Strategy targets legal highs and chemsex – BBC News

Image caption New legislation to tackle “legal highs” was brought in last year

So-called “legal highs” and “chemsex” drugs will be targeted in a government move aimed at cutting illicit drug use.

Figures from the Home Office show the number of 16 to 59-year-olds taking drugs has fallen from 10.5% to 8% in the past decade.

But the department is worried about the use of new psychoactive substances (NPS), performance enhancing drugs and prescribed medicines.

A “national recovery champion” will help users “turn their lives around.”

Home Secretary Amber Rudd, who will chair a new cross-government Drug Strategy Board, said: “Since becoming home secretary I have seen first-hand how drugs can destroy lives.

“I am determined to confront the scale of this issue and prevent drug misuse devastating our families and communities.”

‘Emerging substances’

The number of drug deaths in England and Wales increased by 10.3% to 2,479 in 2015, 14.9% in 2014 and 19.6% in 2013.

NPS, formally known as legal highs, mimic the effects of other drugs, such as cannabis.

Last year, laws were introduced to criminalise the production, distribution, sale and supply of them, but they still fall into the hands of users.


Image copyright PA

By Danny Shaw, BBC home affairs correspondent

In December 2010, with Home Office priorities centred on police reform and immigration, the last government drug strategy felt like a box-ticking exercise. Just 25 pages long, it contained little detail or original thinking and just one paragraph on the problem that was later to engulf prisons, legal highs.

The theme of the last strategy was supporting people to live a “drug-free life”; it emphasised the need for “abstinence” and said too many users were reliant on drug-substitute treatments such as methadone.

The 2017 strategy makes no mention of abstinence or limiting methadone use, but it is setting more demanding and wide-ranging measurements of treatment success.

At double the length of the previous document, there is a sense that the Home Office is more focused on the issue than before, prompted perhaps by the recent rise in drug deaths and the need to prevent a new generation of drug users sparking a fresh crime-wave.

Chemsex – using drugs as part of sexual activity – often involves crystal methamphetamine, GHB/GBL and mephedrone.

Government studies show the practice increases health risks, both mentally and physically, including aiding the spread of blood borne infections and viruses.

Intelligence and recovery

The strategy will start with a new intelligence system to identify the harm that drugs can cause and to stop their use from spreading.

The scheme will also aim to strengthen border controls, learn from global trends and share intelligence on the substances with other countries.

But the Home Office wants to focus on recovery too, with a “champion” to be appointed to look into helping recovering users find homes and jobs, and to help with their mental health – as well as checking on the success of medical treatments.

“This government has driven a tough law enforcement response in the UK and at our borders, but this must go hand in hand with prevention and recovery,” Ms Rudd said.

“This new strategy brings together police, health, community and global partners to clamp down on the illicit drug trade, safeguard the most vulnerable, and help those affected to turn their lives around.”

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When a woman took sick days for mental health, her email sparked a larger discussion

(CNN)Madalyn Parker sent an email to her team at work saying she’d be out of office for a few days to focus on her mental health.

“I was absolutely touched. It brought tears to my eyes,” Parker told CNN. “It was surprising to be applauded for my vulnerability.”

The email

    Parker, 26, lives in Ann Arbor, Michigan. She’s a software developer or “empathy engineer” — a title she chose for herself — for Olark, a Michigan-based live-chat platform that helps businesses talk to customers. It has a staff of about 40.
    She told CNN she suffers from chronic anxiety, depression and post-traumatic stress disorder. And every now and then, she needs to take some time to focus on her well-being.
    “I had experienced several nights of insomnia and was poorly rested and also having lots of suicidal thoughts, which make it difficult to accomplish much at work,” she said.
    A few weeks ago, she sent an email to her team that said:
    “Hey team,
    I’m taking today and tomorrow to focus on my mental health. Hopefully, I’ll be back next week refreshed and back to 100%.

    The response

    The next day, she opened her inbox to find a flood of response. But one that caught her eye was from company CEO Ben Congleton.
    “I can’t believe this is not a standard practice at all organizations,” read part of his email. “You are an example to us all, and help cut through the stigma so we can all bring our whole selves to work.”
    So, Parker posted the exchange online.
    “I thought the internet should see what a good example he’s setting,” she said.
    Ever since, she’s been flooded with messages telling her just how great her boss must be.
    “Wow, I wish! I needed a medical mental health stay once. Upon my return, my boss told me not to let it happen again or my job would be gone,” one woman wrote.
    Another said, “I had to take a mental health day recently and lie about my reasoning for not coming in, because it’s not seen as a viable excuse for missing work.”

    The reason

    Congleton, the boss, said that as he read through the comments on the email chain, he started to get emotional. He realized it was time to make a change.
    “I think there’s a lot of people out there that don’t really understand what mental health is. I feel sorry for them,” he told CNN. “Mental health (is) just as important as physical health in these situations.”
    The National Institute of Mental Health, in a study in 2015, found that an estimated 16.1 million adults in the US experienced a major depressive episode in the previous year.
    And an American Psychological Association survey in 2016 found less than half of working Americans say the climate in their workplace support employee well-being.
    “It’s 2017,” Congleton wrote on Medium. “When an athlete is injured they sit on the bench and recover. Let’s get rid of the idea that somehow the brain is different.”
    His advice to employers? Create a workplace where your employees feel safe talking about what’s bothering them.
    “There’s this misconception that you can leave part of yourself home when you go to work,” Congleton told CNN. “(But) some personal stuff is gonna hang in there and hold on.”

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    Downbeat Republicans no closer to health care deal, but ready to vote next week

    Washington (CNN)Republican senators were no closer to a health care deal on Tuesday after the surprise decision to delay the Senate’s summer recess and as a bombshell revelation about Donald Trump Jr. hung over Capitol Hill.

    GOP senators had hoped to finally get some clarity on the fate of their bill to overhaul Obamacare, after last week’s Independence Day recess deepened some lawmakers’ reservations about the proposal.
    Instead, members arrived at a weekly lunch meeting to a chaotic scene where swarms of reporters peppered senators with questions about the news that President Donald Trump’s eldest son had agreed to meet with a Russian last year after being promised sensitive information that would “incriminate” Hillary Clinton.
      Two hours later, Republicans still didn’t know how the health care bill would be revised — and GOP leaders insisted that there would be a procedural vote next week.
      Adding confusion to the already muddled deliberations over the health care legislation, some senators said Tuesday afternoon that they were led to believe they might see two sets of draft bills and revised reports from the non-partisan Congressional Budget Office, while another veteran Republican declared that he was working on a separate proposal of his own.
      Majority Leader Mitch McConnell, R-Kentucky, decided to add two more weeks until the traditional August recess starts, extending the time senators have to work on health care — but with no guarantee that it will amount to anything.
      Meanwhile, Sen. Lindsey Graham told reporters that he and several other colleagues were in drafting a health care proposal that would likely be introduced as an amendment to the current bill. “I want to do the best I can and I think the best we can is not on the table right now,” the South Carolina Republican said.
      While Graham himself would not share details of his plan, one senior Democratic aide said Graham had reached out to some Democrats on a potential bipartisan approach.
      Asked if that was a bad sign for leadership’s efforts to shore up support for their bill, Texas Sen. John Cornyn, the Senate’s majority whip, acknowledged: “It means this is hard.”
      While GOP leaders emphasized that decisions were still being made about what provisions will make it into a final bill, Cornyn said he expects $45 billion in extra funding to battle the opioid addiction epidemic — a key demand of Republicans Rob Portman of Ohio and Shelley Moore Capito of West Virginia — would make it into the bill.
      He also said two Obamacare taxes on affluent Americans — one a Medicare payroll tax surcharge and the other on investments — that Republicans had initially wanted to repeal, will likely stay in place. Those funds would go to “the innovation and stabilization fund to try to give governors the ability to get premiums lower and deductibles lower,” he added.

      Do they have the votes?

      Even with these changes, Cornyn said, he was unsure whether leaders would get to 50 “yes” votes.
      Sen. John Thune, R-South Dakota, said winning over rank-and-file members opposed to the bill remained a tough task.
      “Every time you kind of move the dial in one direction, you maybe add some new members but lose a couple over here,” Thune said. “Right now we’re just trying to find the sweet spot.”
      Others leaving the lunch were much more tight-lipped.
      “I have no comment on anything,” said Sen. Jim Risch, an Idaho Republican. “You guys have a good day.”
      Sen. Lisa Murkowski, who has expressed serious concerns about the Senate health care bill, was asked whether any progress was made on issues important to her. She simply responded, “No.”
      “You know we are going to be getting a new one,” the Alaska Republican said when pressed about ongoing problems with the legislation.
      McConnell said his decision to delay the start of August’s recess by two weeks was in part to ensure that senators would have time to tackle other legislative priorities after concluding health care.
      To that end, he is moving full steam ahead with a vote next week, with a draft bill being released on Thursday and an updated CBO score expected early next week.

      Cruz amendment divides members

      One major sticking point is a proposed amendment from conservative Sen. Ted Cruz.
      The Texas Republican has been pushing a proposal to give insurers more opportunities to offer plans that don’t comply with Obamacare regulations. But it has drawn criticism from moderates in the conference who worry it could erode protections for people with pre-existing conditions.
      In recent days, some of Cruz’s colleagues have sounded increasingly skeptical about whether the amendment could help create more support for the health care bill and if it would be included in the final bill at all.
      “I think it picks up conservatives votes and loses other votes,” Iowa Sen. Chuck Grassley had said Monday.
      On Tuesday, Cornyn told reporters the proposal was still “in the mix” of revisions being discussed. Meanwhile, Tennessee Sen. Bob Corker said he expects two draft bills — one with the Cruz amendment and one without — to be released on Thursday, while Louisiana Sen. Bill Cassidy said leadership suggested two CBO scores would be released early next week.

      Russia news continues to overwhelm

      What was supposed to be a clarifying day on health care instead turned into yet another day consumed by Russian meddling in the 2016 election, with mobs of reporters clamoring to know exactly what Republicans planned to do with the latest Donald Trump Jr. revelation.
      “These revelations today rise to a level that likely complicates (McConnell’s) health care work given the fact that every one of his senators is going to be getting surrounded like this today,” Democratic Sen. Chris Murphy of Connecticut predicted to a large scrum of reporters in the Senate basement.
      Corker, the chairman of the Senate’s foreign relations committee, argued he was doing his best to stay focused on health care and Russia sanctions legislation.
      “It’s losing focus, and I’m focused on other things,” Corker said, noting that he was getting blood drawn when he learned about the bombshell news on CNN.
      Graham insisted, however, that he was not fazed by the latest headline about the Trump campaign — and that it would not distract him from health care.
      “I can do two things at once,” he said.

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      Meningitis vaccine may also cut risk of ‘untreatable’ gonorrhoea, study says

      Bacteria causing two different illnesses belong to the same family and share much of the same genetic code providing unexpected cross protection

      Hopes to fight untreatable strains of gonorrhoea have risen after it emerged that a new vaccine against meningitis unexpectedly reduced the risk of people getting the sexually transmitted infection.

      Some strains of gonorrhoea are resistant to all available drugs, making vaccine development an urgent global health priority. But according to a study in The Lancet, a vaccine has offered protection against the sexually transmitted disease for the first time.

      Gonorrhoea spreads through unprotected vaginal, oral or anal sex and many of those who contract the disease experience no symptoms. If left untreated, the disease can cause infertility and can increase the transmission of HIV infection.

      A New Zealand meningitis epidemic in the early 2000s prompted the mass vaccination of a million people and fortuitously set the scene for the current study. The vaccine used, known as MeNZB, was designed to protect against meningococcal group B infection the cause of the most deadly form of meningitis.

      But intriguingly, over the next few years, scientists noticed fewer gonorrhoea cases than expected in those who had been vaccinated against meningitis.

      Dr Helen Petousis-Harris, a vaccine specialist from the University of Auckland who led the study, was optimistic: Some types of gonorrhoea are now resistant to every antibiotic we have, and there appeared [to be] little we could do to prevent the steady march of gonorrhoea to superbug status. But now theres hope, she added.

      The research team studied over 14,000 people aged 15-30 whod been diagnosed with gonorrhoea at sexual health clinics across New Zealand and who had been eligible for the MeNZB vaccine during the emergency vaccination programme. They found vaccinated individuals were over 30% less likely to develop gonorrhoea.

      Despite meningitis and gonorrhoea being very different illnesses, both are caused by bacteria from the same family and share much of the same genetic code, providing a possible explanation for the cross-protection that the team observed.

      More than 78 million people worldwide get gonorrhoea each year with most infections in men and women under the age of 25. It is the second most common bacterial sexually transmitted infection in the UK after chlamydia. In England alone, almost 35,000 people were affected in 2014.

      British Association for Sexual Health and HIVs President, Dr Elizabeth Carlin, who was not involved in the study, was more sceptical: These early findings are to be welcomed but its important to keep in perspective that the vaccine offered only moderate protection …. an individual receiving this vaccine remains susceptible to gonorrhoea but just less so than if unvaccinated.

      The MeNZB vaccine used in the current study is no longer manufactured, but Petousis-Harris has high hopes for a similar meningitis vaccine called 4CMenB, available in many countries.

      Petousis-Harris was clear about what needed to happen next. We need an urgent assessment of current meningitis vaccines to see if they protect against gonorrhoea. It may be possible to eliminate many gonorrhoea infections using a vaccine with only moderate protection. It does not need to be perfect, she added.

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      Sense of purpose aids sleep, US scientists find

      People who felt they had a strong purpose in life suffer from less insomnia and sleep disturbance, says neurologist

      The secret to a good nights sleep later in life is having a good reason to get up in the morning, according to US researchers who surveyed people on their sleeping habits and sense of purpose.

      People who felt they had a strong purpose in life suffered from less insomnia and sleep disturbances than others and claimed to rest better at night as a result, the study found.

      Jason Ong, a neurologist who led the research at Northwestern University in Chicago, said that encouraging people to develop a sense of purpose could help them to keep insomnia at bay without the need for sleeping pills.

      More than 800 people aged 60 to 100 took part in the study and answered questions on their sleep quality and motivations in life. To assess their sense of purpose, the participants were asked to rate statements such as: I feel good when I think of what Ive done in the past and what I hope to do in the future.

      According to Ong, people who felt their lives had most meaning were less likely to have sleep apnea, a disorder that makes the breathing shallow or occasionally stop, or restless leg syndrome, a condition that compels people to move their legs and which is often worse at night. Those who reported the most purposeful lives had slightly better sleep quality overall, according to the study in the journal Sleep Science and Practice.

      Insomnia and some other sleep disorders become more common in old age, but Ong said that the findings were likely to apply to the public more broadly. Helping people cultivate a purpose in life could be an effective drug-free strategy to improve sleep quality, particularly for a population that is facing more insomnia, he said.

      Age UK, a charity, advises people who sleep badly to go to bed and rise at the same time every day; establish a bedtime routine; and cut out caffeine, alcohol and nicotine in the evening. Not eating a heavy meal late at night; avoiding exercise before bed; cutting out daytime naps and banning TVs and computers from the bedroom helps too, they add.

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      TrueFace.AI is here to catch the facial recognition tricksters

      TrueFace.AI knows if it's looking at a real face or just a photo of one.
      Image: ian waldie/Getty Images

      Facial recognition technology is more prevalent than ever before. It’s being used to identify people in airports, put a stop to child sex trafficking, and shame jaywalkers.

      But the technology isn’t perfect. One major flaw: It sometimes can’t tell the difference between a living person’s face and a photo of that person held up in front of a scanner.

      TrueFace.AI facial recognition is trying to fix that flaw. Launched on Product Hunt in June, it’s meant to detect “picture attacks.”

      The company originally created Chui in 2014 to work with customized smart homes. Then they realized clients were using it more for security purposes, and TrueFace.AI was born.

      Shaun Moore, one of the creators of TrueFace.AI, gave us some more insight into the technology.

      “We saw an opportunity to expand our reach further and support use cases from ATM identity verification to access control for data centers,” said Moore. “The only way we could reach scale across industries would be by stripping out the core tech and building a platform that allows anyone to use the technology we developed.”

      “We knew we had to focus on spoof detection and how we could lower false positives.”

      TrueFace.AI can detect when a face or multiple faces are present in a frame and get 68 raw points for facial recognition. But its more unique feature is spoof detection, which can tell real faces from photos.

      “While working on our hardware, we tested and used every major facial recognition provider. We believe that doing that (testing every solution available) and applying facial recognition to a very hard use case, like access control and the smart home, allowed us to make a better, more applicable solution,” said Moore. “All of these steps led us to understand how we could effectively deploy technology like ours in a commercial environment.”

      They made their final product by using deep learning. They trained classifiers with thousands of attack examples they collected over the years, and liked the results.

      A “freemium” package is available to encourage the development community that helped TrueFace.AI come up with a solution. Beyond that, the Startup Package is $99 per month while the Scale Package is $199 per month. An Enterprise Plan is available via a custom agreement with TrueFace.AI.

      While Moore couldn’t divulge exactly which companies are using the technology, he did say some of them are in the banking, telecommunications, and health care industries.

      It’s a service that could become increasingly valuable as companies turn to facial recognition technology.

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      ‘Pierced’ baby picture sparks outrage among parents

      (CNN)Enedina Vance was fed up. She felt like other parents didn’t understand her message. She felt like they weren’t listening to her.

      So she got on her phone, found a picture of her 6-month-old daughter and pasted a diamond stud over the infant’s dimple to make it look like she had a piercing.
      Vance, a strong advocate against piercing or circumcising children, posted the edited picture to Facebook, where it had more than 13,000 shares as of Thursday afternoon.
        “I make all of her decisions until she’s 18, I made her, I own her!!” she wrote.
        What Vance didn’t expect was the reaction she’d get from parents around the world. Outrage. Hate mail. Threats to call Child Protective Services.
        But the image also proved her point, and it got parents talking.
        “The reaction that parents have when they see this beautiful perfect baby being … mutilated, that initial shock, that reaction of anger, I want them to hold on to that,” the 35-year-old said.

        Many thought photo was real

        The stay-at-home mom from Fostoria, Ohio, knew that seeing a picture of a baby with a dimple piercing would get her family and friends talking, so she shared it in parenting Facebook groups.
        The post quickly incited outrage among the parenting community, and she was called “a bad mother” and worse.
        Many people assumed the piercing was real and lambasted Vance for her apparent decision.
        “I seriously can not believe how many people missed that this was purely satirical, I actually used the hashtag #sarcasm,” Vance wrote on Facebook. “Yet people were still threatening to beat me to death, call child protective services, & take away my children.”
        Other parents simply disagreed with her stance on piercing.
        One woman wrote, “I got my ears pierced as a baby. I grew up just fine. … I’m having a girl and I will get her ears pierced.”
        Ohio law allows children under age 18 to get piercings and tattoos with a parent or guardian present. Most states allow minors to be pierced with parental consent.
        Amid the death threats and hate mail, Vance said she also got countless positive messages from parents. Some said they felt they didn’t have a choice in whether their sons were circumcised. Another was told it was a “cleanliness thing.”
        “A lot of this responsibility lies on our medical community. They encourage parents,” Vance said. “It shouldn’t be an option. It shouldn’t be a question.”

        ‘Not a good enough reason’

        Vance didn’t always feel so strongly about circumcision.
        Coming from a family of all women, she said she didn’t know a lot about circumcision until she became pregnant for the first time in the late ’90s. Vance had twin girls, but the research she did stuck in her mind.
        “It felt so outdated, so primitive,” she said. “We as a civilized society should have grown past this and (I) was shocked that cutting my infant’s genitals was even an option.”
        Many parents choose to circumcise their children because of hygienic, health or religious reasons.
        In 2012, the American Academy of Pediatrics found that the health benefits of circumcision outweigh the risks. However, the academy said the benefits weren’t great enough to recommend that all newborn boys be circumcised.
        “There is no compelling reason to deny boys their legitimate right to make their own informed decision when they are old enough to do so,” the report said.
        Vance sees this as a call to action and will tell anyone she meets how she feels if it comes up in conversation. She protested last fall in Cleveland with the Bloodstained Men & Their Friends, an organization that advocates against circumcision.
        But her beliefs extend beyond circumcision.
        “No one has the right to alter, modify, or mutilate another human being’s body for aesthetic purposes, not even parents,” she said.
        Vance has argued that ultimately, children should be able to decide for themselves.
        “What 1-week-old is asking to have earrings?” she said. “Just because it looks cute, just because it looks better — that’s not a good enough reason.”

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        McConnell hints healthcare vote could fall short: ‘I’m a guy with a Rubik’s cube’

        Senate majority leader spoke to impasse over key aspects of Republican bill at an event Thursday, but said no action was not an alternative

        Senate majority leader Mitch McConnell on Thursday hinted that the Republican effort to repeal the Affordable Care Act (ACA) could fall short as conservatives and moderates in his conference remain at an impasse over key aspects of the bill.

        Before leaving Washington for a week-long Fourth of July recess, McConnell delayed a vote on the Republican healthcare bill after it was clear there was not enough support for the plan, which would leave 22 million fewer people without health insurance over the next decade, according to an analysis by the Congressional Budget Office.

        If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur, McConnell told constituents at a Rotary Club lunch on Thursday, according to the Associated Press.

        No action is not an alternative, he added. Weve got the insurance markets imploding all over the country, including in this state.

        McConnells comments were quickly embraced by his Democratic counterpart, Senate minority leader Chuck Schumer.

        Its encouraging that Sen McConnell today acknowledged that the issues with the exchanges are fixable, and opened the door to bipartisan solutions to improve our healthcare system, Schumer said in a statement.

        As weve said time and time again, Democrats are eager to work with Republicans to stabilize the markets and improve the law. At the top of the list should be ensuring cost-sharing payments are permanent, which will protect healthcare for millions.

        McConnell faces a daunting task as he works behind the scenes with senators to craft a bill that bridges the ideological divide within his conference. Moderates, especially those from states that opted to expand Medicaid under the ACA (also known as Obamacare) are wary of scaling back spending on the health insurance program for low-income Americans, and conservatives are irked the plan does not go further to repeal the law.

        Im in the position of a guy with a Rubiks cube trying to twist the dial in such a way to get at least 50 members of my conference who can agree to a version of repealing and replacing Obamcare, McConnell told Kentucky voters at a town hall-style event on Thursday, according to NBC. That is a very timely subject that Im grappling with as we speak.

        Senate minority leader Chuck Schumer holds up a photograph of constituents who would be adversely affected by the proposed Republican bill. Photograph: Andrew Harnik/AP

        An initial draft of the Senate Republican healthcare plan mirrors the structure of the House bill, which passed in May. The measure would repeal key pieces of the ACA while extracting deep cuts to Medicaid compared to spending under current law.

        McConnell has since made changes to the bill, including adding $45bn to combat the opioid epidemic, among other adjustments. The CBO is expected to release another analysis sometime next week, a likely indicator that Senate Republicans will not vote on the plan until later this month.

        On Thursday, a handful of senate Republicans echoed McConnells skepticism about whether the party would be able to reach an agreement on health care.

        It is precarious, senator Ted Cruz, a conservative of Texas, said on San Antonios KTSA Radio. The majority is so narrow, I dont know if we get it done or not.

        Senate Republicans are using a special budget process known as reconciliation to avoid a Democratic filibuster of the repeal plan. To pass the bill, Republicans need support from at least 50 of their 52 members. No Democrats are expected to support a repeal measure. In the case of a tie, vice-president Mike Pence would cast the final vote.

        Cruz has offered an amendment that would allow insurance companies to sell non-compliant plans as long as they also offer at least one plan that does meet Obamacare standards. Experts on both sides of the political debate said such an action could devastate insurance markets.

        Senator Jerry Moran, a Republican from Kansas who surprised his party when he came out against the bill, told constituents in Palco that healthcare reform is almost impossible to try to solve when youre trying to do it with 51 votes in the United States Senate, in which there is not significant consensus on what the final result ought to be.

        As the debate over healthcare rages, Senator Pat Toomey, a Republican of Pennsylvania who supports the bill, suggested during a televised town hall on Wednesday that McConnell was several weeks away from winning enough support for a vote. Asked why Republicans were struggling to fulfill a years-long campaign promise, Toomey offered a candid reply.

        Look, I didnt expect Donald Trump to win, he said. I think most of my colleagues didnt, so we didnt expect to be in this situation.

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        Activists cry cowardice as Republican senators shut doors to healthcare town halls

        Pat Toomeys closed-door talk saw him accused of not having the courage to speak to those affected, while Ted Cruz also faced dissent at his ticket-only event

        At a town hall in Pennsylvania on Wednesday night, Republican senator Pat Toomey faced an angry protest over his role in the GOP healthcare bill, while Ted Cruz was heckled over his suggested amendment to the legislation at an event in Texas.

        Scores of people gathered outside the ABC27 studio in Harrisburg, Pennsylvania, where Toomey was holding what had been billed as a town hall meeting.

        But in reality just eight audience members were allowed into the invite-only event, and their questions had been pre-screened by the news channel.

        The closed-door approach did not endear Toomey to the sign-waving protesters outside, who accused the senator of not having courage to speak to people who would be personally affected by the Senate healthcare legislation he helped to write.

        Cruz, meanwhile, was heckled at what in theory should have been a safe event; a ticket-only town hall veterans discussion hosted by Concerned Veterans for America a rightwing advocacy group financed by the Koch brothers.

        Audience questions for Cruz at the event in McKinney, north of Dallas, had been screened in advance by the CVA, but two audience members went rogue to quiz and interrupt the Texas senator over his proposed tweak to the Senate bill.

        The Better Care Reconciliation act, which the Congressional Budget Office says would leave an additional 22m people without healthcare, is currently stuck in the Senate without enough votes to pass. Cruzs amendment would allow insurance companies to sell plans that do not include the Affordable Care Act (ACA)-mandated essential health benefits, in a move he claims would reduce costs.

        At the town hall, however, Cruzs adversaries repeatedly shouted him down as he attempted to defend his measure.

        When you mandate what every policy has to cover you drive up the cost of insurance, Cruz said, which means fewer people can afford healthcare. The essential health benefits also made people pay for coverage that they dont necessarily want, he said.

        Its all fine and good to mandate that everybody get coverage for everything at all times, but what happens in practice is the prices go so high that people are left out in the cold.

        Ted Cruz also faced heckling at a ticket-only town hall event in Texas. Photograph: ddp USA/REX/Shutterstock

        Some 1,300 miles to the north east, Toomey was being given a much easier ride from the eight attendees at his town hall. The majority of the questions from that crowd, as well as from small groups of people invited into the studios of three other ABC affiliates in Pennsylvania, focussed on healthcare, but there was no heckling and no follow-up questioning.

        Asked about the damaging CBO score, Toomey accused the organization of bias and said that its calculations were based on wildly speculative assumptions that I think are extremely likely to come to pass.

        Toomey denied that the process of drafting the bill which has no public hearings had been overly secretive, but was non-committal over whether he supported repealing the ACA without a replacement.

        The senator was asked the question twice, both times saying that he believed the scenario was unlikely.

        I just dont think there are enough votes in the senate to pass that, Toomey said. I just dont think its going to come to pass.

        Meanwhile, outside the studio about a hundred people noisily protested both the senators role in the unpopular healthcare bill and his refusal to hold a truly public event.

        We want Toomey to come home on his recess and actually speak with constituents, instead of doing telephone town halls or televised town halls where he doesnt have to interact with the people hes supposed to be representing, said Katey Dyck in a phone interview, who travelled two hours from her home in Fort Washington, just north of Philadelphia, to attend the protest.

        Hes dismantling our healthcare system without having the courage to speak to people who would be personally affected.

        Dyck travelled to Harrisburg with her two children and two friends, one of whom, Alison Fraser, was arrested after staging a sit-in at Toomeys Washington DC office last week.

        There are issues with the ACA. There are things they can do to bring down costs, Fraser said.

        But they cant just dismantle this bill that has really done so much to protect people, and make sure people arent discriminated against because of pre-existing conditions.

        Also among the protesters was Josh Burkholder, a Democrat who ran unsuccessfully for US congress in Pennsylvanias fourth district last November.

        Theyre giving a huge tax break to the 1% here, Burkholder said, also by phone, of the Senate legislation.

        Its just awful. Making a giant tax break for the ultra rich while simultaneously pulling the rug out from under the poor of the country is just disgusting.

        The majority of Senate Republicans have so far ducked interactions with the public during recess week supposedly a time for elected officials to return to their districts and meet with constituents.

        The Washington Post reported that just four GOP senators planned to attend Fourth of July parades, while only three Cruz, Bill Cassidy from Louisiana and Jerry Moran from Kansas are scheduled to hold public town halls.

        Cruz and Moran are openly opposed to the Senate bill while Cassidy has said he is concerned and has put forward an alternative to the plan.

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        Is there institutional racism in mental health care? – BBC News

        Media playback is unsupported on your device

        Media captionEche explains how he was Tasered when sectioned under the Mental Health Act

        Black people are being failed by the UK’s mental health services because of “institutional racism”, it has been warned. How does this affect those who experience it?

        When Eche Ogbuono, who has bipolar disorder, was sectioned under the Mental Health Act, he should have been taken to a safe environment – usually a hospital – for a medical assessment.

        Instead, he was taken straight to a police station.

        “Being in the police cell was probably the worst thing they could have done to me in the state of mind that I was in,” he tells the BBC’s Victoria Derbyshire programme.

        Under the Mental Health Act, a person can be detained if they are considered to be suffering from a mental disorder and in immediate need of care or control.

        Eche was released two days later. But shortly after, following an altercation at his home, his parents called the police.

        This time, after he refused to go willingly, one of the officers used a Taser.

        Eche says: “I’m in my room, and I’m like, ‘I’m not going [with police].’ The first time, I was compliant.

        “Physically they tried to get me down, that didn’t work. So they brought the Taser out, 50,000 volts.

        “Before I know it, I’m back in handcuffs.

        “It’s made me more resistant and distrusting of the system in general because it felt like a prison experience. I feel like a criminal.”

        ’17 times more likely’

        The matter of black overrepresentation within the mental health system is a complex one.

        Statistics suggest a black man in the UK is 17 times more likely than a white man to be diagnosed with a serious mental health condition such as schizophrenia or bipolar.

        Black people are also four times more likely to be sectioned under the Mental Health Act.

        Issues such as unemployment and poverty play a part in the inequality, but there are fears that institutional racism also has a role.

        Image caption Councillor Jacqui Dyer says mental health services must change for black communities to trust them

        Jacqui Dyer – a councillor in Lambeth, London, the borough with the biggest black population in the country – believes this is the case.

        She is vice-chair of the government-appointed Mental Health Taskforce for England.

        “What we find is that there’s a differential experience so these I might describe as structural inequalities, unconscious bias, institutional racism, whatever you’re more comfortable with in terms of terminology which means decisions that are made in these structures, sort of biases those communities,” she says.

        Ms Dyer says there is a belief within some black communities that if you go into mental health services, “it’s not that you get recovery, it’s that you die [there]”.

        This, she says, leads to people “presenting later” for treatment, when their case is more severe.

        “We have to change the narrative, by actually changing the services,” she says.

        Image caption The Reverend Freddie Brown says the church is “indispensible to the solution”

        According to the Reverend Freddie Brown, from Tooting New Testament Assembly, the Church could play a vital role in creating this change.

        He is part of the Pastor’s Network, set up because of concern about the number of parishioners presenting with mental health problems.

        Church leaders in the network have taken accredited family therapy courses to try to improve the situation.

        He believes – by working with other mental health services – they can be “indispensable to the solution”.

        ‘Feel suicidal’

        Lorraine Khan, from the Centre for Mental Health, also believes “institutional racism” is embedded in the system.

        A new report from the think tank found when black people tried to access help, they were less likely to receive the support they wanted.

        They are now calling on the government to overhaul its approach to mental health to tackle the issue, which she says has been overlooked:

        “I think there is a problem with institutional racism in the way we take action and try to improve things. This problem doesn’t affect the majority of the country so it becomes a minority issue as far as commissioners are concerned.

        “We find there’s not the investment in research to improve the programmes that young men and women say they want. It’s not considered the priority. The priority is, all the services are geared towards white people.”

        A Department of Health spokeswoman said: “We want to make sure that everyone, regardless of ethnicity, age or background, gets the mental health treatment they need.

        “Work to consider reform of mental health legislation will begin to ensure mental health is prioritised in the NHS in England – and in part reflecting concern about the disproportionate rate of detention of black people under the existing system.”

        Maitreya, a singer-songwriter, was sectioned for a second time a few weeks ago, following an argument with a family member.

        She says she found it difficult to access mental health care from the NHS in the year before she was detained.

        “I was actually trying to tell them, ‘I feel very much suicidal at the moment.’

        Image caption Maitreya says she was not taken seriously when she reported suicidal thoughts to doctors

        “I took myself into a hospital. I took myself into A&E. I’ve called ambulances.”

        But Maitreya says she was not taken seriously.

        “It’s made me lose trust in the mental health service.

        “Now I’ve gone through a whole process of being sectioned – and I need more help to deal with the trauma – I’m scared because I’m like, ‘How will the help come now?'”

        After being sectioned, Maitreya has now been diagnosed with psychosis, something she disputes.

        When she was detained she rejected medication, saying she had developed her own coping mechanisms.

        According to some experts, black people are more likely to be medicated while admitted to mental health services.

        Donald Masi, a psychiatric doctor, believes this is the result of a wider cultural perception that black people are more dangerous.

        “Say there’s a petite 50-year-old white lady with a mental illness and a 6ft [1.8m] black guy with the same illness,” he says.

        Image caption Donald Masi says the cultural perception of “black people being the aggressor” feeds into decisions over medication

        “Both may be calm but may have episodes of irritability, frustration or aggression because they’re distressed from their mental illness.

        “People are more likely to think that the black guy is going to do something and hurt them, because essentially there is a cultural idea of black people being the aggressor.”

        Eche believes in his case “there could have been a subconscious [racial] bias”.

        He says: “When I think about some of the other people that I saw in the ward, I’m like, ‘What that person was doing was definitely more aggressive than me – but they stayed in that open ward, they didn’t come into intensive care.'”

        Eche says “it was basically all BME [black and minority ethnic]” in the intensive care unit.

        And the “whole system needs an overhaul” to deal with the ingrained bias.

        “How race impacts your experience in the mental health system, how painful it is, I think something needs to be done,” he says.

        Watch the Victoria Derbyshire programme on weekdays between 09:00 and 11:00 on BBC Two and the BBC News channel.

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