Thank you. >> Thank you. Anyone, yes, opposition. >> Yes, Liddy Bourne representing Martin Cad in pediatrics. We also are opposed to the bill in print. We just received some new amendments, and so my committee has not had a chance to look at them. And until we come to a different conclusion, we are still opposed. >> Thank you. Questions, comments, from any of the members? Yes, Senator Pan. >> First of all, Senator Hill I want to thank you for your leadership and looking at antibiotics stewardship, and I know that you're working very hard with various stakeholders.

As a physician who ran a clinic, which actually had very low antibiotic prescription rate, I know some of the challenges it takes to make that happen. And I look forward to hopefully working with you as this moves forward to try to get to the right place. I have to admit, I also have some reluctance to support mandatory CME. But I think there's some effective things we can try to do to achieve the aims that not only you, but I know what you're doing on behalf of the public, to try to be sure we reduce antibiotic resistance. And so, I would be happy to vote for the bill and even move the bill here today, so you can continue that work.

And I look forward to our continuing dialogue for that. >> We will. >> Senator Hill. >> And if I could, Mr. Chair. And I appreciate Dr. Pan's comments and the idea, because the goal is not to burden or overburden in continuing education, you could be required to have hours and hours. My sense is this would just be a little part of that and a very small part, which is to keep an ongoing awareness of the problem and the issue, and how it can best be served, so thank you. Could appreciate an aye vote, members, thank you on this and we will- >> We don't have a quorum- >> When the time comes. >> I see Monning coming, literally Nielsen left, if we can get him back we can set a quorum and we can actually address your issue Sergeants, can you find out where Nielsen is? Any other questions or comments from any of the members? So I've got, none any question. I got a couple of comments. As you know, I went through BNP. I didn't vote for it there because I knew it was going to come to the health committee.

I understand and applaud you for wanting to bring the issue with regard to over prescription of antibiotics, but I told you my overall concern was, and I was going to be a non recommendation. I wasn't going to be opposed to it, but I wasn't going to vote on it. I'm glad that you're going to be working with the opposition. I will say, my only question, I mean, it could be potentially a concern, I would want to share with Senator Pan as well is, I guess you have a question.

Are you talking about expanding the number of hours or just including it within their CME? >> I don't know in here, again. This just came about last night, but we wanted to work with them, my sense is it could be included somehow in the CME. I'm not think of making it a more. And it doesn't seem like it has to be. The goal is to create an awareness, create an ongoing consciousness of the issue of over prescribing. And to me the continuing education could be just including that and how to consciously make yourself aware of every, when you write a prescription, what is the medical need for it and is it appropriate, is it necessary, just common sense. >> I'm going to go ahead and get a quorum. >> Secretary, call the members please. >> Hernandez? >> Here. >> Hernandez, here. Nguyen? Hall? Mitchell? Monning? >> Here. >> Monning, here. Nielsen? Pan? >> Here. >> Pan, here. Roth? >> Here.

Here. >> Roth Here. Wolk >> Here >> Wolk here. >> The quorum has been established, sorry Senator. Anyway, go ahead. >> Once we finalize the language, once we get it working with the Appropriations and your committee we will certainly share it with the P&P committee as well as health to make sure that everyone is comfortable with it. >> And again, let me just reiterate, I think my only questions is, are you going to increase the number of hours which I think the CMA is going to be extremely opposed to? Are you going to require a certain number of hours within their CME then there may be some questions as well, how are we going to deal with the dentist? How we going to deal with the orthopedic surgeon? So, I'd be more than happy to obviously continue working with you.

Obviously, I have the right to bring the bill back if there's a concern. And I'll work with Senator Laura in Appropriations to make sure that all parties are okay. I still won't vote at this point. I think you should have enough votes to get it out. But at this point is there, you have a question Senator Monning? >> Thank you Mr Chair. Senator, I'm sorry I missed your presentation and if I go over ground you covered I apologize. I do understand it's a work in progress. I applaud the objective of trying to get some controls on over prescribing or unnecessary prescribing of antibiotics. My question goes to, I think you had author amends that are now kind of off the table as you're working on this but I'm particularly curious about inclusion of dentists and podiatrists who I'm not sure they're appropriately included or why. In terms of their level of prescribing antibiotics. >> And if I could Mr Chair and Senator Monning, they were included mainly because the concern of CMA at the time is they wanted, they felt if you're going to include us you should include all of the health professionals.

Chiropractic board wanted to be included they said that they were comfortable. I mean, sorry, it's the issue, that everyone felt that we should have everyone kind of a part of the requirement and so what we're trying to do now is remove those who really don't have the concern. But more importantly, with the conversation today, is that we're looking at from basically the CMA came to our office yesterday and talked about having this as part of continuing education. Was there a suggestion? I think it's a great suggestion. As I mentioned, I'm not married to the idea of having a stewardship program in each office. The goal is just to create the awareness and the conscious prescribing of antibiotics when it's done. And so that's what we're trying to do. And as part of that, we will parrot down a little bit to make sure that it only applies to those where it's necessary. >> Great, and I will be supportive today but I will be watching as it makes its way through the process and I understand the potential interest of CMA to be inclusive or not feel like they're singled out.

But by the same token, if there's not evidence to show that dentists or podiatrists are regularly prescribing antibiotics which I'm not aware that they are. I'm not interested, >> Only about 10%, Sir. It's a small amount. >> So but anyway, you're attuned to that. I'll follow it with interest. Thank you. >> And the analysis pointed that out as well, so we will >> Thank you. >> Take that into consideration. >> All right, thank you. We have a motion? >> I'll move the bill. >> Moved by Senator Monning. We have item number three, it's do pass to Appropriations, we are not amending in this committee. We've got a commitment from the author that he will amend in Appropriations, which I'll coordinate and work with the Senate Appropriations Chair.

>> And we need to bring it back, we'll bring it back. Call the members, please. >> Hernandez, Nguyen, Hall. >> Hall, aye. >> Hall, aye. Mitchell, Monning? >> Aye. >> Monning, aye. Nielsen, Pan. >> Pan, aye. Roth?. >> Aye. >> Roth, aye. Wolk?. >> Aye. >> Wolk, aye. >> Currently has five, that's enough to get out.

We're going to place everyone on call. Thank you to CVC, Senator Canella. Item number five, SB 1098, Medi-Cal Dental Services Advisory Group. >> [INAUDIBLE]. >> And we do have support on both sides. Senator, welcome, good afternoon. >> Got it. SB 1098 creates an advisory group to oversee Denti-Cal policies and priorities. For more than 13 million Californians of modest means Denti-Cal is the only means to dental care outside of an emergency room. As a member of the JLAC Committee and the Little Hoover Commission, I've heard many accounts that Denti-Cal rules and processes are often harmful to beneficiaries. Most California dentists don't participate in Denti-Cal due to its low reimbursement rates and administrative obstructions. Fewer than half the people eligible for benefits use them in any given year. I represent counties with high populations of child beneficiaries where there aren't enough dentists. The impact of this program on my constituents leads to expensive emergency room visits, missed school days, and lost job opportunities.

So, as a member of the Little Hoover Commission, I recently participated in the hearing on the Dental-Cal program. One of the recommendations that came from the hearing was the creation of an evidence-based advisory group to oversee the program's policies and priorities. This bill creates a 15 member advisory group consisting of the state Dental Directory, with members appointed by the Governor, the Senate Rules Committee and the Speaker of the Assembly. The members would serve a three year term with no term limits.

I also request that you approve my amendments, that two additional members and remove the section of the bill that requires that the Dental Director be the Chair of the Advisory Group. I'm pleased to welcome Carol [UNKNOWN]. The name was going to messed up. The executive director of the Little Hoover commission as a witness on this bill. >> Thank you. Please state your name and proceed. >> Sure, good afternoon Chair and Committee Members. My name is Carol [UNKNOWN]. I am the Executive Director of the Little Hoover Commission. Last year Senator Pan and assembly member Wood asked us to look into and review the Denti-Cal program. This was after the scaling state auditors report. We unanimously adopted the report a couple of weeks ago. We found the system that was broken in many ways. Including a department that was seemingly at odds with the providers that are needed to serve the 13 million Californians that are served by the program. Based on our report, we're very much in support of SB 1098. It sets a goal to improve access and it also, as we recommended, creates an advisory group. Many people during our process told us that the decisions that the department makes seems, seem to be unilaterally and mysteriously made.

And they often don't seem to include outside views. It was part of an overall alienation between the department, the providers, and beneficiaries. During our review we heard repeatedly that the provider community had very little input into Denti-Cal decision making. The outcome is widely perceived as not good. During our process there were two issues that were being considered by Department of Health Care Services. One dealt with general anesthesia. The other dealt with hygienists regarding services to remote clients. And the way that the process worked highlighted how the department seemed to ignore outside input. We heard from at our hearing process, as well as through phone calls, through e-mails. Parents in particular of children in special needs population who were stymied with teeth that were in pain and waiting for the state to decide on its murky rules. We decided rather than to weigh in on the issues that what was needed was this outside advisory group. We felt that the Denti-Cal decision making process could benefit from expert outside guidance, more of a high level group than a stakeholder panel. We envisioned a body of independent experts to use the best evidence and science to guide policy and make the most effective use of available money.

They would assure that rules and policies are based not only on cost but also on the best ways to improve oral and overall health for the population being served. I urge your vote on aye on SB 1098 and thank you. >> Thank you anyone else like to speak in support? Good afternoon. Mr. Chair and Members, Megan Allred on behalf of the California Dental Association. CDA has worked for years to address the deficiencies in the Denta-Cal program and it was very encouraged last year with the Little Hoover Commission's review and the findings that came of that. Just because there is now a lot of movement in the program and the ability to make some vast improvements in it. We know that Denta-Cal needs changes both to increase the low provider rates and correct administrative barriers that currently burden the program. And we applaud the author's focus on the goal of increasing utilization for child beneficiaries to at least 60% making the program more comparable with the commercial market.

Addressing the deficiencies of the complicated program will take a multifaceted approach and will require the input of dental care experts' best evidence in all possible resources. For this reason, we are pleased to support the intent of SB 1098 and look forward to working with Senator Canella. And all interested parties to identify the right make up and structure of such an advisory committee. And we would appreciate your support in moving forward so that we can continue to make progress on this broken program. Thank you. >> Anyone else, support? >> Kerry Nikale with Aaron Read and Associates representing the California Dental Hygienists Association. Our hygienists participated in the Hoover Commission hearings and everything that the chair has said is absolutely true. It is also one to note, I also want to know that Senator Cannella had his staff walk over with us and actually participated in a meeting with the Department.

And I think what we all learned was the department was very isolated and insulated as they made their decisions. It was almost like a Haldeman Ehrlichman situation, in which they weren't allowing outside influences to be heard. And I think this is a smart bill. It will bring greater clarity and information to what they finally decide to do. I do want to make one quick distinction however, and that is that the problems we had with the department we did not have with the agency. That when we took our complaints to Secretary Kent, that Jennifer Kent was extremely responsive and very open to discussion, and we appreciated that very much.

Thank you. >> Anyone else? Any opposition to the measure? Questions, concerns, any? We have a motion by Senator Roth. Would you like to close? >> Just respectfully ask for an aye vote. >> Thank you, and item number five, SB 1098. Do pass as amended to appropriations. Call the members. >> Hernandez? >> Aye. >> Hernandez, aye, Nguyen, Hall? >> Aye. >> Hall, aye, Mitchell, Monning? >> Aye. >> Monning, aye, Nielsen? Aye. >> Nielsen, aye. Pan? >> Aye. >> Pan, aye. Roth? >> Aye. >> Roth, aye. Wolk? >> Aye. >> Wolk, aye. >> Thank you. >> [INAUDIBLE] >> Currently at seven. That's enough to get out. We'll place that bill on call. Sergeants, can we call some more members, please? Senator Pan, would you like to go up? because it looks like no one's out here..

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Assessment of clinical risk in mental health services – 2018 (1/2)

This study was about risk assessment and risk
assessment describes the process where in mental health services people are categorised
as at low, medium or high risk in order to predict what’s going to happen to them. The problem is – that prediction tends to
be not very good. So this study of risk assessment for suicide,
we asked every mental health service in the United Kingdom for copies of the tools, the
instruments, they used to collect information on risk. We also did an online survey of mental health
professionals, of patients (service users) and their carers to see what they thought
about risk assessment tools. And then we did a more detailed study of mental
health professionals to get their views and suggestions for how risk assessment tools
might be improved. In terms of what we found, we obtained 156
different risk assessment tools from the mental health services across the country, and there
was little consistency.

Some risk assessment tools were 1 page, others
were 20 pages. They collected different types of information. About 7 out of 10, about 70%, had been locally
developed (just in the services themselves) and contrary to national guidance many of
them sought to categorise people as at low, medium, or high risk and make predictions
about future behaviour. In terms of the online survey, what staff
told us was that sometimes these tools could be helpful. They could be helpful to act as prompts, to
measure change, or to help formulate risks – that is to draw different risk factors together
to further their understanding.

But there were also potential problems with
them, so they might provide false reassurance, there were also issues around training, and
practical issues; so sometimes the risk assessment tools were very long and took a long time
to fill in. So there were practical impediments to their
use as well. Service users and carers, what they told us
was that they wanted staff who were comfortable asking about suicide risk, comfortable asking
those questions. They wanted assessments that were, weren’t
impersonal, tick box exercises, that really sought to engage them and involve them collaboratively. So that was another important message that
service users themselves, and their carers’, needed to be involved in the risk assessment
process.

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Lakeland Regional Health #1 in nation for amount of ER visits

TAMPA POLICE ARE STILL SEARCHING FOR THE SECOND SUSPECT. A LAKELAND HOSPITAL RANKS NO. 1 IN THE COUNTRY FOR EMERGENCY ROOM VISITS. THAT'S A STAGGERING STATISTIC WHEN YOU STOP TO THINK ABOUT IT. LAKELAND REGIONAL HEALTH TOPPED THAT LIST BY A LONG SHOT. NEWS CHANNEL 8'S MELISSA MARINO IS IN LAKELAND TO SHOW US WHAT THAT MEANS. Reporter: JUST TO GIVE YOU A BETTER IDEA, MORE PEOPLE WALK INTO THESE EMERGENCY ROOM DOORS THAN AN ANY OTHER — THAN ANY OTHER HOSPITAL IN THE NATION AND NOW WE'RE GETTING A GLIMPSE INTO WHY. WITHIN MINUTES OF SITTING OUTSIDE LAKELAND REGIONAL HEALTH'S EMERGENCY DEPARTMENT, YOU CAN SEE IT'S A BUSY PLACE.

[ SIRENS ]. Reporter: IN FACTS, IT'S THE BUSIEST. THE HOSPITAL LOGGING MORE THAN 217,000 ER VISITS IN A YEAR. RANKED NO. 1 IN A SURVEY FOR THE MOST ER VISITS IN THE U.S. FOR 2016. ONE THEORY? IF YOU THINK ABOUT A LARGE METROPOLITAN AREA, THERE'S TYPICALLY SEVERAL LARGE HOSPITALS OR SEVERAL HOSPITALS IN A BIG CITY. WITH LAKELAND, WE'RE THE ONLY HOSPITAL IN OUR COMMUNITY AND WE OFFER A VERY DIVERSE ARRAY OF SERVICES, SO IT PULLED A LOT OF VOLUME FROM OUR SURROUNDING COMMUNITY. WITH MY SITUATION I HAVE TO COME BECAUSE I DON'T HAVE MEDICAL INSURANCE.

Reporter: FOR SOME PATIENTS GOING TO THE ER IS THEIR ONLY OPTION. YOU COME HERE AND MAKE PAYMENTS? RIGHT. THAT'S WHAT I HAVE TO DO. I HAVE TO MAKE PAYMENTS ON MY VISITS. WE DO KNOW OF POLK'S POPULATION OF AROUND 640,000 THERE'S ABOUT 100,000 PEOPLE THAT ARE UNINSURED. ALSO, 20% OF OUR POPULATION IS 65 AND OLDER. Reporter: ACCORDING TO THE DEPARTMENT OF HEALTH, POLK COUNTY ALSO HAS A SHORTAGE OF PRIMARY CARE DOCTORS. WE'RE A HEALTH CARE PROVIDER SHORTAGE AREA FOR MEDICAL, DENTAL AND BEHAVIORAL HEALTH. THE ACCESS TO PRIMARY CARE IS A NATIONAL ISSUE. Reporter: BUT FOR THE HOSPITAL, THERE'S A SILVER LINING. THE INCREASING NUMBER OF PATIENTS CHALLENGE THEM TO BECOME MORE EFFICIENT.

WE HAVE EXPERT COMING FROM EVERYWHERE TO SEE HOW WE PROVIDE QUALITY OF CARE. Reporter: WE HAVE THE ENTIRE LIST OF HOSPITALS AND.

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