Thursday, September 28, 2017

Hillary always loved Bush

Hillary Clinton's first post election fundraiser is with Ralph Northam, who voted for Bush twice. But Bernie's not a Democrat.

You can vote for Bully Boy Bush and be okay with Hillary because she's a War Hawk.

Remember her 'excuse' for voting for the Iraq War?

Bully Boy Bush tricked her into it.

He misled her!!!!

Strange then that she's so lovey dovery around him.

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Remember that?

  1. Polarization is Killing the Church: Can Hillary Clinton and George Bush go to church together?

If I was stupid enough to be 'tricked' by Bully Boy Bush and I regretted it, I would not be all over him like a cheap sheet with a low fiber count.

"Iraq snapshot" (THE COMMON ILLS):
Thursday, September 28, 2017.  Chaos and violence continue in Iraq, the US Senate explores veteran suicide rates in a hearing, US Senator Chuck Schumer issues a statement on the Kurdistan referendum, and much more.

Yesterday morning, US Senator Richard Blumenthal noted that he had co-sponsored legislation "called The Veteran Peer Act, legislation that would establish peer specialists in patient aligned care teams within the VA medical centers to do this kind of outreach.  The peer to peer relationship among vets is, I think, an effective way to enable more access."

What was he talking about?

The still troubling suicide rate in the veteran population.

Wednesday, the Senate Veterans Affairs Committee held a hearing on veteran suicides.  Senator Johnny Iskason is the Committee Chair, Senator Jon Tester is the Ranking Member.

The hearing had two panels.  The first panel (which we're focusing on) had three witnesses: Dr. John Daigh of the Office of Inspector General, Dr. Craig Bryan of the National Center for Veterans Studies at the University of Utah and Mr. Matthew Kuntz of the National Alliance on Mental Illness for Montana.

Montana leads in veterans suicides with Nevada right behind it, Senator Dean Heller (of Nevada) pointed out.  Mr. Kuntz noted:

According to the US Dept of Veterans Affairs recently released report, Montana has the highest veteran suicide rate in the country.  This rate of 68.6 per 100,000 is significantly higher than both the National Veterans Suicide Rate of 38.4 per 100,000 and the Western Region Veteran Suicide Rate of 45.5 per 100,000.

He also noted that "Montana is home to more than 108,000 veterans, representing 16.2% f the total state adult population -- the second highest population density of veterans in the United States."

Ranking Member Jon Tester is one of Montana's two US senators.  We'll note this exchange from the hearing.

Ranking Member Jon Tester:  Can you give me an idea of whether the newer generation of veterans are seeking mental health care more readily than the older generation? Or is there no difference?

Dr. John Daigh: I don't have the data on that.  Do you know?

Dr. Craig Bryan: Yeah, my sense -- I don't know the data off hand -- my sense is that there is a decreased likelihood of younger generations of veterans accessing services at the VA.

Ranking Member Jon Tester:  Oh really?

Dr. Craig Bryan: That's my sense --

Ranking Member Jon Tester: So it's actually gotten worse.

Dr. Craig Bryan: That's my understanding. I could be wrong but that was my understanding from some of my VA colleagues.  Maybe someone else has better data or better understanding of the data than me.

Ranking Member Jon Tester: Alright.  One of the things that I think was interesting, we were contacted by a veteran from Sidney, Montana, that's in the far eastern part of Montana, very rural, who noted that the VA is unable or unwilling to include family members in the intervention process if a veteran is in crisis. I-I don't know if this is true or not but, if it is true, I think we're making a big mistake.  I would -- I would love to hear all of your opinions very briefly -- because you've only got about a minute left -- about what VA can do better to engage families?  We'll start with you, Dr. Daigh.

Dr. John Daigh:  I think that the use of advanced directive or some other mechanisms that allows providers to talk about otherwise prohibited information to families widely when there is a crisis to help that intervention process.

Ranking Member Jon Tester:  Okay.  Dr. Bryan?

Dr. Craig Bryan:  I think there are two key strategies that we could work with family members about.  The first is basic crisis management -- how to talk to someone in crisis and how to help them when they're struggling to identify solutions to their current problems --

Ranking Member Jon Tester:  So actually working with the families so that they could recognize --

Dr. Craig Bryan:  Correct. Correct. And this is something we've been doing in Salt Lake City, training family membes on what to do.  Second, related to that, teaching family members and having them involved in the firearm safety aspect.  How do we work with families to increase safety in the household- - even maybe during times of not crisis because if we have a safe household to begin with, during a time of crisis, everyone in the house will be safer over all.

Ranking Member Jon Tester:  Hold it just a second, Matt.  [To Dr. Bryan] Do you have any statistics on how many suicides by veterans are committed by guns as opposed to various other ways?

Dr. Craig Bryan:  Yeah, the vast majority -- close to 70 to 75% -- are through fire arms.

Ranking Member Jon Tester: Okay, Matt?

Matthew Kuntz: Senator Tester, I think telling the families how to communicate with the VAs because you can get around HIPPA, you have to send us a letter, you need to send it to this portal, you can call us, we may not be able to tell you about the veteran but if you're veteran is in trouble this is how you communicate to us and this is the way you do it, we'll respond.  We tell our families, you do written letters to professionals, they start thinking about malpractice and pretty soon and they'll get moving.  But you have to train those families.  And the same thing, we have a family to family course which actually trains them in how to interact with the treatment system.

Most veterans will encounter family and friends much more often that a medical professional.  As a result, they would be much more likely to observe warning signs early on.  And their connections run deeper and would be a great strength to communication and intervention.

Committee Chair Johnny Isakson pointed out, "Timing is everything.  When someone is contemplating suicide, it's not something you put off to an appointment on Wednesday -- or to another day.  It's something you deal with immediately and you deal with quickly and you expedite the response to it."

As Dr. Bryan observed, "Of all the many things we have learned about veteran suicide over the past decade, the most important are the following: (1) some interventions work much, much better than others and (2) simple things save lives."

The suicide rate across all groups in the US -- veteran and non-veteran -- is approximately 30%.  That number is, of course, too high (and professionals tend to believe it's an undercount).  This is approximately the suicide rate for veterans who use VA services.  Again, that's too high.  The difference, as will be pointed out in the next exchange from the hearing we highlight, is only 9% for veterans who do not access VA services.

For more data on suicides in the United States, you can refer to the American Foundation for Suicide Prevention which offers breakdowns by state.  The Veterans Crisis Line is 1-800-273-8255 (press #1).

And now for the section section of the hearing we're going to note.

Senator Richard Blumenthal:  [. . .] the more I learn about this problem, the more complex and challenging I think it is.  Dr. Bryan, one of the very important statistics in your testimony is that the suicide rate among veterans who do not use VA services increased by 39% between 2001 and 2014 -- whereas the suicide rate among VA users increased by only 9%.  Put aside the exact numbers, what I am hearing again and again and again is that the suicide rates are increasing among veterans who lack access -- either because of geographic or other difficulties in reaching these services or because they have received less than honorable discharges and this has become a passion for me because there is a whole group of veterans who suffered from PTS [Post-Traumatic Stress], often undiagnosed, were separated less than honorably and have been cast out and barred from using those services and often feel stigmatized and disengaged -- not only from the VA but from society in general.  But I've met with many of them and I've worked the Dept of Defense on the review process -- which has been changed as a result of leadership within the Dept of Defense  commendably.  But many of those veterans who were using those services who were discharged less than honorably don't know about it -- don't know about the changes in policies, don't know about the possibilities of access to these services.  So it is a vicious cycle -- a lethal cycle -- which can lead to suicide.  So I guess my question to all of you -- not only about the less than honorably discharged veterans but women veterans who also perhaps do not readily access these services and their suicide rates are increasing.  Those segments of the veteran community whose suicide rates are increasing need to be reached.  And my question to each of you is do you see that phenomenon as real?  Do you recognize it?  And can you elaborate on it?  And what are your recommendations for addressing it?

Dr. John Daigh: Sir, I agree with you.  I think the adequate treatment of substance abuse disorder and access to therapy and the adequate treatment of depression, as Mr. Kuntz indicated, you know to include pharmacological treatment and maybe ECT [electroconvulsive therapy] or other treatments that are available I think is critical.  So I think if you can't get people to a competent provider, it's a very difficult problem.  So  I agree with your statement.

Dr. Craig Bryan: I've -- I have two -- two thoughts in response to your statement. The first of which is I-I think what the statistics highlight, uhm, the rates are going up -- even among VA users but it is a much slower rate.  And so the VA is doing something good that is not happening for those who do not receive the services.  And so a common question is how do we get more veterans into the VA?  And I think that is an important question.  The other question though I think we need to ask is, uhm, why are there not other adequate services available to veterans in their communities.  And I think this -- this highlights -- this really came to a head for me several years ago -- I don't know if you've read THE NEW YORK TIMES article about the Marine 2/7 who has had a very high suicide rate [David Phillips' "How a Marine Unit's High Suicide Rate Got That Way"] and a lot of them do not have access to the VA and there's been a lot of discussion about that and the implications of this is some veterans have access to really nothing or they have access to community providers who have little to no experience working with service members and veterans.  They don't know how to treat PTSD.  They've never seen Traumatic Brain Injury before.  And, as the statistics I showed you here, they have no experience with suicide risk.  And so I think part of the solution will be how do we get more veterans into the VA because, as the RAND report recently released highlighted, the quality of care in the VA for mental health exceeds that in the private sector.  But for those who do not access VA services -- either because they're not eligible or because they choose not to -- we have to keep that in mind, some veterans choose not to -- we need to make sure that quality services are available to them.  And what we've done in Salt Lake City -- kind of as a model to this -- is our center is on the University of Utah campus, right across the street from the Salt Lake City VA.  And what we say is we're not a competitor to the VA, we're the augment.  And so the VA sometimes sends some veterans to us for treatment and there are some veterans in the community who cannot go to the VA or who are unwilling and they come to us and we can sometimes connect them with the VA for other services and benefits that they didn't know.  And so I think that we need to look at models like that and how the different communities in the VA can strengthen working together to better meet the needs of all veterans.  Thank you.

Matthew Kuntz:  Senator Blumenthal, thank you for bringing up the less than honorable discharge.  That was something that came up in our family before my step-brother's death.  It's a really big issue.  I'll also point out that one of the ways it was solved in Helen, Montana -- or improved -- was by adding a vet center to our community.  And, at the time, the VA had fought it because they said you already have a hospital and everybody that would go there -- you know, that would go to the vet center -- are already going to the hospital.  And that turned out not to be true.  But I think that part of it is when you're depressed, when you have PTSD, the first thing that you can't stomach is bureaucracy and you just quit.  You face bureaucracy, you face this red tape and you just give up.
And the vet centers have less bureaucracy.  The FQHCs [Federally Qualified Health Centers] have less bureaucracy.  And in order to get in and starting to think that that's what's not really showing in those statistics is-is the folks that give up because they look at the bureacratic red tape and say, "I can't mentally take it."

Committee Chair Isakson's office issued the following on the hearing:

Isakson Discusses Ways to Combat Veteran Suicide

Examines VA's suicide prevention efforts, #BeThere campaign at committee hearing

WASHINGTON – U.S. Senator Johnny Isakson, R-Ga., chairman of the Senate Committee on Veterans’ Affairs, held a hearing Wednesday to examine the Veterans Health Administration’s (VHA) suicide prevention programs and assess what legislative changes may be needed to ensure the U.S. Department of Veterans Affairs (VA) has the necessary resources to combat veteran suicide.

September is National Suicide Prevention Month, and the VA has launched its #BeThere campaign to help spread awareness about veteran suicide and prevention. In 2014, suicide was the 10th-leading cause of death in the United States. The average number of veterans who commit suicide has remained steady at 20 deaths per day since 2011, a statistic that Isakson noted is appalling and unacceptable.

“Suicide is a terrible, terrible, terrible loss, and a wasteful loss of life and a preventable loss of life,” said Isakson.

“Timing is everything. When someone is contemplating suicide, it’s not something you put off to an appointment on Wednesday, or to another day, it’s something you deal with immediately and you deal with quickly and you expedite the response to it,” he added.

To help improve the VHA’s suicide prevention programs, in 2015 Congress passed the Clay Hunt Suicide Prevention for American Veterans Act of 2015. In the Senate, the bill passed unanimously with a 99-0 vote.

Expanding on these efforts, the VHA has appointed a national suicide prevention coordinator, expanded its Veterans Crisis Line (VCL), developed a patient-record “flagging” system to identify high-risk patients, and created suicide prevention programs in each facility.

Isakson questioned VA Secretary David Shulkin and three other witnesses regarding the implementation of these programs and discussed ways to improve flaws in the system.

“We haven’t had enough training in the VA for dealing with suicide and our response timing needs improvement,” Isakson said. “We need to work on that, and Dr. Shulkin has prioritized suicide prevention as a focus of his leadership.”

Isakson continued, “Just like the Heimlich maneuver has saved many a life in a restaurant, …just like CPR has helped people who might be drowning or might have drowned and been brought back to life, being aware of the training that’s necessary to save a life is critically important.”

While many of these programs were identified as positive practices by the VA’s office of the inspector general, it was found that the implementation of newer and more effective strategies should be accompanied by comprehensive training programs.

“Knowing what to do is 90 percent of solving the problem. And 100 percent of solving the problem is identifying it so we’re better aware of the things we need to look for,” said Isakson.

Isakson committed to working with members of the Senate Committee on Veterans’ Affairs and VA Secretary Shulkin to help promote awareness and enhance these suicide prevention initiatives.

“The training that is necessary to save a life is critically important, and we’re going to see to it in our committee that we promote this training throughout the VA and throughout the government to see to it that we are saving lives and helping people to recover and restore their life,” said Isakson.

At the start of today’s hearing, Isakson and Sen. Jon Tester, D-Mont., ranking Democrat on the committee, signed a suicide prevention declaration with Secretary Shulkin to commit to helping spread awareness about veteran suicide and educating others about suicide prevention and resources.

“I’m proud that all of our staff on the majority and minority side have taken the ‘SAVE course’ and now understand how important it is to look for the signs of suicide,” said Isakson. “I think as we embrace the SAVE program in the VA, we will save a lot of lives by simply having the awareness and the direction of knowing what to do.”

Watch Isakson’s opening remarks from the hearing here.

More resources on suicide prevention from the VA can be found here.

The Senate Committee on Veterans’ Affairs is chaired by U.S. Senator Johnny Isakson, R-Ga., in the 115th Congress. Isakson is a veteran himself – having served in the Georgia Air National Guard from 1966-1972 – and has been a member of the Senate Committee on Veterans’ Affairs since he joined the Senate in 2005. Isakson’s home state of Georgia is home to more than a dozen military installations representing each branch of the armed services as well as more than 750,000 veterans. 

Ideally, we'll pick up on the hearing in tomorrow's snapshot for a few more points.

Let's stay with the US Senate for a bit more to note this press release from Senator Chuck Schumer:

For Immediate Release
Date: September 27, 2017

CONTACT: Matt House, (202) 224-2939

Schumer Calls on Administration to Back An Independent Kurdish State

Washington, D.C. -- U.S. Senator Chuck Schumer today released the following statement in support of an independent Kurdistan State after an overwhelming 93% of Kurds voted Monday in favor of independence from Iraq:

"Monday's historic vote in Iraqi Kurdistan should be recognized and respected by the world, and the Kurdish people of northern Iraq have utmost support.  I believe the Kurds should have an independent state as soon as possible and that the position of the United States government should be to support a political process that addresses the aspirations of the Kurds for an independent state.

"Over the last two decades, the Kurds have been one of our strongest and most supportive partners on the ground in the fight against terrorism, and we have relied on the Peshmerga time and again.  They have also stood up for the rights of minorities in a region where the oppression of minorities is too often the rule and conflict is often the result.  And furthermore, the United States should stand for self-determination for our strongest partners.  The Kurds are one of the largest ethnic groups in the Middle East without a homeland and they have fought long and hard for one.  Despite this, the Kurds continue to get a raw deal and are told to wait for tomorrow, which is why it's past due that the world, let by the United States, immediately back a political process to address the aspirations of the Kurds. 

"In the months ahead, I hope all Iraqis will engage in a dialogue and peacefully determine the best way to accommodate the well-deserved and legitimate aspirations of the Iraqi Kurds.  Continued security cooperation between the Kurdish and Iraqi security forces -- particularly on terrorism -- are essential to any transition.  Iraq's neighboring countries, however, led by despots who all oppose a Kurdish State because it threatens the status quo and their self-interests, need to respect the need for the Kurds -- and the Iraqis -- to determine their own future.

RUDAW notes that Schumer is the Minority Leader in the Senate and reminds, "On Monday evening, as people cast their ballots, US Congressman Trent Franks introduced legislation to support Kurdistan’s right of self-determination." Former Iraqi Ambassador to the US Lukman Faily tells Robin Wright (THE NEW YORKER), "The only people who want to hold Iraq together are those who don't live in Iraq."  Susannah George (AP) notes, "The referendum passed with more than 92 percent of voters approving independence, the Kurdish region's election commission told a news conference on Wednesday.  Turnout was over 72%, it said."

People celebrate in Arbil after Iraq's Kurds announce a massive "yes" vote for independence in a referendum that has incensed Baghdad

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The Kurds held a referendum on Monday.  As Betty noted last night:

The northern section of Iraq, the Kurdish section, held a referendum on independence Monday.  It appears to have passed.

Strange though, the media insisted that the referendum might cause violence.

There were no reports of violence on Monday.

And since?

Cutting an "apple" into pieces.

Replying to 
: 's Parliament manded PM Abadi to declare war against Region, invade . Back to Saddam era.
We will wait for true Europeans, true Americans and true democrats worldwide to speak for us for we know we are right.
Prime Minister Barzani to Turkish Media: The referendum is not a threat to in any way.
Barzani: threats of punishment [over independence referendum] wouldnt be tougher than genocide committed in the past

There are threats.

And they are threats of violence.

But they're not coming from the KRG.

They're coming from Iraq, Iran, Turkey.

And the press is treating this as normal.

It's not.

While Iraq blusters -- they're the ones defocusing from the fight against the Islamic State -- they are the ones, not the Kurds.

In addition, Iraq has other issues to worry about:

LIVE: “Representatives in Baghdad not representing Sunnis” - Arab Leader Najeh Mizan says in press conference.

The following community sites -- plus Jody Watley and THE GUARDIAN -- updated:

  • iraq iraq iraq iraq iraq Iraq