Editorial Roundup: United States
Excerpts from recent editorials in the United States and abroad:
The Washington Post on the NFL hiring (or not hiring) Black coaches
“Black Coaches in the National Football League: Superior Performance, Inferior Opportunities.” That was the title of a 2002 report by famed attorney Johnnie Cochran Jr. and civil rights lawyer Cyrus Mehri detailing how Black coaches averaged more wins than their White counterparts but found it harder to get hired and easier to be fired. Nearly 20 years later, nothing has changed, as a damning Post investigation underscores. The NFL can do more.
Compiling and analyzing three decades of data, a team of Post reporters — including Dave Sheinin, Michael Lee, Emily Giambalvo, Artur Galocha and Clara Ence Morse — revealed the long-standing challenges facing the league’s Black coaches. They are vastly underrepresented; while nearly 60 percent of NFL players are Black, just 11 percent of full-time head coaches since 1990 have been Black. When they have been hired, Black coaches have been twice as likely to get fired after posting a record of .500 or better than coaches of other races. They have had to spend significantly longer in mid-level assistant jobs before getting head coaching positions. They have also often been made head coaches on only an interim basis.
Even more powerful than the numbers in “Black Out,” a continuing Post series, are the voices of the Black coaches who saw their hard work unrewarded. Maurice Carthon, who coached for 19 seasons after winning two Super Bowl rings as a running back for the New York Giants, interviewed unsuccessfully for five head coaching jobs before retiring. He spoke of one interview in which a team executive told him, “You know, you’re not going to get this job,” right as he stepped off the plane. In another, he said a team owner told him, “You know, in our organization here, we let the boys wash the cars.”
The NFL has openly acknowledged there are not enough Black coaches and team executives; “unacceptable” is how NFL Commissioner Roger Goodell described the situation to the league’s 32 teams in February. The league points to efforts it has taken over the years aimed at increasing diversity among its coaching ranks. It created networking seminars for minority coaches and front-office executives. It encouraged teams to foster diverse talent pipelines, for example by giving draft choices to teams that develop coaches of color who become head coaches. But the league says it ultimately can’t control what the owners do, and that the predominantly White male group, as The Post’s reporters have made painfully clear, is more comfortable hiring people who look like them.
In fact, the league is not doing all it can; the latest installment of “Black Out,” by Gus Garcia-Roberts, detailed the league’s failure to exert pressure on teams. It failed to enforce the Rooney Rule, which requires teams to interview ethnic-minority candidates for head coaching and senior football operation jobs. That interview process — and how easily it is gamed — figures prominently in the lawsuit brought by former Miami head coach Brian Flores against the NFL and three teams. Just as the threat of a lawsuit in 2002 forced the NFL to take some action by creating the Rooney Rule, let’s hope Mr. Flores’s suit and the attention focused on NFL hiring will finally bring change. Or the league could live up to its words and do the right thing without being forced into it.
The New York Times on mental health in the United States
Across the country hundreds of thousands of Americans with serious mental illnesses, such as schizophrenia and bipolar disorder, have been consigned to lives of profound instability. Instead of therapists to help them manage their illnesses or doctors to oversee their medication regimens or evidence-based treatment for their substance use disorders, they cycle through homeless shelters and the jails and prisons that have become the nation’s largest mental health providers. Or they make their homes on the streets. They are victims of a mental health system that is not designed to meet their needs — and of a society that has proved mostly indifferent to their plight.
Few Americans are receiving adequate psychiatric care or psychological support these days — either because their health insurance doesn’t cover it, or because they don’t have insurance to begin with, or because wait lists run far too long. But even amid such pervasive insufficiency, society’s neglect of the most severely mentally ill stands out. Of the 14 million or so people who experience the most debilitating mental health conditions, roughly one-third don’t receive treatment. The reasons are manifold — some forgo that treatment by choice — but far too many simply cannot connect with the services they want and need.
The most obvious reason is money. Community-based mental health clinics serve the vast majority of Americans with serious mental illnesses. These patients tend to be low-income, to be disabled and to rely on Medicaid, whose reimbursement rates are so abysmal that clinics lose money on nearly every service their doctors provide. “They get 60 to 70 cents on the dollar,” says Chuck Ingoglia, president of the National Council for Mental Wellbeing, a nonprofit representing thousands of U.S. community mental health centers. “I don’t know any other part of health care where your physician is your loss leader.” As a result, staff vacancies can run upward of 30% in public mental health clinics and waiting lists can stretch for months, even for people in crisis.
In many ways, the criminal justice system has become the only reprieve: Because court-ordered patients are granted priority, pressing charges against loved ones is a common way to get them psychiatric attention in a crisis. Jails and prisons also serve as final landings for those who fall through the cracks: They make up the three largest psychiatric facilities in the country, and more than 40% of the nation’s inmates have been diagnosed with mental disorders.
Americans have long accepted that, tragic though it may be, there are no other options. That apathy is easy to understand. When it comes to caring for the mentally ill, the arc of American history has nearly always bent toward failure. But the policies and programs that could undo this crisis have existed for decades.
In 1963, in what would turn out to be the last bill he signed into law, President John F. Kennedy laid out his vision for “a wholly new emphasis and approach to care for the mentally ill.” It involved closing the nation’s state psychiatric hospitals — which had become dens of neglect and abuse — and replacing them with a national network of community mental health centers. The centers, unlike the hospitals, would support and treat the formerly institutionalized so that they could live freely in their communities, with as much dignity as possible.
Lawmakers and health officials executed the first half of that vision with alacrity. Thanks to a roster of forces — Kennedy’s bill, new and effective antipsychotic drugs and a rising tide of activism for patients’ rights — the number of people housed in large psychiatric hospitals fell by 95 percent between the 1950s and the 1990s. But nearly 60 years after Kennedy’s bill became law, health officials and lawmakers have yet to realize the second half: There is still no community mental health system in America, but it is possible to start building one now.
Dr. Steven Sharfstein remembers the Boston State Hospital in Mattapan, a creaking 19th-century building where he and his fellow psychiatry residents were forced to send their most intractable patients.
“It was a terrible place,” says Dr. Sharfstein, who served as president of the American Psychiatric Association. “The lights didn’t always work, the patients wandered around like zombies. Nobody got better.”
Eventually, he and his fellow residents banded together and refused to go. Move the patients back to central Boston, they insisted, and treat them at the community mental health center. Their small protest was part of a growing movement to close state psychiatric hospitals across the nation and replace them with community-based care.
Those hospitals had also arisen from a movement: In the mid-1800s, after visiting hundreds of almshouses, jails and hospitals and seeing the horrid conditions that most people with mental illnesses lived in, the reformer Dorothea Dix begged health officials to create asylums where those patients could be treated more humanely. The first such facilities were small, designed for short-term, therapeutic care, and functioned more or less as Dix had hoped they would. But as local officials began foisting more of their indigent populations onto the states, they morphed into human warehouses. By the time Dr. Sharfstein started his career, most of them held upward of 3,000 patients, often for years at a time.
Advocates of a community-based approach argued that even the sickest psychiatric patients deserved to live in or near their own communities, that they should be cared for in the least restrictive settings possible and that with the right treatment (humane, respectful, evidence-based) the vast majority of them could recover and even thrive.
Kennedy’s bill was meant to enshrine these principles. The plan was to build some 1,500 community mental health centers across the country, each of which would provide five essential services: community education, inpatient and outpatient facilities, emergency response and partial hospitalization programs. Ultimately, the centers would serve as a single point of contact for patients in a given catchment area who needed not just access to psychiatric care but also help navigating the outside world.
The law did not provide long-term funding to sustain these new clinics — just seed grants for planning, construction and initial staffing. The hope was that once those grants expired, states would step in with their own resources. But this thinking proved overly optimistic. Rather than invest the money saved through asylum closures on mental health clinics, most states spent it on other priorities, such as cutting taxes or shoring up pensions.
As the initial grants ran out, programs that had been designed specifically for people with serious mental illnesses shifted focus, Dr. Sharfstein says. Some turned their attention to patients with better health insurance than the indigent had. Others tried tackling an array of nonpsychiatric crises. Alleviate homelessness and food insecurity, the thinking went, and even the most seemingly intractable mental illnesses would all but disappear. “Obviously, there is inherent value in addressing social ills,” says Dr. Paul Appelbaum, a Columbia University psychiatrist and an expert on the intersection of mental illness and law. “But the concept of community mental health became diluted to the point that it neglected psychiatric treatment.”
Congress tried to revive the flailing community mental health initiative in 1980, with a bill that would have more than doubled the federal government’s investment in Kennedy’s original plan. President Jimmy Carter signed that bill into law, but President Ronald Reagan repealed it the following year. He replaced it with a block grant program that gave state leaders broad discretion in how they spent federal mental health dollars. “It was more or less the death knell for a national community mental health system,” Dr. Appelbaum says. “They spent the money on all sorts of things, including things that we already knew were not working.”
In the end, less than half of the centers that Kennedy had envisioned were ever built. Marginalized people continued to spill out of state psychiatric institutions but found no meaningful safety net. By the 1990s, they were turning up in prisons and homeless shelters once again.
What stands out about this history now is not how disastrously wrong it all went but how close officials came to getting it right. The catchment area model laid out in the Kennedy bill would enable people in psychiatric distress to remain anchored in their communities. And single-point-of-access clinics would help families in crisis avoid the desperate gambit of seeking care through courts and judges. “The community mental health model was the right one,” says Dr. Appelbaum. “I talk to so many families who are in crisis today, and they have no idea where to turn.”
Congress could correct course now by writing a new bill that pulls the best of these past attempts together and builds on them.
Federal officials took a promising step in that direction in 2014, when they created a new community mental health demonstration project that enables Medicaid to pay mental health clinics based on what it actually costs to care for patients. “There are so many things you do to support a person with a serious mental illness that you cannot get reimbursed for,” says Mr. Ingoglia, of the National Council for Mental Wellbeing. “Sending case managers to jails and prisons and state hospitals to help clients transition into outpatient care. Working with police to screen the people that they encounter in their work.” The pilot program factors these essentials into the cost of care and reimburses centers accordingly.
So far, the resulting initiatives have proved more sustainable and more effective. In Missouri, behavioral health clinics are serving nearly 30 percent more patients by switching to the new model and have been able to provide same-day service to many clients. In Oklahoma, mental health clinics have effectively “put a therapist in every police car,” officials say, by outfitting cars with an iPad that contains a specially designed app. The program has helped reduce adult psychiatric emergency room visits by more than 90 percent and is now being implemented in homeless shelters and other contact points throughout the community.
Congress has already expanded this demonstration project, and scores of states are experimenting with the new model or planning to. But it will take more than pilot programs for these new centers to succeed where the early community mental health movement failed. Individual projects will have to be evaluated rigorously so that the most effective ones can be scaled. Hospitals, police departments, homeless shelters and other institutions will have to be brought along at every step so that mental health is neither siloed nor forgotten but instead becomes a fully embedded part of the wider community.
Education and outreach will also be essential. People with serious mental illnesses are far more likely to be victims of violent crime than perpetrators. But in an age where mass shootings and random street attacks have become commonplace, that fact has been buried in stigma. And a truly robust mental health system will have to include a range of services — not only outpatient clinics but also short-term care facilities for people facing acute crises, and some congregate institutions for the small portion of people who can’t live safely in the community. To prevent abuse, these facilities will need to be well funded, well monitored and held to a high standard.
None of this will be cheap. By most estimates, it would cost several billion dollars to fully fund and carry out the original community mental health vision today. But those costs would be partly offset by what police departments, jails and hospitals could save. The $193 billion in lost earnings that results from untreated mental illnesses should also be an incentive, and an eventual source of savings.
Americans have accepted the mistreatment and neglect of people with serious mental illnesses for far too long. It’s within our power to break that cycle now, and to change the way that the most vulnerable among us live for generations to come.
The Wall Street Journal on OPEC, the Saudis and Biden’s oil production policies
Oil prices rose Monday on news that the Organization of the Petroleum Exporting Countries (OPEC) and its allies may agree on Wednesday to cut production. The Saudis and Russia are underscoring the folly of President Biden’s limits on oil and gas production, and his non-emergency release of oil from the national petroleum stockpile.
A couple of months ago Mr. Biden sojourned to Saudi Arabia to beg the Crown Prince for help containing surging U.S. gasoline prices. Now it looks like the meeting was worse than unproductive. Reports say OPEC and its allies including Russia will consider slashing their production targets by a million barrels a day when they meet this week.
Analysts estimate this would lift crude prices to about $100 a barrel from the $80 to $90 range of the last month. OPEC countries may be seeking to boost their budgets to cope with rising food prices and the strong dollar. But the timing couldn’t be worse for Mr. Biden and Democrats in Congress.
The Administration has released 200 million barrels or so from the Strategic Petroleum Reserve over the past year and about one million barrels a day in recent months. These drawdowns were scheduled to end this month, but the Administration recently extended the releases into November, no doubt worried that a taper would increase gasoline prices before the midterm election.
But oil traders aren’t naifs. They know the releases will soon end and the Administration will also have to start refilling the reserve, which is at its lowest level since 1984. Much of the oil that remains can’t be efficiently processed by U.S. refiners. So if there were a true national emergency—say, a cyber attack on a major oil pipeline—the U.S. might not have enough inventory to keep supply flowing.
To refill the reserve, the Administration may soon have to buy oil at a higher price than it has been selling it. Sell high and buy higher wasn’t supposed to be the strategy, Mr. President. A smarter strategy to reduce U.S. energy prices would have been to encourage more domestic production.
A new study by the Committee to Unleash Prosperity estimates that the U.S. would be producing between two and three million more barrels of oil a day and between 20 and 25 more billion cubic feet of natural gas if the Trump Administration’s policies had continued. Economists Casey Mulligan and Steve Moore say the Biden Administration’s anti-oil-and-gas policies are costing the U.S. economy $100 billion a year.
Producers normally respond to rising prices by raising output. That was true in the past in the U.S., especially from 2016 to 2019 when production increased by about three million barrels a day. But U.S. producers haven’t responded to higher prices during the Biden Presidency as much as those in other countries, including Russia, Canada and Norway.
Pioneer Natural Resources CEO Scott Sheffield last month estimated that U.S. oil production will likely grow by a mere half a million barrels a day this year and perhaps even less in 2023. So even though oil prices have been about 50% higher under Joe Biden than under Donald Trump, production growth is about 50% lower.
Democrats blame oil drillers for prioritizing profits over production, but companies must consider the long-term return on investment. The Biden policies have created substantial regulatory uncertainty, raised production costs, and directed capital to green energy.
If gasoline prices rise before the November election, the Administration has its own policies to blame.
The Guardian on Qatar’s World Cup
There are now less than 50 days to the World Cup in Qatar, which promoters have taken to describing as a tournament “like no other”. For once the PR hype is justified, and not only because the matches will be played during the lead-up to Christmas rather than in summer. The decision to stage the planet’s biggest sporting event in a country with a notoriously poor human rights record is provoking unprecedented queasiness among competing nations.
Last week, in conjunction with the kit manufacturer Hummel, the Danish football federation unveiled a plain all-black third kit for the tournament. It was designed, said Hummel, in memory of the many migrant workers who died during construction work in the years leading up to the finals. The captains of some European teams – including England’s Harry Kane – aim to wear rainbow “One Love” armbands, symbolizing opposition to discrimination in a country where homosexual acts are illegal. The German federation invited a gay fan to use its platform at an event to address the Qatari ambassador on the subject of LGBT rights. Abdulla bin Mohammed bin Saud Al Thani reportedly responded that human rights issues were distracting from the tournament.
To the extent that this is true, it is of course a good thing. High-profile gestures by companies such as Hummel are far better than nothing at all. But time is running out for the kind of action that could leave a lasting positive legacy from a World Cup that should never have been awarded to these hosts. Football is a global game and a tournament in the Middle East is desirable in principle, but this is not the way.
With justification, Qatari authorities claim they have responded to pressure to reform brutally exploitative conditions for migrant workers. The hated kafala system, for example – which tied a worker to a single employer – has gone, and attempts have been made to compensate for unpaid wages and introduce minimum pay. But the latest in a series of Guardian investigations, published last month, found that, despite high-level initiatives and reassurances, abusive practices were still rife on the ground. Migrant workers at the Al Bayt stadium, where England will play the USA on 25 November, had been obliged to pay huge illegal recruitment fees and lived for months in unfit, overcrowded accommodation, earning £1 an hour. Elsewhere, laborers spoke of 12-hour shifts, six days a week, without proper overtime pay. A climate of fear inhibited many from speaking out about conditions. Migrant workers who have returned home ahead of the World Cup say they were sent back before finishing their contracts or without receiving all they claim they were owed.
A recent YouGov poll, commissioned by Amnesty International, found huge support for a compensation fund for migrant workers who have been mistreated, and for the relatives of those who died. Amnesty, along with other human rights groups, are campaigning for FIFA, world football’s governing body, to set up such a fund using a fraction of anticipated profits of $7bn. The amount proposed is $440m – equivalent to World Cup prize money on offer. After prolonged hesitation, the English FA has now backed the principle of a fund, as have high-profile figures in football such as the Dutch national team manager, Louis van Gaal, and the Brazil coach, Tite. FIFA has said it is thinking about it. It’s time to stop thinking and act.
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