The pending strike by psychotherapists at Kaiser hospital has highlighted the ongoing challenges members have in accessing services. Most of the proposed solutions include staff recruitment, retention and compensation. While necessary, in the long run these strategies fall short. If the goal is to improve mental health outcomes, then the solution requires a wider lens. Here are my suggestions:
Every medical unit would have a designated mental health professional. We need a 24/7 mental health urgent care system in person and online that is actively promoted as crisis intervention. Contract with a network of private providers and adequately compensate them to provide services for members with mild or moderate issues. Clinicians should be able to work part-time. Kaiser therapists should focus on specific populations such as those with severe mental health issues, those with complicated co-occurring physical and mental health or medication issues, and those who can't find a therapist through the network. Treatment plans should indicate individualized services that are not based on what is available. Each Kaiser member should be entitled to four hours a year assistance for problems such as transportation, childcare and employment problems that can impact on mental health.
Kaiser members contract to receive all medically necessary and appropriate services, sometimes paying high premiums and out-of-pocket costs. Kaiser won't pay for them to go outside of their system. Kaiser is not keeping its end of the contract and is missing an opportunity to develop a national model.
Tickled by Pickles
I want to compliment writer James Knight on the "Pickle People" article (June 12) and his writing. It was informative and I'll try the pickled stuff, but mostly it was a treat to read. Some of the turns of phrases are so clever and funny that it kept me happily reading in anticipation of the next ones.
I Have a Plan
What's better than raising the minimum wage ("Minimum Rage," June 12)? Reducing rents! Why? Because: Nobody says lower rents would force employers to cut staff. Nobody says lower rents would feed into higher prices for the poor. When you allow for income tax and withdrawal of welfare, a dollar saved is worth much more than a dollar earned. By definition, the benefit of lower rents isn't competed away in higher rents as a rise in wages would be. Landlords might even try claw back the "gross" increase in wages Lower rents mean lower barriers to job creation. Jobs can't exist unless (a) the employers can afford business accommodation, and (b) the employees can afford housing within reach of their jobs, on wages that employers can pay.
And how do we reduce rents? Impose rent control? No! That makes it less attractive to supply accommodation. But a tax on vacant lots and unoccupied buildings makes it less attractive not to supply accommodation. Better still, the economic activity driven by avoidance of that tax would broaden the bases of other taxes, allowing their rates to be reduced, so that the rest of us would pay less tax.
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