Trying to engage in good faith: would you likewise say that the notion of sports medicine is irrelevant? That even though professional athletes have unique stresses on parts of their bodies that are not common in a general population, unique levels of societal pressure around accelerating their recovery time, and a need for rapid real-time diagnostics... a generalist physician would be as effective as a specialist?
Now imagine you're running a massive sports team, and you have a budget for medical care. But then a government entity comes and says: regardless of outcomes, you're not allowed to hire specialists or allow your team members to elect to go to specialists, because that could be seen as unfair... regardless of whether statistics point to improved outcomes if you were allowed to have certain specialists.
Looping back to suicide hotlines: even if the administration had increased funding to the hotline to compensate for the ended specialist program (which is highly unlikely, and that this was more likely a net funding loss) - it's a similar restriction on whether a lifeline program can allocate resources to specialists. And the stakes here couldn't be higher.
(And if statistics pointed to other groups benefiting similarly from specialization, I’d want a clinician-led organization to evaluate that research and determine budget allocation towards those specialists, too.)
> A national hotline that can handle anyone is clearly the right way
The data suggest otherwise [1].
Which makes sense. “For LGBTQ youth, risk factors such as bullying, abuse, negative family treatment, as well as negative emotions caused by anti-LGBTQ legislation have also been identified” [2]. If you’re in a community that’s tolerating all of that, your trust in generic institutions will be low.
> any more than Black or Asian or Indian cases
If a population is disproportionately committing suicide, they should be disproportionately resourced. “Native Americans and non-Hispanic White Americans” have “the highest suicide rate in the United States” [3].
The law that created the hotline even specifically mentions those two groups, along with rural Americans:
> (a) SENSE OF CONGRESS.—It is the sense of Congress that—
> (1) youth who are lesbian, gay, bisexual, transgender, or
queer (referred to in this section as ‘‘LGBTQ’’) are more than
4 times more likely to contemplate suicide than their peers,
with 1 in 5 LGBTQ youth and more than 1 in 3 transgender
youth reporting attempting suicide;
> (2) American Indian and Alaska Natives have the highest
rate of suicide of any racial or ethnic group in the United
States with a suicide rate over 3.5 times higher than the
racial or ethnic group with the lowest rate, with the suicide
rate increasing, since 1999, by 139 percent for American Indian
women and 71 percent for men;
> (3) between 2001 and 2015, the suicide death rate in rural
counties in the United States was 17.32 per 100,000 individuals,
which is significantly greater than the national average, and
the data shows that between that same time period, suicide
rates increased for all age groups across all counties in the
United States, with the highest rates and the greatest increases
being in more rural counties; and
> (4) the Substance Abuse and Mental Health Services
Administration must be equipped to provide specialized
resources to these and other high-risk populations.
Different people face different challenges, and helping them requires different strategies. You really don't think that there's anything unique about the challenges LGBTQ people face?
> There doesn't need to be a specialist for every group, or worse - some groups.
Why? The struggles different groups generally face are not the same. For a hotline for veterans, wouldn't it make sense to have counselors who are either veterans themselves or have worked extensively with veterans and their specific patterns of issues?
What is this assumption based on? It sounds political.
Are LGBTQ people at a higher risk for suicide? Could hotline staff reduce suicide attempts with special training? Seems like you could measure this.
Thinking about other groups with a higher risk--veterans, abuse survivors, gambling addicts--are there suicide prevention programs for these groups and are they effective?
There was actually a study done on this [0] that found LGBTQ youth are around four times as likely to attempt suicide compared to their non-LGBTQ peers.
> Thinking about other groups with a higher risk--veterans, abuse survivors, gambling addicts--are there suicide prevention programs for these groups and are they effective?
For veterans in the US, at least, there are specific programs targeting them since they do have a disproportionately high level of suicides and suicide attempts compared to the general population.
If a trans kid calls the suicide hotline and the volunteer suggests they stop wearing dresses to school so people won't bully them, I'm pretty sure the outcome will be far worse than anyone intended. There should be specialists who know how to handle specific kinds of callers.
By that logic, pediatricians and gynecologists shouldn't exist.
> A national hotline that can handle anyone is clearly the right way.
Absolutely. That describes this setup. You call the number. You get help. Sometimes that means a person trained in, say, talking to rape victims. (If you go to the ER, they'll have a nurse trained in it too!)
Per the article: "Also known as the 'Press 3 option,' the program gave 988 callers the option to 'press 3' to connect with a counselor trained to assist lesbian, gay, bisexual, transgender and queer youths and young adults (they could also text 988 with the word 'PRIDE'). Nearly 1.5 million contacts were routed to the LGBTQ service since its launch, according to data available on the SAMHSA website."
Those are physical differences. Which isn’t to say that you’re wrong, but we could easily have different things for physical differences and not for mental differences. Should we have different prisons for gays? Same logic, no?
The leading theories for the biological underpinnings of same-sex attraction are also physical—some combination of genes, prenatal environment, and biochemistry—so this argument fails both ways.
It’s moot in any case because the whole point is identifying groups of people who benefit from help tailored at their situation so it’d make sense to specialize even if it was a choice. If we saw tons football fans more likely to contemplate suicide after the Super Bowl we’d want to support them even though that’s unambiguously social. Helping people is what makes civilization worth having.
Good; we agree differences in a patient/customer may require special training/handling.
> Should we have different prisons for gays?
Again, this wasn't a different hotline. Just a phone tree option.
I suspect prisons, at times, have to manage things specific to gay inmates. Seems like it could cause roommate situations to be accounted for, as an example.
> Incarcerated Individuals can contact OSI directly by dialing 444 from any incarcerated individual phone Monday through Friday between the hours of 8:00 am and 5:00 pm.
> Every jail must develop a clear and responsive prisoner grievance procedure, including a formal means of delivering complaints and concerns from a prisoner to the administration and the procedures by which the prisoner receives a written response. However, the prisoner should not be able to use the procedures to avoid institutional rules and regulations.
Deep expertise is not a blank check for funding. There is only so much money to go around and at some point you have to articulate your value to those paying for it (in this case, the tax payers and their representatives).
Yes, this means a high level summary generally focused on ends rather than the gory details of the means.
An expert acting in good faith should be able to provide this or, in the spirit of the Feynman technique, I would argue they aren't much of an expert at all.
> Deep expertise is not a blank check for funding.
Sure. But the people vetting your proposals should have useful expertise in assessing it. Individual grant proposals for scientific research should essentially never be something a congressional rep is deciding on.
Someone needs to assess, say, the B-21's radar absorbent coating project, but it'd be a mistake to think some random pediatrician is the right one to do it.
Congress does not, by and large, get down to that level. They are typically approving a line time that encompasses a form of lump sum (i.e. "$100 million to NSF across these categories").
Defense spending would typically be a gruesome bidding process.
But either way, your proposal must at some point speak to something a generalist would understand. And that is how it should be - anything else is taxation without representation.
I think it's been pretty well established that most legislators do not take the time to understand the details of bills prior to voting.
Moreover, these articles refer to an attempt to question how grant money already given (and presumably spent) was used.
Scrutiny is an inherent part of the powers of the purse. I.e. "we gave you $100 million to provide disaster relief, economic development in our sphere of influence, etc - what did you do with it?"
It's fair to want to retain the spending being questioned, but Congress is explicitly responsible for this function.
