Fragile, handle with care

Renata Alder, a New York Times film critic and award-winning novelist, made a concise observation of society’s need to respond to the needs of the mentally ill. She said, “Nothing defines the quality of life in a community more clearly than people who regard themselves, or whom the consensus chooses to regard, as mentally unwell.”

The tragic shootings in Skagit County that claimed six lives once again reminds us of the fragility of our state’s Mental Health system. It’s not the first time we’ve received this kind of reminder. Eleven years ago, the stabbing death of a retired Seattle firefighter by a mentally ill man who had been released from jail prompted changes in the law. But all too often it takes a tragic crime before we discuss the needs of the mentally ill.

The Heritage Foundation reports, “An estimated 5.6 million Americans suffer from severe mental illness. It strikes without regard to age, gender, race, education, socioeconomic status, culture, or ideology. In many cases it brings suffering not only to the individual but also to family and friends. Depression, which causes many of the 30,000 suicides in America each year, especially targets the elderly…” They also conclude that the “economic costs of mental illness are staggering. America spends over $69 billion yearly on direct treatment costs.”

So what are the major challenges facing the State of Washington’s Mental Health system? A state-commissioned study of residential and hospital bed capacity and need that was completed several years ago found an additional 680 residential and inpatient beds are needed statewide. But no action was taken on that study. Instead, state and local hospital beds have continued to be closed, and even more closures are planned next year.

The 1999 Legislature initiated the “Community Integration Assistance Program” to improve the process of identifying mentally ill offenders released from the Department of Corrections. These individuals, who pose a threat to public safety, were to be provided with treatment and services for up to five years. The funding provided by the state for each person served is $700 per month for Medicaid-eligible participants and $900 per month for those not on Medicaid. The reimbursement rate has not increased since the program began in 2000 despite an enormous increase in housing and other costs. In many cases, especially in King County, the cost of housing alone exceeds the reimbursement received from the state that is meant to cover all costs

Housing is absolutely critical for people with mental illness if the mentally ill are to benefit from treatment and move toward independence, employment, and recovery. It is integral for them to have the best opportunity, yet housing is hard to find for anyone with low income, and even harder for those who have a serious mental illness. The homeless, mentally ill, are much more likely to commit crimes and end up in jail. It is imperative that the housing dollars authorized by the recently adopted sales tax for mentally ill services should not be diverted for other uses.

We need training for our police about how to work with people with mental illness, and more resources for police to refer people to programs that help avert crises and violent acts; to divert people from jail and into treatment.

Legislation on gun ownership for people who have been involuntarily committed needs to better align between the state and county – currently there are different standards – with state legislation allowing ownership if you have been committed for 14 days or less and federal legislation not allowing ownership if you have been committed for any length of time.

There is insufficient state funding to provide services for people who are mentally ill, but not covered by Medicaid, either because they are too disorganized to get through the process, or because their illness is new (such as the first break psychosis of young people), or because of their immigration status. When people can’t get the treatment they so desperately need, they are much more of a risk to themselves and others.

Involuntary commitment is an extremely controversial issue. Most people with mental illness are not dangerous and their civil rights must be protected. Yet many people believe that it should be easier to commit people who have mental illness. As a result, commitment laws have been amended numerous times since 1998, all with the intent of making it easier to commit people who might be a danger.

Last year, the state Mental Health Division brought in national consultants to lead a task force of mental health professionals, law enforcement, consumers, advocates, prosecuting and defense attorneys, and state officials to review the involuntary commitment law. The conclusion of the task force is that changing laws is not the answer; what is needed are more accessible, consumer-focused, comprehensive services.

Even if the state were to respond to all of the issues listed above, there is no way to ensure that nothing like what happened 11 years ago in King County, or last week in Skagit County, will ever happen again. What we can and should do is provide services and safe housing for persons with mental illness that will minimize the risks for them and for society, while also giving them the resources needed to help them in the recovery process.

The Heritage Foundation report concludes, “Current mental health policy tends to support the status quo system regardless of the effectiveness of services.” This must not continue. America has the compassion, resources, and available treatments to care effectively for its citizens who suffer from severe mental illness.”

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Do you have any skin in the game?

In King County our budget process has always been placed above political ambition and the parochial self-interest of different branches. It is my fervent hope that that tradition will continue as we grapple with the most difficult budget the County has ever faced. Unfortunately, that isn’t the tempo of recent public discussions.

Who stands to lose if we continue down the battle path, you the taxpayer, voter, and resident of King County? So the question for you: do you have any skin in this budgetary game?

With all of the recent posturing, press releases, press conferences and rumor mongering, one of the most critical services the County provides has received very little discussion. In this day and age of confrontational politics and news, it could become the unfortunate victim.

So, let me digress a bit. Remember these points. The human body is an ecosystem, flourishing and nurturing hundreds of millions upon billions of bacteria and microbes; the history of disease should worry us; human beings are not a stationary species; and, when we kiss, hold or shake hands, share our food, or engage in sex, we are simply mixing up a new batch of microbial material!

History is replete with the impacts of infectious diseases. Insects, birds, rats, plants, and humans have transmitted these diseases. They have reshaped history and retired entire cultures. Germs reshaped the history of the lands we now call the United States. Disease nearly eradicated the Native American population of North America. It is estimated that two thirds of the Native American population died of illnesses introduced by Europeans. Do we face these same threats today? According to all of the experts, the threat is growing at an ever-increasing rate. These organisms are mutating and evolving with remarkable speed with increasing resistance to medical treatment: they are genetically shrewd and wish to survive. SARS, avian influenza, hantavirus and extensively drug resistant tuberculosis are just a few recent examples of newly identified infectious agents that have caused serious human illness. Our food production and distribution system makes it easier than ever for contaminated products to reach large numbers of persons spread over wide geographic areas. So far this year the US has seen more measles cases than any time since 1996, primarily do to infected persons from other countries traveling to the US and setting off a series of outbreaks. How does all of this happen?

Wikipedia provided this description of the skin: ”The skin supports its own ecosystems of microorganisms, including yeasts and bacteria, which cannot be removed by any amount of cleaning. Estimates place the number of individual bacteria on the surface of one square inch (6.5 square cm) of human skin at 50 million though this figure varies greatly over the average 20 feet2 (1.9 m²) of human skin. Oily surfaces, such as the face, may contain over 500 million bacteria per square inch (6.5 cm²).” That is just the skin!

But, it isn’t just our skin that houses bacteria and microbes. Dr. Trudy M. Wassenaar, in “Bacteria more than Pathogens” says, “We house millions of bacteria on our skin and in our nose, mouth, and gut:

  • Up to 500 species can be found as normal oral flora
  • There can easily be 25 species living in a single mouth
  • A milliliter of saliva can contain as many as 40 million (4 x 107) bacterial cells
  • 108 bacterial cells present in the cecum (the initial part of the colon) per milliliter of content is normal and many of these species are different from those found in the mouth
  • We are born sterile (free of bacteria) but within hours we are colonized by our little friends, not to be left alone again.”

NPR reports, “The human body contains 20 times more microbes than it does cells. In fact, a visitor from outer space might think the human race is just one big chain of microbe hotels.” Inside and out, we are just one big carrier of other life forms!

But, why should King County government care about your body or mine?

Typically, we live in a natural, harmonious balance with the multitude of organism we naturally carry within our bodies and even more potential pathogens living in innumerable natural reservoirs in the environment, including animals, water and soil (I.e., influenza and avian influenza viruses, Legionnaire’s disease, leptospirosis, E. coli, salmonella and other food-borne diseases). We’re literally surrounded by infectious agents.

But, all too often, that natural balance is upset, leaving us vulnerable to disease. Germs constantly learn new tricks – development of drug resistance and new virulence traits allow them to cause disease more effectively in human populations. In addition, new infectious agents emerge when we upset the balance between man and nature, encroaching on new habitats (SARS).

As Mary Wilson from the Harvard School of Public Health and the Harvard Medical School in her seminal paper “ Travel and the Emergence of Infectious Diseases” states, “Today’s massive movement of humans and materials sets the stage for mixing diverse genetic pools at rates and in combinations previously unknown. Concomitant changes in the climate, technology, land uses, human behavior, and demographics converge to favor the emergence of infectious diseases caused by a broad range of organisms in humans, as well as in plants and animals.” Simply put, the introduction of an infectious disease can happen any day, and at anytime. It is not a matter of if, but when. They will arrive with someone, likely a visitor, relative, friend, or a neighbor.

What organizations are there to protect us? The United Nation’s World Health Organization, the US Center for Disease Control, and most importantly, our King County Department of Public Health are responsible for our health safety. The Department of Public Health is our key local first responder, our community’s immune system. It is that department that has the primary responsibility to prevent, detect, treat, and control the widespread introduction of diseases.

Our local Public Health Agency quietly protects us from infectious diseases every single day. They insure that our food and water are safe to consume. If the local and national health and economic security of the general population were our highest priority, public health would also be our highest priority. It is there that the greatest number of lives can be saved and protected. It is that department who we will all turn to when the infection eventually lands as SeaTac; or arrives at our ports; or drives here on I-90 or I-5. If the Department of Public Health fails, we all lose.

Balancing a budget is a challenge. Public Health must be a priority. One can make a compelling case for the preservation of social safety nets, public safety, and justice. We will need a balanced approach. This is not a time for the cynical and expected game of political one-upmanship. Nor should we tolerate the voices that play to our fears, suspicions, distrust, and our base interest. We are a better community when the voices we hear speak to our optimism, even in the most trying times. Maybe we’ll be pleasantly surprised. Maybe, there is a glimmer of a chance that the common good will be united with common sense. Maybe.

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Down the road

We may be entering an era where our major infrastructure will be owned by private entities with public partner. Matt Rosenberg, a senior fellow at the transportation think tank Cascadia Center for Regional Development, eloquently spoke to this in his article, “A state agency eyes public-private transportation” which appeared in the on-line publication Crosscut. The article suggests that the Washington State Investment Board may be interested in financing various highway improvements in the State of Washington through a public private partnership. The Investment Board, like other large organizations with significant pension and other cash accounts, has found that government’s transportation infrastructure provides a good return on investment.

For many reasons, it is quite likely that there is more than a little interest in this outcome. Washington, like other states across this country face multi-billion dollar investments in highway maintenance and expansion projects. In addition, Congress is not interested in another gas tax increase (last time it was raised was 1983). At this year’s Democratic National Convention, I participated in a Rockefeller Foundation funded session entitled “The 2008 Rocky Mountain Roundtable Transportation & Infrastructure Roundtable.” There was an interesting exchange between Pennsylvania Governor Ed Rendell and Rep. Rosa DeLauro (D) Connecticut. Despite the insistence of both Gov. Rendell and former Speaker of the House Richard Gephardt that a gas tax might be necessary, Rep. DeLauro made it clear that the House of Representatives had little appetite for a gas tax increase. Where does that leave us? Clearly, it is unlikely that we’ll see the Federal government pouring billions into any s tate’s roadway system.

What does this mean? Quite frankly, the Central Puget Sound, like every major metropolitan area of the country, will begin to see system wide variable tolling – not taxes – to finance congestion relief and unclog our roadways. This was suggested in a 2007 study of the region by Jack Oplia from Booz Allen Hamilton on behalf of King County. It is also the position of the United States Department of Transportation. In addition, the Puget Sound Regional Council (PSRC) is also looking at system tolling alternatives in their Transportation 2040 update. One alternative involves just limited access roadways; the other: limited access roadways and arterials. Both alternatives show huge congestion relief and revenue generating potential.

Why will we see private/public partnerships? In order to build you must sell bonds against tolling revenue. To get a good rate from the bond market and a lower toll, government usually pledges its full faith and credit. As states and municipalities reach their capacity to bond, they may seek a large private partner to help cover risk. This is where the private market has aggressively stepped into the transportation arena. Investment banking giants, Morgan Stanley, Goldman Sachs and JP Morgan were all represented by senior partners at the Rocky Mountain Roundtable in Denver touting the capacity of the private sector to invest in our public infrastructure assets. It is has done successfully in the United States and abroad

The future will unquestionably bring system-wide variable tolling. It will ease congestion, reduce harmful emissions, and finance and rebuild our transportation infrastructure. Before these tolled facilities will be owned and operated by the private sector is something we will need to watch closely. We owe the public as much.

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Huge increase in Metro bus riders

Usually, Metro Transit ridership dips when the weather warms up, but ridership grew this summer by an astounding 9.9% with 400,000 daily boardings. Check out these new charts.

Metro weekday boardings chart August 2008
Metro weekday boardings chart August 2008
Metro ridership indicator chart August 2008

Metro ridership indicator chart August 2008

Let’s Keep Our Buses Running

Here in King County, just as our ridership is surging, higher fuel costs and lower tax revenues from a faltering economy, are creating a growing deficit in our Metro budget. Our ability to maintain service levels for our existing riders and to respond to new customers who are discovering the ease, convenience, and cost-effectiveness of our transit system, is constrained.

Metro is rated the fastest growing large bus transit agency in the nation and in May set a record for 400,000 riders per day.

Metro is rated the fastest growing large bus transit agency in the nation and in May set a record for 400,000 riders per day.

I fundamentally believe that a robust transportation network that moves people between their homes and their jobs is critical to our long term economic prosperity, as is reducing congestion so that vital freight can get to and through our region. An accessible, reliable and affordable public transportation system is vital to our community. Moreover, reducing the number of cars on the road is essential to reducing carbon emissions and protecting our environment. Thus, we must do all we can to keep our buses running and maintain our existing transit service. We must also remain steadfast with the implementation of the service expansion we promised voters when we asked them to approve the Transit Now initiative.

Therefore, I am proposing a measure that will maintain current bus service levels and will limit our fare increase to 25 cents this year with another 25 cent increase in 2010.

This phased approach would minimize the impact on the young, the old and others who can least afford it. In addition, it will give businesses and institutions like the University of Washington and Children’s Hospital that purchase employee bus passes more time to plan for these expenses so that they can continue to provide this benefit to their employees and support regional mobility.

These fare increases, however, by themselves will not be enough to make up the financial shortfall over the next two years.

Rather than reducing services, I further propose that the shortfall be covered by the sale of some Metro capital assets such as the Bellevue Metro site and by cutting capital projects totaling approximately $65 million. In addition, I propose to spend operating and capital reserves of approximately $45 – $60 million. This is an appropriate time to use these “rainy day” funds given the unprecedented financial storm pounding Metro today.

These actions are painful, but they will allow Metro transit to remain fully funded through the end of 2010 while we continue our work of finding long term funding solutions.

We must begin now to solve the significant deficit at Metro that returns in 2011. This financial gap will be in the range of $30-$40 million in annual operating funds. Over the next two years, we must look across our region’s long-term critical economic, environmental, and infrastructure needs and explore new funding models to create an adaptable and efficient transportation network.

Whether it is transforming the State Route 99 or 520 corridors or serving increased density in our growing suburbs or promoting economic development in rural areas, we will have to rethink every aspect of the movement of people and goods throughout the region. We have a short window to examine our long term funding strategies.

Let us begin now!

Water, water everywhere

One of my favorite University professors was my history teacher, Dr. Raymond Smith at Central Washington. He said history only teaches us that the events that are most historically defining tend to be the one’s whose emergence was least noticed.

I was thinking about Dr Smith’s words as I walked through my garden. Darn it, my garden needed more sun not rain! Water, water everywhere best describes the month of August of 2008. It seems so abundant. But, what if our geopolitical future is not a world shortage of oil, but water? What is our role nationally and locally? If local and regional governments have demonstrated the ability to lead in global emissions reduction, can we lead in water resource management? Can we develop a new economy around water resource technologies like we’ve done in computer, bioscience and nanotechnology?

I think we can and should be a leader. In July, King County entered into a ‘twinning’ agreement with Thailand Wastewater Management Authority. The agreement was an Eco-Asia program funded to United States Agency for International Development (USAID) that promotes improved access to clean water and sanitation.

Why clean water? Well, water conflicts have already led to war. The Six Day War between Israel and its neighbors was a water resource conflict. Lilach Grunfeld, in her Spring 1997 case study on the value of the Jordan rive wrote “Following more than 10 years of silent tensions, the conflict flared again. The Syrian government, inside its borders, attempted to divert the Banyas River, which is one of the Jordan River’s tributaries. This was followed by three Israeli army and air-force attacks on the site of the diversion. These incidents regarding water issues led up to the outbreak of the Six-Day War in June 1967 between Israel against Syria, Jordan, and Egypt. During that war, Israel captured the Golan Heights and the site of the Banyas headwaters, which enabled Israel to prevent the diversion of the Banyas by the Syrians. Israel also gained control of the West-Bank, the Jordan River as well as the northern bank of the Yarmouk.”

Since 1999 United Nations officials have openly discussed where water and resource wars will occur. Klaus Toeper, former director-general of the United Nations Environment Programme felt the need for “monitoring worldwide reserves of drinking water and establishing cooperative agreements for the use of bodies of water, including groundwater.” He also calls for “…economic instruments to stimulate use of new technologies to promote water conservation.”

Kevin Watkins director of the Human Development Report Office at the UN Development Program, and Anders Berntell, executive director of the Stockholm International Water Institute write, “Water conflicts are invariably shaped by local factors. But the sheer scale of these conflicts makes it impossible to dismiss them as isolated events. What we are dealing with is a global crisis generated by decades of gross mismanagement of water resources.”

Watkins and Berntell further note, “The facts behind the crisis tell their own story. By 2025, more than two billion people are expected to live in countries that find it difficult or impossible to mobilize the water resources needed to meet the needs of agriculture, industry and households.”

The conflict in Sudan has become daily headline news. In the Foreign Affairs article “Sudan’s Perfect War” Randolph Martin says, “In the longer term, southern Sudan’s economic interests are likely to lie in the north. The oil boom may last only 30 to 40 years. In the not-too-distant future, southern Sudan’s real strategic value will be its water and agricultural resources. Neighboring Egypt — which has seen its own population double to 70 million in the last 20 years — depends for water on Sudan.”

In an Age of Global Warming it is becoming increasingly clear that water will be this century’s defining issue. We will need entrepreneurs, academicians, technologist, investors, and political leaders that sense these subtle, yet profound, trends and seize the opportunity to grow our 21st century economy. It is imperative that we add water resource technologies to the mosaic of other high tech industries of this region’s New Economy.

Water is fundamental for life and health. The human right to water is indispensable for leading a healthy life in human dignity. It is a pre-requisite to the realization of all other human rights. –The United Nations Committee on Economic, Cultural and Social Rights, Environment News Service, 27 Nov 02

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Trains and boats and planes

Those who are unquestionably opposed to immigration are against what made America the greatest country and economic power in the world. The United States is the world’s grand experiment. We are the first Democracy to achieve super power status without a common gene pool. All of our ancestors arrived here boat, plane and land bridge. Although I have historically respected the opinion of Lou Dobbs, his stance on immigration is not in this nation’s best interest. Those who work to shut the doors of immigration, do so without regard to our future economic growth and prosperity.

According to the Wall Street Journal article “Some States Seek Integration Path for Immigrants” by Miriam Jordan, “The U.S. has absorbed a record number of immigrants since 1990, mainly from Latin America, Asia and Africa. The country is now home to about 38 million legal immigrants and 12 million undocumented immigrants. An additional 31 million people are children of immigrants.”

The Federation For American Immigration Reform reports that King County has 268,00 immigrants which make up 15% of our population.

Is immigration good for the economy? The Federal government thinks so. President George W. Bush’s Council of Economic Advisors issued a 2007 report that concluded, “Our review of economic research finds immigrants not only help fuel the Nation’s economic growth, but also have an overall positive effect on the income of native-born workers.” The Federal Reserve Board in Dallas, TX concluded the pace of recent U.S. economic growth would have been impossible without immigration.

The National Academy of the Sciences also found that “Immigration produces substantial economic benefits for the United States as a whole…”

Bill Gates, the most successful businessman and philanthropist in history, also agrees with the Federal assessments on the benefits of immigration. One only needs to read his persuasive Washington Post Op-Ed “How to Keep America Competitive” .

Professor Gordon H. Hanson of the University of California, San Diego studied immigration through the lens of economics for the Council on Foreign Relations. The report, “The Economic Logic of Illegal Immigration,” concludes, “By focusing on the economic costs and benefits of legal and illegal immigration…stemming illegal immigration would likely lead to a net drain on the U.S. economy—a finding that calls into question many of the proposals to increase funding for border protection.”

The same positive economic growth can be said of illegal immigration. “Illegal workers: good for U.S. economy”.

The National Immigration Law Center also reported that the National Academy of Sciences found that tax payments generated by immigrants outweigh any costs associated with services used by immigrants. Undocumented immigrants contribute to the tax rolls and the Social Security Trust Fund. The U.S. Social Security Administration has estimated that undocumented immigrants contribute approximately $8.5 billion in Social Security and Medicare funds each year. The U.S. Internal Revenue Service has determined that undocumented immigrants paid almost $50 billion in federal taxes from 1996 to 2003.

The Governors of the states cited in the Wall Street Journal article (including our own Governor Chris Gregoire) who encourage both increasing legal immigrants and providing pathways to citizenship for others, will insure their states are the winning economies of the 21st Century. The data is conclusive. It is time to stop arguing. In this globally competitive economy let us unabashedly embrace immigration as a gift to the next seven generations.