Daily Archives: September 15, 2020

Introduction and summary

People with mental health disabilities, like other historically oppressed communities, are experiencing compounded harms due to the COVID-19 pandemic. This is because sanismoppression that has systematically disadvantaged people perceived or determined to be mentally illpervades public policy and life in the United States. People with mental health disabilities face disproportionately high rates of poverty, housing and employment discrimination, and criminalization. The economic and social upheaval caused by the coronavirus outbreak has merely exacerbated these disparities for those who were disabled prior to the crisis, while also exposing scores more people to individual and communal trauma, loss, and uncertainty.

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As the coronavirus crisis continues to wreak havoc on communities, the need for accessible, culturally affirming mental health support services has never been more acute. However, even before the pandemic, the U.S. mental health care system was already failing to meet peoples needs. In particular, for people of color and people with marginalized gender identities, the system too often operates in oppressive ways. The psychiatric establishment, whose leadership is overwhelmingly white and male, has historically denied communities facing various forms of oppression any control over their mental health care. Today, treatment is often cost-prohibitive, scarce, and coercive.

This report lays out the existing barriers to accessing affordable and affirming mental health services and considers the impact of COVID-19 on an already strained and inequitable mental health system. It also recommends that local, state, and federal governments take the following actions:

While the focus of this report is on noninstitutionalized populations, it is critical to note that people institutionalized within psychiatric facilities throughout the United States are acutely vulnerable to infection and death during the pandemic. Confining people within congregate settings is inherently dangerous to their health and well-being, and people with mental illness are disproportionately represented in carceral facilities, institutions, and similar environments. Indeed, with the coronavirus spreading unabated in jails, prisons, veterans hospitals, nursing homes, and psychiatric facilities, large-scale investment in community-based services and supports could not be more urgent. Furthermore, states must reduce the populations of psychiatric hospitals and other congregate care facilities by scaling back admissions and expediting discharges.

For many Americans, mental health care has been unaffordable and inaccessible well before the coronavirus pandemic. A national shortage of mental health providers, the high price of care, and a lack of insurance coverage for mental health services all make it difficult for people with mental health disabilities to access care. In 2016, 11.8 million Americans had a need for mental health services that went unmet; of these, nearly 38 percent could not afford the cost of treatment. Moreover, only about 1 in 5 people with a substance use disorder received treatment in 2016, and only slightly more than 40 percent of adults with any mental illness received treatment in 2017.

Critically, the intersection of systemic sanism and racism fuels the many disparities laid bare by the COVID-19 pandemic. Racial groups that have historically been discriminated againstsuch as African Americans, American Indians, and Alaska Nativesuse mental health services at substantially lower rates than white Americans. There are myriad reasons for this, including geographic inaccessibility, economic disenfranchisement, lower rates of insurance coverage, and mistrust of the health care system due to years of abuse, neglect, and coercive treatment. For example, the coronavirus has been especially devastating in Native communities, with the Navajo Nation reporting among the highest per-capita infection rates in the country for several months. Unmet treaty obligations by the federal government resulting in chronic underfunding of critical services, paired with colonialism and ecological devastation, have contributed to the high infection and mortality rates in Indian Country. As COVID-19 continues to infect and kill Black, Native, and Latinx people at rates that far outpace those of white people, equitable access to affirming mental health supports has become increasingly imperative.

Survey data collected by the U.S. Census Bureau show that clinically significant symptoms of depression and anxiety have more than tripled since the coronavirus pandemic began, with people of color disproportionately affected. Recent data also show that following the release of video footage of George Floyds murder at the hands of Minneapolis police officers, the share of Black people suffering from psychological distress symptoms associated with depression and anxietysuch as feelings of hopelessness or uncontrollable worryjumped from 36 percent to 41 percent. This has grave implications, as the communities bearing the heaviest mental health burdens are the communities that face the steepest barriers to accessing equitable mental health treatment and support.

For people without insurance coverage, out-of-pocket costs to mental health coverage are far from affordable. Notably, people of color are more likely than non-Hispanic whites to be uninsured, with Hispanic or Latinx Americans, American Indians, and Alaska Natives all being more than 2 1/2 times more likely than non-Hispanic whites to be uninsured. Even those with insurance coverage often experience difficulties accessing mental health services. More than half of U.S. counties have no practicing psychiatrists, 37 percent of counties have no psychologists, and two-thirds of counties have no psychiatric nurse practitioners; nonmetropolitan counties have an even higher likelihood of having no accessible providers. Moreover, psychiatrists are far less likely than other providers to accept any type of insurance: While 73 percent of other providers accept Medicaid, only 43 percent of psychiatrists accept Medicaid. And slightly more than half of psychiatrists accept Medicare and private insurance, compared with more than 86 percent of other providers.

While federal parity regulations prohibit insurers from restricting mental health coverage any more than they limit coverage for other medical services, these policies largely do not require insurers to be transparent and accountable with beneficiaries. To increase parity, it is essential that there are network adequacy provisions ensuring that mental health coverage includes a sufficient number of providers that are both accessible and taking new patients; yet unfortunately, these regulations are often left out of parity enforcement. Subsequently, many insured patients with mental health disabilities are unable to find an in-network provider that is willing to see them, even though their insurer, by law, must cover mental health services. Although a limited number of plans offer some out-of-network coverage, many people who are insured may have to pay the full out-of-pocket costs of services or forgo care when they cannot find in-network providers.

Social distancing requirements, including stay-at-home orders, are undoubtedly important tools to slow the spread of the coronavirus. However, social isolation can also be detrimental to many peoples mental health, exacerbating preexisting conditions and adding to newfound mental health concerns. It is therefore essential to provide support for people struggling with several weeks or months of social isolation during the pandemic.

Around the world, prolonged social isolation is exacerbating many individuals psychiatric symptoms and increasing incidence of psychiatric disability. For example, a survey of quarantined children in Hubei, China, found that 1 in 5 children reported experiencing depressive symptomsa rate that is significantly higher than it was before the pandemic. Among U.S. adults surveyed, nearly half of those sheltering in place reported negative mental health effects, compared with 37 percent of those not under stay-at-home orders. Moreover, an analysis featured in the medical journal The Lancet found that people who have been asked to isolate at home or in quarantine facilities reported high levels of negative psychological effects including post-traumatic stress symptoms, confusion, and anger. And another survey found that about one-third of adults in the United States have felt lonelier than usual during the coronavirus pandemic. Notably, chronic loneliness is associated with numerous adverse mental and physical health outcomes.

The COVID-19 pandemic has also sparked an unprecedented economic crisis, with the United States entering what is likely to be an extended and deep recession. This downturn is disproportionately burdening people with disabilities, communities of color, people with marginalized gender identities, and those at the intersection of these identities, while also exposing them to trauma, stress, and uncertainty. A systematic review of the impact of the 2008 Great Recession on health found that an increase in distress symptoms and mental illness coincided with the economic crisis. Given that socioeconomic status is an important social determinant of mental health, the COVID-19-induced recessionas well as economic uncertainty and job loss at all income levelsis likely to exacerbate or trigger new incidences of psychiatric disability.

Furthermore, the economic fallout of the pandemic is disproportionately burdening Black, Native, and Latinx communities. People of color are more likely to work in essential jobs that put them on the frontlines of the pandemic. Essential workersparticularly women and people of colorare also nearly twice as likely to use the Supplemental Nutrition Assistance Program (SNAP), may struggle to afford child care amid closures of schools and their regular child care arrangements, and may have to pay for personal protective equipment (PPE) out of pocket. Additionally, the racial wealth gap may preclude people of color from taking unpaid time away from work since they often lack the personal savings necessary to do so. Making matters worse, occupational segregation and racism in the labor market mean that Black and Latinx people are less likely to have access to paid family or medical leave if they or a family member needs care for mental or physical illnesses. As such, these communities face compounded harms and bear an outsize share of the mental health and economic fallout of the coronavirus crisis.

Frontline health care workers and emergency medical services workers are also facing unprecedented burdens as a result of the pandemic. The World Health Organization recently released a policy brief on the need for proactive mental health action during the pandemic, with specific attention given to health care workers treating patients with COVID-19. Frontline health workers experience elevated levels of stress, anxiety, insomnia, and depression. And preliminary research in the United States shows high levels of psychological and emotional distress among health care workers directly treating coronavirus-infected patients. In a May survey, nearly 3 in 5 health care workers said that their mental health has worsened due to the coronavirus pandemic. Continued PPE shortages, long and physically demanding shifts, the emotional burden of treating and sometimes losing colleagues to the illness, and the ever-present fear of spreading COVID-19 to loved ones are causing severe emotional and mental strain for frontline health providers.

Despite these challenges, there are few accessible options for tailored mental health supports for these frontline workers. Volunteer trauma crisis response groups, peer support networks, and specialists in trauma-informed therapy have mobilized to reach health care workers, but the need outpaces the availability. Furthermore, many physicians delay or forego needed mental health treatment because they could face steep repercussions from state licensing boards, 90 percent of which still require physicians to disclose details of their mental health history. While symptoms of distress will abate for many once the crisis is under control, others may develop trauma-related psychiatric disabilities requiring long-term support.

This underscores the need for long-term investment in mental health services for populations experiencing higher rates of trauma exposure. Moreover, those seeking out and receiving treatment should not face professional barriers.

Panic, uncertainty, social isolation, and economic devastation can, in turn, exacerbate or trigger new forms of child abuse and intimate partner violence. Alcohol abuse, controlling behaviors, unemployment, and limited access to social support systems are factors associated with family violence that have become more common during this crisis. Globally, reports of domestic violence have tripled in China and risen by 30 percent in France and by 40 to 50 percent in Brazil, indicating broader global patterns of rising rates of domestic violence during the pandemic. While data on domestic violence in the United States are limited, several agencies have reported increased rates of physical and emotional abuse during the pandemic and new forms of pandemic-related manipulation. As such, it is essential to provide ongoing tailored support for survivors of intimate partner violence and child abuse both during and following this crisis.

Physical distancing policies, including stay-at-home orders, have also made it difficult for people with mental health concerns to access in-person psychiatric and peer support services. Peer support refers to the guidance, care, and nonclinical support services provided by people with lived experience of mental health disability, trauma, and/or substance use disorders; this model of care emerges from the self-advocacy and organizing of psychiatric service users and survivors. Extensive research has demonstrated its efficacy in reducing hospitalization and symptoms associated with severe emotional distress. Furthermore, peer support promotes an affirming and equitable model of healing that equalizes the inherent power imbalance in traditional clinical relationships. There are several types of peer support programs and modalities, including peer-led respite crisis centers, one-on-one recovery and virtual meal support for people with eating disorders, and the Alternatives to Suicide approach, which creates spaces for people to safely share their experiences with suicidality and acute emotional distress. However, program disruptions caused by the pandemic have threatened the continuity of some of these services.

While some peer support services have managed to ensure continuity of care by transitioning online, pandemic-related movement restrictions have disrupted most in-person mental health outreach in underserved communities. These services, performed by peer workers, community health workers, violence disruptors, and others are critical to expanding service utilization for people living in communities wracked by high rates of violence, displacement, economic disinvestment, ecological destruction, and other forms of oppression. The cessation of such in-person outreach is likely to cause adverse mental health outcomes. According to a recent survey of 880 community behavioral health care organizations, 61 percent have shuttered at least one program due to the pandemic; and nearly all of organizations surveyed have reduced their operations.

As pandemic-related closures and distancing policies continue, many people have turned to telehealth platforms and mental health apps as an alternative. Telehealth can be an important option for patients who cannot access in-person services. However, policymakers must consider privacy concerns and disparate access to broadband, as well as adequately regulate telehealth services as more Americans use virtual options. While detailed recommendations on telehealth are outside the scope of this report, further research is needed.

In order to sufficiently meet peoples needs, it is essential that all funding and reforms put in place during this pandemic remain in place after the emergency declaration expires. Responses to trauma are often delayed, and it is likely that individuals psychiatric symptoms will continue long after the initial spread of the coronavirus is contained. As such, funding to adapt to the current situation, as well as long-term, sustained efforts to offer supports and access to services, will be needed in order to properly address pandemic-related psychological and emotional distress.

There are several important, immediate steps that can be taken to expand health care coverage. Amid rampant job loss, risk of infection and hospitalization, and increased need for mental health services, universal health coverage has never been more important. However, the current administration in the White House is committed to undermining health insurance coverage through its attacks on the Affordable Care Act (ACA) and Medicaid, making this approach unattainable for the time being. As an intermediate step, federal and state governments can and should make every effort to offer affordable coverage to the uninsured within the existing ACA and Medicaid infrastructure.

Under the ACA, people who face certain life eventssuch as the loss of employer-sponsored health insurance, moving, marriage, or the birth or adoption of a childqualify for a special enrollment period (SEP), during which they can sign up for marketplace coverage outside of the yearly open enrollment period. Twelve states that operate their own state-facilitated marketplaces have opened a COVID-19-specific SEP that allows currently uninsured individuals to obtain individual market coverage, regardless of whether they qualify for a traditional SEP. According to estimates by health care analyst Charles Gaba, in the eight states that have opened COVID-19 SEPs and are reporting data, at least 240,000 people already have enrolled in coverage using this pathway.

The Trump administration, however, has refused to implement an SEP for the federally facilitated marketplace in response to the COVID-19 pandemic. Gaba estimates that approximately 920,000 people nationally would enroll in ACA coverage if the federal government opened a national COVID-19 SEP. Allowing more people to enroll in coverage would not only alleviate some of the financial concerns associated with fears of getting sick contributing to individuals psychological distress, it would also allow more people to access mental health services.

The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, which passed the U.S. House of Representatives in mid-May but has stalled in the Senate, establishes an SEP for the ACA marketplaces. It is essential that this provision be included in the final package that passes Congress. In addition to establishing an SEP, policymakers must fund culturally appropriate outreach and enrollment efforts to allow people experiencing job loss to access health care coverage.

Millions of low-income Americans would not have access to coronavirus testing and treatment or mental health care services without the Medicaid program. As the Center for American Progress detailed in June, to streamline Medicaid enrollment for millions of unemployed folks who may have lost their employer-sponsored insurance, states should offer automatic enrollment into Medicaid expansion for the unemployed and receive 100 percent federal funding through the federal matching assistance percentage (FMAP). Moreover, states that have not expanded Medicaid must do so to cover individuals who fall into the coverage gap. More than two million Americans currently do not qualify for traditional Medicaid in their states but also do not have high enough incomes to qualify for financial assistance on the individual market. In states that refuse to expand Medicaid, the federal government should offer a Medicaid option for the unemployed that mimics the state-based option.

To further support low-income individuals, presumptive eligibility is another important provision to allow uninsured and low-income people to access care. Presumptive eligibility allows certain health care providers to enroll patients who would likely qualify for Medicaid into the program for a limited amount of time, typically no more than two months. Thirty-one states currently offer presumptive eligibility in certain settings, but most limit qualification to pregnant women and children; and all but eight states exclude childless adults. Furthermore, hospitals are one of the few entities qualified to use presumptive eligibility. Therefore, many uninsured people may need to seek mental health care in a hospital setting, which could risk their exposure to the coronavirus.

Based on recommendations from the Center for Law and Social Policy (CLASP), there are several steps that states can take to make presumptive eligibility more effective. States can expand qualified entities that are able to screen for eligibility to include urgent-care facilities, child care facilities, youth serving agencies, testing sites, and virtual options. As CLASP suggests: Just as pregnant women are allowed one period of presumptive eligibility per pregnancy, individuals exposed to COVID-19 should be allowed one period of eligibility per COVID-19 exposure. Multiple periods are especially critical for essential workers without insurance who risk multiple exposures throughout the pandemic. Lastly, presumptive eligibility should be available to all potentially Medicaid-eligible individuals.

States should encourage presumptive eligibility providers to assist their patients with submitting a full Medicaid application when using presumptive eligibility in order to gain longer-term Medicaid coverage. This would also allow people to keep their presumptive eligibility coverage until a decision on a full application is made. Additionally, states can apply for Section 1115 waivers to extend presumptive eligibility for a longer period.

While previous stimulus packages have included important supports for providers, clinics, and hospitals, additional funding is urgently needed to address the needs of mental health patients and providers. For instance, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed by Congress and signed into law by the president at the end of March, allocated $250 million to certified community behavioral health centers as well as funding for state and local aid. Meanwhile, the Families First Coronavirus Response Act increased the share of Medicaid payments covered by the federal governmentthe FMAPby 6.2 percentage points through the end of the quarter in which the public health emergency ends. And if it passes the Senate, the HEROES Act would raise the FMAP by 14 percentage points through June 30, 2021; if the public health emergency extends beyond that, the FMAP would return to its original increase of 6.2 percentage points. However, the definition of eligible services for the FMAP bump excludes most community mental health services. Furthermore, community-based behavioral health providers have received little of the CARES Act funding intended to keep providers in business. For these reasons, the Senate must pass the FMAP increase, and Congress as a whole must ensure that critical community mental health services are eligible for the FMAP increase, while also being mindful that federal Medicaid assistance may need to extend beyond the scope of the public health emergency as communities continue to face the repercussions of the pandemic.

Additionally, the $1 billion allocated in the CARES Act is woefully insufficient to meet the significant health needs of tribal nations during the pandemic and in its aftermath. Numerous short-term and long-term policy changes, as outlined in a recent CAP report, are needed to redress the federal governments broken treaty obligations, which have led to disproportionately high rates of COVID-19 infection and mortality in Native communities.

In times of crisis, peer support services are critical. Given the challenges faced by frontline health care workers, essential workers, survivors of COVID-19, the millions of people grieving loved ones, and communitiesparticularly Black, Latinx, and Native communitiesdisproportionately affected by the virus, increased access to affordable mental health services must be coupled with targeted funding for peer-to-peer supports. Accordingly, the Substance Abuse and Mental Health Services Administration must provide grants to peer and mental health support groups by and for people affected by the coronavirus pandemic.

Reports suggest that this pandemic has caused a surge in the number of people with lived experience seeking to complete their peer support certifications. Many peer-led support groups and services have transitioned to online models in order to maintain continuity of care. The CARES Act allocated $200 million to the Federal Communications Commission to disburse funds for telehealth and peer support services that fall within its purview. However, this funding is woefully insufficient to meet the increased demand and to support the costs of rapidly training up people who can provide tailored and culturally affirming resources to those acutely in need.

Critically, peer support specialists and community health workers are developing innovative strategies to conduct outreach to underserved populations and provide tailored support. For example, the 30 million people with eating disorders in the United States are facing new pandemic-related stressors due to elevated concerns about food scarcity and the hoarding of groceries by shoppers, coupled with a surge in media content focused on food and weight. Solutions such as online meal support groups can connect underserved populations with people who have a shared understanding of the unique challenges this pandemic poses. Adequately funding such services through operational grants that extend beyond the duration of the pandemic is crucial to ensuring continuity of care. Furthermore, increased federal funding for peer support training is essential to bolstering existing state and local peer certification programs and facilitating outreach efforts that target the most affected populations during and in the aftermath of the pandemic.

While there clearly are protracted mental health impacts of the COVID-19 pandemic, the Trump administrations claim that lifting stay-at-home orders is necessary to curb suicide rates obscures the reality that much of this distress is due to the administrations failure to mobilize a pandemic response that meets peoples basic needs. Until the government adequately contains the coronavirus and provides economic and social support to those affected, Americans will continue to face increasing distress and trauma.

Psychiatric service provision and the incidence of mental health disability are shaped by the oppressive and traumatizing social conditions many people navigate daily. Racism, sanism, and other structures of oppression produce social and institutional arrangements that put some groups at risk of poorer health outcomes and premature death while allocating life-sustaining resources to others. Extreme social stratification and years of deliberate policy designed to unravel the social safety net have left huge swaths of the countrypredominantly people of color, disabled people, and low-income peopleunable to access life-sustaining resources. As such, without full investment in permanent housing solutions, expanded food assistance through the SNAP, and the elimination of asset limits and other cumbersome barriers to public assistance, distress will only be elevated. The behaviors that biomedical perspectives on psychiatry have defined as disordered are often the outcome of survival behaviors to cope with extreme and oppressive circumstances. Investing in the social determinants of mental health and redressing years of oppressive policymaking would ensure that the mental health interventions deployed in the wake of this crisis do not bolster the oppressive power structures that fomented such distress in the first place.

The explosive spread of the novel coronavirus underscores the importance of transforming mental health care in the United States and redressing the structural inequities baked into the psychiatric establishment and mental health policy. Even prior to the COVID-19 pandemic, people with mental health disabilities faced numerous barriers in accessing competent, affordable and culturally affirming care; this crisis has merely exacerbated these inequities.

Local, state, and federal governments must address the new challenges this crisis poses for people experiencing acute psychological distress or trauma. Their actions must be swift, comprehensive, equitable, and sustainable through the long-lasting impact of the virus.

Azza Altiraifi is a research and advocacy manager for the Disability Justice Initiative at the Center for American Progress.

Nicole Rapfogel is a research assistant for Health Policy at the Center.

This report is a collaborative effort between CAPs Disability Justice Initiative and its Health Policy team. The authors would like to thank Areeba Haider and Justin Schweitzer for their fact-checking assistance, as well as Lily Roberts, Danyelle Solomon, Adam Conner, and the Editorial team for their contributions.

To find the latest CAP resources on the coronavirus, visit ourcoronavirus resource page.

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Mental Health Care Was Severely Inequitable, Then Came the Coronavirus Crisis - Center For American Progress

The Trump administration announced two moves last week that target diversity training at federal agencies and public school lessons about American slavery. Experts in civil rights history and diversity consulting say the actions serve as an appeal to President Donald Trumps base, while further stoking racial divisions that have been called into focus by recent protests.

The Office of Management and Budget issued a directive prohibiting departments from using federal funds to administer diversity training for executive branch staff that incorporate teachings about critical race theory and white privilege. Trump himself also threatened to cut off funding from schools that teach The New York Times Magazines 1619 Project, a Pulitzer Prize-winning effort released last year to coincide with the anniversary of slaves being brought to the Virginia colony 400 years ago.

In the executive memo issued by OMB, department director Russell Vought claimed that diversity trainings run counter to the fundamental beliefs for which our Nation has stood since its inception and also engender division and resentment within the Federal workforce. He specifically cited elements of some training sessions that highlight how white people benefit from racism and may contribute to racial discrimination.

Mary Morten, president of the national consulting firm Morten Group, said federal agencies may become ineffective in serving the public without giving employees the benefit of training that incorporates lessons about diversity, inclusion and equity (or DEI).

If government agencies are prohibited from doing DEI training, theyre missing an opportunity to build a unified workforce, to include groups of people who are underrepresented and to bring these voices forward to effectuate real change. said Morten, whose firm conducts training sessions with government offices, nonprofits and companies. If people arent able to do it at the highest level of government, there will be a trickle-down effect. It means government policies from the federal level wont be inclusive.

Morten said her firm conducts a needs assessment before making recommendations on the types of sessions or training they offer to an organization. Then the organization drafts a long-term action plan based on its training to bolster inclusion.

People realize this is an opportunity to make a difference, Morten said, adding that the work of inclusion is an ongoing process. Race is still the primary indicator of someones success in this country, and its important that we uplift race in our discussions of equity. Some organizations get concerned that centering race means we wont include other areas of oppression. If we dont address race, we wont have equity in these other areas either. Theres no way around it.

While diversity training is primarily informed by academic fields such as sociology, history and ethnic studies, the source material draws heavily from critical race theory, a legal framework that emerged from the work of scholars like Derrick Bell, who was the first tenured Black professor at Harvard Law School. Critical race theory posits that race is socially constructed, and that it is not exceptional but an ordinary and routine occurrence. It also examines how white supremacy and racial discrimination are written into and maintained by the law.

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Critical race theory is important because its in the family of critical thinking, which means you must look at something with an eye towards identifying flaws, truths and opening up different ways of thinking, said Erika George, a professor of law at the University of Utah. George added that critical race theory may highlight ways in which laws and public policies may not explicitly name race as part of its language, but that the measures can still bear racial implications. Its about getting us to a place of understanding where we are by understanding where weve come from, and why it is that things are the way they are.

In Voughts executive memo, both the terms diversity training and critical race theory were offset in quotation marks in some instances, an apparent signifier that the teachings are considered inferior or illegitimate.

The President has directed me to ensure that Federal agencies cease and desist from using taxpayer dollars to fund these divisive, un-American propaganda training sessions, Vought wrote. He continued, The divisive, false, and demeaning propaganda of the critical race theory movement is contrary to all we stand for as Americans and should have no place in the federal government.

The phrasing Vought used echoes government actions from decades past that criminalized or scrutinized elements of academic study, political thought and activism purportedly carried out in the service of communism and treason. The scare tactic, otherwise known as McCarthyism after Sen. Joseph McCarthys notorious efforts, was used to target elements of the emerging civil rights movement and bears historical implications for present day, said Theodore Foster, an assistant professor at the University of Louisiana at Lafayette who focuses on African-American history, civil rights memory and Black studies.

If we think about what is being labeled propaganda, its a diversion. Its a spectacle thats familiar for this administration, but its also part of conservative rhetoric, Foster said. PC culture is a conservative phrase thats become common in our political language [and] diminishes the demands of critical race theory and Black studies in their call for recognition of anti-Blackness in society.

Through her work at an international human rights organization, George said governments that were headed toward authoritarian rule often openly harassed and policed academics.

When ideas are under assault, thats usually dangerous ground that youre treading on, George said, adding that she and her colleagues were concerned with the academics because it was a free thinking space that needed protection for other groups to be protected.

Trumps skepticism about ideas and teachings on race extends to The 1619 Project, which has gained popularity among educators seeking to supplement their lessons about slavery with the projects meditations on how the slave trade influenced American democracy and has continued to carry implications for the civil rights of Black people. The work recently came under fire from Sen. Tom Cotton, R-Ark.

In an interview with The Arkansas Democrat-Gazette, Cotton discussed his proposed bill to block funding from public schools that teach The 1619 Project, and described slavery as a necessary evil upon which the union was built.

The 1619 Project is left-wing propaganda. Its revisionist history at its worst, Cotton told The Democrat-Gazette. Curriculum is a matter for local decisions and if local left-wing school boards want to fill their childrens heads with anti-American rot, thats their regrettable choice. But they ought not to benefit from federal tax dollars to teach Americas children to hate America.

Foster said that while there are valid debates about the presentation of The 1619 Project, teaching the Times work could benefit students who might otherwise receive watered-down lessons from textbooks about the trans-Atlantic slave trade or the Middle Passage.

To call it un-American is to take conversations about power dynamics and relations off the table, Foster said. Theres a lot of criminalization of diversity going on here, [which] goes hand in hand with a criminalization of Black protest and the Black Lives Matter movement, which has demanded an ongoing recognition of anti-Blackness. In this moment, close to the election, it caters to an us-versus-them narrative thats about the spectacle and not the substance.

The apparent disconnect from Trump and his allies on diversity training and The 1619 Project may also signal an investment in maintaining any existing misinformation on the nature of race and racism. George noted that Derrick Bells approach to critical race theory suggested that there will be no progress unless theres an interest convergence between white people in power and racially marginalized people.

Critical race theory doesnt even say that [white] people are inherently racist or evil. It does say that people can be complicit in racist action, George said. I do think this is a play to the fear of displacement from what has been a relatively privileged perch in American society.

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Why the Trump administration is slashing anti-discrimination training - NBC News

Chadema's flag bearer Tundu Lissu when he left Nairobi Hospital after being treated for numerous gunshot wounds that nearly took his life in 2018. [File, Standard]

A solitary man standing in the way of a bulldozer has as much chance of stopping it as a camel squeezing through the eye of a needle.

Tanzanias Opposition leader Tundu Lissu has tried but instead ended up stopping 16 of 38 bullets pumped into his car.

And although the 52-year-old lawyer now limps around or rides in an armoured car sandwiched in a heavily guarded convoy, he says he is ready to pay the ultimate price if that is what it will take to unseat President John Pombe Magufuli, fondly referred to as bulldozer by his supporters. In a candid interview with The Standard, the Chama Cha Demokrasia na Maendeleo (Chadema) presidential candidate, who still walks around with a bullet lodged at the base of his spine, talks of what it takes to oppose an autocratic system that has been entrenched for over 60 years.

When asked how it feels to be back to his country after three years of exile, he chuckles over the phone and says: It feels weird to know that somebody out there could be trying to take you out. I cannot live my normal life. My private life is gone. Its strange to drive in fast-driving convoys, but this is life now.

This is not the only way life for the human rights activist and lawyer has changed since September 7, 2017, when he was attacked by two gunmen shortly after leaving Parliament.

Metal plates

Lissu jokes that his left leg is seven centimetres shorter, he has metal plates implanted in his body, a bullet that cannot be safely removed from his lower back, and numerous scars left by the bullets and surgeons scalpels that opened his body 24 times in Nairobi and Belgium.

But instead of quaking in his boots, the father of 18-year-old twins says he is ready to die for a cause he believes in and is busy preparing for the biggest political duel of his life.

The opposition politician vows that he will not be cowed, adding that he has the support of his wife Alicia Magabe, and sons Agostino Lissu and Edward Buhali, who at times think he is crazy to sacrifice his life in pursuit of political power.

The epic duel will be staged on October 28, when 29 million voters will cast their ballots to decide whether they will continue to be governed by Chama Cha Mapinduzi (CCM) under Magufuli or give Lissus Chadema the all-important task.

People ask whether it is worth it despite all the torture and harassment I have been through. Was it worth it for Nelson Mandela to spend 27 years in prison, or thousands of freedom fighters to die in Kenya? he poses.

Lissu has a ready answer: Freedom is never cheap. It is paid for in blood and treasure. This is the way of humanity. I am inspired by figures like Pio Gama Pinto, JM Kariuki, Tom Mboya, Bishop Alexander Muge and other heroes who died in the name of democracy.

Born on January 20, 1968, Lissu has little respect for Tanzanias founding father Mwalimu Julius Nyerere, who he accuses of setting up the systems that have killed private enterprises and forced Tanzanians to submit to autocratic governments that have no room for opposing voices.

He says he was initiated into politics in the 1970s after State agents stormed his Mahabe village in Sigidi, demolished homes and herded everybody into Ujamaa socialist villages. At the end of the exercise, 8 million Tanzanians had been uprooted.

Lissu recalled how every family, regardless of its size, was allocated only two acres, a development that opened his eyes to the governments oppressive policies that exposed its people to poverty. It is ironic that while Nyerere was hailed as a freedom icon for assisting freedom fighters in South Africa, he created the legal paraphernalia of torture and oppression that have created the imperial presidency in Tanzania. Back at home, Nyerere was an autocrat.

Although he was trained as a lawyer, Lissu treats the numerous criminal cases against him by the State as a badge of honour.

Before the 2017 attack, the former Sigidi East MP said he had been prosecuted once by President Benjamin Mkapas government and three times during Jakaya Kikwetes tenure. He has been in court eight times under the current regime.

Harassment

I have been arrested so many times that I have lost count. In all these cases, some in which I am accused of sedition, I have never been convicted. These cases are just used to harass me. They know I cannot be intimidated but just want to waste my time.

Chadema, he says, had broken new ground by presenting candidates in 85 per cent of the countrys constituencies (or 244 out of the 264 seats).

Lissu explains that 55 of the opposition candidates were disqualified by the Tanzania Electoral Commission over what he termed laughable reasons.

There were instances our candidates were knocked out because of using the name Chadema instead of writing the partys names in full. Others had been eliminated because they used initials of their middle names, he said.

The Opposition leader said some candidates had been abducted, some right in front of electoral body officials as they presented their papers. They were released days later after the deadline had passed.

Although some of them have been allowed to contest after appeals, Lissu condemned the disenfranchisement of 244 candidates contesting local council posts.

He predicted that the campaigns would be tough and elections even tougher since the prevailing conditions had made it impossible for the international community to send observers owing to the Covid-19 pandemic.

Imagine since I came back in July, I have not been allowed to hold any Press conference. It is only yesterday (Wednesday) that I met some editors. The foreign press is not allowed to cover the elections from within, he explained.

But despite the hurdles planted in his way, Lissu said he was still mobilising his supporters through rallies and social media platforms even as he puts pressure on the government to allow free and fair elections.

Although Tanzania has been turned into a pariah state, the international community must demand that free and fair elections are held. They should use diplomacy and sanctions to leverage the government to do the right thing.

In the event Chadema forms the next government, Lissu said he will institute dramatic reforms to return democracy and the rule of law, and revive the economy by rekindling free enterprise and private sector, which had been killed, returning the country to the 1960s.

The Opposition chief also promised that the countrys relationship with its neighbours would change for the better. Our national and foreign policy is in tatters because of Magufulis isolationism. We must bring back Tanzania because it is now regarded as a skunk of the world.

Lissu claimed that the East African Community was in the intensive care unit because Tanzania was not playing its role. In South Africa, we have lost friends and our neighbours are not happy. The world can do without Tanzania but Tanzania cannot do without the world. Magufuli has not been attending regional meetings and the international community shuns us. We must reclaim our place at the community of nations.

The Chadema presidential candidate said he had no illusions about the journey ahead and called on his supporters to brace themselves for a tough six weeks before they could cast their ballots.

With the rest of the worlds attention focused on fighting the coronavirus disease, which Tanzania banished through Executive Order, Lissu and his supporters will be struggling to break CCMs vice-like grip on power.

It is criminal to talk about coronavirus in my country. Magufuli has formally announced there is no corona. When people are sick and suspect it is the virus, they say they are suffering from changamoto za kupumua (breathing difficulties), said Lissu.

The politician, who has spent his adult life crusading for democracy, said the democratic space was shrinking and warned that it would take more than a global pandemic to get the government to lift its collective knee off its citizenry to allow it to draw a gasp of fresh air.See Lissu's press conference in Nairobi 2018.

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Lissu, the MP shot 38 times for standing up to Magufuli - The Standard

Good morning, NBC News readers.

With smoke from the West Coast fires reaching across the country and Hurricane Sally swirling toward the Gulf Coast, climate change has taken center stage in the presidential campaign.

Here's what else we're watching this Tuesday morning.

Deadly and historic wildfires in the West are sending smoke as far away as the East Coast, officials said.

The smoke was creating a hazy appearance in skies over part of Virginia, the National Weather Service said. It was also affecting New York City's skies.

At least 36 deaths have been linked to the fires in California, Oregon and Washington state.

President Donald Trump visited California on Monday where Gov. Gavin Newsom and other officials raised the issue of climate change and the role it's playing in the fires.

Trump interjected at one point and said, "It will start getting cooler." After California Department of Natural Resources Secretary Wade Crowfoot said he wished the science agreed, Trump replied: "I don't think science knows, actually."

Democratic presidential nominee Joe Biden on Monday tore into what he called Trump's lack of "leadership" in combating climate change, bashing him as a "climate arsonist."

Meantime, the Northern Hemisphere experienced its hottest summer on record, according to data released Monday by the National Oceanic and Atmospheric Administration.

The period from June through August was 2.11 degrees Fahrenheit warmer than average in the Northern Hemisphere, while globally, this August ranked as the second-hottest since record keeping began in 1880.

President Trump is spending valuable time in the final weeks of his re-election campaign trying to boost his numbers among Latino voters in hope of offsetting softening support among other key demographics, NBC News White House correspondent Shannon Pettypiece reports.

Trump capped off a three-day Western swing with a "Latinos for Trump" event Monday at a Phoenix resort after having spent two days trying to appeal to Latino voters in Nevada, where he said Joe Biden would be a "disaster for Hispanic Americans."

Meanwhile, the Trump campaign is also trying to flip Minnesota.

Once reliably Democratic and home to strong labor unions,

Minnesota's Iron Range was a stronghold for Trump in 2016 when Hillary Clinton narrowly defeated him in the state by just 45,000 votes.

Now he's trying to build on that base to win the state's 10 Electoral College votes.

If Trump can flip Minnesota, he could afford to lose Michigan, Wisconsin and Pennsylvania and still get re-elected if he holds the rest of his 2016 victories.

Let our news meet your inbox. The news and stories that matters, delivered weekday mornings.

The northern Gulf Coast was getting hit early Tuesday by slow-moving Hurricane Sally's outer bands, which arrived with the threat of strong winds, life-threatening storm surge and flash flooding.

The storm strengthened earlier Monday to a category 2 hurricane and made its way across the Gulf of Mexico toward Mississippi and Alabama with 100-mph sustained winds.

Sally is expected to make landfall late Tuesday or Wednesday. Track Sally's path toward the Gulf Coast states.

As the United States stands poised to record the 200,000th coronavirus fatality, there is a slim silver lining: The rate at which people are dying of Covid-19 has slowed in the last two weeks, new NBC News figures revealed Monday.

The 11,015 deaths recorded between Aug. 30 and Sept. 13 were 17 percent less than the previous two weeks' total of 13,244, the figures showed.

"It may be a statistical blip, it may be because the treatment is getting better, or it may be because the patients have been getting younger," said Dr. Sadiya Khan, an epidemiologist at the Northwestern University Feinberg School of Medicine.

Meantime, a majority of American adults don't trust what Trump has said about a coronavirus vaccine, according to new data from the NBC News|SurveyMonkey Weekly Tracking poll. The share of people who say they would get a government-approved vaccine has decreased in recent weeks, according to the poll.

Trump's "peace" deals for Israel, UAE and Bahrain are shams. They boost oppression, not amity, human rights lawyer Noura Erakat writes in an opinion piece.

The former Meghan Markle is among millions of Americans estranged from close relatives. A new book examines the pain of family rifts and how to reconcile.

Looking for practical items to help make 2020 a little easier? Check out some of the best new hand sanitizers, air purifiers and face masks.

Is there life on Venus? Maybe, scientists say.

The detection of phosphine gas in the clouds of Venus has surprised scientists, who are now wrestling with a big question: Could it be a sign of alien life?

New research published Monday in the journal Nature Astronomy detailed the recent discovery of the gas as well as its possible origins.

And while the scientists behind the research aren't making any definitive conclusions just yet, extraterrestrial life is one of the few explanations that makes sense.

"Its far-fetched, until it's not," said Janusz Petkowski, an astrobiologist at the Massachusetts Institute of Technology who worked on the research.

Thanks for reading the Morning Rundown.

If you have any comments likes, dislikes send me an email at: petra@nbcuni.com

If you'd like to receive this newsletter in your inbox Monday to Friday, please sign-up here.

Thanks, Petra

Petra Cahill is a senior editor and writer for NBC News Digital. She writes NBC News' Morning Rundown newsletter.

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Smoke from Western wildfires seen on East Coast, Hurricane Sally churns toward Gulf Coast and is there life on Venus? - NBC News

The trouble with crying wolf is that, eventually, the wolf gets a free pass, as people stop believing those warning cries and stop rushing out to chase away the predator. The wolf is real and deadly, only made unreal to decent folk by repeated false alarms. Threats to democracy fit the bill today: people are tired of repeated warnings, and threats to democracy enjoy a free ride.

The Delhi Police today would appear to be engineering a conspiracy about a conspiracy: apparently, leftists political leaders and intellectuals were conspiring to destabilise the state using protests against the Citizenship Amendment Act (CAA) and carried out the riots in northeast Delhi in February this year as part of the conspiracy. The police have arrested assorted activists and student leaders, including JNUs Umar Khalid, and have now named Sitaram Yechury, along with Yogendra Yadav, economist Jayati Ghosh and Delhi University professor Apoorvanand as possible conspirators.

In the cases registered by the Delhi police, the focus is solely on those who protested against CAA. BJP leaders who held rallies, threatening to take the law into their own hands if the anti-CAA protests were not lifted, are off the police radar.

This playbook looks as if it has been copied from the police action in the wake of the Bhima-Koregaon violence, which saw a Dalit activist killed and several injured during an attack on Dalit celebration of the 200th anniversary of the victory of Mahar troops of the British East India Company over the Peshwas army, ending Peshwa rule once and for all.

Initial reports blamed right-wing Hindutva groups for the violence, Prakash Ambedkar naming, according to news reports, Milind Ekbote and Sambhaji Bhide as organisers of the attack on the celebration of Dalit victory over Brahmin-Maratha oppression. After a Supreme Court prod, Ekbote was arrested. But the investigations into the role of right-wing organisations was abandoned after an eyewitness who had testified against them was found killed and her family members were charged with attempted murder.

A self-styled think tank conducted an inquiry into the violence and came up with the finding that an elaborate Maoist conspiracy was behind the whole thing. It chided the police for failing to act against this threat to social stability. The police of the Devendra Fadnavis-led BJP government swung into action and rounded up a number of activists and intellectuals, some from as far away as Delhi, such as Sudha Bharadwaj, lawyer and tribal rights activist, and human rights campaigner Gautam Navlakha.

When the government of Maharashtra changed, after the 2019 assembly elections, the Bhima-Koregaon investigation was taken over by the Central Bureau of Investigation, lest facts and evidence change, as they mysteriously tend to in this country, when the political executive overseeing an investigation changes.

Many of those arrested have been charged under the Unlawful Activities (Prevention) Act, which permits incarceration without bail for prolonged periods. Several of those arrested have been in jail for more than two years without the investigation progressing to prosecution or receiving bail.

In Delhi, too, a self-styled group of intellectuals have carried out an inquiry into the February riots and discovered a conspiracy to delegitimise the central government. Delhi Police, under its new Commissioner, whose letter to investigating officers cautioning against hurting the sensibilities of Hindu groups has no bearing, of course, on the nature of the investigations, has warmed up to the conspiracy theory. Anyone opposed to the CAA must have been conspiring to cause riots that would appear to be the working assumption of the investigation.

Liberty, equality and fraternity have been the watchwords of democracy, since the French Revolution. In India, fraternity has been trampled into the mud by rioters and lynch mobs. Equality has been given a formal farewell with the Citizenship Amendment Act that diminishes the quality of Muslim citizenship. If anyone thought that liberty could not survive on its own, they should suppress the urge to cry wolf.

The newly created Uttar Pradesh Special Security Force might come after them. It has been given powers to arrest and search people without a warrant and is obliged to hand over their detainees to the regular force without delay. The degree of urgency that determines what constitutes delay has been left undefined. It would be no surprise if those who disturb the peace with wanton cries of a lupine attack attract the attention of the new Force.

The wolf is amongst us, sometimes in sheeps clothing: social media trolls baying for the blood of anyone questioning the official narrative, editors who allow media management of the sort that sweeps aside pestilence, stark economic distress and barbarians at the gates, in favour of some Bollywood drama with its own tragic victims; an Opposition too scared of being branded a Muslim party to come to the aid of those victimised by the state; judges who accept evidence in sealed envelopes, as if this were compatible with the Constitutions mandate for procedure established by law.

If the bleat coming out of that sheep near you sounds a gravelly bit like a growl, do get your ears checked.

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View: Stop crying wolf over democracy, enjoy the quality of sheeps clothing - Economic Times