Longest Strike Ends: California Mental Health Care Workers Win Big

Cal Wilslow

Counterpunch.org

Originally posted 24 OCT 22

Two thousand mental health clinicians have won; Kaiser Permanente has lost. The 10- week strike has ended in near total victory for the National Union of Healthcare Workers (NUHW). The therapists, walked out on August 15; it became the longest mental health care workers’ strike recorded.

Two issues dominated negotiations from the start: workload for Kaiser therapists and wait time for Kaiser patients. The strikers won on both, forcing concessions until now all but unheard of. The strikers won break through provisions to retain staff, reduce wait times for patients and a plan to collaborate on transforming Kaiser’s model for providing mental health care. The new four-year contract is retroactive to September 2021 and expires in September 2025. Darrell Steinberg, Mayor of Sacramento served as a mediator. Members of the NUHW voted 1561 to 36 to ratify it.

Braving three- digit heat, strikers walked picket lines throughout Northern California and the Central Valley. They picketed, marched and rallied at Kaiser hospitals – in a strike that caught the attention of mental health care advocates everywhere. “Our strike was difficult and draining, but it was worth it,” said Natalie Rogers, a therapist for Kaiser in Santa Rosa. We stood up to the biggest nonprofit in the nation, and we made gains that will help better serve our patients and will advance the cause of mental health parity throughout the country.”

The mental health clinicians I’ve met are almost universally modest and careful in their choice of words, and here is an example. To say that that Kaiser is “the biggest non-profit” is an understatement to say the least – its revenues are in the billions, and its managers make millions while this giant among giants, typically in the world of corporate health care, oversees its empire as if it were making cars and trucks.

I’ve seen NUHW rallies well-attended by patients themselves, also family members and supporters who are angry, bitter. Where frequently they carry signs to the effect that the issues here are life and death, rallies where speakers break down in tears, where placards tell us that suicide can be the outcome of care denied – “Stop the Suicides!” It’s a wonder more therapists don’t move on. The world of pain of the mental health patient can be just as acute as that of the medical patient. Ask a therapist. It’s not that the clinicians don’t want to tell us this.; it’s that, in their own way, they are telling us. It’s why they fight so hard.

The info is here.

The uselessness of AI ethics

Munn, L. The uselessness of AI ethics.

AI Ethics (2022).

https://doi.org/10.1007/s43681-022-00209-w

Abstract

As the awareness of AI’s power and danger has risen, the dominant response has been a turn to ethical principles. A flood of AI guidelines and codes of ethics have been released in both the public and private sector in the last several years. However, these are meaningless principles which are contested or incoherent, making them difficult to apply; they are isolated principles situated in an industry and education system which largely ignores ethics; and they are toothless principles which lack consequences and adhere to corporate agendas. For these reasons, I argue that AI ethical principles are useless, failing to mitigate the racial, social, and environmental damages of AI technologies in any meaningful sense. The result is a gap between high-minded principles and technological practice. Even when this gap is acknowledged and principles seek to be “operationalized,” the translation from complex social concepts to technical rulesets is non-trivial. In a zero-sum world, the dominant turn to AI principles is not just fruitless but a dangerous distraction, diverting immense financial and human resources away from potentially more effective activity. I conclude by highlighting alternative approaches to AI justice that go beyond ethical principles: thinking more broadly about systems of oppression and more narrowly about accuracy and auditing.

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Meaningless principles

The deluge of AI codes of ethics, frameworks, and guidelines in recent years has produced a corresponding raft of principles. Indeed, there are now regular meta-surveys which attempt to collate and summarize these principles. However, these principles are highly abstract and ambiguous, becoming incoherent. Mittelstadt suggests that work on AI ethics has largely produced “vague, high-level principles, and value statements which promise to be action-guiding, but in practice provide few specific recommendations and fail to address fundamental normative and political tensions embedded in key concepts.” The point here is not to debate the merits of any one value over another, but to highlight the fundamental lack of consensus around key terms. Commendable values like “fairness” and “privacy” break down when subjected to scrutiny, leading to disparate visions and deeply incompatible goals.

What are some common AI principles? Despite the mushrooming of ethical statements, Floridi and Cowls suggest many values recur frequently and can be condensed into five core principles: beneficence, non-maleficence, autonomy, justice, and explicability. These ideals sound wonderful. After all, who could be against beneficence? However, problems immediately arise when we start to define what beneficence means. In the Montreal principles for instance, “well-being” is the term used, suggesting that AI development should promote the “well-being of all sentient creatures.” While laudable, clearly there are tensions to consider here. We might think, for instance, of how information technologies support certain conceptions of human flourishing by enabling communication and business transactions—while simultaneously contributing to carbon emissions, environmental degradation, and the climate crisis. In other words, AI promotes the well-being of some creatures (humans) while actively undermining the well-being of others.

The same issue occurs with the Statement on Artificial Intelligence, Robotics, and Autonomous Systems. In this Statement, beneficence is gestured to through the concept of “sustainability,” asserting that AI must promote the basic preconditions for life on the planet. Few would argue directly against such a commendable aim. However, there are clearly wildly divergent views on how this goal should be achieved. Proponents of neoliberal interventions (free trade, globalization, deregulation) would argue that these interventions contribute to economic prosperity and in that sense sustain life on the planet. In fact, even the oil and gas industry champions the use of AI under the auspices of promoting sustainability. Sustainability, then, is a highly ambiguous or even intellectually empty term that is wrapped around disparate activities and ideologies. In a sense, sustainability can mean whatever you need it to mean. Indeed, even one of the members of the European group denounced the guidelines as “lukewarm” and “deliberately vague,” stating they “glossed over difficult problems” like explainability with rhetoric.

A Call to Surrender: A Human Dignity Approach to Russian Citizens Kidnapped to Serve

From Ukraine's Department of Defense
 

Sleep loss leads to the withdrawal of human helping across individuals, groups, and large-scale societies

Ben Simon E, Vallat R, Rossi A, Walker MP (2022) 

PLoS Biol 20(8): e3001733.

https://doi.org/10.1371/journal.pbio.3001733

Abstract

Humans help each other. This fundamental feature of homo sapiens has been one of the most powerful forces sculpting the advent of modern civilizations. But what determines whether humans choose to help one another? Across 3 replicating studies, here, we demonstrate that sleep loss represents one previously unrecognized factor dictating whether humans choose to help each other, observed at 3 different scales (within individuals, across individuals, and across societies). First, at an individual level, 1 night of sleep loss triggers the withdrawal of help from one individual to another. Moreover, fMRI findings revealed that the withdrawal of human helping is associated with deactivation of key nodes within the social cognition brain network that facilitates prosociality. Second, at a group level, ecological night-to-night reductions in sleep across several nights predict corresponding next-day reductions in the choice to help others during day-to-day interactions. Third, at a large-scale national level, we demonstrate that 1 h of lost sleep opportunity, inflicted by the transition to Daylight Saving Time, reduces real-world altruistic helping through the act of donation giving, established through the analysis of over 3 million charitable donations. Therefore, inadequate sleep represents a significant influential force determining whether humans choose to help one another, observable across micro- and macroscopic levels of civilized interaction. The implications of this effect may be non-trivial when considering the essentiality of human helping in the maintenance of cooperative, civil society, combined with the reported decline in sufficient sleep in many first-world nations.

From the Discussion section

Taken together, findings across all 3 studies establish insufficient sleep (both quantity and quality) as a degrading force influencing whether or not humans wish to help each other, and do indeed, choose to help each other (through real-world altruistic acts), observable at 3 different societal scales: within individuals, across individuals, and at a nationwide level.

Study 1 established not only the causal impact of sleep loss on the basic desire to help another human being, but further characterised the central underlying brain mechanism associated with this altered phenotype of diminished helping. Specifically, sleep loss significantly and selectively reduced activity throughout key nodes of the social cognition brain network (see Fig 1B) normally associated with prosociality, including perspective taking of others’ mental state, their emotions, and their personal needs. Therefore, impairment of this neural system caused by a lack of sleep represents one novel pathway explaining the associated withdrawal of helping desire and the decisional act to offer such help.

The research is here.

Gender and ethnicity bias in medicine: a text analysis of 1.8 million critical care records

David M Markowitz

PNAS Nexus, Volume 1, Issue 4,

September 2022, pg157

Abstract

Gender and ethnicity biases are pervasive across many societal domains including politics, employment, and medicine. Such biases will facilitate inequalities until they are revealed and mitigated at scale. To this end, over 1.8 million caregiver notes (502 million words) from a large US hospital were evaluated with natural language processing techniques in search of gender and ethnicity bias indicators. Consistent with nonlinguistic evidence of bias in medicine, physicians focused more on the emotions of women compared to men and focused more on the scientific and bodily diagnoses of men compared to women. Content patterns were relatively consistent across genders. Physicians also attended to fewer emotions for Black/African and Asian patients compared to White patients, and physicians demonstrated the greatest need to work through diagnoses for Black/African women compared to other patients. Content disparities were clearer across ethnicities, as physicians focused less on the pain of Black/African and Asian patients compared to White patients in their critical care notes. This research provides evidence of gender and ethnicity biases in medicine as communicated by physicians in the field and requires the critical examination of institutions that perpetuate bias in social systems.

Significance Statement

Bias manifests in many social systems, including education, policing, and politics. Gender and ethnicity biases are also common in medicine, though empirical investigations are often limited to small-scale, qualitative work that fails to leverage data from actual patient–physician records. The current research evaluated over 1.8 million caregiver notes and observed patterns of gender and ethnicity bias in language. In these notes, physicians focused more on the emotions of women compared to men, and physicians focused less on the emotions of Black/African patients compared to White patients. These patterns are consistent with other work investigating bias in medicine, though this study is among the first to document such disparities at the language level and at a massive scale.

From the Discussion Section

This evidence is important because it establishes a link between communication patterns and bias that is often unobserved or underexamined in medicine. Bias in medicine has been predominantly revealed through procedural differences among ethnic groups, how patients of different ethnicities perceive their medical treatment, and structures that are barriers-to-entry for women and ethnic minorities. The current work revealed that the language found in everyday caregiver notes reflects disparities and indications of bias—new pathways that can complement other approaches to signal physicians who treat patients inequitably. Caregiver notes, based on their private nature, are akin to medical diaries for physicians as they attend to patients, logging the thoughts, feelings, and diagnoses of medical professionals. Caregivers have the herculean task of tending to those in need, though the current evidence suggests bias and language-based disparities are a part of this system. 

The research is here.

Frequently asked questions about abortion laws and psychology practice

American Psychological Association

Updated 1 SEPT 2022

Since the U.S. Supreme Court issued its decision to overturn Roe v. Wade, many states have proposed, enacted, or resurrected a range of laws to either prohibit, significantly restrict, or protect reproductive rights and health care. Currently, the main targets of these laws appear to be medical providers who provide abortions or individuals seeking to obtain an abortion.

APA and APA Services Inc. are striving to provide psychologists with accurate and adequate information about the potential impact on them of reproductive health care laws. Since psychologists have embraced telehealth and many use technology to provide services across state lines, it’s important to be familiar with the laws governing the jurisdiction(s) where you are licensed as well as the jurisdiction(s) where your patients live.

In addition to this FAQ and other APA resources, psychologists will want to be familiar with guidance issued by federal and state agencies, their state licensing board(s), and their liability carrier. Some frequently asked questions follow.

While the situation is dynamic, good psychological practice remains unchanged. The changing landscape in states regarding access to reproductive health care does not change the fundamental approach to psychological care. Psychologists should continue to prioritize the welfare of their patients, protect confidentiality, and ensure their patients’ safety.

Practicing in states with changing abortion laws

Am I practicing in a state where abortion is, or is soon to be, illegal under all or certain circumstances?

The Supreme Court’s decision to overturn Roe v. Wade has put the regulation of abortion in the hands of states. In anticipation of the ruling, 13 states enacted “trigger laws,” designed to ban or restrict abortion upon the Supreme Court’s reversal of Roe v. Wade. Not all trigger laws immediately kicked in, and some that did were immediately challenged in court, delaying their enforcement.

Staying current on laws affecting the states where you practice is important. For a list of existing abortion bans and restrictions within each state, the Center for Reproductive Rights has provided a map that is updated in real time. The Guttmacher Institute, a well-respected research group that collects information on abortion laws across the United States, also tracks current state abortion-related laws.

The information is here.

Moral Injury: Ethical Issues in Context of Trauma-Based Care

 

Moral Injury: Ethical Issues in Context of Trauma-Based Care from John Gavazzi, PsyD, ABPP

Moral Injury Is an Invisible Epidemic That Affects Millions

Elizabeth Svoboda

Scientific American

Originally published 26 SEPT 22

Here are two excerpts:

A 2019 study by researchers at the Salisbury VA Healthcare System in North Carolina reports that moral injury has different brain signatures than PTSD alone: People with moral injury have more activity in the brain’s precuneus area, which helps govern moral judgments, than those who only have PTSD. And after people suffer moral traumas, they display different brain glucose metabolism patterns than those who suffer direct physical threats, according to a 2016 study by researchers at the University of Texas Health Science Center at San Antonio and their colleagues. The results support developing theories that moral injury is a unique biological entity.

As Brock’s Shay Moral Injury Center found its footing, she forged connections with powerful people who could get the word out about moral injury—including Margaret Kibben, the current chaplain at the U.S. House of Representatives. Kibben holds regular events for House members, and one of her recent talks was about moral injury. The event drew about three times more members than usual, Brock reports, “and they all wanted to talk about their experience.” Brock and Kibben’s partnership reflects a growing trend in the study of moral injury: collaboration between scholars and clergy members who aim to chronicle the unspeakable and to help people through it. Moral injury “does really bring together a lot of disciplines,” says psychologist Anna Harwood-Gross of Metiv, the Israel Psychotrauma Center in Jerusalem. “It’s rare to see articles written by chaplains and psychologists together.”

As COVID ravaged the planet from 2020 onward, moral injury research and inquiry took a distinct new turn. Health care workers spoke out about how rationing care was affecting them psychologically, and Dean and her colleagues Breanne Jacobs and Rita Manfredi, both at the George Washington University School of Medicine and Health Sciences, published a journal article that urged employers to monitor moral injury’s effects. “We need time, energy and intellectual capacity to make peace with those specters,” they wrote.

The moral injury Dean sees in health care often doesn’t stem from one-time, cataclysmic events. Many providers are suffering what she calls “death by a thousand cuts”—the constant, stultifying knowledge that they have to give people subpar care or none at all. “They think they suck. They think they’re inadequate,” says trauma surgeon Gregory Peck of New Jersey’s Rutgers Robert Wood Johnson Medical School. “No one’s putting their finger on ‘You don’t suck. This is moral injury you’re suffering.’” 

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But one sticking point with CBT is that it focuses on correcting clients’ distorted thought patterns. For people with moral injury who’ve experienced wrenching events that upend their entire value system, ethical distress is genuine, not the product of distorted thinking, Harwood-Gross says . If people with moral injury simply try to retrain their thoughts, they may be left unsatisfied and unhealed.

Therapies for PTSD can likewise fall short for morally injured patients, in Harwood-Gross’s experience. PTSD-focused approaches teach clients to adapt to traumatic triggers, such as fireworks that sound like gunshots, but this exposure approach doesn’t really help them resolve deep ethical conflicts. Effective moral injury counseling is “more about the processing,” Harwood-Gross says. “There has to be that movement: ‘How do I see it for what it is and, from there, develop something more meaningful?’ It’s a more spiritual approach.”

Recognizing moral injury’s unique challenges, psychologists such as Litz have been creating therapies that more directly address clients’ needs. Litz and other providers have pioneered a moral injury treatment called adaptive disclosure. Researchers at Australia’s La Trobe University and University of Queensland have developed a similar approach called pastoral narrative disclosure. The latter involves discussing moral issues with a chaplain or other spiritual adviser rather than a doctor.

These therapies stress the importance of moral reckoning. They encourage clients to accept uncomfortable truths: “I led that attack on Iraqi civilians”; “I sent that suffering patient home without treatment.” Then, with clients’ input, counselors can help them develop strategies for making amends or pursuing closure—say, apologizing to a family whose child they injured.

Early evidence suggests these approaches make headway where others can’t. In Litz’s initial trial of adaptive disclosure on 44 Marines, participants’ negative beliefs about both themselves and the world diminished. Most also said the therapy helped resolve their moral struggles.

The article is here.

More than a quarter of U.S. adults say they’re so stressed they can’t function

American Psychological Association

Press Release

Originally posted 19 OCT 22

Americans are struggling with multiple external stressors that are out of their personal control, with 27% reporting that most days they are so stressed they cannot function, according to a poll conducted for the American Psychological Association.

A majority of adults cited inflation (83%), violence and crime (75%), the current political climate (66%), and the racial climate (62%) as significant sources of stress.

The nationwide survey, fielded by The Harris Poll on behalf of APA, revealed that 70% of adults reported they do not think people in the government care about them, and 64% said they felt their rights are under attack. Further, nearly half of adults (45%) said they do not feel protected by the laws in the United States. More than a third (38%) said the state of the nation has made them consider moving to a different country.

More than three-quarters of adults (76%) said that the future of our nation is a significant source of stress in their lives, while 68% said this is the lowest point in our nation’s history that they can remember.

Various disparities in stressors emerged among population subgroups. For example, 72% of the members of the LGBTQIA+ community reported feeling as if their rights are under attack, which is a higher proportion than non-LGBTQIA+ adults (64%). Younger adult women (ages 18 to 34) were more likely to report that most days their stress is completely overwhelming, in comparison with older women (62% vs. 48% 35–44; 27% 45–64; 9% 65+) and men ages 35 or older (62% vs. 48% 35–44; 21% 45–64; 8% 65+). Seventy-five percent of Black adults said that the racial climate in the U.S. is a significant source of stress, while 70% of Latino/a adults, 69% of Asian adults and 56% of white adults reported the same.

Furthermore, Latinas were most likely, among racial/ethnic groups, to cite significant sources of stress related to violence, including violence and crime (89% Latinas; 80% Black women; 79% Asian women; 77% Latinos; 75% Black men; 73% white women; 72% white men; 70% Asian men), mass shootings (89% Latinas; 78% Latinos; 77% Black women; 77% Asian women; 73% white women; 71% Black men; 67% Asian men; 66% white men) and gun violence (87% Latinas; 83% Black women; 77% Asian women; 76% Latinos; 75% Black men; 69% white women; 68% white men; 63% Asian men).

“It’s clear that the impacts of uncontrollable stressors are profound for most Americans, but psychological science shows us that there are effective ways to talk about and cope with this type of stress,” said Arthur C. Evans Jr., PhD, APA’s chief executive officer. “Focusing on accomplishing goals that are in our control can help prevent our minds from getting overwhelmed by the many uncertainties in life. From using our breathing to slow racing thoughts, to intentionally limiting our social media consumption, or exercising our right to vote, action can be extremely empowering.”

Adults reported that stress has had an impact on their health; 76% of adults reported they had experienced at least one symptom in the last month as a result of stress—such as headache (38%), fatigue (35%), feeling nervous or anxious (34%) and feeling depressed or sad (33%). Seven in 10 adults (72%) experienced additional symptoms in the last month, including feeling overwhelmed (33%), experiencing changes in sleeping habits (32%), and/or worrying constantly (30%).

The pressor is here.