2010 NFA-LD Cooperative Evidence Pack

2010 NFA-LD
Evidence Set
Cooperative Page 1 of 241
2010 NFA-LD Cooperative Evidence Set –

Master Index
2010 NFA-LD Cooperative Evidence Set – Master Index.....................................1
AFFIRMATIVE EVIDENCE....................................................................6
***IMD AFF - Index***...................................................................6
***Native American Mental Health AFF - Index***........................................26
***Rural Telemental Health Care AFF – Index***.........................................54
***PTSD Military AFF – Index***........................................................69
NEGATIVE EVIDENCE.....................................................................103
***States CP – Index***...............................................................103
***Federalism DA – Index***...........................................................111
***Complementary and Alternative Medicine NEG – Index***..............................118
***Community Base Care CP – Index***..................................................127
***Funding File – Index***............................................................135
***Generic Negative Evidence – Index***...............................................153
***Mental Illness Myth Kritik - Index***..............................................165
***State Spending DA - Index***.......................................................205
***Procedurals – Index***.............................................................218
NOTE: The evidence included in this set is not guaranteed to conform to NFA-LD rules or the AFA Code of
Ethics. The staff at the NFA-LD Cooperative has done their best to ensure that the evidence released in this
set is of a high quality but it is impossible to check and verify all research completed by the students who
attended the cooperative. If you choose to read evidence from this set in competition, please do your
homework and verify the evidence you intend to use before you read it. The evidence in this set is not
designed to support an NFA-LD program, but is merely designed to provide a supplement and direction for
research.
2010 NFA-LD
Evidence Set
AFFIRMATIVE EVIDENCE
***IMD AFF Index***
IMD AFF Index...........................................................................2
1AC 1/8 – Inherency.....................................................................3
1AC 2/8 – Plan Text.....................................................................4
1AC 3/8 – Solvency 1/2..................................................................5
1AC 4/8 – Solvency 2/2..................................................................6
1AC 5/8 – Adv 1 – Prisons 1/2...........................................................7
1AC 6/8 – Adv 1 – Prisons 2/2...........................................................8
1AC 7/8 – Adv 2 – Dehumanization 1/2....................................................9
1AC 8/8 – Adv 2 – Dehumanization 2/2...................................................10
Extensions – Explanations of IMD.......................................................11
Extensions – Private insurance can’t solve.............................................12
Extensions – Human Rights Impact.......................................................13
Extensions – Moral Imperative..........................................................14
Extensions – Soft Power Link...........................................................15
Extensions – Inherency.................................................................16
Extensions – Solvency..................................................................17
Extensions – IMD is discriminatory.....................................................18
Extensions – Stigma causes Dehumanization..............................................19
Extensions – AT – States CP............................................................20
Extensions – AT – Spending.............................................................21
2010 NFA-LD
Evidence Set
1AC 1/8 – Inherency
Observation 1 is Inherency –
Attempts to repeal the Institutions for Mental Disease or IMD exclusion have
failed.
Rebecca Farley, Policy Analyst for the Alliance for Children and Families, 2009 [Medicaid Reimbursement for
Health Services in Institutions for Mental Disease, An Analysis of the IMD Exclusion and Proposals for Change,
http://www.alliance1.org/Public_Policy/Health/IMD_Exclusion.pdf] JH
Numerous attempts to repeal or limit the scope of the IMD exclusion have failed over the years since its
enactment.21 Opponents of the IMD exclusion do not universally support a total and immediate repeal of the rule.
Other proposals to lessen the impact of the rule include creating demonstration projects to evaluate the success of partial repeal, changing the exclusion
so as to allow for a greater number of beds, and pursuing an administrative process for repeal. H.R. 619, introduced by Rep. Eddie Bernice
Johnson (D-TX), would entirely repeal the IMD exclusion. This proposal would immediately allow facilities that provide inpatient
services to people with mental illnesses to expand the number of beds in their facilities or extend treatment to patients age 21 or over. However, there
are also potential downsides: because the 16-bed limit has served to discourage institutionalization of the mentally ill and encourage their treatment in
smaller community-based facilities, some advocates for the mentally ill have expressed concern that removing the exclusion could result in money being
diverted away from community treatment.22 Rep. Johnson has consistently supported a repeal of the IMD exclusion,
introducing legislation in the 110th and 111th Congresses. In the 110th Congress, the bill was never reported
out of committee.23 Because Medicaid reform is taking a central role in overall congressional efforts at health reform in 2009, Johnson’s bill may
have greater support this year. However, part of the difficulty in pushing forward with a total repeal arises from the lack of
information on the fiscal effect of such a move.24 The unknown cost of a repeal may create difficulties in the
current political environment. The Obama administration and fiscally conservative members in the House and
Senate have expressed a commitment to ensuring that health care reform is fully paid for within a 10-year
budget window.25 While Obama proposed a budget blueprint that included over $600 billion for health care reform, reform is expected to cost far
more than that.26 Given these financial realities, any proposal with significant new spending will be closely
scrutinized by Congress and may not be included in the final health care reform package.
2010 NFA-LD
Evidence Set
1AC 2/8 – Plan Text
Therefore I propose the following plan –
The USFG should substantially reform the provision of mental health services to
the chronically mentally ill by repealing Medicaid’s Institutions for Mental
Diseases (IMD) exclusion. Funding and enforcement through normal means
2010 NFA-LD
Evidence Set
1AC 3/8 – Solvency 1/2
Observation 2 is Solvency –
1. The IMD exclusion prohibits Medicaid payments for patients receiving

treatment in an institutions for mental disease, or IMD’s
Treatment Advocacy Center, Fact Sheet on Medicaid discrimination, 2009 [Medicaid Discrimination Against
People with Severe Mental Illnesses, http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=473]
gardog JH
When enacting Medicaid, the federal government specifically excluded payments for patients in state
psychiatric hospitals and other "institutions for mental diseases," or IMDs, to accomplish two goals: 1) to foster
deinstitutionalization; and 2) to shift the costs back to the states which were viewed by the federal government as traditionally responsible for
such care. States proceeded to transfer massive numbers of patients from state hospitals to nursing homes and
the community where Medicaid reimbursement was available. ("[t]he term ‘institution for mental diseases’ means a hospital,
nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis,
treatment, or care of persons with mental diseases, including medical attention, nursing care, and related
services." 42 U.S.C. §1396d(i))
2. The Medicaid IMD Exclusion results in homelessness, incarceration, and

death of the mentally ill and should be eliminated.
D.J. Jeffe and Mary T. Zdanowicz, Co-founder Treatment Advocacy Center & organizer NY Treatment Advocacy Coalition &
executive director of the Treatment Advocacy Center, The Washington Post (and reposted to the Treatment
Advocacy Center website) December 30th 1999. [http://www.treatmentadvocacycenter.org/index.php?
option=com_content&task=view&id=575&Itemid=196] Gardog SS/JH
There were about 470,000 individuals receiving inpatient psychiatric care in state hospitals when the Medicaid program started in 1965, compared with fewer than
60,000 today. Hospital closures have actually accelerated in recent years. Forty state hospitals shut their doors between 1990 and 1997, nearly three times as
many as during the entire period from 1970 to 1990, and many more closings are planned. Of the 3.5 million Americans with schizophrenia
and manic-depression, 40 percent (1.4 million) are not being treated. Medicaid's denial of coverage results in
homelessness, incarceration, victimization and even death for many people who are so ill they are unable to care
for themselves. By the Justice Department's own statistics, there are currently about 283,800 mentally ill
people locked up in the nation's jails and prisons. The Los Angeles County Jail and New York's Riker's Island
are currently the two largest "treatment facilities" for the mentally ill in the country. Another 150,000 to 200,000
mentally ill are homeless, and 28 percent get at least some of their meals from garbage cans. More than 10 percent will die from
suicide. Others will commit acts of violence against family, friends and total strangers. Not only does federal discrimination hurt the mentally ill, it affects
the standard of living for everyone else, too. Many parks and public libraries, once enjoyed by all, are now rendered nearly unusable to the general
community by the visions of lost, psychotic souls who need inpatient care but are locked out by the discrimination embedded in Medicaid law. Seemingly
random acts of violence committed by individuals with a history of mental illness are frequently reported on the evening news. No amount of preaching
by the Surgeon General against "stigma" will overcome the acts of a Russell Weston, a Ted Kaczynski or an Andrew Goldstein, all persons with
untreated schizophrenia. The federal government must accept its share of criticism for a policy that discriminates
against individuals solely on a diagnosis of mental illness. We must steer clear of the iceberg that sank our
state psychiatric hospital system and eliminate the Medicaid IMD exclusion.
2010 NFA-LD
Evidence Set
3. The IMD Exclusion should be repealed to solve the harms suffered by the
mentally ill
National Association of State Mental Health Program Directors, the only national association to represent state mental
health commissioners/directors and their agencies, on their website last updated June 2000 [“Position Statement on Repeal of the Medicaid
IMD Exclusion, http://www.nasmhpd.org/general_files/position_statement/exclusion.htm] Gardog SS
The National Association of State Mental Health Program Directors (NASMHPD) believes that the current
Medicaid exclusion for services provided in Institutions for Mental Disease (IMDs) is discriminatory and
should be repealed. NASMHPD members believe that recovery and participation in community living are and should remain the focus of the
public mental health system. The U.S. Surgeon General's Report on Mental Health provides clear scientific
evidence that recovery is possible in the context of a comprehensive service delivery system that emphasizes community-based
treatment, values consumer experiences and peer-delivered services, and ensures access to clinically appropriate inpatient services when
necessary. However, current Medicaid policy bars from coverage all services provided to adults ages 22 to 64 in
IMDs, which includes psychiatric hospitals and may include community-based residential facilities. This policy isolates individuals
with mental illnesses from all other Medicaid-eligible populations, contradicts the principles of equal treatment and insurance parity for treatment of
mental illnesses, and undermines the ability of states to develop comprehensive systems of care. Specifically, the IMD exclusion has
the following discriminatory effects: Individuals with mental illnesses who receive services in IMDs are singled out for inferior Medicaid
coverage. In general, individuals requiring services in IMDs have the most severe and persistent mental illnesses and often face significant stigma
associated with their illnesses. The IMD exclusion perpetuates the myths that mental illnesses are different than
physical illnesses and that recovery for individuals with serious mental illnesses is not possible.
By failing to reimburse for appropriate and medically necessary services provided to Medicaid-eligible individuals in IMDs, the federal government
unfairly limits its support for mental health treatment. Fewer federal dollars means fewer resources throughout the mental health system, with
resulting negative consequences not only for inpatient services but for community-based treatment and other services provided as part of a
comprehensive continuum of care. In addition, the IMD exclusion creates an enormous barrier to the use of Home and Community
limits the ability of states to develop creative, stable
Based waivers under Medicaid to serve individuals with mental illnesses and
financing mechanisms for the delivery of care. There exists no sound rationale for the IMD exclusion. This
policy is not based on concerns about individual Medicaid eligibility, the medical necessity of services provided, the appropriateness of the service
setting, or the quality of care provided. Nor does the policy reflect system trends over the last four decades dramatically reducing the use of inpatient
care and the length of inpatient stays. Instead, the policy dates back to the origins of the Medicaid program and
appears to be premised on the outdated assumption that the federal government should not share
responsibility for providing treatment to these individuals. NASMHPD urges Congress to repeal the IMD exclusion and to
support universal, non-discriminatory coverage under Medicaid for appropriate, effective treatment and services for individuals with mental illnesses.
2010 NFA-LD
Evidence Set
1AC 5/8 – Adv 1 – Prisons 1/2
Advantage 1 is Prisons –
1. Americans with a serious mental illness are three times as likely to be in jail
as in a mental hospital
Mark Moran, writer for Psychiatric News, the journal of the American Psychiatric Association, June
2010 [Jail More Likely Than Hospital for Severely Mentally Ill, http://pn.psychiatryonline.org/content/45/11/1.1.full] gardog JH
“I think there is no more important issue for psychiatry today,” Richard Lamb, M.D., a coauthor of the report and board member of
TAC, told Psychiatric News. “The data demonstrate that there are many more people with severe mental illness in jails
and prisons than in psychiatric hospitals. It seems that nobody cares—or at least that nobody is doing anything
about it. The number of [hospital] beds continues to fall, and the prison population continues to climb.” Lamb said
that in Sonoma County, California, for example, the county board of supervisors has closed county mental hospitals and
declared that severely mentally ill people who are living on the streets will be taken to jail. “This is slowly
becoming the way that people with mental illness are dealt with,” Lamb said. He has participated in a number of APA
components including, most recently, as a member of the Committee on Jails and Prisons and as vice chair of the Council on Social Issues and Public
Psychiatry. For the United States as a whole, the TAC reports that 1,999,491 people are in jails and prisons. Using the 16 percent assumption, that
means 319,918 of them have a serious mental illness. But just 100,439 people with serious mental illness are occupying an inpatient psychiatric bed, so
an individual with serious mental illness in the United States is 3.2 times more likely to be in jail than in a
hospital, according to the TAC estimate.
2. The IMD exclusion has had the direct effect of transferring the seriously
mentally ill from hospitals wards to prison cells.
Bruce Rheinstein, J.D., Policy Analyst for the Treatment Advocacy Center, Catalyst Magazine, 2000 [True
Parity Means Eliminating MEDICAID'S IMD Exclusion, http://www.treatmentadvocacycenter.org/storage/tac/documents/2000march-
aprilcatalyst.pdf] gardog JH
The IMD exclusion precludes states from using those federal funds for most of the care provided in state psychiatric
hospitals, making the IMD exclusion a gigantic economic carrot feeding the process of deinstitutionalization.
States started locking the front door and opening the back in an effort to get patients out of state funded hospitals and into settings where the federal
government would help pay the tab. As a result, it has become increasingly difficult for the most severely ill to get inpatient treatment. Hospitals are
discharging patients sicker and quicker in a mad long dash to make them Medicaid eligible by ending their inpatient residency. The primary question that
drives the system today is not, “What does the patient need?” but rather, “What will federal programs pay for?” The consequences of
Medicaid’s discriminatory nature are staggering for the severely mentally ill, their families, and the communities in which they
live. The United States has lost effectively 93% of its state psychiatric hospital beds since deinstitutionalization began in
1955,3 resulting in increased rates of incarceration, homelessness, victimization and violence. The race for Medicaid dollars
has, in fact, reduced the total number of state psychiatric hospital patients to less than 60,000 today, compared to 500,000 in 1965 when Medicaid was
enacted. For many people with severe mental illness, deinstitutionalization has meant nothing more than
transinstitutionalization from a hospital ward to a prison cell—a grim reality indeed. A recent study by Steven Raphael at the
Goldman School of Public Policy at Berkeley established a causal connection between deinstitutionalization of the severely mentally
ill from state psychiatric hospitals and increases in rates of incarceration in jails and prisons. According to the Department of
Justice’s (DOJ) statistics, 275,900 persons (16% of all prisoners) in state jails and prisons are mentally ill. With some 3,500 and 2,800 mentally ill
inmates respectively, the Los Angeles County Jail and New York’s Riker’s Island are currently the two largest psychiatric inpatient treatment facilities in
the country.4 With many states still closing hospitals, the trend to criminalize the mentally ill continues .
2010 NFA-LD
Evidence Set
1AC 6/8 – Adv 1 – Prisons 2/2
3. There are over 200,000 mentally ill patients in prisons, they receive little
treatment and suffer painful deterioration.
Jamie Fellner, Director of Human Rights Watch, writing for the Harvard Civil Rights – Civil Liberties
Law Review, 2006 [Vol. 41, A Corrections Quandary: Mental Illness and Prison Rules,
www.law.harvard.edu/students/orgs/crcl/vol41_2/fellner.pdf] gardog JH
There are more than 200,000—perhaps as many as 300,000—men and women in U.S. jails and prisons suffering from
mental disorders, including such serious illnesses as schizophrenia, bipolar disorder, and major depression. 3
The proportion of prisoners with mental illness is increasing. The high number and growing proportion of persons with mental illness in U.S. prisons are
unintended and tragic consequences of inadequate community mental health services combined with punitive criminal justice policies. Numerous
studies and surveys have documented this rise in the incarceration of the mentally ill. The Bureau of Justice Statistics estimates that sixteen percent of
adult inmates in state prisons and local jails are mentally ill.4 There are three times as many mentally ill people in prisons than in mental health hospitals,
and the rate of mental illness in prisons is two to four times greater than in the general public.5 Although there is little historical data, corrections and
mental health experts believe the proportion of the prison population with mental illness is increasing. Nineteen of thirty-one states responding to a 1998
survey reported a disproportionate increase in their seriously mentally ill population during the previous five years.6 While some portion of the increase
may be attributable to improved mental health screening and diagnosis of mental health problems, there is a consensus in corrections that the numbers
also reflect a real change in the rate at which the mentally ill are being sent to prison.7 The crisis in the mental health system in the United States has
undoubtedly contributed to the number of mentally ill prisoners. As a presidential advisory commission in recent years reported, the mental health
system is “in disarray.”8 It is fragmented, chronically under-funded, and rife with barriers to access, particularly in minority communities. As a result, too
many people who need publicly financed mental health services cannot obtain them until they are in an acute psychotic state and are found to be a
danger to themselves or others. Left untreated and unstable, people with serious mental illnesses—particularly those who are also
break the law and then enter the criminal justice
poor, homeless, and suffering from untreated alcoholism or drug addiction—may
system. The failure of mental health systems has led to what some have called the criminalizing of the mentally
ill. As the Council of State Governments has noted: [I]f many of the people with mental illness received the services they
needed, they would not end up under arrest, in jail, or facing charges in court . . . . [T]he ideal mechanism to prevent people with mental
illness from entering the criminal justice system is the mental health system itself—if it can be counted on to function effectively.9 The nation’s
aggressive and punitive anti-crime policies, including its “war on drugs,” have also contributed to the number of mentally ill in prison. These tough-on-
crime approaches dominant in U.S. criminal justice policy have resulted in a quadrupling of prison and jail populations in three decades.10 Persons with
mental illness are among those masses swept behind bars. The sheer number of mentally ill inmates has transformed prisons into facilities for the
mentally ill. Yet prisons cannot provide the range of services mentally ill prisoners need in the necessary quantity and quality.
Seriously ill prisoners confront a paucity of qualified staff to evaluate their illness, develop and implement treatment plans, and monitor their condition.
They confront treatment that often consists of little more than medication—and even that may be poorly administered and supervised, as O’Bryant notes
—or no treatment at all.11 They live without the diversity of mental health interventions they need, much less the long-term supportive and therapeutic
environment that would best help many of them manage their illnesses. Without necessary care, mentally ill inmates suffer painful
symptoms and their conditions can deteriorate.12
4. The placement of the mentally ill in prisons is a violation of international
human rights norms.
Jamie Fellner, Director of Human Rights Watch, writing for the Harvard Civil Rights – Civil Liberties
Law Review, 2006 [Vol. 41, A Corrections Quandary: Mental Illness and Prison Rules,
www.law.harvard.edu/students/orgs/crcl/vol41_2/fellner.pdf] gardog JH
The failure of U.S. prisons to address adequately the special needs of prisoners with serious mental illness,
including in their disciplinary systems, flies in the face of international human rights standards. While U.S. constitutional law sets low
minimum standards which as a practical matter allow inhuman and degrading treatment of the mentally ill, international human rights law
affirms positive obligations to treat mentally ill prisoners with dignity. Human rights law also prohibits subjecting
prisoners to punishment that might be considered torture or otherwise cruel, inhuman, or degrading treatment,
be it punishment for the crime that sent them to prison, or for disciplinary infractions while incarcerated. Full compliance with international
human rights norms requires removing the most seriously ill prisoners from prisons altogether and placing
them in mental institutions.
2010 NFA-LD
Evidence Set
1AC 7/8 – Adv 2 – Dehumanization 1/2
Advantage 2 is ending Dehumanization –
1. The mentally Ill frequently become homeless and suffer greatly

Rose M. Garland, writer, editor and contributor to News Blaze, June 05, 2010 [“Severely Mentally Ill Individuals
Still Struggle with Homelessness” http://newsblaze.com/story/20100105111318moxy.nb/topstory.html] Gardog SS
severely mentally ill continue to struggle with homelessness. The U.S. Department of
One oft-neglected portion of our society, the
Housing and Urban Development (HUD) reports that on
any given night, approximately 664,000 people are homeless. Of
those approximately 26.3 percent are severely mentally ill. The United States Department of Health and Human Services
Substance Abuse and Mental Health Services Administration (Samhsa) reports about the reasons that the severely mentally ill have such difficulty with
homelessness. In essence, Samhsa states that their symptoms make it harder for them to meet their basic needs.
They have higher difficulties in finding places to live, and often fear the mental health system where many have
had contact with previously. They are also less likely to be healthy in other ways, such as respiratory
infections, tuberculosis, or exposure to HIV. Although not all do, many also have substance abuse problems. These
individuals tend to stay in the same communities they became homeless in, and usually have no family who remain in contact with them or support
them. A major difficulty is finding shelter for those who are resistant to mental health treatments. Another is finding places that can offer mental health
services combined with substance abuse treatment for those who need it. Also, unfortunately, the mentally ill among the homeless population are twice
as likely as other homeless people to end up in negative interactions with the legal system which can cause even more difficulties with finding
appropriate shelter
2. The IMD exclusion causes deinstitutionalization to homelessness, leading to

the dehumanization of the mentally ill. Repealing it would recognize their
humanity.
Joanmarie Illaria Davoli, Director, Law & Psychiatry Center, and Clinical Professor of Law, George Mason University
School of Law. B.A., University of Virginia, in American Journal of Law and Medicine 2003 [“No Room at the Inn: How
the Federal Medicaid Program Created Inequities in Psychiatric Hospital Access for the Indigent Mentally Ill”; Georgetown University Law Center, 1988,
29 Am. J. L. and Med. 159, 2003 lexis] Gardog SS
The IMD exclusion is a major, but rarely noted, cause of deinstitutionalization that has contributed to the high
number of mentally ill among the homeless--a group treated as if they were less than human. A New York
journalist recently described his reaction to the homeless mentally ill: "Slowly, inexorably, I have became [sic] acclimated to ignoring the plight of
others." n118 Yet, the only way to acclimate oneself to ignoring suffering is to deny the humanity of the sufferers.
Let none rationalize our
As Albert Deutsch emphasized in his 1948 expose on the deplorable condition of state psychiatric hospitals:
inhuman treatment to the mentally sick by false notions that these sick don't feel cold or hunger or indignity
or neglect, that they don't think about real things, that they are stripped of human values, that they actually
descend to subhuman status as a result of their sickness . . . . Real reform of our state hospitals hinges on the acceptance of a
single fundamental truth: mental patients are people, however sick they may be. n119 It is time for the federal
government to acknowledge the humanity of the untreated mentally ill and fulfill the promises of Medicaid by
providing payment for treatment, even when psychiatric hospitalization is necessary. Eliminating the IMD exclusion would
greatly assist in the elimination of inequities in psychiatric care for the indigent mentally ill. Reforms should ensure
that the open-air asylums operating in many cities are permanently closed down.
2010 NFA-LD
Evidence Set
1AC 8/8 – Adv 2 – Dehumanization 2/2
3. The IMD exclusion has returned the mentally ill to the horrible conditions of
300 years ago. Repeal of the provision would solve.
From imprisoning the mentally ill in "a circle of the Inferno" to warehousing them in "hell," treatment of the
mentally ill today, in the absence of adequate psychiatric hospitals, closely resembles the conditions of 300
years ago. Good intentions do not prevent bad results. While the drafters of the IMD exclusion clearly intended to facilitate the release of
patients from psychiatric [*180] hospitals, they believed that closing down hospitals would improve the quality of life for mentally ill individuals. n108
The early 1950s and 1960s were full of optimism and confidence that medical science would quickly cure the mentally ill and thus render psychiatric
hospitals unnecessary. "However negative they might be about the prospects for reforming mental asylums, psychiatrists in the 1950's had
enormous faith in their own therapeutic powers and the need to exercise them in a much broader arena." n109 The failure of deinstitutionalization
n110 to improve treatment for the mentally ill is reminiscent of the failure of state-run psychiatric institutions to deliver humane, effective treatment
and care over an extended period of time. n111 Both began with good intentions, but both produced horrific results. In suggesting that the
federal government repeal the IMD exclusion to allow for treatment in state-run psychiatric institutions, this
Article does not endorse a return to the post World War II conditions of overcrowded, filthy, inhumane
hospitals. In fact, the critics of the 1940s and 1950s were not advocating the elimination of psychiatric hospitals, but the reform and improvement
of those hospitals. n112 Indeed, repealing the IMD exclusion would eliminate all incentives for states to transfer
mentally ill individuals to inappropriate settings, such as nursing homes or boarding houses. Medicaid
reimbursement should be premised upon the provision of appropriate, effective treatment and placement for the mentally ill. It should not be
that benefits are denied when a mentally ill individual is hospitalized, but granted when he is merely
warehoused.
4. Dehumanization is worse than any war or plague, and risks the destruction of
civilization.
Ashley Montagu and Floyd Matson, professor at the University of Hawaii and at the University of
California at Berkeley, The Dehumanization of Man, Published 1983 [page xi, edited to use gender neutral
language] Gardog JH/SS
This book is concerned with an invisible disease, an affliction of the spirit, which has been ravaging humanity in recent
times without surcease and virtually without resistance, and which has now reached epidemic proportions in the
western world. The contagion is unknown to science and unrecognized by medicine (psychiatry aside); yet its wasting
symptoms are plain for all to see and its lethal effects are everywhere on display. It neither kills outright nor inflicts
apparent physical harm, yet the extent of its destructive toll is already greater than that of any war, plague,
famine, or natural calamity on record—and its potential damage to the quality of human life and the fabric of civilized
society is beyond calculation. For that reason this sickness of the soul might well be called the “Fifth
Horse[person] of the Apocalypse.” Its more conventional name, or course, is dehumanization.
2010 NFA-LD
Evidence Set
Extensions – Explanations of IMD
The IMD provision prevents federal Medicaid funding for patients in inpatient
facilitates.
Mark Moran, writer for Psychiatric News, the journal of the American Psychiatric Association, June
2010 [Jail More Likely Than Hospital for Severely Mentally Ill, http://pn.psychiatryonline.org/content/45/11/1.1.full] gardog JH
The
Repeal of the Medicaid Institute for Mental Diseases (IMD) Exclusion would provide for greater federal funding of treatment in the community.
IMD exclusion prohibits federal Medicaid matching funds from going to inpatient facilities with more than 16
beds whose patient roster is more than 51 percent people with severe mental illness. The policy dates from the
enactment of Medicaid in 1965, when very large numbers of patients with mental illness were in state and local
psychiatric hospitals already receiving public funds.
2010 NFA-LD
Evidence Set
Extensions – Private insurance can’t solve
The most seriously mentally cannot afford private insurance.

gardog JH
For the most severely mentally ill, private insurance is essentially meaningless. Because of their illnesses,
most individuals with the severest forms of brain disease are unemployed and private insurance is a luxury
they cannot afford. While the federal government seeks "parity" for treatment of lesser forms of mental illness
by private insurers, it continues to discriminate against those with severe mental illnesses by denying them
coverage under Medicaid when they require hospitalization in a psychiatric hospital.
2010 NFA-LD
Evidence Set
Extensions – Human Rights Impact
Human rights do not need justification, they have inherent value that you as the
judge should evaluate and weight against the impacts of the negatives
disadvantages.
Amitai Etzioni, Professor at The George Washington University, writing for Human Rights Quarterly,
2010 [The Normativity of Human Rights Is Self-Evident, JSTOR] JG
Attempts to justify human rights in terms of other sources of normativity unwittingly weaken the case of human
rights. Instead these rights should be treated as moral causes that speak to us directly, as one of those rare
precepts that are self-evident. All will hear self-evident moral claims unless they have been severely distracted, and even these
persons will hear these claims once they are engaged in open moral dialogue. Oddly, the strongest support for treating human rights as self-evident may
well be a consequentialist argument.Numerous attempts have been made to justify human rights in terms of other sources
of normativity, or values that can be used to justify these rights. This article suggests that such attempts unwittingly weaken the case of
human rights and that instead these rights should be treated as moral causes that speak to us directly, as one of those rare precepts that is self-
evident.1 Suggesting that human rights should be treated as self-evident does not deny the value of examining their historical sources, nor the need to
spell out what they entail; it merely contends that attempts to support human rights by inserting a foundation underneath them end up undermining their
construction. Human rights stand tall on their own.
2010 NFA-LD
Evidence Set
Extensions – Moral Imperative
Society has a moral imperative to help the incarcerated mentally ill

Daniel P. Mears, Ph. D in , the urban institute, in his book Mental Health Needs and Services in the
Criminal Justice System Published in 2004 [Page 255 http://heinonline.org/HOL/LandingPage?
collection=journals&handle=hein.journals/hhpol4&div=14&id=&page=]
Policymakers and practitioners increasingly are concerned about the need to address better the mental health needs of offenders throughout all stages
of the criminal justice system. The concern is understandable: Society arguably has a moral obligation to provide treatment to
mentally ill offenders, and the presence of a mental illness can make it considerably more difficult for justice-
involved offenders to become productive and law-abiding citizens. Juxtaposed against this concern is a lack of
reliable and accurate empirical information about the prevalence of mental illness among offenders throughout
the criminal justice system, the size of the needs-services gap from one stage of the system to the next, and
how best to fill the needs-services gaps at each stage. In this paper, I discuss these issues and suggest avenues for empirical
research that can assist policymakers and practitioners to develop defensible strategies for strategically allocation resources to treat mentally ill
offenders
2010 NFA-LD
Evidence Set
Extensions – Soft Power Link
US double standards on human rights have lead to mistrust of US leadership

abroad and undermined our international credibility.
Christina Finch, government relations director for Amnesty International USA, and professor of law at
George Mason University School of Law, May 4th 2010 [Human Rights: Time to Practive What We Preach”
http://blog.amnestyusa.org/us/human-rights-time-to-practice-what-we-preach/] Gardog SS
The commitments to “principled engagement” and “living our values” are especially vital to advancing human rights.
For years, U.S. leadership on the world stage has suffered because the U.S. seems to hold a double standard
on human rights. Historically, notions of U.S. exceptionalism and selectively ignoring injustices and human rights
violations at home and abroad have bred mistrust of U.S. leadership based on our incomplete commitment to universal human
rights. The Obama administration, however, has committed to leading by example. According to Secretary of State Hillary Clinton, this means “holding
everyone to the same standard, including ourselves.” In many areas, the administration’s actions have matched its rhetoric. Joining the United Nations
Human Rights Council and signing the Convention on the Rights of Persons with Disabilities have both sent the right message that President Obama is
prepared to engage with the international community on new and more principled terms than previous administrations. The appointment of many officials
who are self-defined human rights champions with careers both inside and outside the government promoting civil and human rights evinces a
commitment to “a vision of common humanity, universal rights and rule of law.” Moreover, the willingness of this administration to work with members of
civil society to align our human rights rhetoric with our human rights practices demonstrates a commitment to lead by example based on both “principled
engagement” and “living our values.” These efforts, however, are not enough. What we have yet to see are new bold steps that
prioritize human rights at home. This administration has not adopted domestic policies designed to translate its
rhetoric and commitments into reality. And although the administration has made positive statements about the indivisibility of rights and
the importance of recognition of economic, social and cultural rights, there has been no concrete action to fully incorporate those principles into domestic
policies. “Principled engagement” and “living our values” require nothing short of a complete reversal of the positions,
policies and practices from which this administration has assiduously worked to distance itself. This is the type of
change an Obama presidency promised. This is the hope on which many relied when casting their votes in the 2008 election.
2010 NFA-LD
Evidence Set
Extensions – Inherency
Deinstitutionalization has political support from both parties, meaning it will

continue, despite evidence it has been a disaster.
E. Fuller
Torrey, M.D. Executive Director, Stanley Medical Research Institute, Treatment Advocacy
Center, May 2010 [More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States,
http://www.treatmentadvocacycenter.org/storage/tac/documents/final_jails_v_hospitals_study.pdf] gardog JH
Deinstitutionalization, the emptying of state mental hospitals, has been one of the most well-meaning but poorly planned
social changes ever carried out in the United States. It was a product of the overcrowding and deterioration of hospitals; new
medications that significantly improved the symptoms of about half of patients; and a failure to understand that many of the sickest patients were not
able to make informed decisions about their own need for medication. Deinstitutionalization drew enthusiastic support from fiscal
conservatives interested primarily in saving funds by shutting state hospitals, as well as from civil rights advocates who believed that
mental patients needed to be “liberated,” as in Ken Kesey’s One Flew over the Cuckoo’s Nest. This merging of the political right and left
has made for strange—indeed, bizarre—bedfellows but has been a political juggernaut, ensuring that deinstitutionalization
will continue to take place, as it does even today, despite clear evidence that for many patients it has been a
disaster.1
Nothing in the Healthcare reform has solved for mental health.

Lloyd Sederer, Medical Director, New York State Office of Mental Health, writing for the Huffington
Post, September 2009 [Where is Mental Health in Health Care Reform? http://www.huffingtonpost.com/lloyd-i-sederer-md/where-
is-mental-health-in_b_295776.html] gardog JH
One in four Americans suffer from a mental or substance use disorder each year; 50% during the course of their lifetimes.
In other words, these conditions are more common than diabetes, heart disease and cancer. Yet only 40% get any
treatment for these common, painful and potentially disabling conditions. Worse still, quality is typically abysmal with a highly noted
national study showing that only one in eight people with mental health problems in primary care settings (the major site where people go for care) get
"minimally adequate care". We should be ashamed. We don't understand how this level of primary care performance is tolerated, especially since the
effectiveness of proper treatment for common mental disorders like depression and anxiety conditions is in the range of 75%, as good or better than the
other ongoing illnesses served in these settings. It's not the doctors, its how we go about health care, especially mental
health care. Have you heard a word about mental health in the deluge of information and policy discussions
that populate health reform communications on TV, radio and newsprint? Have you seen any mention in
Federal legislative offerings? Oops, we forgot to include highly treatable and deeply burdensome conditions that
spare hardly a family, community, school or business as we try to re-engineer health in this country. We don't get it. Untreated depression
complicates the treatment of diabetes, heart and lung disease, asthma and cancer, increasing the likelihood of disability and premature death, and
driving up the costs of medical treatment. The productivity of American workers and the educational success of students hinges on recognizing and
effectively treating mental disorders. Being older really hurts: 75% of seniors who killed themselves were in a primary care doctor's office in the 30 days
anteceding their death -- 40% in the week before. Is anybody paying attention?
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Evidence Set
Extensions – Solvency
The IMD results in homelessness, incarceration, and death for the mentally ill.
(this supports the 1999 evidence from solvency, but is from 2009)
gardog JH
Medicaid’s denial of coverage results in homelessness, incarceration, victimization and even death for many
people who are so ill they are unable to care for themselves. Of the 4 million Americans with schizophrenia and
manic-depression, approximately 50 percent (2 million) are not being treated on any given day. By the Justice Department's own
statistics, there are currently about 283,800 mentally ill people locked up in the nation's jails and prisons. The Los
Angeles County Jail and New York's Riker's Island are currently the two largest "treatment facilities" for the
mentally ill in the country. Another 150,000 to 200,000 mentally ill are homeless, and 28 percent get at least some of their
meals from garbage cans. More than ten percent will die from suicide. Others will commit acts of violence against family, friends and
total strangers.
Elimiating the IMD Exclusion is the simplest way to terminate the incentives to
mistreat the mentally ill.
Currently, the need remains for inpatient psychiatric hospitalization. While future scientific research into the causes and the development of cures for
mental illness may eventually eliminate the need for hospitalization, provision must still be made for the current and immediate future care and treatment
of the mentally ill. [*177] The existing non-system of revolving door psychiatric hospitalization, n97 incarceration in jails and prison, n98 sporadic
intervention by outpatient mental health clinics n99 and homelessness n100 must be replaced with a commitment to providing decent care for the
mentally ill. The best way to provide treatment is the coordination of care, when a mentally ill individual has a treatment team that follows the prognosis
of his illness; facilitates his access to therapy, medical care and job training; ensures that he applies for all available benefits; and assists him in locating
affordable housing. n101 Such options must also include the availability of hospitalization when necessary. "While segregation from others is no longer
the only effective treatment for the mentally ill, inpatient hospitalization remains a necessary option to provide both respite care for those who
decompensate, n102 and also long-term care for those whose illnesses remain resistant to medication." n103 The simplest manner in which
the federal government can terminate the incentives to mistreat the mentally ill is to eliminate the IMD
exclusion in Medicaid. There is precedent for such action as the exclusion for state psychiatric hospitalization for patients under age twenty-one
was eliminated in 1973. n104 Additionally, Congress should reconsider the distinction between care for psychiatric
illnesses and care for physical illnesses. Distinguishing between the two [*178] makes little sense as scientific
discoveries demonstrate that mental illness is a physical disease of the brain, similar to epilepsy and multiple sclerosis.
n105 Without access to psychiatric treatment and hospitalization, the severely mentally ill of today are victims of
neglect and callousness, much as they were hundreds of years ago. Many end up homeless, incarcerated in
prisons and the victims of violence. In the following quotations, it is hard to distinguish which dates from the 18th century, and which is from
the 21st century:
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Evidence Set
Extensions – IMD is discriminatory
The IMD exclusion is discriminatory and should be ended.

National Alliance on Mental Illness, no date given [Medicaid Funding of Mental Illness Treatment,
http://www.nami.org/Template.cfm?Section=Issue_Spotlights&template=/ContentManagement/ContentDisplay.cfm&ContentID=43407]
gardog JH
Current federal Medicaid policy bars from coverage all services provided to adults’ ages 22 to 64 in IMDs that
includes psychiatric hospitals and many community-based residential facilities. This policy isolates individuals
with mental illnesses from all other Medicaid-eligible populations, contradicts the principles of equal treatment and insurance parity for treatment
of mental illnesses, and undermines the ability of states to develop comprehensive systems of care. The result is that
individuals with mental illnesses who receive services in IMDs are singled out for inferior Medicaid coverage. In general, individuals requiring services in
The IMD exclusion
IMDs have the most severe and persistent mental illnesses and often face significant stigma associated with their illnesses.
perpetuates the myths that mental illnesses are different than physical illnesses and that recovery for
individuals with serious mental illnesses is not possible. Further, by failing to reimburse for appropriate and medically necessary
services provided to Medicaid-eligible individuals in IMDs, this policy unfairly limits its support for mental health treatment. Fewer federal dollars means
fewer resources throughout the mental health system, with resulting negative consequences not only for inpatient services but for community-based
treatment and other services provided as part of a comprehensive continuum of care. In addition, the IMD exclusion creates an enormous barrier to the
use of Home and Community Based waivers under Medicaid to serve individuals with mental illnesses and limits the ability of states to develop creative,
stable financing mechanisms for the delivery of care. NAMI urges Congress to repeal the IMD exclusion and to support
universal, non-discriminatory coverage under Medicaid for appropriate, effective treatment and services for
individuals with mental illnesses.
2010 NFA-LD
Evidence Set
Extensions – Stigma causes Dehumanization
Stigma against the mentally ill dehumanizes them.

Stephen P. Hinshaw and Dante Cicchetti, Development and Psychopathology Journal, 2000 [Stigma and
mental disorder: Conceptions of illness, public attitudes, personal disclosure, and social policy. Development and Psychopathology, 12,
pp 555-598
doi:10.1017/S0954579400004028, http://journals.cambridge.org/action/displayFulltext?
type=1&fid=62532&jid=DPP&volumeId=12&issueId=04&aid=62531] Gardog SS
The end of the last millennium witnessed an unprecedented degree of public awareness regarding mental disorder as well as motivation for policy
change. Like Sartorius, we contend that the continued stigmatization of mental illness may well be the central issue
facing the field, as nearly all attendant issues (e.g., standards of care, funding for basic and applied research
efforts) emanate from professional, societal, and personal attitudes towards persons with aberrant behavior. We
discuss empirical and narrative evidence for stigmatization as well as historical trends regarding conceptualizations of mental illness, including the field’s
increasing focus on genetic and neurobiological causes and determinants of mental disorder. We next define stigma explicitly, noting both the
multiple levels (community, societal, familial, individual) through which stigma operates to dehumanize and
delegitimize individuals with mental disorders and the impact of stigma across development. Key
developmental psychopathology principles are salient in this regard. We express concern over the recent oversimplification of
mental illness as “brain disorder,” supporting instead transactional models which account for the dynamic interplay of genes, neurobiology, environment,
and self across development and which are consistent with both compassion and societal responsibility. Finally, we consider educational and policy-
related initiatives regarding the destigmatization of mental disorder. We conclude that attitudes and policy regarding mental disorder reflect, in
microcosmic form, two crucial issues for the next century and millennium: (a) tolerance for diversity (vs. pressure for conformity) and (b) intentional
direction of our species’ evolution, given fast-breaking genetic advances.
2010 NFA-LD
Evidence Set
Extensions – AT – States CP
The IMD is undermining the states mental health system, your CP can never
solve.
D.J. Jaffe and Mary T. Zdanowicz, director of the Treatment Advocacy Center, The Washington Post,
December 1999 [OPED Federal Neglect of the Mentally Ill, http://www.treatmentadvocacycenter.org/index.php?
option=com_content&task=view&id=575&Itemid=196] gardog JH
The recently released Surgeon General's Report on Mental Health is the equivalent of describing the maiden
voyage of the Titanic without mentioning the iceberg. While the report criticizes private insurance companies for failing to provide
"parity" in their coverage of mental illnesses, it is totally silent on the failure to provide parity in Medicaid , the federal government's
insurance program. For the most severely mentally ill, private insurance is essentially meaningless. Because of their
illnesses, most are indigent, and private insurance is a luxury they cannot afford and are not in a position to obtain through
employment. Many of these individuals do have insurance through Medicaid: a federal insurance program that covers their care, except for a single
exception--inpatient care in psychiatric hospitals. The federal government's Institution for Mental Diseases (IMD) exclusion
prohibits Medicaid from reimbursing for most individuals who need care in a psychiatric hospital. If you have a
disease in your heart, liver or any other organ and need treatment in a hospital, Medicaid contributes. But if you have a disease in your brain and need
care in a psychiatric hospital, Medicaid does not. As a result of this federally sanctioned discrimination, state psychiatric
hospitals are locking the front door and opening the back, making it increasingly difficult for the most severely ill to get
inpatient treatment. They are discharging patients sicker and quicker in a headlong dash to make them
Medicaid eligible by ending their inpatient residency.
2010 NFA-LD
Evidence Set
Extensions – AT – Spending
The IMD exclusion has lead to shifting of the seriously mentally ill to prisons.
This has cost the federal government $14 billion dollars.
Sharra Hurd, MA, Paradigm Magazine, Summer 2001 [NEWS On Track: Treatment Advocacy Center,
http://www.treatmentadvocacycenter.org/index2.php?option=com_content&do_pdf=1&id=553] gardog JH
The federal government’s exclusion of IMD’s left states with little financial incentive to treat consumers of
mental health services in state psychiatric facilities. States continued to shift the cost of psychiatric care back to the federal
government by transferring patients to nursing homes and general hospitals or out into the community where Medicaid reimbursement was available.
Thus, “federal dollars have created transinstitutionalization”. 1 With the focus on avoiding overt costs, the true
financial impact associated with a failure to treat chronic and severe mental illness has not been fully realized.
States access federal funds by transferring patients from state units to general hospital units, where the
treatment costs are more expensive. In fact, “costs in general hospitals are often $200 per day or more higher
than the costs in public psychiatric hospitals.” 2 Cost shifting and cost avoidance has also led to greater numbers of
people with schizophrenia and bipolar disorder in our jails and prisons - with a resulting higher cost to the
states. A 1996 Department of Justice source book on criminal justice statistics estimated the annual cost of
people incarcerated with these illnesses to be $14 billion. The number does not take into account the additional
expenses associated with incarcerating an individual, such as police costs, court costs, social work services, ambulances
and emergency room visits. It would be more financially prudent for the states to actually provide the right amount and
type of mental health services for the seriously mentally ill.
The states place the mentally ill in inappropriate places in order to save
themselves the cost, at the expense because Medicaid won’t fund them.
However, the actual cost of the appropriate places is less and would save more
money in the long term.
Mary Zdanowicz Executive Director of the Treatment Advocacy Center, and Bruce Rheinstein, The
Orlando Sentinel, March 23, 2000, Special to The Sentinel
[“OPED Florida's Mentally Ill Left Out in the Cold”http://treatment.nonprofitsoapbox.com/index.php?option=com_content&task=view&id=572&Itemid=196]
Gardog SS
The IMD exclusion created an incentive for Florida and other states to empty their psychiatric hospitals and provide
"treatment" in general hospitals to save money. Although care of the severely mentally ill in general hospitals
costs as much as $300 per day more than in state psychiatric hospitals, it costs less to the state because
treatment is reimbursable with federal Medicaid dollars. Unfortunately, general hospitals are ill-equipped to provide long-term
treatment for severe mental illnesses. And having fewer beds available to treat those who are acutely ill means that the
psychiatrically ill are quickly released to the streets, where many fall through the cracks and receive no
treatment whatsoever. This lack of treatment ultimately costs society more not less.
2010 NFA-LD
Evidence Set
***Native American Mental Health AFF Index***
***Native American Mental Health AFF Index***..........................................22

1AC 1/6 – Inherency and Plan...........................................................23
1AC 2/6 – Advantage 1/5................................................................24
1AC 3/6 – Advantage 2/5................................................................25
1AC 4/6 – Advantage 3/5................................................................26
1AC 5/6 – Advantage 4/5................................................................27
1AC 6/6 – Advantage 5/5................................................................28
1AC – Short Version 1/.................................................................29
1AC – Short Version 2/.................................................................30
1AC – Short Version 3/.................................................................31
Extensions – Assimilation/Colonialism 1/...............................................32
Extensions – Assimilation/Colonialism 2/...............................................33
Extensions – Cultural Insensitivity Prevents Care 1/...................................34
Extensions – Cultural Insensitivity Prevents Care 2/...................................35
Extensions – Solvency..................................................................36
Extensions – Solvency – Colonialism....................................................37
Extensions – Solvency – Collaboration..................................................38
Extensions – Solvency – Cultural Competency............................................39
Negative Evidence 1/...................................................................41
Gone’s 4-Step Recommendations for Cultural Competency..................................47
2010 NFA-LD
Evidence Set
1AC 1/6 – Inherency and Plan
Observation One – Inherency
A. The US mental health system has many disparities and lacks a competent
system of services for American Indians.
Dolores Bigfoot, Associate Professor University of Oklahoma College of Medicine. August 1, 2010.
Journal of Clinical Psychology http://www3.interscience.wiley.com/journal/123522951/abstract?CRETRY=1&SRETRY=0 Boyer SB
Recent research has identified the disparities in mental health services for American Indian and Alaska Native
populations. The New Freedom Commission on Mental Health reported that the United States mental health
system has yet to meet the needs of racial and ethnic minorities, including American Indian and Alaska Native
populations (NFCMH, 2003). The system of services for treating mental health problems in Indian Country is a
complex and inconsistent set of tribal, federal, state, local, and community-based services (Manson, 2004). The
need for mental health care is significant, but the services are lacking, and access can be difficult and costly.
American Indian and Alaska Native (AI/AN) children are more likely to (a) receive treatment through the juvenile justice system and inpatient facilities
than non-Indian children, (b) encounter a system understaffed by specialized children’s mental health professionals, and (c) encounter systems with a
consistent lack of attention to established standards of care for the population.
B. There is an imperative need for mental health service for American Indians,
and in some cases, this need is greater than the need of the general population
of the United States.
Janette Beals Ph.D. Director of Research, University of Colorado American Journal of Psychiatry in
September 2005. [“Prevalence of Mental Disorders and Utilization of Mental Health Services in Two American Indian Reservation
Populations: Mental Health Disparities in a National Context http://ajp.psychiatryonline.org/cgi/content/abstract/162/9/1723] Boyer SB
OBJECTIVE: The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors
Project (AI-SUPERPFP) provided estimates of the prevalence of DSM-III-R disorders and utilization of services for
help with those disorders in American Indian populations. Completed between 1997 and 1999, the AI-SUPERPFP was designed to
allow comparison of findings with the results of the baseline National Comorbidity Survey (NCS), conducted in 1990–1992, which reflected the general
United States population. METHOD: A total of 3,084 tribal members (1,446 in a Southwest tribe and 1,638 in a Northern Plains tribe) age 15–54 years
living on or near their home reservations were interviewed with an adaptation of the University of Michigan Composite International Diagnostic Interview.
The lifetime and 12-month prevalences of nine DSM-III-R disorders were estimated, and patterns of help-seeking for symptoms of mental disorders were
examined. RESULTS: The most common lifetime diagnoses in the American Indian populations were alcohol dependence, posttraumatic stress disorder
(PTSD), and major depressive episode. Compared with NCS results, lifetime PTSD rates were higher in all American Indian samples, lifetime alcohol
dependence rates were higher for all but Southwest women, and lifetime major depressive episode rates were lower for Northern Plains men and
women. Fewer disparities for 12-month rates emerged. After differences in demographic variables were accounted for, both American Indian samples
were at heightened risk for PTSD and alcohol dependence but at lower risk for major depressive episode, compared with the NCS sample. American
Indian men were more likely than those in NCS to seek help for substance use problems from specialty providers; American Indian women were less
likely to talk to nonspecialty providers about emotional problems. Help-seeking from traditional healers was common in both American Indian populations
and was especially common in the Southwest. CONCLUSIONS: The results suggest that these American Indian populations
had comparable, and in some cases greater, mental health service needs, compared with the general
population of the United States.
PLAN – the United States Federal Government through an act of Congress will
require mental health professionals working on reservations to undergo cultural
competency training and require Indian Health Services clinics to collaborate
with local communities and spiritual leaders on mental health treatment.
2010 NFA-LD
Evidence Set
Funding and Enforcement is through normal means and the affirmative reserves
the right to clarify the intent of plan.
2010 NFA-LD
Evidence Set
1AC 2/6 – Advantage 1/5
Observation Two – the Advantage
A. Native Americans are facing a severe mental health crisis
1. Native Americans are a higher risk for mental health disorders and treatment
is severely limited and focused on treating individual symptoms
US Commission on Civil Rights, an independent bipartisan agency established by Congress,
September 2004. [“Broken Promises: Evaluating the Native American Health Care System”
http://www.usccr.gov/pubs/nahealth/nabroken.pdf] Boyer JB
Native Americans are at a higher risk for mental health disorders than other racial and ethnic groups in the
United States,40 and are consistently overrepresented among high-need populations for mental health
services.41 The Surgeon General reported that this overrepresentation might be attributed to the high rates of homelessness, incarceration, alcohol
and drug abuse, and stress and trauma in Native American populations.42 The Surgeon General’s report further indicated that the U.S. mental
health system is not well-equipped to meet these needs; more specifically, IHS is mostly limited to basic
psychiatric emergency care, due to budget constraints and personnel problems.43 According to Dr. Jon Perez, IHS
does not provide ongoing, quality psychiatric care.44 Instead, the approach adopted by IHS is one of
responding to immediate mental health crises and stabilizing patients until their next episode.45
2. Depression is a dominant concern on the reservation and is growing through

community-based issues and intergenerational trauma
The most significant mental health concerns today are the high prevalence of substance abuse, depression,
anxiety, violence, and suicide.46 Substance abuse, most notably alcoholism, has been the most visible health disorder crisis.47
Depression is also emerging as a dominant concern.48 These two illnesses are commonly attributed to isolation on
distant reservations, pervasive poverty, hopelessness, and intergenerational trauma, including the historic
attempts by the federal government to forcibly assimilate tribes.49
3. Increasing depression on Native American reservations is leading to an

increasing rate of suicide
As identified earlier, depressionis the most serious emerging mental health disorder in the Native American
population. One of the more troubling indicators of the toll it takes on Native Americans is reflected in suicide
rates. From 1985 to 1996, Native American children committed suicide at two and one-half times the rate of
white children. During this period, 449 Native American children committed suicide.53
The suicide rate for Native Americans continues to escalate and is 190 percent of the rate of the general
population. According to the IHS FY 2005 Budget Justification, the highest suicide rate for the general population is found among individuals 74 and
2010 NFA-LD
Evidence Set
older. Among Native Americans, the highest suicide rate is found in the 15-year-old to 34-year-old age range.54 In fact, suicide is the second leading
cause of death for Native Americans 15 to 24 years old and the third leading cause of death for Native American children 5 to 14 years old.55 Recent
data from the American Academy of Pediatrics indicate that in 2002 the youth suicide rate for Native Americans was twice as great among 14- to 24-
year-olds, and three times as great among 5- to 10-year-olds, as it was in the general population.56
2010 NFA-LD
Evidence Set
B. In the face of the mental health crisis, Native Americans are not seeking
treatment
1. Despite high demand, Native Americans go without treatment for mental

illness
Despite a significant demand for mental health services, there are approximately 101 mental health
professionals available per 100,000 Native Americans, compared with 173 mental health personnel per
100,000 whites.57 With a greater need for mental health specialists, but fewer available for treatment, Native
Americans frequently go without the necessary care for substance abuse, depression, anxiety, suicide ideations, and other
mental health conditions.
2. Cultural barriers prevent American Indian access to mental health services

American Psychiatric Association, HealthyMinds.org, 24 February 2010. [“American Indians / Alaskan
Natives” http://www.healthyminds.org/More-Info-For/American-IndiansAlaskan-Natives.aspx] Boyer TC
Cultural factors can influence how people feel or describe mental illnesses and their acceptance of mental
illness and treatment. Among Indians/Native people, the concept of mental illness has different meanings and
interpretations. Often physical concerns and psychological concerns are not separated and emotional distress may be expressed in different ways.
Many Indians/Natives have difficulty accessing mental health services because of economic barriers, social and
cultural differences, mistrust, and the lack of providers. With proper treatment, most symptoms of mental illness can be controlled. If
mental illness is a concern for you or someone you care about, mental health services are available.
2010 NFA-LD
Evidence Set
C. The impact is colonialism
1. The current regime of mental health treatment for Native Americans is

colonizing
Joseph Gone, Professor at the University of Michigan, published in Culture and Psychology in 2008.
[“So I can be like a Whiteman: The cultural psychology of space and place in American Indian mental health.”
http://cap.sagepub.com/content/14/3/369.full.pdf+html] Boyer JB
In a tense postcolonial context, the ethical and political costs associated with professional practice-as-usual in
Native American communities amount to nothing less than an extension of the colonizing project. For those
American Indians who share Traveling Thunder’s cultural standpoint (and there are many who do), reservation-based mental health
clinics—despite their intentional designation as therapeutic spaces—may thus be seen to function as sites of
colonial incursion and Native resistance.3 As I have argued, the terms of such incursion and resistance are cultural, and presumably
extend to such subtle ethnopsychological constituents of human experience as spatial orientation and sense of place. As a result, any modern
professional call to ‘cultural competence’ in the delivery of mental health services must grapple substantively not just with the overt diversity (e.g.,
language fluency, religious beliefs, family values) of the ‘culturally different’ (Sue & Sue, 1999), but also with the deeply embedded and subliminal habits
and orientations that cultural processes and practices furnish for meaning-full human experience and interaction in politically tense postcolonial contexts
around the world.
2. Colonialism enslaves thoughts and actions, and makes violence the only
possible outcome
Kofi Ankomah, Ph.D, Human Nature Review, June 2003 [book review of “Colonialism and NeoColonialism” by Jean-Paul
Sartre, Available online at http://www.human-nature.com/nibbs/03/sartre.html] SD
In short, the foundation of colonialism, though economic - what Ellen Meiksins Wood in her Empire of Capital describes as “means by which the
wealth of the subject was being transferred to the master” - is racism manifested in many mutually-reinforcing facets of politics and
society. It is pervasive in social institutions, modes of production, and exchange/distribution. It is potent in the ways and means it enslaves
the thought of people: the colonizers and the colonized. The abuse of human rights is rampant and oppression
is pervasive. Poverty, ignorance and resulting dehumanization are the effects of colonialism, with violent
resistance the only predictable outcome. Above all else, colonialism is violence in thought and action; it inflicts
mental and physical torture on the colonized. Whatever good results from it is unintended. As both Sartre and Fanon have reported, the French
experience in Algeria was no exception. Though the natives had allies in the West in their struggles against such oppression, very few had the courage to fight the
colonial system openly. Jean-Paul Sartre was an exception. He risked his life to write and speak against colonialism in its many manifestations, in spite of the many
serious threats.
2010 NFA-LD
Evidence Set

D. Cultural sensitivity and collaboration solves
1. Culturally sensitive mental health solutions require a reorientation of our

treatment methods
Joseph Gone, Professor at the University of Michigan, in Professional Psychology, in 2004. [“Mental Health
Services for Native Americans in the 21st Century United States.” http://sitemaker.umich.edu/joseph.p.gone/files/mh_services.pdf]
Boyer JB
any substantive
The implications of such unsettling considerations for professional psychology are undoubtedly profound, for they suggest that
commitment to cultural preservation and revitalization within contemporary tribal communities—which are, we
must not forget, still recovering from the shattering effects of Euro American colonialism—requires a serious
reorientation to our business of promoting mental health and preventing psychological dysfunction. Indeed, the principal challenge for us
is to “begin before the beginning”—that is, to jettison (or, at least, to keep at bay) a host of professional assumptions,
convictions, attitudes, beliefs, and conventions surrounding our disciplinary consensus regarding the desirable
attributes of “mental health” to formulate much more subtly and rigorously, in culturally local terms, the
contours of wellness and dysfunction that would enable us to develop rich, culturally consonant alternatives to
mental-health-services-as-usual. In sum, before we can presume to know how to help Native communities in
culturally appropriate ways, we must first study the cultural underpinnings of wellness from the perspective of
contemporary community members.
2. Including ritual and tradition in mental health services provided to Native

Americans will solve therapeutic neocolonialism
In this article I endeavored to demonstrate through close analysis of a single ethnographic interview that profound cultural divergences in Western
professional and indigenous therapeutic discourses, respectively, may well emanate from subtle and easily overlooked sources of ethnopsychological
orientation and intelligibility. More specifically, analytic attention to the cultural psychology of space and place as constructed within the interview
responses of a middle-aged Traditionalist from the Fort Belknap Indian reservation in north-central Montana revealed that robust ‘mental health’ (or well-
being) was seen to result from participation in indigenous ritual spaces (e.g., the sweatlodge, the vision quest) enacted or performed in designated
sacred places on or near the reservation (e.g., the Little Rocky Mountains). For this respondent, the power of these ritual practices for
achieving beneficial therapeutic outcomes contrasted markedly with the neocolonial or assimilative encounters
of Native ‘clients’ with ‘White psychiatrists’ in the officially designated ‘therapeutic’ spaces of the IHS behavioral
health clinic. In contrast to professional discourse, the hypothetical consultation of an IHS clinician by a distressed tribal member was seen by
Traveling Thunder as an open invitation to ‘brainwash me forever so I can be like a Whiteman’. Thus, although physically located within
sovereign reservation boundaries, the arena of the ‘modern Whiteman system’ known as the mental health
clinic would seem to harbor ideological dangers that remain transparent to some tribal members.
2010 NFA-LD
Evidence Set
3. Collaboration solves for the ideological dangers of colonialism

Boyer JB
Once the parameters that circumscribe the applicability of standard clinical intervention have been identified (with appropriate attention to local culture
and ethnopsychology), the systematic development, implementation, and evaluation of novel and ongoing
therapeutic efforts should proceed in close collaboration with key community members in Indian country. Given
that much of Native America views disorder and healing in the context of spirituality and religious practice, local
consultation with medicine persons, ritual leaders, and even Christian clergy may be essential to the
successful implementation of any form of psychotherapeutic practice (whether novel or conventional). Furthermore, the
enlistment of a variety of active healers and other “natural” helpers from the community would afford a degree of insight
into the culturally salient interventions already practiced in the community and would also allow for a joint analysis of the validity, viability,
and effectiveness of novel forms of therapeutic intervention in unfamiliar cultural contexts. Finally, I should add that close
collaboration with community members may be the only means of determining which of the cultural transformations wrought by psychotherapy are
welcomed in the interest of help and healing and which are seen as undesirable or inappropriate in local cultural contexts. Only through such
close collaboration can the subtle ideological dangers of neocolonialism be overcome. This call to collaboration for
professional psychologists serving Indian country underscores the significance of ongoing consultation with community members regarding nearly every
facet of clinical activity. If this collaboration is taken seriously, the result is likely to be a new kind of behavioral health clinic that
allocates a substantial portion of its resources to the interface between the clinic and the community to
maximize the relevance, efficiency, and utility of the services it provides. Clearly, the professional psychologist
employed in such a setting will assume many responsibilities beyond the conventional role of psychotherapist—
experience in community relations, creative administration, program development, clinical supervision, outcome assessment, and grant writing would
help to ensure the success of such a collaborative endeavor.
2010 NFA-LD
Evidence Set
1AC – Short Version 1/
A. The US mental health system has many disparities and lacks a competent
system of services for American Indians.
Recent research has identified the disparities in mental health services for American Indian and Alaska Native
populations. The New Freedom Commission on Mental Health reported that the United States mental health
system has yet to meet the needs of racial and ethnic minorities, including American Indian and Alaska Native
populations (NFCMH, 2003). The system of services for treating mental health problems in Indian Country is a
complex and inconsistent set of tribal, federal, state, local, and community-based services (Manson, 2004). The
need for mental health care is significant, but the services are lacking, and access can be difficult and costly.
American Indian and Alaska Native (AI/AN) children are more likely to (a) receive treatment through the juvenile justice system and inpatient facilities
than non-Indian children, (b) encounter a system understaffed by specialized children’s mental health professionals, and (c) encounter systems with a
consistent lack of attention to established standards of care for the population.
Observation Two – Harms
A. Cultural barriers prevent American Indian access to mental health services

American Psychiatric Association, HealthyMinds.org, 24 February 2010. [“American Indians / Alaskan
Natives” http://www.healthyminds.org/More-Info-For/American-IndiansAlaskan-Natives.aspx] Boyer TC
Cultural factors can influence how people feel or describe mental illnesses and their acceptance of mental
illness and treatment. Among Indians/Native people, the concept of mental illness has different meanings and
interpretations. Often physical concerns and psychological concerns are not separated and emotional distress may be expressed in different ways.
Many Indians/Natives have difficulty accessing mental health services because of economic barriers, social and
cultural differences, mistrust, and the lack of providers. With proper treatment, most symptoms of mental illness can be controlled. If
mental illness is a concern for you or someone you care about, mental health services are available.
B. Native Americans are a higher risk for mental health disorders and treatment
is severely limited and focused on treating individual symptoms
Native Americans are at a higher risk for mental health disorders than other racial and ethnic groups in the
United States,40 and are consistently overrepresented among high-need populations for mental health
services.41 The Surgeon General reported that this overrepresentation might be attributed to the high rates of homelessness, incarceration, alcohol
and drug abuse, and stress and trauma in Native American populations.42 The Surgeon General’s report further indicated that the U.S. mental
health system is not well-equipped to meet these needs; more specifically, IHS is mostly limited to basic
psychiatric emergency care, due to budget constraints and personnel problems.43 According to Dr. Jon Perez, IHS
does not provide ongoing, quality psychiatric care.44 Instead, the approach adopted by IHS is one of
responding to immediate mental health crises and stabilizing patients until their next episode.45
2010 NFA-LD
Evidence Set
2010 NFA-LD
Evidence Set
C. Depression is a dominant concern on the reservation and is growing through

community-based issues and intergenerational trauma
The most significant mental health concerns today are the high prevalence of substance abuse, depression,
anxiety, violence, and suicide.46 Substance abuse, most notably alcoholism, has been the most visible health disorder crisis.47
Depression is also emerging as a dominant concern.48 These two illnesses are commonly attributed to isolation on
distant reservations, pervasive poverty, hopelessness, and intergenerational trauma, including the historic
attempts by the federal government to forcibly assimilate tribes.49
D. The increasing depression on Native American reservations is leading to an

increasing rate of suicide
As identified earlier, depressionis the most serious emerging mental health disorder in the Native American
population. One of the more troubling indicators of the toll it takes on Native Americans is reflected in suicide
rates. From 1985 to 1996, Native American children committed suicide at two and one-half times the rate of
white children. During this period, 449 Native American children committed suicide.53
The suicide rate for Native Americans continues to escalate and is 190 percent of the rate of the general
population. According to the IHS FY 2005 Budget Justification, the highest suicide rate for the general population is found among individuals 74 and
older. Among Native Americans, the highest suicide rate is found in the 15-year-old to 34-year-old age range.54 In fact, suicide is the second leading
cause of death for Native Americans 15 to 24 years old and the third leading cause of death for Native American children 5 to 14 years old.55 Recent
data from the American Academy of Pediatrics indicate that in 2002 the youth suicide rate for Native Americans was twice as great among 14- to 24-
year-olds, and three times as great among 5- to 10-year-olds, as it was in the general population.56
PLAN – the United States Federal Government through an act of Congress will
require mental health professionals working on reservations to undergo cultural
competency training and require Indian Health Services clinics to collaborate
with local communities and spiritual leaders on mental health treatment.
Funding and Enforcement is through normal means and the affirmative reserves
the right to clarify the intent of plan.
2010 NFA-LD
Evidence Set
Observation Three – Solvency
A. Culturally sensitive mental health solutions require a reorientation of our

treatment methods
Boyer JB
any substantive
The implications of such unsettling considerations for professional psychology are undoubtedly profound, for they suggest that
commitment to cultural preservation and revitalization within contemporary tribal communities—which are, we
must not forget, still recovering from the shattering effects of Euro American colonialism—requires a serious
reorientation to our business of promoting mental health and preventing psychological dysfunction. Indeed, the principal challenge for us
is to “begin before the beginning”—that is, to jettison (or, at least, to keep at bay) a host of professional assumptions,
convictions, attitudes, beliefs, and conventions surrounding our disciplinary consensus regarding the desirable
attributes of “mental health” to formulate much more subtly and rigorously, in culturally local terms, the
contours of wellness and dysfunction that would enable us to develop rich, culturally consonant alternatives to
mental-health-services-as-usual. In sum, before we can presume to know how to help Native communities in
culturally appropriate ways, we must first study the cultural underpinnings of wellness from the perspective of
contemporary community members.
B. Collaboration with community leaders and spiritual healers will overhaul

mental health services for Native Americans, dramatically improving their
effectiveness
Boyer JB
Once the parameters that circumscribe the applicability of standard clinical intervention have been identified (with appropriate attention to local culture
and ethnopsychology), the systematic development, implementation, and evaluation of novel and ongoing
therapeutic efforts should proceed in close collaboration with key community members in Indian country. Given
that much of Native America views disorder and healing in the context of spirituality and religious practice, local
consultation with medicine persons, ritual leaders, and even Christian clergy may be essential to the
successful implementation of any form of psychotherapeutic practice (whether novel or conventional). Furthermore, the
enlistment of a variety of active healers and other “natural” helpers from the community would afford a degree of insight
into the culturally salient interventions already practiced in the community and would also allow for a joint analysis of the validity, viability,
and effectiveness of novel forms of therapeutic intervention in unfamiliar cultural contexts. Finally, I should add that close
collaboration with community members may be the only means of determining which of the cultural transformations wrought by psychotherapy are
welcomed in the interest of help and healing and which are seen as undesirable or inappropriate in local cultural contexts. Only through such close
collaboration can the subtle ideological dangers of neocolonialism be overcome. This call to collaboration for professional psychologists serving Indian
country underscores the significance of ongoing consultation with community members regarding nearly every facet of clinical activity. If this
collaboration is taken seriously, the result is likely to be a new kind of behavioral health clinic that allocates a
substantial portion of its resources to the interface between the clinic and the community to maximize the
relevance, efficiency, and utility of the services it provides. Clearly, the professional psychologist employed in
such a setting will assume many responsibilities beyond the conventional role of psychotherapist— experience in
community relations, creative administration, program development, clinical supervision, outcome assessment, and grant writing would help to
ensure the success of such a collaborative endeavor.
2010 NFA-LD
Evidence Set
Extensions – Assimilation/Colonialism 1/
Mental health practitioners attempt to assimilate patients to their own cultural

backgrounds
The importance of culturally competent health services to the overall quality of health care has been generally
acknowledged.45 Moreover, authorities realize the necessity of offering health care that recognizes and complies with the patient’s values, beliefs,
and traditions, in order to provide acceptable services for specific populations.46 According to the Department of Health and Human
Services: Health care providers typically presume they are color blind in their delivery of services. Few
providers have thought about the biases they bring to patient encounters or about their own cultural/ethnic
backgrounds, health beliefs, and health practices. These biases often result in both the system and its
providers attempting to get the patient to conform to the mainstream instead of meeting a patient on her or his
own cultural ground. Yet patient attitudes about health, religious views, and concepts of death often influence compliance, affect disease
management, and alter health outcomes.47
Mental health practitioners and even IHS clinicians are assimilating Native
American patients into the Western psychological tradition
Boyer JB
Because we as mental health professionals— even those of us who belong to communities indigenous to this continent— have invested
a great deal of time and energy in completing our training and establishing our credentials, it remains exceedingly
difficult for us to concede to this unusually reflective tribal member that our most prevalent therapeutic technologies and
techniques may actually harbor risk in the form of cultural displacement and assimilation for many tribal
communities. And yet, given the cultural origins of most conventional clinical practices— grounded in and
emerging from the “Western” traditions of individualism, dualism, and secular modernity—is it really so difficult
to imagine that IHS clinicians are, in several quite crucial respects, subtly and inadvertently prescribing
Western selves (or, more accurately, subjectivities) through their therapeutic ministrations to their distressed Indian
“clients”? Could it be that Winston is right—that conventional mental health services in Indian country involve a
subtle but significant form of cultural “brainwashing”?
We know that Native Americans experience trauma based on their colonial past,
yet we do not evaluate how we should reshape our methods to better treat that
trauma
Nevertheless,despite commonplace assertions by mental health researchers that explicitly link the colonial
ravages of Native lands and landscapes to epidemic prevalences of intergenerational trauma and unresolved
grief in tribal communities (Brave Heart & DeBruyn, 1998; Duran & Duran, 1995), almost nothing has been written in the
2010 NFA-LD
Evidence Set
health literature about the ways in which cultural constructions of space and place per se shape or constitute
wellness, healing, and the therapeutic.
2010 NFA-LD
Evidence Set
Extensions – Assimilation/Colonialism 2/
Native American community members avoid IHS clinics because they believe
that they represent a new form of colonialist brainwashing
Thus far in this article I have attended closely to Traveling Thunder’s words in the effort to appreciate the complexities of culture and ‘mental health’ for
at least some members of the Fort Belknap tribal community (including several of the other publicly acknowledged cultural authorities
on the reservation such as ‘Marvin’ [J.P. Gone, 2006c], who grumbled with some disdain that the local IHS behavioral health
clinic would be the ‘last place’ he would go for assistance or support in a time of crisis). It seems clear that for Traveling
Thunder these complexities arise from the incendiary cultural conflict that epitomizes the colonial encounter. The key opposition throughout his
interview was the divergent cultural orientations (and their associated institutions and practices) that characterize the ‘old
Indian system’ and the ‘modern Whiteman system’, respectively. The modern Whiteman system, according to
Traveling Thunder, is pathogenic for Native people, leading to anomie, depression, drinking, and, in too many
instances, suicide. He therefore rejected the possibility that ‘White psychiatrists’ staffing the IHS clinic—just one more instantiation of the modern
Whiteman system—might effect truly therapeutic outcomes for tribal members (a concern perhaps shared by tribal members from a Southwest
reservation ‘who were more likely to consult traditional healers than medical professionals about [psychiatric disorders]’; see Beals et al., 2005, p. 105).
Instead, he worried that IHS clinicians would ‘force their White ways and White beliefs’ on their vulnerable clientele,
effectively ‘brainwashing’ them into Euro-American forms of subjectivity. In contrast, then, to this site of transformation
controlled by mental health professionals, Traveling Thunder acknowledged and celebrated an alternative site of transformation better suited for a
vibrant Postcolonial Revitalization at Fort Belknap: the hills and mountaintops that comprise an indigenous ritual space wherein one might ‘put up’ a
ceremony.
The mental health of American Natives are undeniably linked to the historic
events and federal policies that have affected their lives
To understand the mental health needs of American Indian, it is necessary to clearly comprehend the critical
historical events and federal policies that have dramatically affected their lives. The military action, missionary efforts, the
Federal Indian Boarding School Movement, the Dawes Act, the Indian Self-Determination and Education Assistance Act, and the Indian Child Welfare
Act forever changed the economic, physical, and social lives of AI/AN people (BigFoot, 2000; Manson, 2004). Once self-reliant and self-
sufficient, the policies of the federal government forced tribes/indigenous people toward removal, relocations,
isolation, and, in some cases, termination and extinction, resulting in social, economic, and spiritual
depravations. Over the past 200 years, American Indian and Alaska Native people have suffered from a lack of
education, unemployment and economic disadvantage, family disorganization, and personal despair (Manson,
2004). Poverty contributes to a number of less than desirable environmental conditions that create increased stress and trauma. Approximately 26% of
AI/AN live in poverty, compared with 13% of the general population and 10% of White Americans (NCANDS, 2002). Single- parent AI/AN families have
the highest poverty rates in the country. Trauma in Indian Country is often cumulative because of these conditions and can increase feelings of
hopelessness and helplessness. Among adults, AI/AN males are four times more likely and AI/AN females are three times more likely to attempt suicide
than other racial groups (CDC, 2004). The number of American Indian children and adolescents reporting depression and suicidal ideation is a
significant cause for concern in the United States (Olson & Wahab, 2006).
2010 NFA-LD
Evidence Set
Extensions – Cultural Insensitivity Prevents

Care 1/
Cultural insensitivity of mental health care providers presents a barrier to Native

Americans receiving care
For Native Americans, there is a concern that health care providers’ cultural insensitivity and the lack of
acceptance of traditional healing practices and traditional medicine may create barriers to receiving care.42
Accordingly, it is important that “culturally competent”43 health services be available to Native Americans. If
health services are not offered to the targeted patient population in a culturally and linguistically appropriate
manner, treatment will remain ineffective and any effort to eliminate racial and ethnic health care disparities will
fall short.44
Lack of cultural experience impedes counseling effectiveness and cultural

competency can improve the counselor-client relationship
Joseph E. Trimble, Center for Cross-Cultural Research, Western Washington University, The
Counseling Psychologist, February 2010. [“The Virtues of Cultural Resonance, Competence, and Relational Collaboration
With Native American Indian Communities: A Synthesis of the Counselling and Psychotherapy Literature”, SAGE] Boyer TC
The article extends the scholarship, observations, and recommendations provided in Joseph Gone’s article, “Psychotherapy and Traditional Healing for
American Indians: Prospects for Therapeutic Integration” (2010 [this issue]). The overarching thesis is that for many Indian and Native
clients, interpersonal and interethnic problems can emerge when a counselor’s lack of culturally resonant
experience and knowledge, deeply held stereotypes, and preconceived notions interfere with the counseling
relationship and impede counseling effectiveness. A brief synthesis of the counseling literature themes suggests that there is
ample evidence that by using particular culturally resonant techniques, counselors can promote client trust,
rapport, and cultural empathy and improve the counselor–client relationship, both in general and with American
Indian and Alaska Native clients specifically. Topics consistent with Joseph Gone’s main thesis also are explored that relate to spiritual
healing and other counseling considerations involving relational collaborations with Indian and Native communities. Information provided in this article is
focused on helping to stimulate effective cross-cultural contacts between mental health counselors and Native American Indians.
Mental health disparities are caused by biased and uninformed judgments by

mental health practicioners
A report discussing racial and ethnic disparities in the diagnosis and treatment of mental illnesses concluded that disparities can be attributed
to bias.21 Citing a 2001 report, Race, Culture and Ethnicity and Mental Health, issued by then-Surgeon General David Satcher, the report concluded
that disparities in access and treatment leave minority mental health patients without proper treatment. 22 The report
explained that one possible reason for racial and ethnic disparities in mental health treatment is that “practitioners
and mental health program administrators make unwarranted judgments about people on the basis of race or
ethnicity.”23 Relying on these types of assumptions can lead to inappropriate decisions, and action or inaction,
by practitioners and program administrators that affect the overall health care of minorities.24
2010 NFA-LD
Evidence Set
2010 NFA-LD
Evidence Set
Extensions – Cultural Insensitivity Prevents

Care 2/
Mental health care remains unable to provide culturally sensitive treatment and
IHS clinics are massively underfunded and lack
Boyer JB
Like other Americans, Native people might also qualify for mental health services through the usual variety of other venues: state and county public
health clinics and programs, HMOs, and private or independent service providers who accept Medicare/Medicaid or personal insurance reimbursements.
Because many Indian families contend with poverty and unemployment, however, a disproportionate number are uninsured or underinsured (Brown,
Ojeda, Wyn, & Levan, 2000) and are therefore unable to afford quality mental health services requiring nonfederal third-party payment. In any case, it
remains exceedingly unlikely that the vast majority of these “mainstream” services— even when actually
accessible to Native people—are capable of providing “culturally sensitive” assessment and treatment (i.e.,
services that are intentionally formulated to assist Indian clients). Thus, the “behavioral health” and substance abuse treatment
programs sponsored by most IHS service units remain the primary access points for Native people— 60% of
whom rely on the IHS for their health care (IHS, 2002a)—to obtain psychological services in times of distress
(for a more thorough review of Indian health and mental health issues in the context of IHS policy and practice, see Gone, 2003).
Unfortunately, as I mentioned previously, the IHS is woefully underfunded with regard to providing truly
adequate
services. And with only 7% of the IHS budget devoted to mental health and substance abuse treatment
services, these areas are particularly shortchanged. Within its behavioral health programs specifically (because
most substance abuse treatment programs are contracted for direct administration by tribal governments), IHS employs
some 300 full-time staff members, two thirds of whom are licensed (or licensable) clinicians. Of the roughly 20 psychiatrists, 60 psychologists, and 110
social workers working in the behavioral health clinics, many are themselves Native American (although only 2 of the
psychiatrists and 17 of the psychologists are Indian; J. Davis-Hueston, personal communication, June 22, 2001). These personnel were
expected to provide clinical services at the annual rate of 208,000 “client contacts” (or assessment and treatment sessions) during the 2001 fiscal year.\
2010 NFA-LD
Evidence Set
Extensions – Solvency
We must provide culturally distinct mental health solutions to Native Americans

If culturally and linguistically appropriate health services are desirable to Native Americans, based on their
unique cultures and the unique relationship with the federal government, distinctive approaches to health care
should also be included in the delivery of health services to this population. Many Native Americans continue to employ
traditional medicines and practices either as their sole form of health care or as a component of their overall health care.48 Accordingly, in March 2002,
the Association of American Indian Physicians unanimously approved a resolution acknowledging and supporting Native American traditional healing
and medicines as part of the spectrum of health care appropriate for Native Americans. As part of this resolution, the association intends to work
collaboratively with traditional healers for the benefit of Native patients and community health.49
Mental health care practitioners must recognize and adapt to the clash between
native and western cultures
mental health professionals and researchers must acknowledge that the

At the confluence of these distinctive strategies,
‘culture’ of the mental health clinic is not the ‘culture’ of the Native American community (J.P. Gone, 2004a, 2004b,
2006b, 2006c, in press-a; J.P. Gone & Alcántara, 2007). Moreover, owing to the shattering legacy of Euro-American
colonialism, it is crucial to recognize that these divergent cultural formations meet on especially uneven
ideological terrain in Indian country. As a result, a pivotal question in regard to culture and mental health in indigenous communities
remains: under what conditions might mental health professionals, whose clinical approaches and techniques emerge from and depend upon a variety of
‘Western’ notions and norms, therapeutically benefit their vulnerable Native ‘patients’ or ‘clients’ without reinforcing (or re-enforcing) the colonial project?
2010 NFA-LD
Evidence Set
Extensions – Solvency – Colonialism
Status quo legislative solutions only lead to ‘formal equality’ – however mental
health issues are diverse and different based on the community – failure to
address and include these differences increases discrimination and inequality in
health care
Jonathan Burns, professor at the Nelson Mandela School of Medicine, published in Health and Human
Rights, in 2009. [“Mental health and inequity: A human rights approach to inequality, discrimination, and mental disability”
http://www.hhrjournal.org/index.php/hhr/article/viewArticle/170/255] Boyer JB
statutes on their own often introduce only

Thus, legislation may be enacted to reduce or eradicate inequalities in health care, but
“formal equality” — that is, the law treats all individuals or health conditions alike. This is a superficial and
deceptive form of equality, however, as there are many social, economic, and political factors at play that obstruct the translation of a law into
the real, individual experience of equality. Formal equality alone gives an illusion that all are equal and that fairness exists,
without addressing underlying inequalities in power, access, and socioeconomic and political circumstances.4 In
this way, formal equality alone tends to perpetuate discrimination and inequality because it often fails to address
real inequality in circumstances. Under a seemingly progressive veneer of respectability, disparities grow
unchecked as public advocacy groups relax their activist efforts. Thus, far from bringing about progressive
change, the introduction of equality legislation can have reactionary effects, exacerbating existing disparities in
health access and care.
2010 NFA-LD
Evidence Set
Extensions – Solvency – Collaboration
We must develop Native American mental health solutions that focus on the
communities’ role in the illness and treatment
UC Davis Center for Reducing Health Disparities in collaboration with the California Department of
Mental Health, a report in March 2009. [“Building Partnerships: Conversations with Native Americans about Mental Health
needs and Community Strength.” http://www.dmh.ca.gov/PEIStatewideProjects/docs/Reducing_Disparities/BP_Native_American.pdf]
Boyer JB
For many participants, lack of appropriate mental health care was a prominent issue. They talked about the
lack of available mental health services, the lack of adequate funding to continue to support existing services,
and the absence of Native American providers who can adequately address the cultural aspects of mental
health issues within the community. Western mental health focuses on the individual as the locus of illness,
while for Native Americans an individual’s mental illness is just a symptom of a whole community that is
suffering from its own history of oppression and violence. What is needed is a holistic approach which includes
the healing of the community as a whole.
Exploring Native American preferences in mental health therapy will help

increase commitment to cultural competency
As Wilson has demonstrated, exploration of the cultural psychology of space and place in relation to therapeutic
landscapes among contemporary
Native American peoples—too many of whom are still reeling from the destructive legacies of Euro-American
colonization—stands to illuminate both cross-cultural explorations of ‘how the healing process works itself out
in places’ and cross-cultural notions of the therapeutic. Increased understanding of the former promises to
advance our theoretical construal of therapeutic landscapes within interdisciplinary inquiry into health and
health services, while increased understanding of the latter promises to invite a more searching and
substantive critique of 21st-century professional commitments to ‘cultural competence’ in mental health service
delivery. Thus, in order to engage these considerations in some detail, this article provides an interpretive analysis of a single ethnographic interview
with a middle-aged Native American Traditionalist who addressed—albeit implicitly—the concerns of space and place in the ‘treatment’ of reservation-
based ‘mental health’ problems.
Tribal representatives are demanding improved approaches to behavioral health

By the Arizona American Indian Behavioral Health Forum, Arizona Department of Health Services.
March 24, 2010 [“Arizona American Indian Behavioral Health Forum: Communicating and Collaborating for Wellness Needs”
http://www.azdhs.gov/phs/tribal/pdf/Final%20Tribal%20Forum%20Report%203-26-10.pdf Boyer. SB
Tribal representatives made over two dozen suggestion on expanding, leveraging, re-allocating or allowing creative application of state, federal
or other funds. They expressed a desire to better address the needs of rural areas, education and training, crisis services, in-
home services youth in detention, case management, prevention services, holistic and traditional healing, urban Indian health, and
the need for additional facilities.
2010 NFA-LD
Evidence Set
Extensions – Solvency – Cultural Competency
A. Health insurance providers must understand the cultural differences between

themselves and their clients to properly create cultural competence.
Spero M. Manson Ph.D Director in National Association of Mental Health Directors. 2004.
[“Meeting the Mental Health Needs of the American Indians and Alaskan Natives, Cultural Diversity Series.”
http://www.nasmhpd.org/general_files/publications/ntac_pubs/reports/native%20american%20FINAL-04.pdf] Boyer. SB
Developing cultural competence within a mental health system is a dynamic and evolutionary process. Some
mental health systems and providers seeking to increase cultural awareness may inadvertedly rely on
overgeneralizations that ignore subgroup and individual variation, this belying the basic value of cultural
competence. To be truly culturally competent, mental health systems must be aware of the significant
differences in lifestyle and worldview among diverse populations, while valuing and responding to the distinct
needs of each client.
2010 NFA-LD
Evidence Set
Native American health care is traditionally underfunded with mental health

services being the worst example
Boyer JB
Since 1976, with congressional passage of Public Law 94-437, better known as the Indian Health Care Improvement Act, the supreme law of the land
has been to realize the “highest possible health status” for this nation’s small but vibrant population of Native Americans. Ambiguous goals frequently
frustrate ambitious agendas, however, and as the country moves toward a fourth reauthorization of this landmark legislation—the legal capstone
bolstering federal provision of health care services to American Indians and Alaska Natives—actual congressional allocations to the Indian
Health Service (IHS) remain only 52% of that required to ensure adequate “personal health services” for
today’s tribal citizens (Federal Disparity Index Workgroup, 2002). If health care services in general suffer from such
intimidating fiscal constraints, then mental health services in particular bear a disproportionate share of this
budgetary burden, with less than 7% of IHS funding designated for “behavioral health” and substance abuse
treatment services combined (National Indian Health Board, 2002). Thus, despite the surgeon general’s recent call for interventions in
American Indian and Alaska Native communities (also referred to as Indian country) that “promote the strengths, resiliencies, and other psychosocial
resources that characterize full, productive, and meaningful lives” (U.S. Department of Health and Human Services, 2001, p. 97), the sad reality is
that the mental health needs of this nation’s Native American citizens remain largely overlooked and ignored.
2010 NFA-LD
Evidence Set
Negative Evidence 1/
Lack of leadership will lead to the failure of cultural competency

Nisha Dogra. PhD Harvard University. Journal of The National Medical Association. Feb 2009
The Relationship Between Drivers and Policy in the Implementation of Cultural Competency Training in Health Care.
http://www.nmanet.org/images/uploads/Documents/OC127.pdf Boyer SB
The lack of clarity about external organizations’ expectations from individual health care organizations creates
uncertainty and anxiety about programs for cultural competence. Several participants stated that organizations responded to
external drivers in a reactive fashion. Their actions had more to do with being perceived as doing the right thing rather
than fostering any real change.
Participants also expressed concerns that activities related to external partnerships and members were pri-
oritied above internal issues. Organizational leadership was also a problem. For example, an onboard CEO
would enable a strategic overview with organizational goals and specific targets, but the task would often be
left with individuals. For 3 of the organizations the CEO was engaged in the agenda relating to cultural compe-
tence but for different reasons had not yet made a significant impact.
Significant barriers to cultural competency training already exist – including the

high cost of training
Nisha Dogra. PhD Harvard University. Journal of The National Medical Association. Feb 2009
The Relationship Between Drivers and Policy in the Implementation of Cultural Competency Training in Health Care.
http://www.nmanet.org/images/uploads/Documents/OC127.pdf Boyer SB
Five major barriers were identified:

• lack of leadership and accountability within the organization;
• lack of information and useful data;
• access to the whole organization and size of the
organization (the people with responsibility for implementing training rarely had direct access to the whole
organization, and organizations were generally too large for the small numbers allocated for cultural
competence training);
• barriers to funding;
• staff barriers for organizations (staff were not
well motivated and did not always see any clinical or financial benefits).
None of the respondents could point to an individual in their organization with overall responsibility for what the organization could or should do. Even a
CEO actively involved in achieving cultural competence for his staff could be thwarted by the chiefs of key hospital departments, who can directly or
indirectly sabotage organizational initiatives.
Every department has its own leadership, organizational structure, cultural structure...I can’t imagine that he [the president] would mandate cultural
competency training because the chief might say we don’t have to really do this (interview 2).
Lack of useful data can make it difficult to relate findings to individual practice and motivate change. Even with useful data, organizations face varying
data- bases that may or may not be consistent.
Small plans felt that their size meant that they had little financial or influencing power. They felt they were too insignificant to mandate expectations of
their providers, as their penetration of any 1 practice would be generally limited . Cost, especially for training and interpreters, was a
barrier recognized by many of the participants, with only 1 organization having protected resources. A major
issue was that despite federal mandates, such as the requirement to provide interpreter services, no federal
money surfaced to fund such initiatives. Clinical staff may not have protected time for training, but organizations also faced cynicism of the
priority that cultural competence is given by medical staff. Staff resistance and skepticism were a challenge, and some responses suggested a mismatch
between organizational and individual priorities
2010 NFA-LD
Evidence Set
Cultural Competency oversimplifies patients’ problems

Kleinman A, Benson P, Professor of Psychiatry and Medical Anthropology at Harvard Medical School ,
PLoS medicine October 24, 2006 . [Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It.
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030294 ] Boyer AP
Perhaps the most serious side-effect of cultural competency is that attention to cultural difference can be
interpreted by patients and families as intrusive, and might even contribute to a sense of being singled out and
stigmatized [3,11,12]. Another danger is that overemphasis on cultural difference can lead to the mistaken idea
that if we can only identify the cultural root of the problem, it can be resolved. The situation is usually much
more complicated. For example, in her influential book, The Spirit Catches You and You Fall Down, Ann Fadiman shows that while inattention to
culturally important factors creates havoc in the care of a young Hmong patient with epilepsy, once the cultural issues are addressed, there is still no
easy resolution [33]. Instead, a whole new series of questions is raised.
There is not adequate research on the impact of cultural competency

Cindy Brach, Irene Fraserirecto, Agency for Healthcare Research and Quality. Medical Care Research
and Review, Vol. 57, November 2000. [Can Cultural Competency Reduce Racial And Ethnic Health Disparities? A Review
And Conceptual Model.
http://brando.med.uiuc.edu/FacultyDev/ClinicalEnviron/CulturalCompetence/CCCModelToReduceDisparitiesBrach.pdf ] Boyer AP
Unfortunately, at this point there is little by way of rigorous research evaluating the impact of particular cultural
competency techniques on any outcomes, including the reduction of racial and ethnic disparities. The only
Exception is that subset of techniques related to overcoming language barriers. Most linkages among cultural
competency techniques, the processes of health care service delivery, and patient outcomes have yet to be
empirically tested. Comparisons of culturally competent interventions with interventions uninformed by patients’
language and culture are particularly critical, given That the research literature has not been able to firmly rule
out the confounders of education, literacy, and class as causes for racial and ethnic disparities.
2010 NFA-LD
Evidence Set
Cultural competency training doesn’t last long enough to affect behavior.

Sunil Kripalani (Emory University School of Medicine) et al, The Journal of General Internal Medicine,
October 2006. [w/ Jada Bussey-Jones and Marra J. Katz of Emory University School of Medicine, and Ingenia Genao of Yale
University School of Medicine. “A prescription for cultural competence in medical education”, SpringerLink] Boyer TC
Becoming culturally competent is a complex, life-long process. However, most cultural competence education
for medical students has a total contact time of less than 1 week, a duration that is unlikely to lead to long-term
behavior change. To reinforce culturally relevant knowledge and skills, cultural competence training should be infused throughout students' clinical
education. There are many opportunities to discuss cultural issues with our learners. Whether treating a patient from another culture or simply one who
does not share the Western biomedical view of disease, the discussion during medical rounds should be broad and include the patient's cultural
background and its impact on disease and health behavior, in addition to teaching about pathophysiology and management.
Cultural competency training has no effect on students

Brenda Beagan, School of Occupational Therapy, Dalhousie University, Academic Medicine, June
2003. [”Teaching social and cultural awareness to medical students”, PubMed] Boyer TC
Students in Time 2 did not demonstrate increased

The response rate for Time 1 was 59% (n = 72), for Time 2, 51% (n = 61).
awareness of social and cultural issues. Most failed to recognize, or even denied, the effects of race, class,
gender, culture, and sexual orientation. Those who acknowledged the effect of social differences tended to deny social inequality, or at
best recognized disadvantages experienced by Others, but not the accompanying privileges enjoyed by their own social group.
In general, students concluded that learning about social and cultural issues made little or no difference when
they did their clinical rotations. For a medical school to produce physicians who are sensitive to and competent working with diverse
communities requires a balance between attention to "difference," attention to self, and attention to power relations.
Cultural competency training reinforces existing stereotypes and prejudices

Sunil Kripalani (Emory University School of Medicine) et al, The Journal of General Internal Medicine,
October 2006. [w/ Jada Bussey-Jones and Marra J. Katz of Emory University School of Medicine, and Ingenia Genao of Yale
University School of Medicine. “A prescription for cultural competence in medical education”, SpringerLink] Boyer TC
Cultural competence programs have traditionally followed a knowledge-based approach. Such curricula often include lists of
preferred words, images, or approaches for treating minority groups, portraying each group as having particular values, beliefs,
and behaviors based on culture. This oversimplified practice fails to acknowledge diversity within groups and
emphasizes differences between groups, potentially reinforcing stereotyping behavior.
Cultural training diverts resources away from patients

Lisa C. Ikemoto, Loyola Law School, Saint Louis University Law Journal, Fall 2003. [“Racial disparities in
health care and cultural competency”, LexisNexis] Boyer TC
These two threads of discourse offer a narrow vision of health, equality, and the role of health care in society. A vision based on free-market
individualism would protect the market players above all else. It would protect the professional autonomy and financial interests of providers and health
care organizations, and in doing so, this vision would minimize their accountability. If this vision dominates the political discourse, then cultural
competency efforts would remain only voluntarily assumed professional or institutional standards . If enacted or promulgated at all, cultural
competency requirements might even include among its goals the use of cultural competency for financial gain.
Such requirements would also pay deference to cost concerns at the expense of patients, especially patients of color.
That deference would limit the requirements imposed on health care and social service providers and organizations. The revision of the HHS LEP Policy
Guidance serves as an example of this process.
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Evidence Set
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Evidence Set
Studies of cultural competence effectiveness are methodologically flawed

Eboni G. Price (Johns Hopkins University School of Medicine) et al, Academic Medicine, June 2005. [w/
Mary Catharine Beach, Tiffany Gary, Karen A. Robinson, Aysegul Gozu, Ana Palacio, Carole Smarth, Mollie Jenckes, Carolyn
Feuerstein, Eric B. Bass, Neil R. Powe and Lisa Cooper of Johns Hopkins University School of Medicine. “A Systematic Review of the
Methodological Rigor of Studies Evaluating Cultural Competence Training of Health Professionals”, LWW Journals] Boyer TC
Our critical
To our knowledge, this is the first analysis of the methodological rigor used in studies evaluating cultural competence training.
appraisal of 64 educational research articles suggests that the quality of the evidence from interventions to improve
cultural competence of health professionals is generally poor. Specifically, most studies did not meet our criteria
for high study quality, which were based on published guidelines for assessing the evidence of educational
practices.
Cultural competency training is already standard for health care professionals

Eboni G. Price (Johns Hopkins University School of Medicine) et al, Academic Medicine, June 2005. [w/
Mary Catharine Beach, Tiffany Gary, Karen A. Robinson, Aysegul Gozu, Ana Palacio, Carole Smarth, Mollie Jenckes, Carolyn
Feuerstein, Eric B. Bass, Neil R. Powe and Lisa Cooper of Johns Hopkins University School of Medicine. “A Systematic Review of the
Methodological Rigor of Studies Evaluating Cultural Competence Training of Health Professionals”, LWW Journals] Boyer TC
Previously, we reported the results of a systematic review of cultural competence training interventions targeted at health care providers and designed to
improve minority health. The review identified good evidence that cultural competence training influences provider knowledge, attitude, and skills.
However, few studies assessed patient outcomes. Additionally, the heterogeneity of curricular content, teaching methods, and evaluation strategies
made it difficult to determine the impact of training on outcomes.
Even so, cultural competence is now considered to be a federal standard of care and is among educational
objectives for various accreditation bodies in medical education. Researchers and educators have described conceptual
frameworks for integrating cultural competence training into medical education. However, there are no standard guidelines to help educators effectively
design, evaluate, or report cultural competence interventions. Furthermore, little has been done to examine the rigor of evidence upon which the
development and implementation of future interventions in this area might be based.
TURN – federal funding creates dependence – that hinders true development

Robert Capriccioso, Washington staff reporter at Indian Country Today on 7-9-2009. [“A complex tale to be
told” http://indiancountrynews.net/index.php?option=com_content&task=view&id=1615&Itemid=84&limit=1&limitstart=0] JB
Continuing to push for economic independence won’t be easy in the years to come, but most everyone agrees it
must be done—and done, some say, with even less financial support from the federal government.
“The 1990s saw substantial improvement in many tribal citizens’ material welfare and fiscal health –
independent of federal program spending,” according to The State of the Native Nations. “Maintaining and expanding this rate of growth
is clearly critical to the long-term economic health of Native America. Rates of unemployment and poverty remain unacceptably high and suggest much
productive economic potential within.”
Cornish takes the independence thought a step further, saying that some tribal leaders are currently much too dependent on
federal government payments. “One day soon those payments could be gone,” he says. “Being a leader means planning for that possibility.”
Cornish says that part of the change that still has to occur is getting more tribes to focus on self-determination. “Federal funding should be
like training wheels,” he says. “You’ve got to get them off. Or else you’re never going to be on your own.”
2010 NFA-LD
Evidence Set
Government authority over tribes is what has lead to the massive amounts of
poverty
Ward Churchill, professor of American Indian studies @ the University of Colorado at Boulder, 2005.
[“Since Predator Came”, 2005. pgs. 36-37] JB
internal colonialism, applies as it was to the specific context of American Indians in the late twentieth century, has yielded a
Bob’s notion of
powerful analytical utility of those of us seeking to decipher the peculiarly convoluted relationships of the
federal government to North America’s native peoples, and how this relationship has caused Indians in the “land of
the free”- despite our nominal retention of land and resources sufficient to make us the wealthiest single racial/ethnic population aggregate on the
continent- to experience literal Third World levels of impoverishment. By the mid-1970’s, the idea of Indians as colonies had taken
firm hold among a number of scholars exploring questions of Indian rights. Even elements within the government itself to some extent admitted the
validity of premise, with the U.S. Civil Rights commission publishing a major study of conditions among the Navajos entitled “The Navajo Nation: An
American Colony”. A whole new understanding of the native North American context was beginning.
Federal leadership over reservations causes all acts of violence, poverty

Ward Churchill, professor of American Indian studies @ the University of Colorado at Boulder, 2005.
[“Since Predator Came”, 2005. pgs. 36-37] JB
For grassroot Indian people, the broader human costs of ongoing U.S. domination are abundantly clear. The 1.6
million American Indians within the United States remain, nominally at least, the largest per capita land owners
in North America. Given the extent of the resources within their land base, Indians should by logical extension
comprise the wealthiest ethnic group on North American society. Instead, according to the federal
government’s own statistics, they are the poorest, demonstrating far and away the lowest annual and lifetime
incomes, the highest rate of unemployment, lowest rate of pay and when, the lowest level of educational
attainment of any North America population aggregate. Correspondingly, they suffer, by decisive margins, the greatest incidence of
malnutrition and diabetes, death by exposure, tuberculosis, infant mortality, plague, and similar maladies. These conditions in combination
with the general disempowerment which spawns them breed an unremitting sense of rage, frustration, and
despair which is reflected in the spiraling rates of domestic and other forms of intragroup violence, alcoholism
and resulting death by accident or fetal alcohol syndrome. Consequently, the average life expectancy of a reservation-based
Native American male in 1980 was a mere 44.6 years, that of his female counterpart less than three years longer. Such a statistical portrait is
obviously more indicative of a Third World environment than that expected of people living one of the world’s
most advanced industrial states.
2010 NFA-LD
Evidence Set
IHS continues to suffer from gross mismanagement of property and funds

despite oversight
Government Accountability Office, Report to Congressional Requesters, 18 June 2008. [GAO-08-727, “IHS
Mismanagement Led to Millions of Dollars in Lost or Stolen Property”, http://www.gao.gov/new.items/d08727.pdf] Boyer TC
We substantiated the allegation of gross mismanagement of property at IHS. Specifically, we found that thousands
of computers and other property, worth millions of dollars, have been lost or stolen. We analyzed IHS reports for
headquarters and the 12 regions from the last 4 fiscal years which identified over 5,000 property items, worth about $15.8 million, that were lost or stolen
from IHS headquarters and field offices throughout the country. The number and dollar value of this missing property is likely
much higher because IHS did not conduct full inventories of accountable property for all of its locations and did
not provide us with all inventory documents as requested. Despite IHS attempts to obstruct our investigation, our full physical
inventory at headquarters and our random sample of property at seven field locations identified millions of dollars of missing
property. We also found that IHS has made wasteful purchases over the past few years. For example, IHS has
bought computer equipment that is currently unused in its original box and has issued IT equipment to its employees that duplicate
the equipment already provided to them.
IHS mismanages money

Government Accountability Office, Report to Congressional Requesters, 2 June 2009. [GAO-09-450, Millions
of Dollars in Property and Equipment Continue to Be Lost or Stolen”, http://www.gao.gov/new.items/d09450.pdf] Boyer TC
We found that property continues to be lost or stolen at IHS at an alarming rate. From October 2007 through January
2009, IHS identified about 1,400 items with an acquisition value of about $3.5 million that were lost or stolen
agencywide. These property losses are in addition to what we identified in our June 2008 report. Our full
headquarters inventory testing and our random sample testing of six field offices estimated that over a million dollars worth of IT equipment was lost,
stolen, or unaccounted for, confirming that property management weaknesses continue at IHS. Also, IHS headquarters and
many IHS regions continue to reconcile 2008 inventory as of March 2009. In addition to the $3.5 million reported as lost or stolen, IHS also had
thousands of unreconciled and unaccounted for property items with an acquisition value of $14.5 million missing about 2 months after conducting its
2008 inventory. These unreconciled and unaccounted for items had largely been located at four field locations that had over 40 percent of inventory
items missing. Some of these items will likely be reported as lost or stolen.
IHS already provides deeply substandard care and sows discord between Native
American communities
National Indian Health Board, June 2009. [“Open Tribal Letter Supporting the Reauthorization of the Indian Health Care
Improvement Act”, http://www.nihb.org/docs/IHCIA/June%20o9%20tribal%20leader%20letter%20on%20IHCIA.pdf] Boyer TC
We recognize that there is a National need for health care reform. However, as frequently noted, the United States is the only developed country that
does not guarantee health care coverage for all of its citizens. The irony of reforming health care is that it means more to Indian people than fixing a
broken system. Compared to what we were promised, health care in Indian Country is an atrocity; funding that
does not adequately provide quality health care for our people, substandard health conditions due to
government inefficiency, and pitting Tribe against Tribe for construction, repair, and maintenance of health
facilities, just to name a few.
We have been patiently expecting and remain very optimistic about the passage of the reauthorization of the Indian Health Care Improvement Act. We
have sacrificed much, yet we continue to be deprived of the right to quality health care… a trust obligation
agreed to between Great Men during a time when you had nothing and we had everything to offer.
2010 NFA-LD
Evidence Set
2010 NFA-LD
Evidence Set
Gone’s 4-Step Recommendations for Cultural

Competency
Joseph Gone elaborates on a 4 step process to achieving a culturally competent

mental health service
Boyer JB
There is, of course, a great deal more that might be conveyed regarding these concerns (see Gone, 2003, for an in-depth discussion), but for now I
conclude with a series of recommendations for clinicians desiring to be mindful of these considerations while directly confronting the prospect of serving
Native American clients and communities. We must be guided by four principles as we attempt to cultivate modes of
inquiry that proactively assess and surmount the dangers of a nearly invisible (but potentially
countertherapeutic) “cultural proselytization” of psychotherapy clients in Indian country (and perhaps in cross-
cultural encounters or in non-Western settings more generally). The specifics of such an endeavor should
minimally include the following:
1. Keep CULTURE in Mind
The recent “Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists” (APA, 2003) provide a
reasonably comprehensive overview of the multicultural endeavor within the profession and explicitly prescribe a reflexive commitment by psychologists
to “cultural awareness and knowledge of self and others” (p. 382). Awareness of one’s own deeply embedded cultural
assumptions is often quite elusive unless or until one encounters others whose shared (i.e., collective, as opposed to idiosyncratic) sense of
what is true, good, right, proper, and beautiful collides with one’s own. Such cross-cultural collisions are likely to be more frustrating than illuminating,
however, unless one is fairly committed to excavating the intelligibility of unfamiliar cultural practices (e.g., adolescent female circumcision in sub-
Saharan Africa vis-a-vis infant male circumcision in the United States; see Shweder, 2002). In the absence of such a commitment, however, the
proclivities and habits shared by one’s own community are likely to seem “natural” instead of cultural—and thus universal instead of local—in their
applicability. The obvious implication here is that although all psychologists would benefit from the searching reflexivity
cultural self-awareness is absolutely mandatory for professionals aspiring to work with
prescribed by the Guidelines,
Native American clients and communities.
Furthermore, even though the Guidelines emphasize the significance of cultural self-knowledge for multiculturally sensitive professionals, their
discussion of therapeutic techniques, practices, and interventions as culture-laden tools employed by such professionals is less satisfying. We must
remember that the modern psychotherapies are cultural “artifacts” (i.e., cultural creations or products situated within a unique time and place) whose
mechanisms and meanings emerge from and depend upon the cultural intelligibility of their operations to both therapist and client. As cultural artifacts,
the modern psychotherapies can be studied in terms of their historical origins and evolution within the West, as well as in their adoption and adaptation
throughout the world. For example, Cushman (1995) has written a fascinating account of the cultural history of psychotherapy in America that illuminates
the broader societal contexts that render psychotherapy practices viable in the contemporary United States. Thus, it is incumbent upon all
mental health professionals working in cross-cultural contexts, including in Indian country, to be reflexively
aware of the origins, assumptions, and predispositions of their particular therapeutic orientations and practices.
In short, it is necessary for us to recognize the cultural constituents of our own training and technique, including any received notions of wellness,
distress, disorder, and healing—this is incumbent upon us not only as enculturated persons but also as enculturated professionals. Fortunately, reflexive
awareness of the cultural foundations of professional practice is rather readily obtained through simple comparison with other documented healing
traditions around the world. In the context of my own community, I usually recommend perusal of the published biography of our most famous medicine
person, Bull Lodge, for insight into ancestral Gros Ventre healing tradition (Gone, 1980). Comparison of Bull Lodge’s calling, credentialing, and career
activities with the efforts of the modern psychotherapist reveals obvious divergence in the origins, assumptions, meanings, and mechanisms of these
rather disparate healing traditions.
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Evidence Set
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2. Keep Culture in MIND
In addition to recognizing the modern psychotherapies as cultural artifacts, mental health professionals aspiring to be of service
in Indian country also must attend to the cultural contours of mind, self, and personhood across societal
contexts. Any commitment to the application of the modern psychotherapies cross-culturally presupposes an empirical basis to guide substantive
innovations that might better serve targeted clients. An increasingly influential interdisciplinary tradition with clear relevance here is the reemerging field
of cultural psychology (Bruner, 1990; Cole, 1990; Shweder & Sullivan, 1993). Cultural psychology takes as its conceptual point of departure the co-
constitution (i.e., interdependent existence) of culture and mind (Shweder, 1990). Its central locus of inquiry therefore concerns the meaningful (i.e.,
semiotic, symbolically mediated, or “meaning-full”) nature of all human experience. The careful formulation of local ethnopsychology within the
framework of cultural psychology thus encompasses multiple relevant content areas, including the complex relationships between culture, language, and
mind; the experiential foundations of self and personhood; the nuanced diversity of emotional experience and expression; the conceptual underpinnings
of health, illness, and healing; and research reflexivity (i.e., attention to how the knower constructs the known). Each of these phenomena contains
important implications for exporting modern psychotherapies to American Indian and Alaska Native communities. Obviously, the careful
formulation of an indigenous ethnopsychology is most relevant for professional psychologists working not just
with an occasional American Indian client but with an actual Native community. This is true not only because the effort
required to familiarize onseself with the cultural psychology of a given community is extremely time-consuming but also because the diversity of Native
America limits the ability to generalize across the experiences of Indian clients from different communities. As a result, it is rather difficult to offer specific
advice to professional psychologists desiring to assist an occasional Native client. Although several previous reviews offer helpful recommendations to
practitioners for treating American Indian clients in general (LaFromboise, Trimble, & Mohatt, 1990; Trimble, Manson, Dinges, & Medicine, 1984; Trimble
& Thurman, 2002), there is simply no such thing as a “Generokee” (i.e., generic American Indian) ethnopsychology available to guide the work of
clinicians in such circumstances in any specific way. Thus, a clear logistical advantage lies in the professional commitment to
serving an American Indian community. In the context of a community-based practice, then, professional psychologists have several
means of exploring and identifying key aspects of the local ethnopsychology. First, psychologists should insist that part of their initial
professional efforts include time for community outreach, during which they might participate in community
activities and events and consult with ritual leaders and cultural authorities regarding the role of psychologists
as service providers in the community. In addition, psychologists should peruse the anthropological literature originating in the community
—soliciting recommended sources from community members themselves—in an effort to identify important facets of the local ethnopsychology (see,
e.g., Strauss’s [1977] report on Northern Cheyenne ethnopsychology or Anderson’s [2001] treatment of Northern Arapahoe personhood). Finally, after
consulting carefully with community leaders on the matter, psychologists might consider inviting a cultural anthropologist from a nearby college or
university to consult with the clinic on matters of ethnopsychology and healing.
3. Develop, Implement, and Evaluate Therapeutic Efforts Collaboratively
Once the parameters that circumscribe the applicability of standard clinical intervention have been identified
(with appropriate attention to local culture and ethnopsychology), the systematic development, implementation, and evaluation of
novel and ongoing therapeutic efforts should proceed in close collaboration with key community members in
Indian country. Given that much of Native America views disorder and healing in the context of spirituality and
religious practice, local consultation with medicine persons, ritual leaders, and even Christian clergy may be
essential to the successful implementation of any form of psychotherapeutic practice (whether novel or conventional).
Furthermore, the enlistment of a variety of active healers and other “natural” helpers from the community would
afford a degree of insight into the culturally salient interventions already practiced in the community and would
also allow for a joint analysis of the validity, viability, and effectiveness of novel forms of therapeutic
intervention in unfamiliar cultural contexts. Finally, I should add that close collaboration with community members may be the only
means of determining which of the cultural transformations wrought by psychotherapy are welcomed in the interest of help and healing and which are
seen as undesirable or inappropriate in local cultural contexts. Only through such close collaboration can the subtle ideological
dangers of neocolonialism be overcome. This call to collaboration for professional psychologists serving Indian country underscores the
significance of ongoing consultation with community members regarding nearly every facet of clinical activity. If this collaboration is taken
seriously, the result is likely to be a new kind of behavioral health clinic that allocates a substantial portion of its
resources to the interface between the clinic and the community to maximize the relevance, efficiency, and
utility of the services it provides. Clearly, the professional psychologist employed in such a setting will assume many responsibilities beyond
the conventional role of psychotherapist— experience in community relations, creative administration, program development, clinical supervision,
outcome assessment, and grant writing would help to ensure the success of such a collaborative endeavor.
Of course, such work would seem all but impossible within the organizational structures of a conventional psychological clinic. Given the possibilities for
tribal assumption of mental health service delivery, it remains plausible that behavioral health services in Indian country might emulate the many tribally
controlled substance abuse treatment programs whose administrative structures are intentionally designed to facilitate the creative integration of culture
and community into their efforts. Such arrangements typically result in the institutionalized consultation of ritual and cultural authorities, who are
respectfully compensated for their expert contributions in the form of curriculum development, case management, mutual referral, intervention analysis,
and so forth.
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Evidence Set
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<Gone continues...>
4. Assess Process and Outcome More Comprehensively
The obvious question confronting professional psychologists in Indian country is whether their interventions are accomplishing genuinely therapeutic
effects. That is, given the frequent and pervasive possibilities for cross-cultural dissonance of every sort, careful
attention to therapeutic outcomes in Native America is obviously warranted. In addition to tracking outcome, many
psychologists are also familiar with the assessment of psychotherapy process, a research strategy with obvious promise for cultivating a more
comprehensive understanding of the effectual mechanisms inherent to clinical intervention. Given the kinds of therapeutic innovations
that will result from collaborative implementation efforts in Native communities, the assessment of effects—
both therapeutic and countertherapeutic—throughout the course of intervention must be both rigorous and
extensive. For example, in addition to tracking the presumed or desired outcomes of these “translated” or
“adapted” therapies, professional psychologists in Indian country must also attend more comprehensively to
the miscommunications, standoffs, breakdowns, and failures in the course of therapeutic intervention, because
such mishaps may signify subtle and implicit incommensurability between therapeutic models and local
ethnopsychology. Furthermore, post-therapy outcome assessments should include attention to the impressions and opinions of the clients’
significant others regarding the kind and extent of therapeutic benefits obtained; such attention will help to illuminate the broader cultural consequences
of therapeutic socialization for clients, their families, and their communities.
In short, professional psychologists committed to serving Native American communities must dust off their
research skills in order to chart therapeutic process and assess therapeutic outcome. When resources are limited, this
might simply involve thorough note taking following each session and the pre- and post-therapy administration of paper-and-pencil symptom checklists
and rating scales (with a brief follow-up assessment some months later). Brief analysis of these data may illuminate patterns of clinical response over
time. When resources are greater, more rigorous designs affording additional precision and control could yield results that effectively reduce the range of
competing explanations for observed phenomena. In sum, practicing psychologists undertaking innovative therapeutic activities with American Indian
clients and communities must never forget their profession’s commitment to testing suppositions, expectations, and explanations empirically.
The foundation of competent professional practice is a robust clinical psychological science. As should by now
be obvious, the prescribed regimen for therapeutic practice in American Indian and Alaska Native communities
is not especially well-tailored to the institutional realities of conventional health care service delivery. Nevertheless,
the consequences of proceeding as if the cultural transactions that occur within the therapy session in Indian country are trivial may signal an
unacceptable return to an all-too-easy and familiar colonizing dynamic by the very individuals who are both ethically
and professionally charged with facilitating the robust mental health of all of their clients, regardless of their race, ethnicity, or cultural origin (APA, 1990,
2003). In the end, there can be no question that those of us with professional responsibilities in the field of Native
American mental health confront both substantial challenges and rare opportunities. Thus, to surmount the
challenges and master the opportunities before us, we must think beyond convention and work tirelessly to
provide Native communities with fully accessible, culturally appropriate, and demonstrably effective programs
and interventions that only innovative and culturally informed psychologists can create and sustain.
2010 NFA-LD
Evidence Set
***Rural Telemental Health Care AFF – Index***

***Rural Telemental Health Care AFF – Index***.........................................50
1AC 1/5 – Inherency....................................................................51
1AC 2/5 – Harms........................................................................52
1AC 3/5 – Harms and Plan...............................................................53
1AC 4/5 – Solvency 1/2.................................................................54
1AC 5/5 – Solvency 2/2.................................................................55
Extensions – Solvency 1/...............................................................56
Extensions – Solvency 2/...............................................................57
Extensions – Solvency – Funding Key....................................................58
Extensions – Harms.....................................................................59
Extensions – Harms – Rural Poverty.....................................................60
2010 NFA-LD
Evidence Set
1AC 1/5 – Inherency
A. The cost of bandwidth and telecommunications is the reason telemental

health hasn’t taken off in rural areas
Henry A. Smith and Ronald A. Allison, researchers for the Health Resources and Services
Administration, Oct 2001. [Telemental Health: Delivering Mental Care at a Distance,
http://www.hrsa.gov/telehealth/pubs/mental.htm] Boyer, CG
Start-up costs for a telemental health network are becoming more affordable due to decreasing equipment costs, and are
therefore now within reach of most rural mental health programs. Indeed, in many cases, providers will find it more cost-effective to join a network than
to purchase an automobile to transport mental health consumers to distant service providers. However, the single biggest limitation on
the use, expansion, and long term sustainability of telemental health systems is often the ongoing
telecommunication costs.
The type of telecommunication service(s) available from telephone companies will dictate network design and cost. In many rural areas, advanced
transmission technologies or services, such as Integrated Services Digital Network (ISDN), are not yet available. Also, transmission charges
are often more expensive in rural areas because many transmission rates are distance-based.
The more advanced the transmission technology, the greater the bandwidth a telecommunications system will
have available. Bandwidth refers to the information-carrying capacity of the telecommunications channel (i.e., the size of the pipeline that carries
the video and audio signals). At higher bandwidths, picture and sound are transmitted more quickly and with better quality. Lower bandwidth
systems are more affordable, but they create noticeable lags in video and audio transmission that may
negatively impact the service applications.
B. Rural America is facing a mental health crisis and the infrastructure and
attention is not being paid by the government
Rural Assistance Center, last updated on July 21st, 2010. [“Mental Health.”
http://www.raconline.org/info_guides/mental_health/] Boyer JB
Mending a Broken Heartland is such a compelling title, how could anyone resist the temptation to pick up this publication? Written in the 1980s by Joyce
Barrett, it details how rural communities find ways to survive through the farm crisis. However, even with all the concern, it is well documented
that rural America still lags behind its urban counterparts in mental health care, with little difference between
the prevalence of clinically defined mental health problems in urban America versus rural. Rural America
continues to suffer from an economic crisis; besides farming, there are other struggling industries related to
natural resources - such as mining and logging - that are experiencing a net loss in economic strength. Jobs
are scarce in rural America, local businesses and services are closing, and young people are moving to the
urban areas leaving the elderly back home. The need for outreach and community-based mental health
services is as critical in rural communities as it is in urban regions but the health care just isn't there to do the
mending.
2010 NFA-LD
Evidence Set
1AC 2/5 – Harms
Observation Two – Harms
A. Rural mental health issues include significant rates of depression and suicide
Diane Gustafson, et al. Professor at Creighton University, Center for Rural Affairs, May 2009. [Kim
Preston and Julia Hudson from the Center for Rural Affairs. “Mental health: Overlooked and disregarded in rural America.”
http://files.cfra.org/pdf/Mental-Health-Overlooked-and-Disregarded-in-Rural-America.pdf] JB
Addressing mental health issues is a concern across the country, though the situation may be worse in rural
America. Here, major depression rates in some areas significantly exceed those in urban areas.10 Teens and
older adults in rural areas have significantly higher suicide rates than their urban counterparts.9 Further, stress is
associated with increased mental health disorders and rural people experience stress with cyclical farm crises, natural disasters and
social isolation. The Farm Crisis Response Council of Interchurch Ministries of Nebraska operates a “hotline” designed to help any rural
person who is negatively affected by rural crisis. According to the most recent reported data by the “Hotline,” between July 2008 and
March 2009, nearly 50 percent of their calls were related to mental health issues.17
B. Stigmas prevent rural Americans from utilizing mental health services

Given the scarcity of mental health services in rural areas, it is no wonder that distance to mental health
providers and a lack of public transportation to reach care prevent rural people from accessing needed mental
health services. But even when care is available nearby, still other barriers prevent individuals from accessing
this care. One reason is the social stigma attached to mental health problems. This stigma in combination with
a general lack of anonymity in many small communities leads some people to forego treatment.
C. Mental health problems increase rate of poverty

Chloe Borton, MD in Patient UK, March 2009 [Poverty and Mental health http://www.patient.co.uk/doctor/Poverty-and-
Mental-Health.htm] Boyer BF/CG
The link between poverty and mental health is well known. Arguments regarding the causality of the relationship continue, but it
seems likely that it is bi-directional:
· Those with low incomes
are more likely to suffer from poor mental health and poverty effectively causing
or contributing to poor mental health. Observationally, both individual and neighbourhood deprivation increase
the risk of poor general and mental health.1 The rate of compulsory admission under the Mental Health Act tends to be higher in
deprived areas.2 Whilst this suggests more serious mental illness in such areas, it does not mean that poverty causes mental illness. Do urban,
deprived areas lead to mental health problems or do individuals with those problems gravitate toward them?
Those with mental health problems are more likely to experience poverty: once incapacitated, an individual's
socio-economic status (SES) is likely to fall further ('selective social drift'). For example, the GHQ-28 was used to assess a cohort of
people born in 1947. Poorer reported mental health in men (though not in women) was associated with downward socio-
economic trajectory over the whole life course.
2010 NFA-LD
Evidence Set
1AC 3/5 – Harms and Plan
D. Rural Poverty is particularly bad in the status quo and getting worse
William P. O’Hare, visiting senior fellow at the Carsey Institute, Carsey Institute report published 2009
[“The Forgotten Fifth Child Poverty in Rural America” New Hampshire University Available Online
http://www.carseyinstitute.unh.edu/publications/Report-OHare-ForgottenFifth.pdf] Boyer SD
Rural children are not only more likely to be poor, they are more likely to be living in deep poverty, with family
incomes less than 50 percent of the poverty threshold. The official poverty rate does not differentiate how poor a person is. A family
that has an income one dollar below the poverty threshold is classified as poor, without making a distinction from the family that has income thousands
of dollars below the threshold.
Deep poverty is important because for most of these families, poverty is entrenched and their needs are more
desperate. The poorest families benefited the least from the economic boom in the late 1990s, and the major
reform of the welfare system in the late 1990s may have exacerbated their plight (Blank 2007). For low-income families,
an income difference of even a few thousand dollars a year can have a major effect on child well-being (Duncan, Brooks-Gunn, Yeung, and Smith
1998). Small differences in expenditures in early childhood can also have implications for well-being in adulthood (Duncan and Kalil 2008). Again, as
Table 3 shows, rural children are more likely than urban children to be living in deep poverty (with income less than one-half the poverty threshold). Ten
percent of rural children lives in deep poverty compared with 8 percent of urban children. The extent to which a family’s income falls below the poverty
threshold is often referred to as the poverty gap. The mean poverty gap for rural families with children (the difference between a family’s income and the
poverty threshold) is just under $9,000. It would take $10 billion to lift all rural children out of poverty. Although $10 billion is a lot of money, it is small
relative to America’s $3 trillion federal budget or the $14 trillion economy. The impact of poverty on families and children who are
poor year after year is more severe than the impact on those experiencing a brief bout of poverty. Persistent
poverty can have an impact at the personal and community level. People who are persistently poor are
disadvantaged, but so are people who live in communities that are persistently poor. Persistently poor families
who live in persistently poor communities are doubly burdened.
The rural poor tend to be poor for longer spells than their urban counterparts. The median length of poverty in rural areas is 15 percent longer than in
urban areas (U.S. Census Bureau 2005.) Nine percent of rural people who became poor at some point between 1996 and 1999 were still poor twenty-
four months later, compared with only 7 percent of people in urban areas. Other studies tend to confirm this pattern (Duncan 1984).
The Economic Research Service of the United States Department of Agriculture defines “persistently poor counties” as those in which the poverty rate
has exceeded 20 percent at every decennial census since 1970. Children living in places that are persistently poor face special problems because com-
munities shape a child’s schoolmates, peers, and role models. Of the 730 counties that, since 1970, experienced persistent child poverty, 601, or 82
percent, are located in rural America (Lichter and Johnson 2007). Most of these persistently poor counties are among the more isolated rural counties.
These counties with high and enduring child poverty tend to be concentrated in the rural South and Southwest (Lichter and Johnson 2007; Johnson and
Lichter 2007).
At the county level, the child poverty in rural areas is also more concentrated than in urban areas. In 2000, 56 percent of poor rural children lived in high-
poverty counties (20 percent poverty rate or higher) compared with only 40 percent of poor urban children (Lichter and Johnson 2007, 346). Minority
children are also highly concentrated in high-poverty rural areas. The overwhelming majority (83 percent) of rural poor black children live in high-poverty
counties, as do two-thirds of rural poor Hispanic children. Moreover, there are signs that segregation of poor children from nonpoor children increased in
the 1990s in rural American. All this suggests an enormous disadvantage for this segment of children growing up in rural America. Researchers Daniel
Lichter and Kenneth Johnson conclude that “rural children—those still in persistently poor counties—may be more
disadvantaged than ever, if we measure disadvantage by lack of opportunities and community resources that can
promote positive development” (Lichter and Johnson 2007, 354). Map 2 shows persistently poor rural counties.
Plan – The USFG will fully fund a grant-program to provide all necessary
materials and upgrades for the installation of telemental health facilities in rural
areas. Funding and enforcement will be through normal means and the
affirmative reserves the right to clarify the intent of plan.
2010 NFA-LD
Evidence Set
Observation Three – Solvency
A. Telemental health services increase rural access to mental health care and
need federal funding to become more widely available
Barriers related to the availability of mental health care services in rural areas may be reduced through the use
of telehealth technology. Telehealth refers to the use of current information technologies and
telecommunication systems to make health education and health care available despite distance or travel
barriers. According to the Health Research and Services Administration13,telemental health services are in the top three
most used telehealth services. Through this technology, individual, family and group consultation and care may
be offered in homes, rural clinics and hospitals, community mental health centers, schools, residential
programs/group homes and longterm care facilities. It also allows for ongoing education and training of rural
mental health practitioners. To develop and expand rural telehealth services, state and federal policies and
funding for rural broadband are needed.
B. Telemental health services increase the quality of care and access

Substantial Benefits
The range of mental health services provided to rural consumers over a telemental health network is virtually limitless. At the present time, it appears
that all traditional mental health services, which do not involve direct physical contact with the client, can be provided by telemental health.
Telemental health networks are also used for education and training for mental health staff, and to bring
consumers and family members together for information and support.
In some situations, telemental health services may be superior to face-to-face services. For example,
telemental health allows a psychiatrist to observe a patient close up, without invading his or her personal
space. This makes it easier to examine a patient for side effects of psychotropic medications.
Telemental health applications also enhance continuity of care for consumers in rural areas. With telemental health, a "virtual treatment team" can be
formed between the community and the inpatient psychiatric facility staffs. Consumers can be followed in the community by the same physician who
treats them in the hospital, and family members can be involved in treatment and discharge planning.
Positive Outcomes
Much of what is known about the impact of telemental health comes from the combined experience of staff and consumers who operate and participate
in these networks. Though no rigorous outcome studies have been done to date, informal findings suggest that telemental health improves
continuity of care for rural consumers, increases family and consumer involvement in treatment, and reduces
lengths of stays and readmission rates to state psychiatric facilities. Participant satisfaction surveys reveal that
consumers perceive telemental health services as worthwhile, of high quality, and worth continuing.
2010 NFA-LD
Evidence Set
C. Telemental health reduces the stigma and enables people to seek help
Julie Weingarden Dubin, journalist writing in Time.com, March 22, 2010 [Telemental Health: Videoconferencing
As Psychiatry Aid, http://www.time.com/time/health/article/0,8599,1974196,00.html] Boyer, CG
In addition to expanding the geographic reach of individual psychiatrists, videoconferencing can help cut down
on some of the stigma of going to see a shrink. Students at Ball High School in Galveston, Texas, can now go to the school's health
clinic and — without having to press a button or flip a switch — be face to face with a psychiatrist. "There is a flat-screen TV, and that's where they can
see the clinician and talk in real time," says Dr. Fred Thomas, a psychiatric epidemiologist who heads community-based mental-health services and
policy for the University of Texas Medical Branch, which now includes five telepsychiatry locations in Galveston. "The clinician has a remote and can
move the camera around and zoom in on someone's face to see changes in expression or to see if someone is tearing up."
Oftentimes, according to Thomas, videoconferencing can reduce the anxiety of office visits for children and adolescents.
"It's much easier to talk via a screen, especially with issues like anxiety disorders and sexual abuse," he says.
"Students feel safe."
D. Improving mental health will improve rural economies

Living and working in rural America presents a variety of distinct stresses and strains as varied as rural
America itself. Regardless of differences, state leaders from across the nation indicate that mental and behavioral
health problems are a major, widespread rural concern.1 Mental health is one of the top 10 leading health indicators
targeted by Healthy People 2010, the nation’s blueprint for improving health.2 And mental health care is the most expensive care for
people, accounting for nine percent of their personal health spending.3 Unfortunately, this need for mental health care has
not been met with widely available and accessible mental health services in rural areas. Among other factors, the
problem of inadequate mental health care is strongly tied to a lack of affordable, meaningful health insurance coverage. This
problem must be addressed for prosperous rural families, economies and communities.
2010 NFA-LD
Evidence Set
Extensions – Solvency 1/
Telemedicine is a perfect fit for rural areas

EM Rygh, medical adviser at the Norwegian Centre for Telemedicine, Rural and Remote Health 2007
[Continuous and integrated health care services in rural areas. A literature study. http://www.rrh.org.au/articles/subviewnew.asp?
ArticleID=766 ] Boyer BF
Telemedicine may be defined as ‘Medicine practiced at a distance. It therefore encompasses diagnosis,

treatment and medical education’36. The benefits of telemedicine involve the facilitation of access to health
services and medical information regardless of time and place. In this context, there is abundant literature on
applications in rural settings; however, there is a lack of evidence supporting its clinical and cost advantages relative to traditional services37.
Telemental health improves the quality of mental health care and trains mental
health providers for rural practice
telemental health services have consistently been one of the

Since the re-emergence of telemedicine programs in the late 1980's,
top three most frequently provided health services using telehealth technologies. In 1998-99, over 61 programs
in 35 states were delivering telemental health services. Telemental health services are bridging the health
services access gap not only for those who traditionally have had limited access to mental health services, in
particular those in rural and frontier areas, but also for those who because of mobility problems, poverty, or
incarceration have limited access to health care services.
Telemental health services are being delivered in a range of settings -- rural primary care clinics, hospital emergency rooms, community mental health
centers, schools, and nursing homes. They are also being delivered directly into homes as well as on board Navy ships and in jails, and state and
federal prisons.
Telemental health technologies are being utilized to provide the full range of mental health services, including pre-admission and discharge planning,
assessments and evaluations, case management, medication management, family visits, pyschotherapy, court commitment hearings, and family and
consumer support groups. These technologies also provide a means to train mental health providers for rural practice.
In some states, the one-year clinical internship of master's level prepared social workers is supervised via
telehealth technologies. The use of these technologies for continuing education and in-service sessions is also
providing access to educational opportunities that have been limited in rural areas.
2010 NFA-LD
Evidence Set
Telemedicine can be utilized for a variety of uses.

Rygh EM, medical adviser at the Norwegian Centre for Telemedicine, Rural and Remote Health 2007
[Continuous and integrated health care services in rural areas. A literature study. http://www.rrh.org.au/articles/subviewnew.asp?
ArticleID=766 ] Boyer BF
One report of well-functioning telemedicine services comes from the state of Maine, USA, where there has been rapid a growth in state-wide
telemedicine systems in rural, economically disadvantaged areas38. Here telemedicine is used in a broad array of interactive
videoconferencing applications, including mental health and psychiatry, diabetes management, primary care,
paediatrics, genetics, and dermatology. An article from Tennessee, USA, describes an integrated telehealth
network linking three hospitals, a healthcare clinic and patient homes39. Outcomes from the disease management program for
diabetes showed an increase in the number of diabetic patients who had managed to control their blood glucose levels. In Scotland, remote nurse
practitioners in a community hospital staffed accident and emergency services, supported by telemedicine advice from a regional hospital by
videoconference and a document camera which allowed transmission of still images of wounds and radiographs40. Both professionals and
patients reported high levels of acceptance and satisfaction.
Telemedicine is useful
Kerri Gibson, National Research Council Institute for Information Technology, October 2009 [Clinicians’
Attitudes toward the Use of Information and Communication Technologies for Mental Health Services in Remote and Rural Areas
http://nparc.cisti-icist.nrc-cnrc.gc.ca/npsi/ctrl?action=rtdoc&an=15073198&lang=en ] Boyer BF
Our first inquiry was usefulness of the technology. Mental health workers were asked how useful they found videoconferencing and telemental health for
providing services to their clients. There was a distinct contrast between the perceptions of the survey respondents and the interview participants. The
survey participants were comprised of mental health workers, who had less experience with videoconferencing (only 4% reporting use of it) and they
seemed more skeptical of its use than the interview participants. Many of the survey respondents rated the usefulness of the technology at least 3 out of
5 (or higher). However the interview participants who had actually used the technology often gave very positive
statements about videoconferencing and reported finding it extremely useful. One interview participant who
had experience with telemental health for First Nations clients explained that prior to using videoconferencing
she had limitations in her mind about what would be possible, but as she became more involved she realized
the potential of ICT and how often the barriers to use exist mostly within our own minds. Further analysis of the
data will investigate whether the differences between perceived usefulness of technology and other attitudes
differ significantly as a function of experience with or use of the technology.
2010 NFA-LD
Evidence Set
Extensions – Solvency – Funding Key
Telemental health services need more funding

Financing
Ongoing expenses often prove to be a barrier to continued operation of a telemental health network. In
response, many programs form alliances to gain a broader base of support, and network members share the
costs for equipment, maintenance, personnel, and transmission systems. Federal, State, and private funds,
and third-party reimbursement and service contracts, help sustain these vital efforts.
Meeting the Challenge
Telemedicine, and in particular, telemental health networks, have the potential to diminish the disparity of
mental health care based on population density characteristics. However, additional funding is needed to
support research into the effectiveness of telemental health programs, and to enable additional areas of the
country to benefit from this new tool for mental health service provision.
2010 NFA-LD
Evidence Set
Extensions – Harms
Mental illness is a leading factor of disability and disease in rural communities

Larry Gramm 2003, Rural Healthy People [Mental Health and Mental Disorders – A Rural Challenge: a Literature Review
http://srph.tamhsc.edu/centers/rhp2010/08Volume2mentalhealth.pdf ] Boyer BF
Mental illness can seriously undermine the employment participation of the rural workforce. Among all illnesses
and health behaviors, mental disorders are identified as one of the leading contributors to disability and
associated disease burden, defined as years of life lost to premature death and weakend by disability. Days
and dollars of lost productivity or avoidable expensive hospitalizations are clearly identifiable with untreated
depression.
Mental illness increases risk of suicide

Higher suicide rates are found in rural areas, particularly among adult males and children. For adult males, this is most
pronounced in the less populated nonmetropolitan counties, without a city of 10,000 or more. Suicide rates increase with age and are a serious problem
among the elderly; the rates are highest among white-American males ages 65 years and older. The presence of more than on mental
disorder Is major risk factor for suicide. Major depression combined with alcohol abuse, for example, presents
a serious added risk. An Arkansas study finds that rural individuals suffering from bipolar disorders report
higher rates of suicide attempts than their urban counterparts, In addition to mood disorders such as
depression and bipolar disorder, unwillingness to seek help because of the stigma attached to mental illness
and barriers to accessing mental health treatment are also major risk factor for suicide,
Rural areas have a minimal amount of mental health care professionals

There is relatively low availability of mental health providers in rural areas, and even lower availability of
specialized providers such as psychiatrists and child psychiatrists in the most rural counties. The directional
disparity for the least populated counties exists, although at a lesser magnitude, for psychologists and social
works. One Arkansas study, for example, reports 7.2, 5.0. and 3.9 times more psychiatrists, social workers, and psychologists per capita,
respectively, in metropolitan that in non-metropolitan counties. Another study from the same state finds more than 10 times as
many of both medical providers and mental health specialists within 30 miles of urban individuals with
depression compared to these providers within 30 miles of their counterparts.
2010 NFA-LD
Evidence Set
Extensions – Harms – Rural Poverty
Mental Health problems create economic hardship for both the afflicted and
non-afflicted
Necole S. Ervin, Foundation for the Mid-South, 2008 [“Minds Matter: Making the Connection Between Mental Health
and Community Well-Being” Available Online http://www.fndmidsouth.org/Documents/Mind_Matters_final.pdf]
Mental health directly affects many of the factors that determine our quality of life, from our personal
well-being to our education to the economy. Mental disorders are the leading cause of disability in the nation and cost
approximately $193 billion in lost earnings alone according to a World Health Organization study.2 Mental wellness not
only affects how we function in society or on the job, it can also shrink our bottom line, causing lower pay
checks for those affected and a weaker economy for all—increasing taxpayer costs in health care, Social Security, and
criminal justice, among others.
If poor mental health is one of the underlying factors in many of the disparities we face, why do the mental health needs of too many people remain
unmet? We have a few theories—based upon research and the opinions of mental health professionals:
Rural/Urban dichotomy is real and getting worse

William P. O’Hare, visiting senior fellow at the Carsey Institute, Carsey Institute report published 2009 [“The Forgotten Fifth Child
Poverty in Rural America” New Hampshire University Available Online http://www.carseyinstitute.unh.edu/publications/Report-OHare-
ForgottenFifth.pdf] Boyer SD
The relatively high poverty rate for children in rural America today is not new (Duncan 1992). In 1970, the poverty rate was 12 percent for urban children
and 20 percent for children in rural areas. Although the gap between rural and urban child poverty narrowed in the 1970s and 1980s, it has widened (see
Figure 1) from 3 percentage points in 1990 to 5 percentage points in 2007. The rise of child poverty in rural America is consistent
with the growing income gap between urban and rural families (Economic Research Service 2006).
The rural/urban dichotomy used in most analyses does not fully capture the extent of poverty discrepancies.
Poverty rates in rural areas are highest in counties that are the most remote and lowest in counties that are in
or adjacent to metropolitan areas. Table 1, based on Census Bureau data from 2007, shows a close relationship
between a county’s level of “rurality” and the percentage of children in poverty. The most urban counties have the lowest
percentage of children in poverty (16 percent) and the most rural counties have the highest share of children in poverty (27 percent).
2010 NFA-LD
Evidence Set
There are access barriers preventing mental health solutions in rural America
Despite the substantive calling for mental health services in rural areas, many barriers prevent rural Americans
from receiving the care they need. These barriers revolve around issues of availability and accessibility. In
many rural communities, mental health services are simply not available. In fact, more than 85 percent of the
1,669 federally designated mental health professional shortage areas are rural.16And only in rural America did the
National Advisory Committee on Rural Health (1993) find entire counties with no practicing psychiatrists, psychologists, or social
workers.16 This desperate lack of trained mental health professionals means that individuals who need emergency care will likely be
transported out of their communities to other locations where care is available. 16
There are several barriers to telemedicine

Kerri Gibson, National Research Council Institute for Information Technology, October 2009 [Clinicians’
Attitudes toward the Use of Information and Communication Technologies for Mental Health Services in Remote and Rural Areas
http://nparc.cisti-icist.nrc-cnrc.gc.ca/npsi/ctrl?action=rtdoc&an=15073198&lang=en ] Boyer BF
Several barriers to increased ICT and telemental health use appear to exist. These include underdeveloped
technical infrastructure (specifically within rural and remote communities), lack of funding for programs and
technology, and accessibility problems. Client attitudes were also cited as a barrier – as one respondent remarked, when possible, clients
prefer face to face interventions. Client confidentiality and privacy can sometimes be another barrier – though at the same time it can work in telemental
health’s favor. For instance, sometimes videoconference rooms are not entirely soundproof, and of course people can be seen going into and out of the
hospital. At the same time, in remote and rural communities, connecting with a therapist via videoconferencing means
that the chances of encountering the therapist in the community or of being in a dual relationship with the
therapist decreases significantly. As we continue this research it will be important to flesh out all of the barriers to use of the technology, so
that these can be targeted for improvement, and also so clinicians and clients can be educated on the barriers and ways to overcome them.
2010 NFA-LD
Evidence Set
PMN – Rural communities are underinsured which will severely limit those who
can seek telemental health treatment
Perhaps the most pervasive factor limiting access to mental health care services in rural America is the lack of
affordable, meaningful health insurance coverage. Although rural Americans have demonstrated a need for
mental health services, they are less likely than urban Americans to have health insurance that covers mental
or behavioral health services.11 The Center for Rural Affairs has released several reports outlining the problems of uninsurance
and under insurance in rural areas. Because mental health care is the most expensive care for people, it is largely unaffordable as an
out-of-pocket expense.3 With many families already struggling to pay their health insurance premium or existing medical debt,
accessing uncovered mental health treatment is not a choice they can make.
Inherency – States are already beginning to develop telemental health services

Increasingly, state and local agencies responsible for mental health services are exploring the use of telehealth
technologies to assist them in delivering services to rural and frontier populations and meeting their mandates.
Some have begun to invest in telehealth technologies or provide payment for services delivered via telehealth.
We hope that this report will assist policy makers, as well as mental health professionals and consumers, as
they explore how to effectively utilize these technologies, integrate the technologies into their practices, or advocate for their use to enhance access
to services.
INH/Harms take-out – Telemental health is already being offered

Henry A. Smith, LCSW Ronald A. Allison, MA, for the Health Resources and Services Administration,
October 2001[Telemental Health: Delivering Mental Care at a Distance, http://www.hrsa.gov/telehealth/pubs/mental.htm] Boyer CG
all
Federal and State funds have been critical in initiating telemental health networks and State funds have been critical in sustaining them. Almost
telemental health networks were developed with Federal grant funding. Between 1994 and 1997, a total of 191
telemedicine projects received $110.5 million from seven agencies. Three of these--the Office of Rural Health
Policy, HRSA, DHHS, the National Library of Medicine, NIH, DHHS, and the Rural Utilities Service, USDA--
provided $70 million to 163 projects, many of which included mental health services as a primary application.
A new telecommunications subsidy program, the Universal Service Program for Rural Health Providers, will be critical to sustaining telemental health
networks. Under the Telecommunications Act of 1996, Universal Service telecommunication provisions were
extended to include advanced telecommunication services, and special provisions were made for public and
non-profit rural health providers. Under these latter provisions, public and non-profit rural health providers are
eligible for subsidized telecommunication services up to 1.544 Mbps. The subsidy or discount a rural provider
receives is the difference between what it must pay for a telecommunication service and the cost of the service
in the nearest urban areas.
Once a network has been established and demonstrates successful outcomes and benefits, state departments of mental health may be willing to help
support and expand the telemental health network. In addition, special taxes or awards from state lotteries or other programs may be available. For
example, the Northern Arizona Regional Behavioral Health Authority's (NARBHA) telepsychiatry project is funded in large part through an allocation of
state tobacco tax revenues. Other telemedicine projects, such as in Georgia, were funded by a return of telephone company overcharges.
2010 NFA-LD
Evidence Set
Telemental health is unsafe due to unsupervised locations

David D. Luxton, Ph.D, et al. for the The National Center for Telehealth and Technology, August 2010.
[Anton P. Sirotin, B.A.,and Matthew C. Mishkind, Ph.D.Safety of Telemental Healthcare Delivered to Clinically Unsupervised Settings: A
Systematic Review, http://www.liebertonline.com/doi/pdf/10.1089/tmj.2009.0179] Boyer, CG
Advances in technology have outpaced policies regarding telemental health services. Regulations that often
predate the widespread use and acceptance of telemental healthcare are now looked to for guidance to
address specific concerns, including the safe provision of medical care to clinically unsupervised locations,
such as a personal residence. Although these policies are designed to protect both consumers and providers,
they may also create artificial barriers that limit progress and the ability to fully realize the benefits associated
with telemental health. Establishing the safety of telemental healthcare is vital to inform policy decisions and
increase the dissemination of a range of available services. Although there is now little debate that telemental healthcare that
uses two-way audio/visual equipment in clinically supervised environments is safe and effective when properly conducted,1,2 the safety of telemental
health delivered to clinically unsupervised settings, suchas a patient’s home, has not been documented.
There are safety concerns with telemental health treatment for the mentally ill
David D. Luxton, Ph.D, et al. for the The National Center for Telehealth and Technology, August 2010.
[Anton P. Sirotin, B.A.,and Matthew C. Mishkind, Ph.D.Safety of Telemental Healthcare Delivered to Clinically Unsupervised Settings: A
Systematic Review, http://www.liebertonline.com/doi/pdf/10.1089/tmj.2009.0179] Boyer, CG
Telemental health services delivered to traditional clinically supervised settings, such as a hospital or outpatient clinic, have appropriate treatment staff
onsite who are immediately available to reduce or mitigate safety issues when they occur. For example, adverse emotional or behavioral reactions
during therapeutic sessions can be immediately addressed by on-site staff; therefore, the risk that the patient will leave the site in an adverse state (e.g.,
suicidal or homicidal) is reduced. Telemental healthcare delivered to unsupervised settings, such as a patient’s home,
however, would not have clinical staff immediately available on-site to respond to adverse events. Thus, there
are a number of unique potential risks with telemental healthcare delivered to clinically unsupervised settings
that heighten concern compared to traditional care at locations with on-site clinical supervision. One of the
paramount concerns during the delivery of any mental health service is the risk of patient self-harm or harm to
others. Similar to in-person treatments, providers should consider screening patients for self-harm or other risk
before initiating treatment, and also continuously assess risk for harm to self or others during the course of
care. Further, providers must maintain an awareness of safety issues with patients displaying strong affective
or behavioral states throughout a protocol timeline and upon conclusion of treatment sessions. A well-defined
safety plan (e.g., appropriate screening and routine suicide risk assessments) can mitigate the risk of a treatment.
Must assess safety and effectiveness before implementing telemental health

services
Trine S Bergmo, Professor of Health Economics, BioMed Center, Oct. 24, 2009 [Can economic evaluation in
telemedicine be trusted? A systematic review of the literature, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770451/pdf/1478-7547-7-
18.pdf] Boyer, BF
As with any other form of health care technology there is a need to assess effectiveness, efficiency and safety
before it is brought into wider use [3]. Telemedicine evaluation should first ensure that the technology is safe
and generates as much benefit as conventional care. If using the technology produces equal or better health or
quality of life, the next step is to analyse differences in costs (one should note, however, that services could
generate less benefit at lower cost and still be considered cost-effective). Cost savings and other benefits of
telemedicine are often suggested by the logic of its impact on health care delivery and by the optimistic
2010 NFA-LD
Evidence Set
promise of ICT in general [2]. Systematic information on costs and consequences has been called for to support decision-making both in
order to control health care spending; and to document value for money to facilitate reimbursement of telemedicine activities.
2010 NFA-LD
Evidence Set
High Transmission Costs limit effectiveness of telemedicine

Transmission Costs. There are three types of ongoing costs associated with network transmission: the monthly cost of long-distance service access, the
varying cost of long-distance service usage, and the cost of bridging service.
For ISDN, monthly access costs can range from $30 per ISDN circuit to as much as $100 per circuit. With
ISDN, networks must also pay usage charges, which are typically based on distance and the type of
connection. For example, at 384 kbps, rates can vary from $35 to $60 per hour.
For a dedicated long-distance T-1 line, costs can range from $400 to $8,000 a month. However, with this type of service,
there is often no usage charge.
Bridging service is necessary to connect three or more sites in a multi-site meeting. Bridging services can be
obtained from long-distance telephone companies and private providers, with costs ranging from $45 to $60
per hour per site connected.
Some networks with frequent needs for multi-site conferences choose to purchase their own bridge. However , equipment costs range from
$50,000 to $100,000, and staff are required to operate the bridge service during meetings. Networks with only
a few monthly multi-site meetings are better off purchasing bridging services.
Telemental programs must be cost effective for any long term solvency
Trine S Bergmo, Professor of Health Economics, BioMed Center, Oct. 24, 2009 [Can economic evaluation in
telemedicine be trusted? A systematic review of the literature, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770451/pdf/1478-7547-7-
18.pdf] Boyer, BF
In the final analysis,telemental health programs must show that they are cost effective if they are going to survive.
56 There is little point in creating the complex infrastructure required to create a telemental health program if it
is not going to be sustainable. Unfortunately, the first that some program managers think about the question of sustainability is when the end
of their grant-funding cycle is imminent. From the first moment of putting together a telemental health program, whether it
is grant funded or revenue driven, obsessive thought must be given to how the program will prove its worth in
the harsh economic world of health care and generate revenue.
Telemental health is costly and poses significant challenges to diagnosing

illness
Leslie Morland PsyD et al, US Department of Veteran Affairs, January 2007 [Leslie Morland, PsyD, Carolyn
Greene, PhD, Josef Ruzek, PhD, & Linda Godleski, MD. “PTSD and Telemental Health”
http://www.ptsd.va.gov/professional/pages/ptsd-telemental.asp] Boyer, BF

However, telemental health is not without its drawbacks. The equipment, maintenance, and fees for VTC, for
example, can be costly. The quality of the equipment ranges widely, with lower-end equipment being quite
unreliable. Clinicians need to be properly trained so that they can maximize the benefits of the technology and
minimize technical malfunctions. Some technical malfunctions will inevitably occur, so it is recommended that the clinician have a backup
technician available. There are significant clinical challenges when using telemental health for PTSD. Perhaps the
biggest clinical challenge is that the clinician is not physically present to address crises such as suicidal
thoughts and aggression, which are commonly associated with chronic PTSD. Having a backup clinician on-
site with the patient is strongly suggested. Although quality VTC equipment and connections can render extremely clear images,
2010 NFA-LD
Evidence Set
may find it somewhat challenging to pick up on nonverbal cues such as psychomotor agitation or poor
clinicians
hygiene. There is also a risk that the patient will not pick up on the clinician's warmth and empathy and will perceive the interaction as impersonal.
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***PTSD Military AFF – Index***

***PTSD Military AFF – Index***........................................................65
1AC 1/5 – Intro, Inherency and Plan....................................................66
1AC 2/5 – Harms 1/2....................................................................67
1AC 3/5 – Harms 2/2....................................................................68
1AC 4/5 – Solvency 1/2.................................................................69
1AC 5/5 – Solvency 2/2.................................................................70
Extension – Failure to treat PSTD leads to Discharge...................................71
Extension – AT – Increase Fraud........................................................72
Extension – Solvency 1/................................................................73
Extension – Solvency 2/................................................................74
Extension – Inherency 1/...............................................................75
Extension – Harms 1/...................................................................80
Extension – Harms 2/...................................................................81
Extension – Harms 3/...................................................................82
Extension – Harms 4/...................................................................83
Extension – Harms 5/...................................................................84
Extension – Harms 6/...................................................................85
Extension – Harms 7/...................................................................86
Extension – Harms 8/...................................................................87
Extension – Harms 9/...................................................................88
Extension – Harms 10/..................................................................89
Extension – Answers to Spending/Tix....................................................90
Extension – Potential Alt Plan/Solvency................................................91
Extension – Overstretch Case Cards 1/..................................................92
Neg Cards 1/...........................................................................95
Neg Cards 2/...........................................................................96
Neg Cards 3/...........................................................................97
Neg Cards 4/...........................................................................98
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1AC 1/5 – Intro, Inherency and Plan
Introduction –
In July of 2010 the Veterans Affairs eased its requirements concerning the
diagnosis and treatment of PTSD of our nation’s veterans. Though this change
is a step in the right direction towards improving our veteran’s mental health,
the recent change continues to disallow Private Doctors and intuitions from
treating and diagnosing PTSD. This is reducing the overall welfare of our
veterans. Today you will hear why the USFG needs to take immediate and direct
action to address this continuing problem.
Observation One is Inherency – Currently the VA is not required to take into

account private doctor’s diagnosis of PTSD for Veterans. This is causing
soldiers with legitimate claims of PTSD to continue to go untreated
JAMES DAO, correspondent for the NYT, New York Times, July 12, 2010 [“Groups Find Trauma Rule for
Veterans Lacking,” http://www.nytimes.com/2010/07/13/us/13vets.html?_r=1&src=mv&pagewanted=print] McNabb NM
Richard Cohen, executive director of the National Organization of Veterans’ Advocates, a membership group for legal
representatives, said he had handled cases in which federal clinicians with minimal experience with P.T.S.D. had
rejected legitimate claims. He also said department examinations were often cursory, even though widely
accepted protocols recommend detailed testing. Federal officials said that veterans were free to submit
materials from private doctors, but that the department would not be required to accept them. In cases where a
private diagnosis conflicted with the government’s opinion, Mr. Cohen said, the department would be likely to reject
the private diagnosis. “You can’t assume these veterans are going to get sympathetic and accurate exams”
from the government, Mr. Cohen said. “For that reason, I don’t see this helping anything.”
Thus, I propose the following Plan
The United States Federal Government shall amend current legislation to create
Private-Public Partnerships with the VA for the Treatment and Diagnosis of
P.T.S.D. in U.S. Military Veterans.
Enforcement through the Veteran Administration
Funding through Normal Means

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Evidence Set
1AC 2/5 – Harms 1/2
Observation Two is Harms
1. Over 400,000 Veterans from the current wars will need treatment for Disorders
such as PTSD.
Chairman Henry WAXMAN. House of Representatives, COMMITTEE ON OVERSIGHT AND
GOVERNMENT REFORM MAY 24, 2007 [INVISIBLE CASUALTIES: THE INCIDENCE AND TREATMENT OF MENTAL
HEALTH PROBLEMS,http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=110%5Fhouse%5Fhearings&docid=f:46429.pdf]
McNabb NM
The most recent statistics on the number of soldiers suffering from mental illnesses caused by the war are staggering. Dr. Zeiss, the VA’s
top psychologist, will testify today about 100,000 soldiers that have already sought mental health care, while Dr. Insel, the Director of the National
Institute of Mental Health, predicts that many more will return from Iraq and Afghanistan with post-traumatic stress disorder. Recent figures from
the Defense Department indicate that up to 40 percent of soldiers will report psychological concerns. With
almost 1 million soldiers and Marines having served in Iraq or Afghanistan during the course of this war,
hundreds of thousands of troops will need screening or treatment for combat-related mental illnesses such as
clinical depression, anxiety disorder, and posttraumatic stress disorder
This means time is of the essence. The longer we use the antiquated VA
system, more and more veterans will go without treatment. This will, in turn
further exacerbating the current problems in the Veteran Community.
2. 18 Veterans Commit suicide day from PTSD, of those 18 only 5 have received
care from the VA and of those 5 only half received the adequate amount of aid.
ROBERT MORGENTHAU, former district attorney for Manhattan,Wall Street Journal, JULY 21, 2010
[Ending the Stigma of War-Related Stress, http://online.wsj.com/] Mcnabb, E.F
VA reported that 18 veterans commit suicide every single day—that's more than 6,500 veterans a
In April, the
year. But only five of the 18 had been receiving care through the VA health-care system. Rand projects that
only about half of those who need treatment for PTSD actually seek it, and only half who seek care receive an
adequate amount.
3. Lack of Treatment for returning Vets with PTSD has lead to Drug addiction,
homelessness, and Violent Crimes.
Allowing large numbers of veterans with PTSD to go untreated is not an option. The effects are socially and
economically disastrous. Untreated PTSD can lead to drug use, marital problems, unemployment and
homelessness. The recent news reports of violent crime among veterans, and the establishment of veterans'
courts in several communities designed specifically to deal with this problem, should be warning enough.
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Evidence Set
1AC 3/5 – Harms 2/2
4. PTSD has created a Secret Suicide EPIDEMIC in Our Veteran Communities.

Incompetence cause by the VA has destroyed our once Proud Soldiers mental
and physical conditions.
Richard Gale and Gary Null, former Senior Research Analyst in the biotech and genomic industries.
Gary Null, PhD, July 20, 2010 [Gulf War Syndrome, PTSD and Military Suicides: U.S. Government's Message to America’s
Vets: "Drop Dead", http://www.globalresearch.ca/index.php?context=va&aid=20186] McNabb NM
"Since only 5 of 18 veterans are under direct VA care, it is very likely more veterans are taking their lives than
is being reported. Moreover, the military has already established a past record of reporting some suicides,
such as an overdose when a soldier is thoroughly doped up on a cocktail of prescribed medications, as death
by natural causes. Official figures, therefore, greatly underestimate the truth underlying the suicide epidemic .
Government and military psychiatrists, psychologists and social workers are not knowledgeable enough in
treating the seriousness of many mental conditions. Navy Commander Mark Russell, a mental health specialist, found
that almost 90 percent of psychiatric staffs servicing veterans have no formal training in PTSD therapies. Within
the active duty ranks, the bottom line for treatment has been indiscriminate, multiple drug prescriptions. A startling 98 percent of military personnel
seeking assistance for mental complications are simply being drugged and returned to their units.[23] "
5. Suicide Rates are up 60%, and have now exceeded Killed in action Numbers.
The primary problem preventing these numbers from decreasing is the stigma
surrounding seeking treatment for PTSD.
Mary Kendall, The Washington Times, June 23rd 2009. [Winning the soldier's heart; Some of the worst wounds are
carried deep inside, Lexus Academic] Mcnabb NM
"Soldier's Heart" - the name given to that dazed stare of Civil War soldiers, ceaselessly reliving ear-piercing, nerve-wracking blasts, bloody carnage and
the stench of death - afflicts between about 300,000 and 600,000 American troops (20 percent to 40 percent) returning from Middle East theaters of war.
They have helped win the peace, only to be robbed of inner peace.
Skyrocketing suicide rates - up 60 percent since 2003, now exceeding killed-in-action numbers - have
prompted an intense effort by top military brass to fight and win this battle of the soldier's heart.
The biggest problem is the stigma attached to admitting mental wounds as if a sign of weakness. As an antidote, the
Defense Department recently launched its Real Warriors campaign (www.realwarriors.net) communicating that it's OK to get help - "You're not alone."
Abraham Lincoln, for one, suffered from depression, signaling, rather than weakness, that what's now called post-traumatic stress disorder (PTSD)
shows one's specialness.
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Evidence Set
Observation Three is Solvency
1. Private practioners are capable of treating and diagnosing PTSD, in fact the
VA uses private practitioners in many other areas of disability claims currently.
PRNewswire, international newswire service, July 8 2010,[New VA Regulations Will Simplify PTSD Claims
Process for Veterans, http://www.prnewswire.com/news-releases/new-va-regulations-will-simplify-ptsd-claims-process-for-
veterans-98044204.html] McNabb JP
Searle disagrees with VA's

continuing requirement that PTSD must be diagnosed and treated by the agency's own
medical staff – not private practitioners. "This requirement seems to be a step backward in an otherwise
commendable move by the VA," Searle said. "Private health-care providers should be given the opportunity to
work with veterans and diagnose those who suffer from PTSD." He said that if VA has concerns about the consistency of PTSD
assessment standards, it should create a certification process for private practitioners that would satisfy its requirements. Referring to VA's continued
exclusion of private doctors in the diagnosis and treatment of PTSD, de Planque agreed that VA needs to guarantee a certain level of expertise among
doctors who deal with the traumas of warfare. "But many private practitioners are quite experienced in dealing with this sort
of trauma and are fully capable of rendering authoritative medical opinions. "Furthermore, VA allows for private
medical opinions in every other area of disability claims," de Planque said.
2. Private doctors and institutions working with the VA (Public-Private

Partnerships) have been successful before at convincing those previously
unwilling to get treatment for PTSD to seek treatment
We know from our experience in New York following 9/11 that such a public-private partnership can help. The
New York City Police Foundation Partnership combined with Columbia University/New York-Presbyterian
Hospital to provide free treatment to police officers needing counseling to cope with the aftermath of the
terrorist attacks, and who may have been reluctant to seek treatment through the NYPD. To date, the program
has provided 47,000 sessions, paid for by a combination of government and private sources.
3. The Veterans Affairs cannot solve this problem alone. Private institutions
(Private partnerships), even a small ones would greatly increase the care given
to PTSD sufferers
While the VA is rightly proud of the care it gives, the problem of PTSD is too big for one agency. Public-private
partnerships are needed that can make money available to civilian hospitals to treat returning veterans. If the
federal government dedicated even a small percentage of the multibillion dollar budget for veterans' mental
health care to such partnerships, it would go a long way toward providing care for veterans who might
otherwise not seek or get it.
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Evidence Set
4. Early treatment of PTSD reduces the impact of PTSD symptoms

US DEPARTMENT OF VETERAN AFFAIRS WEBSITE, Updated May 31, 2007
[http://ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what_can_i_do.html] Mcnabb NM
"Early treatment is better Symptoms of PTSD may get worse. Dealing with them now might help stop them
from getting worse in the future. Finding out more about what treatments work, where to look for help, and
what kind of questions to ask can make it easier to get help and lead to better outcomes. "
5. We as a Nation Have a Moral Obligation to Aid these Veterans to the Fullest

Barak Obama, Prez of US, White House Press Release, May 05, 2010 [Remarks by the President at Signing of
Caregives and Veterans Omnibus Health Services Act, http://www.whitehouse.gov/the-press-office/remarks-president-signing-
caregives-and-veterans-omnibus-health-services-act] Mcnabb JP
Since the 9/11 attacks more than eight years ago, the United States has been a nation at war. In this time, millions
of Americans have worn
the uniform. More than a million have served in Afghanistan and Iraq. Many have risked their lives. Many
have given their lives. All are the very embodiment of service and patriotism. And as a grateful nation, humbled by their
service, we can never honor these American heroes or their families’ enough.Along with their loved ones, we give thanks every time
our men and women in uniform return home. But we’re forever mindful that our obligations to our troops don’t end on the
battlefield. Just as we have a responsibility to train and equip them when we send them into harm’s way, we
have a responsibility to take care of them when they come home. As I’ve said many times, our nation’s
commitment to our veterans and their families is a sacred trust, and upholding that trust is a moral obligation
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Evidence Set
Extension – Failure to treat PSTD leads to

Discharge
Lack of Treatment for PSTD leads to a decrease in available personnel.

Gregg Zoroya, Staff Writer, USA TODAY, July 23, 2010 [Mental illness costing military soldiers;
Experts point to deployment toll, Lexis] McNabb JP
failure of early detection and treatment allow mental illnesses to fester into problems
But veterans groups argue that the
so severe that a soldier must be discharged from the service.
"The military is excellent at treating visible wounds," says Joe Davis, a spokesman for Veterans of Foreign Wars. " The
military and entire
medical community at large still have a long way to go to effectively and reliably screen and treat wounds to
the head and mind. Before discharging troops for behavioral reasons, it is absolutely imperative that
commanders first ask 'What caused this?' "
A Pentagon analysis in May reported that in 2009, for the first time in 15 years, mental health disorders caused
more hospitalizations among U.S. troops than any other medical condition, including battle wounds.
2010 NFA-LD
Evidence Set
Extension – AT – Increase Fraud
Fraud will continue to increase no matter the policy of the VA concerning PTSD.
Increased survival rates for injured soldiers means more PTSD
Los Angeles Times, July 13, 2010. [War's unseen wounds, lexis] Mcnabb JP
Not everyone who experiences traumatic events develops the disorder, and those who claim benefits under
the new rules still must have a diagnosis from a Veterans Administration doctor, which is why we believe fears
that fraud will skyrocket are unfounded. Undoubtedly claims will continue to rise. Thanks to modern medicine,
there is a 90% survival rate for battlefield injuries in Iraq and Afghanistan, meaning more people are coming
home wounded, some of them with concussions and other brain injuries that do not appear until later. A RAND
Corp. study estimates that 20% of returning military personnel suffer from PTSD. We know they need help, and that help
costs money -- which is no reason to deny them the help they deserve.
Evidence shows that veterans are not committing fraud

The Palm Beach Post, Newspaper, The Palm Beach Post, July 14, 2010. [Treatment veterans deserve: VA makes
it easier to get benefits for post-traumatic stress, including, palmbeachpost.com, google news] Nichelle Mcnabb, E.F.
"(We) are very pleased

"This is huge. It really is," said Paul Sullivan, executive director of Veterans for Common Sense, an advocacy group.
that President Obama and VA Secretary Eric Shinseki are following the law and science by providing faster
access to PTSD health care and benefits for our veterans. This is tremendous good news.Though there are documented cases of
PTSD fraud, studies show the vast majority of veterans receiving benefits have legitimate claims. A 2005 VA investigation into 2,100
cases found no evidence of fraud.
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Evidence Set
Extension – Solvency 1/
Veterans Prefer Private Doctors

JAMES DAO, national correspondent for The New York Times covering military and veterans affairs. ,
New York Times, July 12, 2010. [Rule to Ease Veterans' Mental Health Claims Doesn't Go Far Enough, Groups Say, lexis]
McNabb JP
federal clinicians and claims adjudicators were

Sullivan, executive director of Veterans for Common Sense, a nonprofit group, said that
often adversarial in dealing with veterans seeking benefits. As a result, many veterans prefer going to private
clinicians. ''V.A. needs to train their examination staff so that they understand that P.T.S.D. is associated with
deployment,'' Mr. Sullivan said. ''It's a cultural thing.''
Private practitioners are better able to identify PTSD because of constant

personal contact.
Portland press herald, it’s a newspaper, July 29 2010 [Maine Voices: Rules eased for PTSD vets, but read the fine
print, http://www.pressherald.com/opinion/rules-eased-for-ptsd-vets-but-read-the-fine-print_2010-07-29.html] Mcnabb JP
The new law allows the VA doctors to have the final say on the veteran's claim, specifically whether the
diagnosis of PTSD is supported by the alleged incident or stressor that occurred while in service.In the past, if the
veteran's private physician diagnosed PTSD related to military service, but a VA physician did not, then generally speaking the tie went to the runner and
the veteran was granted benefits.While the VA doctors are dedicated to serving and helping our veterans, it is a bit
concerning that they have the final say over other second opinions -- including the opinion of a veteran's own
physician who may have established a long history of treatment with the veteran and may be in the best
position to comment on his or her condition.The stated reason for the VA doctors having the final say is to ensure that standards are
consistent for the assessments and because VA examiners have the necessary training to properly assess claims. However, I worry that there
may be a stronger chance of a potential conflict of interest since the VA doctors will make the final decision in
determining eligibility for benefits. Limiting the weight of the opinion of an outside doctor reduces the checks
and balances available under the previous law. Veterans who suffer from service-related PTSD have obviously
sacrificed a great deal for us.
Government attempts to treat PTSD are not enough. We need to work with
private hospitals and organizations to make care available for veterans all
around the country.
[Ending the Stigma of War-Related Stress, http://online.wsj.com/] McNabb JP
Recently the federal government moved to make disability benefits more accessible to veterans suffering from
post-traumatic stress disorder (PTSD). It's a welcome step, but it does not go far enough. The government
should actively encourage private hospitals and other nonprofits to partner with the Veterans Administration
(VA) in efforts to destigmatize this disorder, and to make adequate care more widely available in every community
across the country.
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Evidence Set
Extension – Solvency 2/
Private physicians are needed to solve PTSD. There is a backlog of cases

Kim Dvorak, San Diego County Political Buzz Examiner, July 20, 2010 . [ “U.S. moves forward with relaxing PTSD
treatment regulations for veterans”, http://www.examiner.com/x-10317-San-Diego-County-Political-Buzz-Examiner~y2010m7d20-US-
moves-forward-with-relaxing-PTSD-treatment-regulations-for-veterans, google ] McNabb SK
However the Chairman of the House Veteran Affairs Committee, Rep. Bob Filner (D-CA) says soldiers shouldn’t prove they have PTSD, but they should
have to prove they don’t. The Congressman has worked tirelessly on these issues and believes the military is letting down the soldiers by not
decompressing these guys once they return from the battlefield. The new PTSD regulations will relieve veterans from proving a single wartime moment
that caused the hopelessness and fear. Now veterans only need to show evaluators they served in a region where there would be cause to fear the
reprisal of terrorist attack. “I don’t think our troops on the battlefield should have to take notes to keep for a claims application. And, I’ve met enough
veterans to know that you don’t have to engage in a firefight to endure the trauma of war,” Obama said.The American Legion’s Veterans Affairs and
Rehabilitation Division Barry Searle concurs; “This requirement seems to be a step backward in an otherwise commendable move by the VA. Private
healthcare providers should be given the opportunity to work with veterans and diagnose those who suffer from
PTSD.”Searle points out that if the VA has real concerns about the treatment methods of PTSD assessment standards, “it should create a certification
process for private practitioners that would satisfy its requirements.”If the government opened up returning veterans to the Tri-Care health program,
which is similar to a PPO health care plan, the private sector doctors could alleviate the backlog for PTSD/TBI
treatment.“When the VA makes claims they have enough doctors on staff to take care of the PTSD cases they
are wrong. I just went to the La Jolla, CA VA and they said there was a hiring freeze for psychiatrists,” Filner
said. “It’s baloney; we don’t have enough psychiatrists to treat these guys and girls.”
Currently Service Members are reluctant to seek treatment for mental stress.
RAND Corp, nonprofit research organization,2008 [Invisible Wounds of War Psychological and Cognitive Injuries, Their
Consequences, and Services to Assist Recovery, http://www.rand.org/pubs/monographs/MG720/] McNabb, JP
Many servicemembers are reluctant to seek services for fear of negative career repercussions. Policies must
be changed so that there are no perceived or real adverse career consequences for individuals who seek
treatment, except when functional impairment (e.g., poor job performance or being a hazard to oneself or others) compromises fitness for duty.
Primarily, such policies will require creating new ways for service members and veterans to obtain treatments
that are confidential, to operate in parallel with existing mechanisms for receiving treatment (e.g., command referral,
unit-embedded support, or self-referral)
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Evidence Set
Extension – Inherency 1/
Current changes aren’t enough. USFG should allow private doctors to make
diagnose as well.
JAMES DAO, correspondent for the NYT, New York Times, July 12, 2010 [“Groups Find Trauma Rule for
Veterans Lacking,” http://www.nytimes.com/2010/07/13/us/13vets.html?_r=1&src=mv&pagewanted=print] McNabb NM
A new federal regulation that is intended to make it easier for veterans to receive disability benefits for post-
traumatic stress disorder is coming under fire from some of the advocates who had pushed for it.
The rule, which takes effect Tuesday, eliminates a requirement that veterans document specific events like
firefights or bomb blasts that might have caused their P.T.S.D., whose symptoms include emotional numbness, anxiety,
irritability and flashbacks. Such documentation was often difficult or even impossible to find, veterans groups say.
But veterans advocates say that while the rule is a major improvement, it does not go far enough in lowering
obstacles to veterans seeking health care or disability compensation for P.T.S.D At issue is a provision saying
that a final determination on whether a veteran’s disorder is tied to service — instead of, say, a car crash — can be
made only by a physician or psychologist working for the Department of Veterans Affairs. Advocates have
urged the department to allow private clinicians to make those determinations as well. Some advocates said
they hoped Representative John Hall, a New York Democrat who has championed legislation similar to the new rule, would
push for passage of his bill, because it would allow private mental health professionals to make final diagnoses
of P.T.S.D. in disability cases.
Changes don’t make diagnosis of PTSD easier only access to those that have
already been diagnosis.
Portland press herald, it’s a newspaper, July 29 2010 [Maine Voices: Rules eased for PTSD vets, but read the fine
print, http://www.pressherald.com/opinion/rules-eased-for-ptsd-vets-but-read-the-fine-print_2010-07-29.html] Mcnabb JP
it is apparent to me that the changes in the regulations may not make it

As an attorney representing veterans before the VA,
any easier for a veteran to obtain an actual diagnosis of PTSD. The VA has stated as such in the Federal Register comments:
"This rule, however, does not concern the evaluation of mental disorders. It liberalizes the evidentiary standard for corroboration of a stressor in certain
cases." Veterans who have difficulty obtaining the diagnosis of PTSD to account for their symptoms do not
necessarily benefit from this new rule. These changes may only help the veteran who has already been
diagnosed with PTSD to connect it to his or her military service and obtain benefits
Fear for stigmatization over a PTSD diagnosis prevents veterans from seeking
treatment in a government facility
[Ending the Stigma of War-Related Stress, http://online.wsj.com/] McNabb JP
According to the 2008 Rand study, active duty members of the armed services report concerns about the
impact of seeking treatment on their military careers. And as recognized in a paper published in 2008 by the
Naval Center for Combat and Operational Stress Control, veterans—many of whom work as police officers,
firefighters, and other first responders—express similar anxieties about the consequences of a PTSD diagnosis
for their careers. Such concerns often prevent veterans from seeking treatment in a government
facility.
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Evidence Set
Veterans don’t seek help for PTSD because they fear it will hurt their career,
social life, marital status, and the like.
Project co-leader Lisa Jaycox and group of 25 researchers of RAND Health, a division of the RAND
Corporation, is the nation’s largest independent health policy research program, with a board research
portfolio that focuses on quality, costs and health services delivery, April 17, 2008. [RAND | News Release |
One In Five Iraq and Afghanistan Veterans Suffer from PTSD or Major Depression." RAND Corporation Provides Objective Research
Services and Public Policy Analysis. Web. 01 Aug. 2010. http://www.rand.org/news/press/2008/04/17/.] Aivazyan, NM
Nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all
— report symptoms of post traumatic stress disorder or major depression, yet only slightly more than half have
sought treatment, according to a new RAND Corporation study.Many service members said they do not seek treatment for
psychological illnesses because they fear it will harm their careers. But even among those who do seek help for PTSD or major
depression, only about half receive treatment that researchers consider "minimally adequate" for their illnesses. "If
PTSD and depression go untreated or are under treated, there is a cascading set of consequences," Jaycox said. "Drug use, suicide, marital
problems and unemployment are some of the consequences. There will be a bigger societal impact if these
service members go untreated. The consequences are not good for the individuals or society in general.""We need to remove the
institutional cultural barriers that discourage soldiers from seeking care," Tanielian said. "Just because someone is getting mental health care does not
mean that they are not able to do their job. Seeking mental health treatment should be seen as a sign of strength and
interest in getting better, not a weakness. People need to get help as early as possible, not only once their
symptoms become severe and disabling."
Only VA can evaluate PTSD

JAMES DAO, New York Times, July 12, 2010 [“Groups Find Trauma Rule for Veterans Lacking,”
http://www.nytimes.com/2010/07/13/us/13vets.html?_r=1&src=mv&pagewanted=print]
The rule, which takes effect Tuesday, eliminates a requirement that veterans document specific events like firefights or bomb blasts that might have
caused their P.T.S.D., whose symptoms include emotional numbness, anxiety, irritability and flashbacks. Such documentation was often difficult or even
impossible to find, veterans groups say. In his weekly radio address on Saturday, President Obama hailed the new rule as a “long-
overdue step,” saying, “I don’t think our troops on the battlefield should have to take notes to keep for a claims application.” But veterans
advocates say that while the rule is a major improvement, it does not go far enough in lowering obstacles to
veterans seeking health care or disability compensation for P.T.S.D. At issue is a provision saying that a final
determination on whether a veteran’s disorder is tied to service — instead of, say, a car crash — can be made
only by a physician or psychologist working for the Department of Veterans Affairs. Advocates have urged the
department to allow private clinicians to make those determinations as well.
VA makes diagnostic errors

Paul Sullivan, Veterans for Common Sense, May 12, 2010 [Paul Sullivan, Veterans for Common Sense tries to give VA some
facts,” http://woundedtimes.blogspot.com/2010/05/paul-sullivan-veterans-for-common-sense.html]
At a conference designed to help veterans service organizations better understand the issues their clients face, Paul Sullivan of Veterans
for Common Sense tried to tie it up in a one-page document of new data from the Veterans Affairs Department: After looking at eight
Veterans Benefits Administration regional offices in 2009 and 2010, VA’s inspector general found a 28 percent
error rate. In fact, the San Juan, Puerto Rico, overall error rate stood at 41 percent, while the Nashville office
had made errors in 52 percent of its post-traumatic stress disorder cases. In Baltimore, 55 percent of cases of diabetes in
connection with Agent Orange had errors, and in Roanoke, Va., 49 percent of traumatic brain injury cases had errors. “VA has a very
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significant quality problem in adjudicating their claims,” Sullivan said. “VA’s own reports indict the place. VBA is
the dam that holds veterans up from getting the medical care they need.”
Military needs more doctors who can address PTSD

The Nation, October 10, 2007 [Veterans' Health-Care System Does Not 'Support The Troops’
http://www.thenation.com/blog/veterans-health-care-system-does-not-support-troops] McNabb, NM
The report (A House Veterans' Affairs Committee hearing on Wednesday reviewed the 544-page commission report ) chronicled the
stunning backlog in processing claims, which the Government Accountability Office first documented two
weeks ago. The GAO report found disability payments were delayed an average of six months after the claim
was made. Committee members and Terry spent much of the hearing agreeing that the military needs more
doctors who can identify and competently address PTSD
Military has an economic incentive NOT to diagnose PTSD (They’ve done it

before)
The Nation, October 10, 2007 [Veterans' Health-Care System Does Not 'Support The Troops’ http://www.thenation.com/blog/veterans-
health-care-system-does-not-support-troops] McNabb, NM
if the military diagnoses a personality disorder as a pre-existing condition, then it does not have to
As Kors reported,
pay for medical benefits. According to the commission's report, in the mid-1980s, the Pentagon, as a cost-
cutting measure, encouraged military doctors to diagnose veterans with only one condition. That means that if
a military doctor can diagnose a veteran suffering from PTSD with another pre-existing condition, the pentagon
does not have to provide treatment for PTSD.
Military misdiagnoses soldiers to deny them benefits

Joshua Kors, Investigative Journalist for The Nation, Huffington Post, April 14, 2010 [‘When the Army Uses
"Enhanced Interrogation" on an American Soldier,” http://www.huffingtonpost.com/joshua-kors/when-the-army-uses-
enhanc_b_536727.html] McNabb NM
Luther's call did not come out of the blue. For two years I had been investigating this personality disorder
scandal: how military doctors were purposely misdiagnosing soldiers, wounded in combat, as having this pre-
existing mental illness. As in the civilian world, where people can be locked out of the insurance system if they
have a pre-existing condition, soldiers whose wounds can be attributed to a pre-existing illness can be denied
disability benefits and long-term medical care.
The VA has Control over PTSD

Department of Veterans Affairs, Office of Public Affairs Media Relations July 12, 2010 [“New Regulations on
PTSD Claims”, http://www.va.gov/PTSD_QA.pdf, google, McNabb SK]
10. Asthe regulatory revision seems to require an enhanced role for the examining VA mental health
professional, whose role is it to determine whether the claimed stressor is consistent with the Veteran’s
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service? VA adjudicators, not the examining psychiatrist or psychologist, will decide whether the claimed
stressor is consistent with the Veteran’s service.
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Current actions and decisions by VA doctors suggest malingering.

Neal Powers, retired U.S. Air Force captain, Southeast Missourian, Sunday, August 1, 2010. [“PTSD and
the VA: Just who’s malingering?”, semissourian.com, google news] Nichelle Mcnabb, E.F.
But here is the part that the VA is not telling. Their psychiatrists and psychologists aren't supermen. They
graduated from the same institutions as private practitioners all across the country. Putting on a uniform after
graduation doesn't make them better than their classmates. It just means they go to work in a different suit.
And every one of them follows the same manual: the fourth edition of the Diagnostic and Statistics Manual of
the American Psychiatric Association, or DSM IV. The criteria for diagnosing PTSD is spelled out there in
language so plain that any layman can understand.Although the VA has relaxed its documentation rules, it still
retains the sole authority to diagnose PTSD. The VA staff is not even required to entertain the opinions of their
civilian counterparts. Because of this, the credibility of the VA is at risk.This is the wrong time in history for the
VA to engage a turf war with people who are just as smart as they are. They will need help from their civilian
counterparts. The VA's unfinished business will eventually fall on the churches, communities and families of
our returning servicemen and women. For once, let's call it the way it is and get our patriots the help they need.
VA cannot solve for PTSD and is making the situation worse

Sally Satel, Psychiatrist and resident scholar at the American Enterprise Institute, New York Times,
July 8, 2010 [Should More Veterans Get P.T.S.D. Benefits? http://roomfordebate.blogs.nytimes.com/2010/07/08/should-more-veterans-get-p-t-s-d-
benefits/?src=me] McNabb NM
For too long war veterans seeking medical benefits have been met with the antiquated V.A. medical claims
system. They are put through unconscionable red tape. The consequences of the V.A.’s failure to provide
prompt treatment for P.T.S.D. and traumatic brain injury and benefits are sobering. The bureaucratic delays
can often worsen depression, which in turns makes it more difficult for the veteran to connect with family
members, find employment, regain economic viability and avoid further crises like substance abuse.The
tragedy is veterans suffering from P.T.S.D. are especially ill equipped to deal with the V.A.’s inordinate delays
in determining an initial request for disability benefits, let alone the delays in resolving appeals of incorrect
decisions, which are even longer. In other words, the very system that is supposed to help veterans often
makes matters worse.
Military can’t solve for mental illness now, not enough resources
McNabb NM
the Defense Department’s Mental Health Task Force has flatly stated, ‘‘The military system does not have
indeed,
enough resources or fully trained people to fulfill its broad mission of supporting
psychological health in peacetime, and fulfill the greater requirements during times of conflict.
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Military is not providing adequate services to mental health issues for returning
vets
Kristina Kaufmann , military family advocate, Washington Post, May 11, 2009 [Army Families Under Fire,
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/03/AR2009050301850.html] McNabb NM
The blogosphere provides a sense of the many families coping with health issues and the less tangible effects
of war and military life, including how marginalized many feel. "Spare me the rah rah party line about how much
the Army is doing for the soldiers once they come home," wrote one wife whose husband had suffered a
traumatic brain injury. "[T]hey don't do even half of what they should to provide adequate treatment for soldiers
coming back from deployment." Wrote another wife: "We are outsiders living inside an institution that doesn't want to
see or hear us. . . . You don't have to wear a uniform to be wounded by these wars, but no one outside of those
of us impacted seem[s] to know this.
MILITARY THERAPISTS GIVE IN TO THE MILITARY'S NEEDS IN TERMS OF

DIAGNOSING
THE NEW YORK TIMES, June 6, 2010 [For Therapists In the Military, Painful Stories] mcnabb, lexis
Experts say that the military has made big strides in taking mental health issues seriously, but that military
therapists are sometimes pressured to place the needs of the force above the needs of the patient. Indeed,
they can be overruled by commanders who need soldiers in the field.
Since 2001, the military has deployed many soldiers with post-traumatic stress disorder or other ailments. ''The
focus in the military is readiness,'' said Charles Figley, a psychologist at Tulane University. ''There is an inherent conflict.''
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Extension – Harms 1/
Those suffering from PTSD have significantly higher rates of suicide

RAND Corp, nonprofit research organization, 2008 [Invisible Wounds of War Psychological and Cognitive Injuries, Their
Although not as strongly associated with suicide as depression ,PTSD is more strongly associated with suicide ideation and
attempts than any other anxiety disorder (Kessler, Borges, and Walters, 1999). In the National Comorbidity Survey, two different
studies have indicated that persons with lifetime PTSD were significantly more likely to report having thought
about killing themselves and to have made an attempt, even after accounting for a variety of potential sociodemographic and mental
health confounding factors (Kessler, Borges, and Walters, 1999; Sareen et al., 2005). Among a sample of 100 Vietnam veterans with
PTSD at a VA hospital, 19 had made a suicide attempt and 15 more had been “preoccupied” with thoughts of
suicide since the war (Hendin and Haas, 1991). Psychological autopsies have also indicated that PTSD is linked to suicide deaths. In a study of
Vietnam veterans, those who died from suicide were more likely to have symptoms of PTSD than a comparison group who died in motor vehicle crashes
(Farberow, Kang, and Bullman, 1990).
PTSD veterans cause trauma to surrounding family members around them when
discharged
RAND Corp, nonprofit research organization, 2008 [Invisible Wounds of War Psychological and Cognitive Injuries, Their
In addition to the direct effect of PTSD, depression, and TBI on emotional intimacy, these impairments also
represent a substantial, and usually unexpected, care giving burden. Most often, it is the intimate partner or
spouse who bears this burden. Figley (1993), writing specifically about the wives of Vietnam veterans with PTSD, suggested that the stress
of caring for a loved one with a mental disorder can result in secondary traumatization— i.e., a situation in which the intimate partners of
trauma survivors themselves begin to experience symptoms of trauma. Figley initially applied this term restrictively, referring
only to spouses who develop stress reactions (e.g., nightmares, intrusive thoughts) to specific events that their partners had experienced. Later writers
(Galovski and Lyons, 2004) expanded the use of this term to refer more broadly to any distress experienced by those close to a traumatized individual.
With respect to PTSD, there is extensive evidence that secondary traumatization, at least in its broader sense,
occurs and has serious negative consequences for the emotional and psychological well-being of the spouses
of veterans with PTSD (Dirkzwager et al., 2005; Verbosky and Ryan, 1988).
PTSD can be passed on between spouses giving it to other members in the

family.
Susan Nelson, The Washington Times, July 2nd, 2009. [Military Spouses also Suffer Severe Stress, Lexus Academic]
McNabb JT
Many military spouses also experience PTSD symptoms.“I thought all would be great when Sam got back from Iraq,” said Jennifer
Yarborough, a military spouse living in San Antonio, Texas. Her husband, Sam, was in Iraq from September 2006 until January 2008. “But my mood
swings into depression became too much to cope with. I didn’t understand what was happening to me.”
PTSD can affect any person exposed to a traumatic event, experts say. Individuals who have experienced or
witnessed an incident that involves actual or possible serious injury or death can develop the stress disorder.
The disorder can include recurring feelings of intense fear, helplessness or horror.“While [Sam] was in Iraq, I
would get so depressed I couldn’t get out of bed some days.
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Veterans who go untreated for PTSD are more likely to develop heart disease,
sexual, and alcohol problems.
Marilyn Elias, National Institute of Mental Health, October 27, 2008. [Post-traumatic stress is a war within the
body; But military combat is not the top cause of biological condition, Lexus Academic]
Because PTSD can impair so much of a person's life, mental health experts are concerned about the fallout for young soldiers.
Vietnam veterans with PTSD but no heart disease in their mid-30s were twice as likely as veterans
without PTSD to die of heart disease by their 50s, shows a new study by psychologist Joseph Boscarino of the
Geisinger Health System in Danville, Pa. That's equal to the greater heart attack risk from smoking two to three
packs of cigarettes a day for more than 20 years, Boscarino says.
Although the military screens today's troops for PTSD, which wasn't done during Vietnam, about half of recent veterans with PTSD symptoms haven't
sought treatment, according to the Rand study this year. The longer someone has PTSD, the more likely he'll develop drug or
alcohol abuse, Tuma says. And sexual problems in veterans with traumatic stress are another concern, says
Suzie Chen, who counsels veterans at the VA Hospital in Long Beach, Calif. Between 63% and 80% of combat veterans
with PTSD have sexual problems, according to studies from the Vietnam era through the Iraq war. Combat troops
with PTSD are far more likely than other men to have erection difficulties, suggest studies in a research review by Chen. The causes may be biological
or emotional. Some don't even sleep in the same rooms as their spouses because of nightmares, she says.
Letting our military men and women go untreated has been part of a larger trend
of an increase of suicides of military members.
Gregg Zoroya, USA TODAY, January 13, 2009. [Soldier's death reflects impact of stress in ranks;
Incidents increase as Pentagon extends time many spend in combat, Lexus Academic] Mcnabb JF
He was embittered about the post-traumatic stress disorder (PTSD) that crippled him, the Army's failure to
treat it, and the strains the disorder put on his marriage.Despite the firepower he brought with him, Barber, 31, took only one life that
day. He killed himself with a shot to the head."He went to Fort Lewis to kill himself to prove a point," Kelly Barber says. " 'Here I am. I was
a soldier. You guys didn't help me.' "For two days, a surveillance camera recorded the truck sitting in the Madigan Army Medical Center parking lot.
Inside the truck, the body lay undisturbed.If Josh Barber wanted his suicide to make a statement, no one seemed to notice.Barber's suicide is
part of a larger story: the record number of soldiers, Marines and combat veterans who have killed themselves
in recent years, at a time when the Pentagon has stretched deployments for combat troops to meet President Bush's security plans in Iraq. The
Marine Corps reported 41 actual or suspected suicides in 2008, a 20% increase over 33 in 2007. In 2007, the
Army counted 115 suicides, the most since tracking began in 1980. By October 2008, that record had been surpassed with 117
soldier suicides. Final numbers for 2008 have not been released.
150,000 diagnosed with PTSD – is an underestimate

Brad Knickerbocker, Staff writer, Christian Science Monitor, July 10, 2010 [“New regs will make it easier for war
vets to get help,” http://www.csmonitor.com/USA/Military/2010/0710/PTSD-New-regs-will-make-it-easier-for-war-vets-to-get-help]
McNabb NM
Today, more than 150,000 veterans of the Iraq and Afghanistan wars have been officially diagnosed with
PTSD. The number likely is higher because of the stigma attached to the disorder and also because some
service members have sought out private treatment rather than through the Defense Department or
Department of Veterans Affairs (VA).
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300,000 Iraq/Afghanistan vets have PTSD

Brad Knickerbocker, Staff writer, Christian Science Monitor, July 10, 2010 [“New regs will make it easier for war
vets to get help,” http://www.csmonitor.com/USA/Military/2010/0710/PTSD-New-regs-will-make-it-easier-for-war-vets-to-get-help]
McNabb NM
critics and veterans groups say many vets with legitimate claims have
While some false claims no doubt have been filed,
been denied adequate treatment or compensation because officials demanded documented proof of a specific
trauma-causing incident. The RAND Corp. estimates that 300,000 Iraq and Afghanistan war veterans (some 20
percent of the total) have symptoms of PTSD or major depression.
The dogma of admitting a problem is a weakness has developed into a deadly

predicament. Despair, guilt, and depression eventually end with suicide.
Bruce Alpert, a journalist for The Times-Picayune, interviewed Eric Shinseki the Veterans Affairs
Secretary in his recent article, January 15, 2010. ["Military Suicide Response Hinges on Erasing Stigma against Seeking
Help | NOLA.com." New Orleans, LA Local News, Breaking News, Sports & Weather - NOLA.com. Web. 02 Aug. 2010.
http://www.nola.com/military/index.ssf/2010/01/military_suicide_response_hing.html.] Aivazyan, NM
Earlier in the week,

the Veterans Affairs Department reported that the suicide rate among 17- to 29-year-old male
veterans jumped 26 percent from 2005 to 2007.
On average, 18 veterans per day take their own lives, officials said. All this bad news comes despite stepped-up efforts to encourage
military members and their families to seek help if they feel overwhelmed, depressed or unsure of whether they want to
keep on living. “Who’s vulnerable? Everyone,” said Veterans Affairs Secretary Eric Shinseki at a military
suicide prevention conference. “Young and old, outgoing and reserved, male, female, officer, enlisted, me
included. Warriors suffer emotional wounds just as they suffer physical ones.” “He definitely was very good about hiding his feelings,” Kristen
Fabacher said of her husband, Luke, 35, an Army sergeant from Lafayette who took his life in 2008 after an Iraqi deployment. “The military trains them
well to kind of get hold of their emotions during war, and sometimes that holds over when they return.”Fabacher “loved the military,” his wife said, and
would have signed up for another tour in Iraq or Afghanistan “if he didn’t have a wife and young child at home.” She said that when her
husband did open up, he expressed guilt about the “eight friends of his that were killed in Iraq.” families of several
Louisiana soldiers agree with research that military training that emphasizes toughness and coolness under fire
fosters a mentality that soldiers shouldn’t be seeking help for “personal problems,” even when they are back home after
their assignments in Afghanistan and Iraq are done.
Mental Illness by Soldiers has a ripple effect

Peter Rothberg, the Nation's Associate Publisher for Special Projects, The Nation, March 31, 2008 [“War
is Hell,” http://www.thenation.com/blog/war-hell ]
Last year, some 67,000 soldiers returned from combat in Iraq and Afghanistan were treated for Post Traumatic
Stress Disorder. Eighty-nine of them committed suicide. Perhaps even more than physical injuries, mental
trauma incurred by servicemen tends to have an insidious ripple effect on the affected families and
communities. Numerous studies suggest that domestic violence, child abuse, drug and alcohol abuse and
other destructive behavior is a regular byproduct of untreated PTSD.
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80% of veterans in some areas of the country have combat related mental health
problems
McNabb NM
Yesterday I received a memorandum from the Los Angeles County Department of Mental Health about the
impact of combat-related mental health problems in my District and the surrounding area. According to the
Mental Health Department, some Los Angeles area veterans’ service providers are reporting PTSD incidence rates
for returning veterans that are as high as 80 percent. The Department has also described case studies of area veterans who
returned from Iraq with mental health problems. One involved a 24 year old veteran who served two tours of duty in Iraq but
came home with PTSD and saw his life enter a downward spiral of substance abuse, homelessness, and
crime. As these accounts demonstrate, we are facing a public health problem of enormous magnitude. While
often invisible, these mental health injuries are real, and, if left untreated, they can devastate soldiers and their
families.
We have an obligation to stand by our troops

Thomas Davis, House of rep, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, MAY 24,
2007 [INVISIBLE CASUALTIES: THE INCIDENCE AND TREATMENT OF MENTAL HEALTH PROBLEMS
,http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=110%5Fhouse%5Fhearings&docid=f:46429.pdf] McNabb NM
"Every American we send into combat brings something of that experience back. We owe every one of them
our respect and our gratitude and a compassionate embrace for any who come home bruised or broken in
body or soul. If the war in Iraq ended tomorrow, our obligation to understand the mental battles of current and
future warriors would not. Mindful of that enduring debt, I hope the testimony of our witnesses today will shed needed light on the mental
stresses encountered by today’s warriors and how we can better heal the inner wounds of modern warfare."
Statistics for arrested vets/homelessness

Gary Null, PhD . Global Research, July 20, 2010 [Gulf War Syndrome, PTSD and Military Suicides: U.S. Government's
Message to America’s Vets: "Drop Dead", http://www.globalresearch.ca/index.php?context=va&aid=20186] McNabb NM
Penny Coleman, a widow of a veteran who committed suicide, has been investigating suicide and crime rates among all
war veterans. Although accurate numbers of veterans now in correctional institutions are unavailable, it is estimated that in 2007, there
were 703,000 under supervision and approximately 1.2 million vets arrested.[27] And once released from prison, marked as
a felon, there is little chance a job awaits them during a severe recession. The street or forests, therefore,
become their best options.
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Increasing trend of suicides and violent crimes with new veterans

Gary Null, PhD Global Research, July 20, 2010 [Gulf War Syndrome, PTSD and Military Suicides: U.S. Government's
Message to America’s Vets: "Drop Dead", http://www.globalresearch.ca/index.php?context=va&aid=20186] McNabb NM
A recent study published in the Journal of Studies on Alcohol and Drugs discovered that veterans from the current Afghan and Iraq
wars are more likely to commit suicide by violent means. In fact, the University of Michigan researcher publishing the study found
violent suicide deaths, particularly by firearms, are now most common. This is a trend never before witnessed among active duty
personnel and veterans from previous wars. It is also a trend that finds a parallel in the large number of
veterans arrested for violent crimes, serving prison terms or on correctional probation.
Depression and PTSD in veterans is leading to alcohol abuse.

Amanda Gardner, Health Day, CNN.com, June 7, 2010. [Depression, PTSD plague many Iraq vets, health.com, google
news] Nichelle Mcnabb, E.F.
Up to 31 percent of soldiers returning from combat in Iraq experience depression or post-traumatic stress
disorder that affects their jobs, relationships, or home life, according to a new study by Army researchers.
For as many as 14 percent of these veterans, depression and PTSD cause severe problems in their daily life.
These problems are often accompanied by alcohol misuse and aggressive behavior, the study found.
Roughly half of the soldiers with PTSD or depression reported having abused alcohol or engaged in
aggressive behavior, such as punching a wall or getting into a fight.
Veterans who go untreated for PTSD are more likely to develop heart disease,
sexual, and alcohol problems.
Marilyn Elias, National Institute of Mental Health, October 27, 2008. [Post-traumatic stress is a war within the
body; But military combat is not the top cause of biological condition, Lexus Academic]
Because PTSD can impair so much of a person's life, mental health experts are concerned about the fallout for young soldiers.
Vietnam veterans with PTSD but no heart disease in their mid-30s were twice as likely as veterans
without PTSD to die of heart disease by their 50s, shows a new study by psychologist Joseph Boscarino of the
Geisinger Health System in Danville, Pa. That's equal to the greater heart attack risk from smoking two to three
packs of cigarettes a day for more than 20 years, Boscarino says.
Although the military screens today's troops for PTSD, which wasn't done during Vietnam, about half of recent veterans with PTSD symptoms haven't
sought treatment, according to the Rand study this year.
The longer someone has PTSD, the more likely he'll develop drug or alcohol abuse, Tuma says. And sexual
problems in veterans with traumatic stress are another concern, says Suzie Chen, who counsels veterans at the VA Hospital in
Long Beach, Calif.
Between 63% and 80% of combat veterans with PTSD have sexual problems, according to studies from the
Vietnam era through the Iraq war. Combat troops with PTSD are far more likely than other men to have erection difficulties, suggest studies
in a research review by Chen. The causes may be biological or emotional. Some don't even sleep in the same rooms as their spouses because of
nightmares, she says.
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PTSD can be passed on between spouses giving it to other members in the

family.
Susan Nelson, The Washington Times, July 2nd, 2009. [Military Spouses also Suffer Severe Stress, Lexus Academic]
McNab JT
Many military spouses also experience PTSD symptoms.“I thought all would be great when Sam got back from Iraq,” said
Jennifer Yarborough, a military spouse living in San Antonio, Texas. Her husband, Sam, was in Iraq from September 2006 until January
2008. “But my mood swings into depression became too much to cope with. I didn’t understand what was happening to me.”
PTSD can affect any person exposed to a traumatic event, experts say. Individuals who have experienced or
witnessed an incident that involves actual or possible serious injury or death can develop the stress disorder.
The disorder can include recurring feelings of intense fear, helplessness or horror. “While [Sam] was in Iraq, I
would get so depressed I couldn’t get out of bed some days. Now that he is home, I still get very depressed. I can’t sleep
[because of nightmares], and I question Sam’s love for me and our kids,” Mrs. Yarborough said.
Many spouses try to suppress symptoms of PTSD
Letting our military men and women go untreated has been part of a larger trend
of an increase of suicides of military members.
Gregg Zoroya, USA TODAY, January 13, 2009. [Soldier's death reflects impact of stress in ranks;
Incidents increase as Pentagon extends time many spend in combat, Lexus Academic]
He was embittered about the post-traumatic stress disorder (PTSD) that crippled him, the Army's failure to
treat it, and the strains the disorder put on his marriage.Despite the firepower he brought with him, Barber, 31, took only one life that
day. He killed himself with a shot to the head."He went to Fort Lewis to kill himself to prove a point," Kelly Barber says. " 'Here I am. I was
a soldier. You guys didn't help me.' "For two days, a surveillance camera recorded the truck sitting in the Madigan Army Medical Center parking lot.
Inside the truck, the body lay undisturbed.If Josh Barber wanted his suicide to make a statement, no one seemed to notice.Barber's suicide is
part of a larger story: the record number of soldiers, Marines and combat veterans who have killed themselves
in recent years, at a time when the Pentagon has stretched deployments for combat troops to meet President Bush's security plans in Iraq. The
Marine Corps reported 41 actual or suspected suicides in 2008, a 20% increase over 33 in 2007. In 2007, the
Army counted 115 suicides, the most since tracking began in 1980. By October 2008, that record had been surpassed with 117
soldier suicides. Final numbers for 2008 have not been released.
Depression and PTSD in veterans is leading to alcohol abuse.

Amanda Gardner, Health Day, CNN.com, June 7, 2010. [Depression, PTSD plague many Iraq vets, health.com, google
news] Nichelle Mcnabb, E.F.
Up to 31 percent of soldiers returning from combat in Iraq experience depression or post-traumatic stress
disorder that affects their jobs, relationships, or home life, according to a new study by Army researchers.
For as many as 14 percent of these veterans, depression and PTSD cause severe problems in their daily life.
These problems are often accompanied by alcohol misuse and aggressive behavior, the study found.
Roughly half of the soldiers with PTSD or depression reported having abused alcohol or engaged in aggressive behavior, such as punching a wall or
getting into a fight.
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Soldiers with multiple deployments commit suicide 21% more often
ELISABETH BUMILLER, staff, New York Times, July 30, 2010 [“Pentagon Report Places Blame for Suicides,”
http://www.nytimes.com/2010/07/30/us/30suicide.html?src=mv]
General Chiarelli said that he believed — but could not prove statistically — that the overall Army suicide rate
Nonetheless,
had been driven up by the 21 percent of suicides committed by soldiers with multiple deployments. “That has
just always been my concern, that they may be it, that may be the reason,” he said. “But I don’t have any data
that I can tie that to.”
Army suicide rates have doubled in the last decade

Katie Maloney, Newsweek Blog, July 30, 2010 [“Pentagon Report Looks for Answers to High Rates of Soldier Suicide,”
http://www.newsweek.com/blogs/the-human-condition/2010/07/30/where-to-place-blame-for-army-suicide-rates.html]
Accusations of inadequate mental health care has plagued the Army for several years. Two years ago,
NEWSWEEK reported on the record-breaking 2007 suicide rates. That article cited a statistic originally
reported by the Washington Post: in 2001 the rate of active-duty Army suicides was 9.8 for every 100,000
soldiers. The current rate, reported yesterday, is 20 suicides for every 100,000 active duty soldiers.
Suicide threatens military preparedness

US Army, “Army Health Promotion, Risk Reduction and Suicide Prevention Report,” 2010 p.1
[http://usarmy.vo.llnwd.net/e1/HPRRSP/HP-RR-SPReport2010_v00.pdf]
This report reflects a year’s worth of work at the direction of the Army’s Senior Leadership to provide a “directed telescope”
on the alarming rate of suicides in the Army. It represents both initial findings of the Army Suicide Prevention Task Force and informs
the future of Suicide Prevention within the Army. Suicide is a devastating event. What was once considered a private affair
or family matter now threatens our Army’s readiness. Equally alarming to the rising rate of suicide in the Army
is an increasing number of Soldiers who engage in high risk behavior. Equivocal deaths,1 deaths by drug
toxicity, accidental deaths, attempted suicides, and drug overdoses are reducing the ranks and negatively
effecting the Army’s ability to engage in contingency operations in Iraq and Afghanistan. These deaths further
strain efforts to sustain institutional operations.
There’s a stigma that prevents soldiers from trying to get help

Stigma is typically the perception among leaders and Soldiers that help-seeking behavior will either be
detrimental to their career (e.g., prejudicial to promotion or selection to leadership positions), or that it will
reduce their social status among their peers. The perceived stigma associated with seeking behavioral health
treatment represents a very real barrier to care for individuals who would benefit from professional treatment.
This barrier is further increased within the military culture where mental toughness is seen as a sign of
strength, while seeking behavioral health assistance may be a sign of weakness.
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Evidence Set
We need to reduce stigma more

While stigma associated with seeking behavioral health treatment remains a problem in the military, there is
evidence that the current anti-stigma communications campaign is improving perceptions.24 The Army
Research Institute’s Sample Survey of Military Personnel found changes in responses from 1999 to 2009
indicate a positive trend among the general Army population, while other surveys found little or no change.
While this is encouraging, 51% of both officer and enlisted Soldiers still believe that seeking behavioral health
counseling would negatively affect their careers. This indicates that a majority of the active duty population still
believes behavioral health counseling/care would have a negative impact on their career. Until the stigma
associated with behavioral health treatment can be overcome, the Army should continue to look at alternative
methods for identifying Soldiers who may be in need of such care, either by command intervention or through
medical encounters.
Military stress has increased suicide risks

General Peter W. Chiarelli , US Army, “Army Health Promotion, Risk Reduction and Suicide Prevention
Report,” July, 28th 2010 p.i [http://usarmy.vo.llnwd.net/e1/HPRRSP/HP-RR-SPReport2010_v00.pdf]
In Fiscal Year (FY) 2009 we had 160 active duty suicide deaths, with 239 across the total Army (including
Reserve Component). Additionally, there were 146 active duty deaths related to high risk behavior including 74
drug overdoses. This is tragic! Perhaps even more worrying is the fact we had 1,713 known attempted suicides
in the same period. The difference between these suicide attempts and another Soldier death often was
measured only by the timeliness of life-saving leader/buddy and medical interventions. Some form of high risk behavior
(self-harm, illicit drug use, binge drinking, criminal activity, etc.) was a factor in most of these deaths. When we examined the
circumstances behind these deaths, we discovered a direct link to increased life stressors and increased risk
behavior. For some, the rigors of service, repeated deployments, injuries and separations from Family resulted
in a sense of isolation, hopelessness and life fatigue.
Conditions have pushed the military to its breaking point

General Peter W. Chiarelli , US Army, “Army Health Promotion, Risk Reduction and Suicide Prevention
Report,” July, 28th 2010 p.ii [http://usarmy.vo.llnwd.net/e1/HPRRSP/HP-RR-SPReport2010_v00.pdf]
We all recognize the effects of working under an unprecedented operational tempo for almost a decade. The
challenges of serving in today’s Army have tried our leaders, tested our Soldiers and exhausted our Families.
On one hand we have successfully transformed the Army, simultaneously prosecuted contingency operations
in two theaters, implemented BRAC, mobilized the Reserve Component in historic numbers and responded to
natural disasters. On the other hand, we now must face the unintended consequences of leading an
expeditionary Army that included involuntary enlistment extensions, accelerated promotions, extended
deployment rotations, reduced dwell time and potentially diverted focus from leading and caring for Soldiers in
the post, camp and station environment. While most have remained resilient through these challenges, others
have been pushed to their breaking point.
2010 NFA-LD
Evidence Set
Suicide figures have passed combat mortality

The New York Times, August 2, 2009 [After Combat, Victims of an Inner War, Lexis] McNabb, NM
"The number of suicides reported by the Army has risen to the highest level since record-keeping began three
decades ago. Last year, there were 192 among active-duty soldiers and soldiers on inactive reserve status,
twice as many as in 2003, when the war began. (Five more suspected suicides are still being investigated.) This year's
figure is likely to be even higher: from January to mid-July, 129 suicides were confirmed or suspected, more
than the number of American soldiers who died in combat during the same period."
Veterans Highly likely to commit violent acts after discharge

The New York Times, February 15, 2008 [When Strains on Military Families Turn Deadly, Lexis] Mcnabb NM
"Some researchers draw a fairly firm connection between post-traumatic stress disorder and domestic
violence. A 2006 study in The Journal of Marital and Family Therapy looked at veterans who sought marital
counseling at a Veterans Affairs medical center in the Midwest between 1997 and 2003. Those given a
diagnosis of PTSD were ''significantly more likely to perpetrate violence toward their partners,'' the study found,
with more than 80 percent committing at least one act of violence in the previous year, and almost half at least
one severe act."
SUICIDES are UNDER-COUNTED

The New York Times, August 2, 2009 [Source: "After Combat, Victims of an Inner War, lexis] Mcnabb NM
"Those statistics, of course, do not offer a full picture. Suicide counts tend to be undercounts, and the trend is
less marked in other branches of the military. Nor are there reliable figures for veterans who have left the
service; the Department of Veterans Affairs can only systematically track suicides among its hospitalized
patients, and it does not issue regular suicide reports."
SUICIDES AND DIVORCES ARE UP

THE DALLAS MORNING NEWS, June 6, 2010 ["PRIVATE BATTLES, lexis] Mcnabb, NM
Repeated combat tours to Iraq and Afghanistan have split up marriages and forced kids to grow up without one
or both parents for chunks of their childhood. •Troops return home from combat tours with severe injuries and
psychological disorders, thrusting spouses and other family members into new roles as long-term caregivers.
Suicides in the military have risen to record levels, and the divorce rate has climbed steadily since the U.S.
went to war in 2001.
THERE ARE NOT ENOUGH MILITARY MENTAL HEALTH PROVIDERS

Yet "there
are not enough mental health providers to meet the demand, case managers and providers are
overwhelmed, wait times are too long for appointments and between appointments for those in need of mental
health and other services," the report stated. The institute's two-year study was mandated by Congress to help
veterans readjust to civilian life.
2010 NFA-LD
Evidence Set
MILLIONS OF CHILDREN WILL BE IMPACTED

"The extended military operations and multiple combat tours are not just a short-term problem for military
families. They will have a lasting impact on the well-being of the next generation - the nearly 2 million children
who are growing up in military households. "This isn't going away," said Ybarra, 33, the mother of a 10-year-old girl and a 6-year-old boy,
who lives near Fort Hood. She has been separated from her husband, a first sergeant, for a year and is in the process of divorce. He is leaving soon on
his sixth deployment."I can guarantee you that in the next 10 years," she said, "we'll
2010 NFA-LD
Evidence Set
Extension – Answers to Spending/Tix
VA issues are bipartisan because of the coming midterm elections.

ANDREW TAYLOR, staff writer, Associate Press, July 30 2010 [For veterans bill, Republicans put budget ax aside,
Lexis] McNabb JP
House Republicans who have spent months demanding spending cuts blanched Wednesday at their first
opportunity to actually make them, instead joining Democrats in treating a bill to pay for veterans programs in
2011 as politically sacrosanct in an election year. It's of little surprise that Democrats picked the Veterans Affairs bill as the first in the
appropriations pile to bring to a vote. It passed by a 411-6 vote. House Minority Leader John Boehner, R-Ohio, offered the only
amendments to cut the veterans bill but withdrew them as soon as Democrats started making political hay out
of them.
Costs will be off set

THE LEAF CHRONICLE, Newspaper, July 14, 2010
[PTSD burden of proof lowered ,http://www.theleafchronicle.com/article/20100714/OPINION01/7140305/EDITORIAL-PTSD-burden-of-proof-lowered]
McNabb NM
More than 400,000 veterans 19,000 of whom are women who had to satisfy a higher burden of proof since they technically are not allowed in
combat already receive benefits for the disorder. Veterans diagnosed with PTSD are entitled to monthly payments of up to $2,700. The VA has not
estimated how many more veterans may now qualify nor what the price tag may be. Military experts do say the cost of increased
claims may be largely offset by what the VA will save in the previous time-consuming process.
2010 NFA-LD
Evidence Set
Extension – Potential Alt Plan/Solvency
Controversial PTSD treatment is supported by President Obama, but not by the

Pentagon.
Katie Drummond, Danger Room, July 19, 2010. [Obama Loves This Freaky PTSD Treatment; the Pentagon, Not So
Much, wired.com, google news9] Nichelle Mcnabb, E.F.
Dr. Eugene Lipov, a Chicago-based anesthesiologist, pioneered the modern-day use of stellate-ganglion block,
or SGB, in 2004 to eliminate hot flashes among post-menopausal women. SGB, which has been used to
relieve migraines and chronic pain since the 1920s, involves a single injection into the sympathetic nerve
tissue on the right side of a cervical vertebra.Denied, despite one rather high-profile backer. In 2007, then-Senator Barack
Obama wrote a letter to the Army as part of Lipov’s funding application. “There is a growing body of evidence
to suggest that PTSD is afflicting a growing number of our heroic service members,” the letter reads. It “is
important to consider any new approaches that may hold potential for helping our service members get the
care they need.”Concerns over risks, especially that the injection can trigger seizures, hit a key artery or puncture the lung, are valid, Lipov admits.
Still, they’re rare: A 1992 study evaluating 45,000 SGB cases found adverse effects in 20 patients. And Lipov has come up with a distinct method, which
he calls the “Chicago Block,” that targets the C6 vertebra rather than the traditional C7. Because C6 is farther from important arteries and the lungs, it’s
less likely to be implicated in problems during an SGB procedure.“Realistically, 1 in 100,000 people might have serious
complications,” he admits. “Say we treat 300,000 veterans — that’s three people. Compare that to the military’s
suicide rate.”So far, the Pentagon isn’t listening. Which makes sense: Yes, the military’s been open-minded about investigating all kinds of
alternative PTSD remedies. But there’s a big difference between an hour of downward-facing-dogs and an injected chemical intervention that tries to
180 a patient’s fragile hormonal stress responses. But a dearth of Pentagon funds also means that an interesting idea goes
under-researched. For now, Lipov is self-funding a limited clinical trial: a single-blind test of SGB injections on war veterans. So far, three patients
have received the injection, and Lipov is looking to recruit 19 to 22 more. “Look, of course everyone would rather wait until 10,000 people have tried it,”
he says. “I’m trying to get there.”A single procedure costs around $800. Most PTSD patients have shown solid results
with only one injection, but Lipov’s first patient proved that there’s a possibility of relapse. Questions also persist over
how long the effects can endure, and what percentage of PTSD sufferers will respond to the method. And, of course, there’s the undeniable fact that
SGB injections are a Band-Aid treatment, rather than prevention or all-out cure. But according to Lipov, they’re the best we can do.“This has been
around, it’s been done, it is not going to grow you a new tail,” he says. “It’s out-of-the-box, I understand that. But, really, with the number of guys we’re
going to have coming home sick, I’m hard-pressed to see where there’s a better option.”
2010 NFA-LD
Evidence Set
Extension – Overstretch Case Cards 1/
Allowing for confidentiality would increase military readiness and retention. By

encouraging individuals to seek care before problems become a critical issue.
RAND Corp, nonprofit research organization,2008 [Invisible Wounds of War Psychological and Cognitive Injuries, Their
We are not suggesting that the confidentiality of treatment should be absolute; since both military and civilian treatment providers
already have a legal obligation to report to authorities/commanders any patients who represent a threat to themselves or
others. Information about being in treatment is currently available to command staff, although treatment itself
is
not a sign of dysfunction or poor job performance and may not have any relationship to deployment eligibility.
Providing an option for confidential treatment has the potential to increase total-force readiness by encouraging
individuals to seek needed health care before problems accrue to a critical level. In this way, mental health
treatment would be appropriately used by the military as a tool to avoid or mitigate functional impairment,
rather than as evidence of functional impairment. We believe this would ultimately lead to better force
readiness and retention, thus being a beneficial change both for the organization and for the individual.This
recommendation would require resolving many practical challenges, but it is vital for addressing the mental
health problems of those servicemembers who are not seeking care out of concern for their military careers.
Overstretch has created high risk behaviors that risk our preparedness
Office of the Chief of Public Affairs Press Release , US Army web site, July 28, 2010 [“Army Health Promotion,
Risk Reduction and Suicide Prevention Report,” http://www.army.mil/-news/2010/07/28/42934-army-health-promotion-risk-reduction-and-suicide-
prevention-report/index.html?ref=home-headline-link0]
“This comprehensive review exposes gaps in how we identify, engage, and mitigate high-risk behavior among
our soldiers. After nearly a decade of war we must keep pace with the expanding needs of our strained Army,
and continuously identify and address the gaps that exist in our policies, programs and services,” said Chief of
Staff Gen. George W. Casey Jr. Casey told the Army’s two- and three-star commanders and command sergeants
major recently that “our challenge over the next several years will be to maintain our combat edge at an
appropriate tempo while reestablishing garrison systems to better care for our soldiers and families. The
combination of Comprehensive Soldier Fitness with these health promotion efforts provides the foundation to
improve the resilience of the force.” Unprecedented operational tempo has dictated that leaders remain
primarily focused on preparing for their next deployment. As a result, enforcement of policies designated to
ensure good order and discipline has atrophied. This, in turn, has led to an increasing population of Soldiers
who display high risk behavior which erodes the health of the force.
Military is desperate for troops even taking violent offenders

The New York Times, February 15, 2008 [When Strains on Military Families Turn Deadly, Lexis] Mcnabb NM
"The fatalities examined by The New York Times show a military system that tries and sometimes fails to
balance the demands of fighting a war with those of eradicating domestic violence. According to interviews with
law enforcement officials and court documents, the military has sent to war service members who had been
charged with and even convicted of domestic violence crimes.
2010 NFA-LD
Evidence Set
The overall attitude in the military is that you do not go seek help because it may
hurt your career.
Terri Tanielian, Director of RAND Study, RAND Center for Military Health Research, 2008. [Invisible Wounds
of War; Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, RAND Corp.] Mcnabb JT
Examination of the three broad classes of barriers revealed that institutional/cultural barriers were the most
frequently endorsed class of obstacles (see Table 4.9). In particular, respondents were most likely to regard concerns
about confidentiality and discrimination as presenting barriers to seeking treatment. For example, the belief
that seeking care could harm one’s career was endorsed by over 40 percent of persons. Concern about the possible
inability to receive a security clearance in the future and the belief that medical records would not be kept confidential were also widely endorsed.
The perception in the military is that if you go to find help, you are just faking
your symptoms.
The view that

Perceptions regarding malingering further dissuade individuals with true signs and symptoms of PTSD from seeking treatment.
many soldiers with PTSD are faking their symptoms was common in focus groups conducted with senior
NCOs. One participant believed that as many as 75 percent of all individuals who said they had PTSD were
faking (Army focus group).
Because the VA operates under a fixed budget it needs to make priorities of who
they give treatment.
Because the VA operates under a

All OEF/OIF veterans, including deactivated reservists, are eligible to receive services from the VA.
fixed budget, access to its health care services is limited by design and guided by a priority system, with nondisabled veterans
lower in priority than those with designations of disability. Recent congressional budget allocations to the VA have increased funding to expand capacity
and improve services for OEF/OIF veterans. New resources will help the VA reduce gaps in access to health services for such veterans, but it will take
time to plan where expansion is most critical, to fill new positions with qualified personnel, and to develop and provide appropriate training and
supervision for these staff. Rushed expansion could have deleterious effects on quality, so the VA must plan and implement carefully, even though
political pressures to expand access quickly are intense.
2010 NFA-LD
Evidence Set
Improved technologies in defense and medicine have produced fatality rates far
lower than other prolonged wars leading to more mental problems.
Since October 2001, approximately 1.64 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation
Iraqi Freedom (OIF; Iraq). The pace of the deployments in these current conflicts is unprecedented in the history of the all-volunteer force (Belasco,
2007; Bruner, 2006). Not only is a higher proportion of the armed forces being deployed, but deployments have
been longer, redeployment to combat has been common, and breaks between deployments have been
infrequent (Hosek, Kavanagh, and Miller, 2006). At the same time, episodes of intense combat notwithstanding, these
operations have employed smaller forces and have produced casualty rates of killed or wounded that are
historically lower than in earlier prolonged wars, such as Vietnam and Korea. Advances in both medical
technology and body armor mean that more servicemembers are surviving experiences that would have led to
death in prior wars (Regan, 2004; Warden, 2006). However, casualties of a different kind are beginning to emerge—invisible wounds, such as
mental health conditions and cognitive impairments resulting from deployment experiences. These deployment experiences may include multiple
deployments per individual service member and exposure to difficult threats, such as improvised explosive devices (IEDs).
An extended war with an all-volunteer force puts more stress on the military
because they’re being stretched thin.
Probably the signal difference of the conflicts in

Each conflict has its own distinguishing characteristics beyond size and location.
Afghanistan and Iraq is that they mark the first time that the United States has attempted to fight an extended
conflict with a post–Cold War all-volunteer force. Operation Desert Storm also drew on volunteer forces, but that operation lasted only
a matter of months. But today, the Services have no easily accessible personnel pool to draw on to expand their
ranks, as was the case during the Vietnam War, when hundreds of thousands of draftees were called up to
serve. Active duty forces in fiscal year 2007, which for the Army numbered about 482,000 and for the Marine Corps, about 180,000 (DoD, 2008), are
the most available source of troops, followed by the Reserve Component forces, which totaled about 550,000 for the Army National Guard and the Army
Reserve combined in 2007 (Office of the Assistant Secretary of the Army, 2007), and 39,600 for the Marine Corps (Department of the Navy, 2007). The
thought underpinning the creation of the all-volunteer force was that it would be smaller but highly professional and capable of deploying worldwide and
winning conflicts in a relatively short time. Operation Desert Storm seemed to bear out that thinking, when U.S. and coalition forces crushed Iraqi forces
in a matter of a few months. However, the extended nature of the conflicts in Afghanistan and Iraq has subjected the U.S.
military to demands that, arguably, it was not sized, resourced, or configured to meet at the time. The ground forces,
composed predominantly of personnel from both the Army and the Marine Corps, have borne the brunt of the conflict in casualties and wounded in
action. To meet the demands of both conflicts, DoD has devised rotational policies that cycle forces and equipment through both conflicts. In a
memorandum from January 2007, the Secretary of Defense announced benchmarks of one year of deployment to a combat theater for every two years
outside of combat (i.e., training and re-equipping) for the Active Components of all Services, and one year of deployment to a theater of war to five years
non-deployed for the Reserve Components (Office of the Under Secretary of Defense, 2007). Although the Army policy is clear on both
the length of deployment and the amount of time back in the States before another deployment, the demands
of the conflicts in Afghanistan and Iraq have made implementation of this new policy difficult (GAO, 2007). The
Congressional Budget Office (2005) offers evidence, in fact, that some combat units are spending much less time back in the
United States between deployments; even when they are in the United States, the units are preparing for their
next deployment by training away from their home stations. Further, the demands of the Iraq conflict have
prompted the Army to extend the deployments of some units from 12 to 15 months.
2010 NFA-LD
Evidence Set
Neg Cards 1/
Veteran homelessness is down due to the help being provided by different

organizations
Kim Lamb Gregory, qualifications if available, Ventura county star, August 1, 2010. [Homeless veterans get a
hand up at Stand Down, vcstar.com, googlenews.com] Mcnabb, E.F.
Currently, about 200 cities in the nation host Stand Down events .
Federal statistics say there were more than 130,000 homeless
veterans in the nation in 2009, down from 195,000 six years ago.The Stand Down is designed to help
homeless veterans break the cycle of homelessness with a host of services, from the basics of food and
shelter to services to help get them on their feet again, such as medical and dental treatment, legal services,
employment counseling and housing information. The American Red Cross served the vets meals. The vets
could take showers and received tents to stay in throughout the weekend. The veterans also received
information on drug and alcohol counseling and government and social services.
It isn’t military deployments that make soldiers commit suicide
The report, released Thursday at the Pentagon, found that it was not only the stress of repeated deployments over nearly
a decade in Iraq and Afghanistan that has driven the Army suicide rate above the civilian rate for the first time
since the Vietnam War. Significantly, the report said that 79 percent of the soldiers who committed suicide had had
only one deployment, or had not deployed at all. “For us to blame this thing just on the war would be wrong,”
Gen. Peter W. Chiarelli, the vice chief of staff of the Army, said at a news conference about the report. “That’s
not what we’re trying to do here.”
Military really doesn’t have a higher suicide rate than the general population
According to the Army, roughly 20 out of 100,000 soldiers have killed themselves, compared with a rate of
roughly 19 out of 100,000 for the civilian population.
2010 NFA-LD
Evidence Set
Neg Cards 2/
PTSD cannot be avoided/prevented

Michael Blumenfield, M.D.., Sidney E. Frank Distinguished Professor Emeritus of Psychiatry, New York
Medical College, Huffington Post, August 2, 2010 [“We Can't Prevent Suicides and PTSD in the Military,”
http://www.huffingtonpost.com/michael-blumenfield-md/we-cant-prevent-suicides_b_666004.html]
This is a misguided view that somehow if we did the right thing we could prevent these events. We haven't been able
to prevent the increasing number of Americans being killed by IEDs. War is hell and soldiers get killed. We train them the best
way that we know how, but inevitably soldiers die when there is a war. Maybe some soldiers, despite the best
training available, aren't quite as good in a combat situation as others. Some may be able to know when to zig
rather than zag. Some have better instincts than others and that may make them more likely to survive. Some inherently may be able
to handle the stress of war better than others. However, the best training in the world and all the preventive
measures in the world will not eliminate combat injuries and death. Nor can PTSD and suicides be avoided.
The most combat savvy soldiers in our military cannot hide from a bullet with their name on it nor can the most well
adjusted soldiers avoid being affected by extraordinary human experiences in a war zone.
Soldiers self-induce stigma

a large percentage of those who would benefit from behavioral health

Data from OEF and OIF support the fact that
treatment often resist seeking care due to the perception of peer disapproval.22 Additionally, once Soldiers
have been identified with a behavioral health issue, they may tend to internalize negative stereotypes and
enforce “self-stigma.”23 These factors contribute to the fact that those who need behavioral health care the
most are typically the least likely to seek care.
Military is keeping questionable soldiers
In addition, the report said that the pace of constant deployments in two wars had forced a lowering of
recruiting and retention standards. Many new recruits were granted waivers, it said, for behavior that would
have kept them out of the service in earlier years. Of 80,403 waivers granted since 2004, the report found that
47,478 were granted to people with a history of drug or alcohol abuse, misdemeanor crime or “serious
misconduct,” which it defined as felony. At the same time, the report found that there was a decrease in
soldiers forced to leave the Army for misconduct. “This has likely resulted in the retention of over 25,283
soldiers who would have otherwise been separated in previous years,” the report said.
2010 NFA-LD
Evidence Set
Neg Cards 3/
Treatment does nothing; the facilities are just as bad as not treating them
JAMES DAO and DAN FROSCH, staff, New York Times, April 24, 2010 [“Feeling Warehoused in Army Trauma
Care Units,” http://www.nytimes.com/2010/04/25/health/25warrior.html?_r=1]
Created in the wake of the scandal in 2007 over serious shortcomings at Walter Reed Army Medical Center, Warrior Transition
Units were intended to be sheltering way stations where injured soldiers could recuperate and return to duty or
gently process out of the Army. There are currently about 7,200 soldiers at 32 transition units across the Army,
with about 465 soldiers at Fort Carson’s unit. But interviews with more than a dozen soldiers and health care
professionals from Fort Carson’s transition unit, along with reports from other posts, suggest that the units are far from
being restful sanctuaries. For many soldiers, they have become warehouses of despair, where damaged men and
women are kept out of sight, fed a diet of powerful prescription pills and treated harshly by noncommissioned
officers. Because of their wounds, soldiers in Warrior Transition Units are particularly vulnerable to depression and
addiction, but many soldiers from Fort Carson’s unit say their treatment there has made their suffering worse.
Some soldiers in the unit, and their families, described long hours alone in their rooms, or in homes off the
base, aimlessly drinking or playing video games.
THERE REALLY ISN'T A PTSD TREATMENT WE KNOW that WORKS

DR. INSEL, March 23, 2010, DIRECTORNATIONAL INSTITUTE OF MENTAL HEALTH, NATIONAL
INSTITUTES OF HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES [ HEARING OF THE
SUBCOMMITTEE ON MILITARY CONSTRUCTION, VETERANS AFFAIRS, AND RELATED AGENCIES OF THE HOUSE
APPROPRIATIONS COMMITTEE;congress.gov] Mcnabb NM
If we were talking about cancer I would say the same thing. It's very important to provide really good service for
cancer and heart disease and diabetes, but the reality is that even with the very best treatments we have today
people with cancer die. And that's true for PTSD as well that we do not have the best treatments; the
treatments that we know will make the greatest difference for every individual.
Military is already moving to solve the PTSD problem, No need to take action
The New York Times, August 2, 2009 [Source: "After Combat, Victims of an Inner War, lexis] Mcnabb NM
Even so, stung by criticism from veterans groups and mental health advocates, the Pentagon and the veterans
agency have increased efforts to understand and address the problem. They have bolstered suicide-prevention
programs, hiring hundreds more mental health providers. At Fort Campbell, in Kentucky, where at least 14 soldiers have
killed themselves this year alone, normal activities were suspended for three days in May and replaced with suicide-prevention training.
Late last year, the Army commissioned a five-year, $50 million study of the causes of suicide among soldiers,
turning to four outside experts to lead the research. ''The 'business as usual'attitudes of the past are no longer
appropriate,'' said George Wright, an Army spokesman. ''It's clear we have not found full solutions yet, but we
are trying every remedy.'' "
2010 NFA-LD
Evidence Set
Neg Cards 4/
Flood gate of spending if restrictions loosened

WACOTRIB.COM, July 14, 2010 [Streamlining of PTSD guidelines is overdue, recognizes changes in warfare,
http://www.wacotrib.com/opinion/98392419.html] McNabb NM
Some critics ask if these new guidelines will open the floodgates for more and more claims from a federal
government deep in debt. Fair enough. That’s why VA clinicians who must determine who qualifies must be
expertly trained to recognize a medical condition characterized by sharp mood swings, persistent flashbacks and emotional disengagement, some
acute enough to hinder readjustment to the homefront.
2010 NFA-LD
Evidence Set
NEGATIVE EVIDENCE
***States CP – Index***
***States CP – Index***................................................................99
States CP 1/..........................................................................100
States CP 2/..........................................................................101
Extensions – Solvency 1/..............................................................102
Extensions – Solvency 2/..............................................................103
Extensions – Multi-Actor Fiat Good....................................................104
AFF Answers – States CP 1/............................................................105
AFF Answers – States CP 2/............................................................106
2010 NFA-LD
Evidence Set
States CP 1/
Observation 1 the plan: All 50 states will enact appropriate legislation mandating
______________________<Insert AFF Plan>_______________________________
Funding and enforcement will be through normal means.
The counterplan is non topical, since the 50 states are not the USFG.
The counterplan will compete through net benefits, by avoiding the DisAd.
Observation 2 is Solvency –
1. States are the primary payers for mental health services.

Robert Erickson, Nevada County Health and Human Services Agency, 2003
[http://www.mynevadacounty.com/bh/index.cfm?ccs=717&cs=640] JB
In the United States, Mental Health services are usually a function of states, not counties. For a variety of reasons,
some financial, some philosophic, California has opted to have counties be the primary operators of its mental health system, while the state retains
primary responsibility for funding the system. This is an unusual model . In most of the country, the state is still the level of
government that provides the service. The federal government takes very little responsibility for mental health
care. Its chief contribution is through the Medicaid program, known in California as Medi-Cal. This is essentially an
insurance program for which the federal share is about 50%. The federal government also provides relatively small amounts for
services through competitive grants.
2. Demands on state budgets have forced innovation and efficiency to develop

at the state level.
Sylvia Perlman and Richard Dougherty, the Commonwealth Fund, August 2006 [State Behavioral Health
Innovations: Disseminating Promising Practices, http://www.commonwealthfund.org/~/media/Files/Publications/Fund
%20Report/2006/Aug/State%20Behavioral%20Health%20Innovations%20%20Disseminating%20Promising
%20Practices/Perlman_statebehavioralhltinnovations_945%20pdf.pdf] JH
Many of the projects described in this report result in no small part from the demands placed on state agencies to meet an
increased need for services with a reduced budget. Many states have little choice but to try to improve
performance and increase efficiency and effectiveness. They have sought to accomplish these goals by
adopting approaches from other parts of the health care system, like performance-based contracting, and
projects from the private sector, like primary care integration and chronic disease management. While careful reporting on the results of
these efforts is crucial to the design of new initiatives, evaluations are often funded insufficiently or not at all. Yet, in the absence of competent studies,
state policymakers cannot be sure which innovations are worthy of consideration. New models of evaluation are needed—ones that can document
change and report on a set of standard and comparable measures. By facilitating local efforts, sharing best practices, and reporting on the
outcomes of innovations wherever possible, states can act as “incubators” of promising practices. Disseminating details about
current innovations, including accomplishments and challenges, is one vital component of this approach.
2010 NFA-LD
Evidence Set
States CP 2/
3. A top down federal approach to mental health reform will fail; change must
come from the state and local level.
Sylvia Perlman and Richard Dougherty, the Commonwealth Fund, August 2006 [State Behavioral Health
Innovations: Disseminating Promising Practices, http://www.commonwealthfund.org/~/media/Files/Publications/Fund
%20Report/2006/Aug/State%20Behavioral%20Health%20Innovations%20%20Disseminating%20Promising
%20Practices/Perlman_statebehavioralhltinnovations_945%20pdf.pdf] JH
Across the country, states are trying to respond to the challenges laid out by the Federal Action Agenda and the IOM. Each
state mental health and substance abuse agency is approaching issues in its own way, trying to make its system more
consumer-centered, collaborating with other state agencies, and improving performance and the quality of the
services it purchases. Such dramatic change cannot and will not be accomplished by a topdown, federal approach;
instead the federal and state governments must act as “incubators,” facilitating local efforts, sharing best
practices, and reporting on the outcomes of innovations wherever possible. Methods must be developed for states to share
knowledge—with a wide audience and with minimal bureaucratic hurdles—about what each initiative has accomplished. This “incubator” method is
consistent with SAMHSA’s Transformation Grants to seven states; 43 others require the encouragement to incubate new ideas as well. Disseminating
details about current innovations, including accomplishments and challenges, is one vital component of this state-by-state approach.
2010 NFA-LD
Evidence Set
Giving states greater flexibility in treating the mentally ill would allow for the
best solutions through local innovation.
E. Fuller Torrey, writing for City Journal, Autumn 2003 [Leaving the mentally ill out in the cold, http://www.city-
journal.org/html/13_4_leaving_the_mentally.html Torrey is Executive Director of the Stanley Medical Research Institute (SMRI) and
founder of the Treatment Advocacy Center (TAC), a nonprofit organization with the goals of eliminating legal and clinical obstacles to
the treatment of severe mental illness] JH
Here, truly, is ground for hope. Nothing

would improve mental health care more swiftly than giving states not just
greater flexibility—the commission is far too cautious—but as much control as is politically feasible in spending mental
health–care dollars, and then holding them accountable by measuring various outcomes, which could include quality-of-life ratings by patients
and their families, the number of homeless and incarcerated mentally ill, the employment rate of mentally ill people, quality of housing, and so on. The
federal government would need to collect accurate data from the states in all these areas, woefully lacking at present. The feds would then reward states
that did a good job by giving them more funding; states that let homeless mentally ill individuals use government funds to stay drunk and live on the
streets would lose money. As a first step, federal officials could set up an experimental program in half a dozen states and analyze the results. Local
innovation, as the commission recognizes, has already created most of the nation’s best mental health programs. A
prime example: the so-called clubhouse model, which originated with New York’s Fountain House. In these community
facilities, mentally ill people can come together in a low-key, friendly atmosphere and receive vocational and social help. Clubhouse staff don’t prescribe
medicine or provide therapy, but they do remind clients to take their medicine and are on hand to give guidance and encouragement. These
inexpensive programs are a big success, as their clients’ high employment and low re-hospitalization rates prove. Another
example of an effective local initiative: Wisconsin’s Assertive Community Treatment teams. Each team consists of ten
professionals or paraprofessionals, including a psychiatrist, linked to a hospital or community mental health center. Rather than wait for
seriously mentally ill people to seek out treatment themselves, the teams search for the untreated in homeless
shelters and jails, and get them on the right medication and treatment routine. The teams also visit recently released hospital
patients to help them ease back into society. Thanks to its 120 ACT squads, Wisconsin has slashed re-hospitalization rates 90 percent. Turning
responsibility for mental health over to the states, while holding them accountable, would unleash many more such
policy experiments, just as states that received waivers from the federal government to pursue welfare initiatives during the late 1980s and
nineties came up with effective welfare innovations that set the stage for federal welfare reform.
Different states have different needs in health policy, necessitating a state by

state approach
The Reforming States Group, May 2009 [Healthy States/Healthy Nation: Essays for a New Administration and a New
Congress, http://www.milbank.org/reports/HealthyStates2009/HealthyStates2009.html] JH
An essential interaction is the relationship between state health policies and federal health policy—a cornerstone
dynamic in all policy since the founding of the American republic. In health policy, federalism shapes Medicaid, insurance regulation, and a
myriad of state rules that govern licensure and a scope of practice issues, food and drug policy, and much more. States have distinct
political and health system cultures, reflecting varying health care delivery systems and regulatory approaches.
These differences show how local needs influence a particular state’s political system and health care marketplace.
States vary in their rural and urban mix of populations, in their degree of competition among hospitals and
health insurers, in their regulatory structures, and in many other dimensions. This variance creates state-
specific health policy foundations that determine “rules of the road” for each state system. This diversity must
be taken into account when designing federal policy.
2010 NFA-LD
Evidence Set
States are closer to the people and more creative, making them better suited to
respond to health policy challenges
Lawrence Gostin, Public Health Law, 2000 [Public Health Law: Power, Duty, Restraint. Gostin is the former Legal Director
of the National Association of Mental Health] JH
This nation has long struggled with the problem of attaining the proper balance of powers between the federal
government and the states. This problem is particularly acute in matters of public health because both levels of government want to be seen
as responding to the electorate’s concerns about health and safety. States and localities are closer to the people and understand
better threats to their health. Because they are closer to the people and the community, they can adapt
prevention strategies to meet the needs of localities. States also are better placed to experiment with solutions
to complex health problems. By permitting states to act as laboratories for innovative health policies, the
federalist system can, in theory, sort out effective from less effective interventions.
State and local governments are the primary payer for mental health services
Report of the Surgeon General on Mental Health 1999
[http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html#approach] JH
State and local government has been the major payer for public mental health services historically and remains
so today. Since the mid-1960s, however, the role of the Federal government has increased. In addition to Medicare
and Medicaid, the Federal government funds special programs for adults with serious mental illness and children with serious emotional disability.
Although small in relation to state and local funding, these Federal programs provide additional resources. They
include the Community Mental Health Block Grant, Community Support programs, the PATH program for people
with mental illness who are homeless, the Knowledge Development and Application Program, and the Comprehensive Community
Mental Health Services for Children and Their Families Program.
States have emerged as leaders and innovators in transforming health policy in

America
Howard Leichter, Health Policy Reform in America: Innovations from the States, 1997. [Chapter 1, p. 3-4
http://www.questia.com/PM.qst?a=o&d=37781730] JH
Although it would be misleading to suggest that the states have shown greater inventiveness in one particular
area of public concern than in others, few areas have stimulated as much creativity, activity, and interest as
that of health policy. Faced with problems involving access, cost containment, the quality of health care, and the promotion of
responsible life-styles, state governments have assumed new roles and obligations in the area of health policy. This
book is about some of the recent state efforts to meet these challenges. The purpose of this chapter is to examine both the conditions that have fostered
increased state policy innovation and reform in general and those that relate specifically to the health field. The story that will unfold is one of federal
retreat, unprecedented demands on the health care system, and a fundamental reorientation in the way both medical professionals and the general
public have come to think about the problem of ill health. Political, philosophical, epidemiological, and life-style changes have
conspired to relocate the locus of health policymaking in this country to the state capitals. All this is not to
suggest that the federal government has meekly abandoned the field to the states. The chapters in this book tell a story of
continued active federal involvement and rekindled interest in the health policy arena. Yet that involvement and interest is often in the form of
piecemeal responses to chronic health policy problems rather than attempts at fundamental policy change. Nothing the federal government
has done in the last decade in health policy has been as innovative or controversial, as, say, the Oregon experiment in health
care rationing for Medicaid recipients. Nor has the national government been as attentive or responsive to the health care needs of the
American people as many of the state governments described in the chapters in this volume.
2010 NFA-LD
Evidence Set
Extensions – Multi-Actor Fiat Good

1. Multiple Actor fiat is good for several reasons.
a. Multiple Actor Fiat is normally accepted. The AFF generally fiats how the president,
congress, and the courts will act with regard to a particular policy, and this has never
been theoretically controversial.
b. Almost all AFF plans require action by multiple agents. Reciprocity stipulates that
the NEG should be given the same freedom.
2. Fifty-State fiat is good for several reasons.
a. No Bright Line – their multiple actor claims do not have a bright line. The USFG is
made up of multiple actors – a president, his cabinet, nine Supreme Court justices, and
535 people on capitol hill.
b. Heart of the Topic – the issue of federalism and states rights is at the very heart of the
topic. Our evidence proves this to be true. There is no abuse, because the CP is
grounded in topic literature.
c. Real-world – 50 state action is a consideration in real policies, especially civil liberties.

Furthermore real world organizations such as the National Governors Association exist
for the coordination of uniform policy decisions between all 50 states.
d. Not a voter – at most, reject the argument, not the team. The use of this CP does not
warrant voting down the NEG.
2010 NFA-LD
Evidence Set
AFF Answers – States CP 1/
An expanded federal role in mental health policy is needed to transform the

system. States alone will fail to solve.
Mental Health America policy position statement, June 2006 [Position statement 14: the federal government’s
responsibilities for mental health services, http://www.nmha.org/go/position-statements/14] JH
Many considerations –ranging from social justice to economic self-interest -- make it imperative that the federal
government assume a major, focused, coordinated role in mental health policy, a role both different and larger than it
currently plays. Among the many factors dictating a robust federal role is the extraordinary toll –in disability, productivity, and premature death –that
mental illness takes in this country. Time after time, the federal government, armed with scientific tools, has responded aggressively to looming risks of
disease endangering its citizens. In the 1960s, the federal government founded community mental health centers to begin to make community-based
mental health treatment a reality. Expansion of Medicare and Medicaid coverage in the last 30 years increased coverage of some community mental
For nearly 200 years, states have played a
health services. But both of those initiatives are spent, and a new federal role is needed.
major role in the provision of mental health services. As the New Freedom Commission’s reports document so clearly, we now
have a complex patchwork of services that provides vastly different types and levels of care for people in the
various states. And the increasing budget pressures on states make it difficult for any state to re-tool current
service structures, much less undertake leadership initiatives. Just as federal leadership was needed in the
1960’s to show the way toward community-based service systems rather than the longstanding reliance on asylums, federal
leadership is needed today.
States lack the funds to adequately pay for mental health services
Daniel Eisenberg and Richard Scheffler, Mental Health Financing in the United States, 2003 [http://www-
personal.umich.edu/~daneis/papers/mentalhealthftm.pdf] JH
Although the public sector plays a large role in providing mental health services, many would argue that its
funding is still woefully inadequate. In the tight fiscal times of the past couple years, many state mental health budgets
have been hit hard. Hogan suggests that state mental health funding has been eroding even in good economic times,
largely because many state mental health systems decentralized during the 1990s. During this period state governments
devolved administration and responsibilities for mental health services to the county and community levels. As a result, mental health
funding frequently lost its foothold as a fixed state budget item tied to inflation. By 1999, decentralization had reached the
point where three quarters of the nation’s population lived in states where mental health service responsibilities were held by county-based
organizations.
States must balance budgets and can’t raise taxes, making it impossible for
them to pay for reforms
Frank Thompson, Federalism and Health Care Policy, 2001 [Toward Redefinition, The New Politics of State Health
Policy, Chapter 2] JH
Or consider issues of state fiscal capacity. Analysts have long understood that state capacity to deal with cyclical downturns
in the economy tends to be less than that of the federal government due to legal requirements that states
balance their budgets and their inability to print money. Over the last 25 years, however, the repeated triumphs of
the antitax movement have further eroded the fiscal capacity of many states. As of the late 1990s, over half of
the states had added tax or expenditure limitations to their constitutions or statutes. These provisions assume myriad forms,
but all of them add to the hurdles that state policymakers must jump to increase tax rates or appropriate monies beyond a certain increment. The
provisions tend to add decision sites to the fiscal policy process (e.g., require voter approval of a choice made by the legislature) or mandate that
supermajorities (e.g., a two-thirds voe of both houses of the legislature) approve certain tax or expenditure decisions . These measures make it
all the more difficult for states to increase their support for Medicaid or other health programs through greater tax
effort.
2010 NFA-LD
Evidence Set
AFF Answers – States CP 2/
The recession is destroying the states’ abilities to pay for mental health services
Christine Vestal, Stateline Staff Writer, July 19 2010 [As economy takes toll, mental health budgets shrink,
http://www.stateline.org/live/details/story?contentId=499181] JH
Mental health policies in America have changed radically over the past 60 years. A one-time emphasis on caring for
patients in large institutions has shifted to treating them in outpatient settings in the community. The ways mental disorders are diagnosed and
categorized have changed. And the use of psychotropic medications is more prevalent than it used to be. But throughout the decades, one
thing has remained the same. States have taken the lead role in publicly funded care for the mentally ill, and
paid the majority of the expenses. Even through recessions, the states have steadily increased their mental
health budgets every year to meet increasing demand. Now, as states face their biggest fiscal challenge in modern
history, the trend has reversed. For the first time in more than three decades, mental health funding is
declining. The drop-off is translating into a reduction in the number of psychiatric hospital beds, as well as fewer services for mental health
emergencies and longer waiting lists for housing for the chronically mentally ill. The cuts are coming just as some experts say
economic pressures are creating an increase in mental illness.
It is inaccurate to consider states as the source of innovation in health policy,

most innovation comes from federal funds
Thomas Oliver, State Health Politics and Policy, 2001 [Rhetoric, Reality, and the Challenges Ahead, The New Politics
of State Health Policy, Chapter 11] JH
The rhetoric of states as laboratories assumes that innovations spread from state to state or from states to the
federal government, whereas the empirical record demonstrates that there is considerable interaction between state and
federal debates and policies, and some innovations diffuse from the federal level downward. In fact, states are often
dependent on the federal government for research and development projects, which produce the technical instruments such as
DRGs and risk adjusters for HMO capitation. Sparer and Brown (1996) suggest that state innovations are frequently the joint product of federally funded
scientists and state laboratories. States also commonly depend on federal funding to support “innovations”; the Oregon Health
Plan, TennCare, and the vast majority of children’s health insurance expansions would not have gone forward without federal endorsement and funding.
Finally, state actions are often facilitated by federal political pressure, even when federal policymakers ultimately
cannot reach agreement on reforms of their own. The president’s Commission on Health Care Quality spawned a number of bills of
rights for patients at the state level, for example. The 1992 Synar amendment to prohibit sales of tobacco products to minors as well as the ultimately
unsuccessful attempt of the Food and Drug Administration to regulate nicotine as an addictive substance both greatly accelerated state policies to
restrict teen smoking. Thompson notes how the Health Care Financing Administration sent four separate letters between 1998 and 2000 to state
officials, warning them to increase their efforts to boost enrollment in Medicaid and SCHIP. Ultimately, it is inaccurate and simplistic to
regard states as the primary engines of policy innovation.
2010 NFA-LD
Evidence Set
***Federalism DA – Index***
***Federalism DA – Index***...........................................................107
Federalism DA – 1NC Shell – 1/3.......................................................108
Extensions – Link.....................................................................111
AFF Answers – Federalism 1/2..........................................................112
AFF Answers – Federalism 2/2..........................................................113
2010 NFA-LD
Evidence Set
Federalism DA – 1NC Shell – 1/3
A. Uniqueness – States are reasserting their rights to regulate the social

services provided to their citizens, and the federal government is not putting up
a fight.
Harold Jackson, writer for the Philadelphia Inquirer, July 25 2010 [States rights: A 19th-century concept rears its
head again, http://www.philly.com/inquirer/columnists/20100725_States_rights__A_19th-century_concept_rears_its_head_again.html]
JH
Americans today have so many distractions that few realize their country has been gripped by a critical debate
over states' rights that parallels the pre-Civil War argument over preserving the Union. That's not to say people are ready to meet on the
battlefield, brother against brother, to settle the current dispute. But today's arguments could have an effect on the role of the
federal government that is just as profound. From immigration and health-care reform to abortion rights and gay
marriage, states are asserting the right to regulate the legal status and social conduct of their residents.
Conservative courts may lean in their favor, and Congress appears too politically divided to put up a fight.
B. Link – 1. States are the primary payers for mental health services, the plan
undermines states role by expanding the power of the federal government.
Robert Erickson, Nevada County Health and Human Services Agency, 2003
[http://www.mynevadacounty.com/bh/index.cfm?ccs=717&cs=640] JB
In the United States, Mental Health services are usually a function of states, not counties. For a variety of reasons,
some financial, some philosophic, California has opted to have counties be the primary operators of its mental health system, while the state retains
primary responsibility for funding the system. This is an unusual model . In most of the country, the state is still the level of
government that provides the service. The federal government takes very little responsibility for mental health
care. Its chief contribution is through the Medicaid program, known in California as Medi-Cal. This is essentially an
insurance program for which the federal share is about 50%. The federal government also provides relatively small amounts for
services through competitive grants.
2. The Supreme Court has consistently upheld the right of states to care for the
mentally ill, the plan reverses this trend by passing mental health law that
overrides the states.
Supreme Court Justice Thomas dissenting in US v. Comstock, May 17 2010
[http://www.supremecourt.gov/opinions/09pdf/08-1224.pdf] JH
This Court, moreover, consistently has recognized that the power to care for the mentally ill and, where
necessary, the power “to protect the community from the dangerous tendencies of some” mentally ill persons,
are among the numerous powers that remain with the States. Addington v. Texas, 441 U. S. 418, 426 (1979). As a
consequence, we have held that States may “take measures to restrict the freedom of the dangerously
mentally ill”—including those who are sexually dangerous—provided that such commitments satisfy due process and other
constitutional requirements. Kansas v. Hendricks, 521 U. S. 346, 363 (1997).
2010 NFA-LD
Evidence Set
C. Internal Link – 1. Increasing intrusion into state affairs will completely destroy
federalism in America.
Samuel Rohrer, PA state representative, Tenth Amendment Center, March 9th 2009. (Samuel E., Pennsylvania
state rep. 128th district, “The Necessity for Action” Tenth Amendment Center, March 9, 2009. http://www.tenthamendmentcenter.com/2009/03/09/the-
necessity-for-action/)
Sometimes thought of as an afterthought, to “sweep up” anything the Founders may have forgotten,
the 10th Amendment today is taking
on monumental importance as increasing federal intrusion into state affairs threatens to completely destroy the
balance between state and federal power. In the Federalist Papers, authors Jay, Madison, and Hamilton labored to convince a monarch-
shy colonial population that they needed a strong government to preserve a free, cohesive nation. The authors took pains to outline how the
Constitutional structure of the government would prohibit the federal government from becoming big enough to overwhelm the powers of both the states
and the democratic process. The 10th Amendment was foundational to this system of checks and balances, constitutionally restricting the federal
government to covering issues related to commerce, national defense, the postal system, and the like. “Power begets power,” though, as the
saying goes, and the federal government slowly began expanding its powers. One of the most effective and
insidious ways that the federal government has taken over control of state affairs is by first passing a mandate
and then offering federal money to states with significant strings attached. Whether the issue is welfare, Real ID, No Child Left Behind, or
health insurance programs, tantalizing packages have been dangled in front of state governors and legislators, promising to
stop the budget gap or expand a politically successful program. States have taken the money and over time, the requirements
and restrictions on those state funds have slowly but surely changed the direction of state policy. Instead of
developing programs to fit the needs of state citizens and altering them to best use the state resources, programs are instead clumsily built around the
federal funding requirements, so the state does not lose a single available dollar. This significant paradigm shift should be a wake-up call to every citizen
not only in Pennsylvania, but also across the nation. Therefore, because the Supreme Court allowed the federal government to offer funds on
conditions, states have subjected themselves to Washington. This submission completely distorts the checks and balances
inherent in our Constitution, and enshrined in the 10th Amendment.
2. US federalism globally modeled

Steven Calabresi, Professor at Northwestern, Michigan Law Review in 1995. (Steven Calabresi, Assistant Prof –
Northwestern U., 1995, Michigan Law Review, 94 Mich. L. Rev. 752, p. lexis)
U.S.-style constitutional federalism has become the order of the day in an extraordinarily large
At the same time,
number of very important countries, some of which once might have been thought of as pure nationstates. Thus, the Federal Republic of
Germany, the Republic of Austria, the Russian Federation, Spain, India, and Nigeria all have decentralized power by adopting constitutions that are
significantly more federalist than the ones they replaced. Many other nations that had been influenced long ago by American
federalism have chosen to retain and formalize their federal structures. Thus, the federalist constitutions of Australia,
Canada, Brazil, Argentina, and Mexico, for example, all are basically alive and well today. As one surveys the world in 1995, American-style
federalism of some kind or another is everywhere triumphant, while the forces of nationalism, although still
dangerous, seem to be contained or in retreat. The few remaining highly centralized democratic nation-states like Great Britain,
France, and Italy all face serious secessionist or devolutionary crises. Other highly centralized nation-states, like China, also seem
ripe for a federalist, as well as a democratic, change. Even many existing federal and confederal entities seem
to face serious pressure to devolve power further than they have done so far: thus, Russia, Spain, Canada, and Belgium all
have very serious devolutionary or secessionist movements of some kind. Indeed, secessionist pressure has been so great that some federal structures
recently have collapsed under its weight, as has happened in Czechoslovakia, Yugoslavia, and the former Soviet Union. All of this still could be
threatened, of course, by a resurgence of nationalism in Russia or elsewhere, but the long-term antinationalist trend seems fairly secure.
There is no serious intellectual support for nationalism anywhere in the world today, whereas everywhere people seem interested in exploring new
transnational and devolutionary federal forms. The democratic revolution that was launched in Philadelphia in 1776 has won, and now it seems that
democrats everywhere join Madison in "cherishing the spirit and supporting the character of federalists."
2010 NFA-LD
Evidence Set
D. Impact – This solves massive global war

Calabresi as previously cited. (Steven Calabresi, Assistant Prof – Northwestern U., 1995, Michigan Law Review,
94 Mich. L. Rev. 752, p. lexis)
federalism is a good thing, and it is the best and most

First, the rules of constitutional federalism should be enforced because
important structural feature of the U.S. Constitution. Second, the political branches cannot be relied upon to
enforce constitutional federalism, notwithstanding the contrary writings of Professor Jesse Choper. Third, the Supreme Court is
institutionally competent to enforce constitutional federalism. Fourth, the Court is at least as qualified to act in this area as it is in the Fourteenth
Amendment area. And, fifth, the doctrine of stare decisis does not pose a barrier to the creation of any new, prospectively applicable Commerce Clause
case law. The conventional wisdom is that Lopez is nothing more than a flash in the pan. Elite opinion holds that the future of American constitutional
law will involve the continuing elaboration of the Court's national codes on matters like abortion regulation, pornography, rules on holiday displays, and
rules on how the states should conduct their own criminal investigations and trials. Public choice theory suggests many reasons why it is likely that the
Court will continue to pick on the states and give Congress a free ride. But, it would be a very good thing for this country if the Court decided to surprise
us and continued on its way down the Lopez path. Those of us who comment on the Court's work, whether in the law reviews or in the newspapers,
should encourage the Court to follow the path on which it has now embarked. The country and the world would be a better place if it did. We have seen
that a desire for both international and devolutionary federalism has swept across the world in recent years. To
a significant extent, this is due to global fascination with and emulation of our own American federalism
success story. The global trend toward federalism is an enormously positive development that greatly
increases the likelihood of future peace, free trade, economic growth, respect for social and cultural diversity,
and protection of individual human rights. It depends for its success on the willingness of sovereign nations to strike federalism deals in
the belief that those
deals will be kept. The U.S. Supreme Court can do its part to encourage the future striking of such deals by enforcing vigorously our own American
federalism deal. Lopez could be a first step in that process, if only the Justices and the legal academy would wake up to the importance of what is at
stake.
2010 NFA-LD
Evidence Set
Extensions – Link
The US House of Representatives, as well as the courts have recognized and

upheld the states’ right to treat the mentally ill.
Robert Long and Ann O’Connell, Brief For Respondents, US v. Comstock, October 2009
[http://www.abanet.org/publiced/preview/briefs/pdfs/09-10/08-1224_Respondent.pdf] JH
As a committee of the House of Representatives noted in refusing to expand the federal role in civil
commitment, “[c]ommitment and treatment of the mentally ill has traditionally been left to the states pursuant to
their parens patriae or general police power. The Federal government has no such authority.” H.R. Rep. No. 96-1396, at 561
(1980), quoted in Cohen, 733 F.2d at 137.13 The historical record bears out this conclusion, see Samuel Jan Brakel et al., The
Mentally Disabled and the Law 22 (3d ed. 1985); Albert Deutsch, The Mentally Ill in America 137-41 (2d ed. rev. 1949), and courts have long
recognized it. See generally Note, Federal Hospitalization of Insane Defendants Under Section 4246 of the Criminal Code, 64 Yale L.J. 1070, 1070
n.2 (1955) (collecting cases)
The US House of Representatives has stated that the treatment of the mentally ill
is a power that belongs with the states.
US House of Representatives Judiciary Committee, 1980, quoted by Justice Antonin Scalia, writing the majority
opinion for the US Circuit Court of Appeals, District of Columbia in US v. Cohen, 1984.
http://ftp.resource.org/courts.gov/c/F2/733/733.F2d.128.81-1036.html JH
The Committee recognizes that the Federal government is one of specifically enumerated powers. State governments, on the other hand, may act in any
given area unless specifically prohibited by the Constitution. Commitment and treatment of the mentally ill has traditionally been
left to the states pursuant to their parens patriae or general police power. The Federal government has no such authority. Foote,
A Comment on Pre-Trial Commitment of Criminal Defendants, 108 U.Pa.L.Rev. 832 (1960).... [The report then considers in detail whether Congress has
the constitutional authority to provide for a nationwide federal commitment procedure, but draws no firm conclusion.]15 … In view of these
considerations, the Committee believes that a Federal procedure for the commitment of the dangerously
mental[ly] disturbed would constitute an inappropriate interference with the balance of Federal and State
powers. Moreover, such a procedure could constitute a precedent for further Federal involvement in the care of
the mentally ill. Once the Federal Government takes on the task of caring for the dangerously mental[ly] ill that become involved
in the Federal criminal system, Congress would most likely be asked to expand the Federal role even further. For
example, legislation might be proposed allowing the Federal Government to take over State mental health
institutions, or to accept the transfer of those incarcerated there, when the State is allegedly not doing a satisfactory job. The Committee thus
believes that the care of the mentally ill is a task that uniquely belongs within the parens patriae powers of the
States.
H.R.REP. NO. 1396, 96th Cong., 2d Sess. 559, 561 (1980). If we were reviewing this aspect of the legislation as though it were merely the rule of a
federal agency, we could hardly ask for a clearer and more persuasive statement of basis and purpose.
2010 NFA-LD
Evidence Set
AFF Answers – Federalism 1/2
The federal role in funding mental health is changing in the status quo, most of
the funding now comes from the feds.
Daniel Eisenberg and Richard Scheffler, Mental Health Financing in the United States, 2003 [http://www-
personal.umich.edu/~daneis/papers/mentalhealthftm.pdf] JH
Although the state and local levels organize and administer much of the publicly funded mental health care, the
original source of funding has increasingly been federal programs, including Medicare, Medicaid, Social Security
Disability (SSD) and Social Security Income (SSI). Predictably, Medicare’s contribution has grown with the aging of the population. Medicaid is
growing even faster. According to a study by Jeffrey Buck of the Substance Abuse and Mental Health Services Administration (SAMHSA), Medicaid
accounted for one third of state and local public mental health spending in 1987, one half in 1997, and may grow to
two thirds by 2017. Medicaid’s share has risen largely due to expansion of eligibility terms for recipients, as well as efforts by states to maximize
federal revenue by shifting state funded items to Medicaid funded items. Medicaid is set up as a “matching grant” in which the federal government
matches the state’s contribution at a rate determined by the state’s per capita income (poorer states receive more favorable rates).
The federal government already takes part in all aspects of public health policy
Lawrence Gostin, Public Health Law, 2000 [Public Health Law: Power, Duty, Restraint. Gostin is the former Legal Director
of the National Association of Mental Health] JH
The modern role of the federal government in public health is broad and complex. Public health functions, which include
public funding for health care, safe food, effective drugs, clean water, a beneficial environment, and prevention services, can be found in an array of
agencies. The bulk of all health responsibilities lies with the Department of Health and Human Services and its many subparts. However, the Department
of Agriculture, the Department of Labor, and the Environmental Protection Agency, to name a few, also have important public health functions. As the
United States has garnered more resources (principally through a national income tax) and as the Supreme Court has
permitted direct and indirect regulation (under the powers to tax, spend, and control commerce), the federal
presence in public health has grown. Today, it is nearly impossible to find a field of public health that is not
heavily influenced by United States government policy.
Non-unique: Obama is not a federalist.

Gene Healy, writer for the CATO institute, DC Examiner, 2009 [Obama’s Phony Federalism,
http://www.cato.org/pub_display.php?pub_id=10971] JH
Not yet a year into his administration, Obama's record on 10th Amendment issues is already clear: He'll let the
states have their way when their policies please blue team sensibilities and he'll call in the feds when they
don't. Thus, he'll grant California a waiver to allow it to raise auto emissions standards, but he'll bring the hammer down when the state tries to cut
payments to unionized health care workers. That's not how it's supposed to work. As Madison explained in Federalist 45, the powers delegated to the
federal government were "few and defined," to be exercised mainly on "external objects" like foreign policy and international trade. All else — criminal
law, marriage, social policy — remained with the states or the people. Of course, No. 45 also contains one of the Federalist's saddest sentences, in
which Madison predicts that federal tax collectors will be "principally on the seacoast, and not very numerous." (Sometimes the Framers weren't all that
prescient.) Indeed, the federal government's massive power to tax and spend has increasingly allowed it to
trample state prerogatives. As the $786 billion stimulus package came online this year, for the first time ever,
federal aid surpassed the sales tax as the largest source of revenue for the states. "This money isn't manna from
heaven," warned Indiana state Sen. Jim Buck, "it comes with a price."
2010 NFA-LD
Evidence Set
AFF Answers – Federalism 2/2
Non-unique – Federalism is dead – stimulus states to take money and to use it as the
federal government mandated
Staff researcher for the Ethan Allen Institute, March 2009. (EAI – free market public-policy think tank, “The Murder of
Federalism,” March 2009, http://www.ethanallen.org/commentary.php?commentary_id=372)
The Stimulus bill, its effects sharply illustrated by Gov. Sanford’s letter, opens possibly the final chapter in the long-running
demise of federalism. Forty years ago, the federal government offered states money to do what the Federal government wanted done; states
could decline, and thus got no money. Then, with the 55-mph speed limit and increased drinking age laws, Congress informed the states that unless
they did Congress’s bidding, not only would they not get the money, but they would lose other money already granted (“crossover sanctions”). Now
Congress is telling the states that they must take the money, and they must use it as Congress directs,
regardless of effects on state budgeting, taxation and responsibilities. For instance, the Stimulus bill reverses the landmark
welfare reform legislation of 1996 by rewarding states for adding people to the welfare rolls, instead of helping them find gainful employment. To the
extent that Stimulus funds pay for infrastructure improvements, broadband deployment, debt reduction and other one-time projects, the states can
benefit (at the expense of future generations). But to the extent the act changes entitlements and creates expectations of
subsidies that are not likely to continue beyond 2011, the venerable American principle of federalism will enter
its terminal decline. That this was done by a wholly irresponsible Congress, voting through a 1,434 page bill
almost overnight, makes the murder of federalism even more deplorable.
Non-unique – Federalism no longer exists

Brian Garst, MA in Political Science from West Florida, February 2nd, 2009. (Brian, M.A. in Political Science,
Security and Diplomacy from the University of West Florida, 2/25/09 http://conservative-compendium.com/wordpress/2009/02/stimulus-
marks-the-death-of-federalism/ )
If federalism wasn’t dead already, the “stimulus” killed it. That is, the relationship between the federal
government and the states has become so distorted compared to the original conception held by our founders
that it would make little practical difference if we just went ahead and abolished the concept of states
altogether. The Constitution designed a system in which the states share sovereignty with a federal government. According to Madison, the powers
of the federal government were to be “few and defined,” while those remaining with the states would be “numerous and indefinite.” This is no longer so.
The federal government now has the final say in most areas which used to be the sole responsibility of the
states. Criminal law, an area left exclusively to the respective states, is becoming ever more federalized. Obeying the laws of
California and growing pot for medical use is no protection from federal agents. Whatever one might think of this behavior, it’s the voters of California
who should get the final say.A fifty-five mph speed limit, promptly ignored by most motorists, was dictated to the states by passage of the 1974
Emergency Highway Energy Conservation Act. Although the national speed limit was later repealed in 1995, numerous federal standards remain, such
as the minimum ages for drinking and smoking. The federal government has largely accomplished this power grab by
opening the spigot of federal dollars, then threatening to cut off any state that doesn’t kowtow to Washington’s
demands.So when a number of governors of both parties balked at taking federal money for unemployment
insurance, knowing that they would be stuck with the bill of an expanded government welfare mandate when
the federal funds expired, it should come as no surprise that the beltway response was to attempt to denigrate
and browbeat the rogue states into compliance. Democratic Senator Charles Schumer responded to their rejection of federal funds by
admonishing governors for playing “political games,” then boldly declared, “whether the governors want to or not, they can be forced to take the whole
thing.” This astonishing declaration strikes at the heart of our federalist system. Even the race card has been played to
shame governors into accepting the dictates of Washington, such as when democratic House member James Clyburn shamelessly alleged that any
rejection of stimulus money, and the strings that came with it, amounts to “a slap in the face of African-Americans.” Not all states have the foresight to
resist such federal encroachments. State financial shortfalls and a narrow view of state interest leads some, such as California Governor Arnold
Schwarzenegger, to turn to Washington hat in hand. Aside from the eventual subjugation of state authority, funneling federal dollars into the states also
leads to significant waste. No longer dependent on their constituents for financial support, the states become rent-seekers looking to game the federal
system. This is why 250,000 Washington State residents recently received a $1 check in the mail. As a reward for this wasteful spending, the federal
government will pump into the state millions in new welfare funds. This seemingly irrational and grossly wasteful spending is encouraged by the present
system, where states have financial incentives to meet federal bureaucratic rules that allow them to qualify for more funding. The impact on the taxpayer
is simply not important to the state in this calculus. Alexander Hamilton described the balance between national and state governments as one of
“utmost importance” that should be “dwelt on with peculiar attention.” Yet hardly a thought was given by Congress to this fundamental principle when it
2010 NFA-LD
Evidence Set
hastily passed almost $1 trillion in new federal spending, $144 billion of which has been designated for state consumption. And so we must now repeat
in vain Thomas Jefferson’s wish “never to see all offices transferred to Washington.”
2010 NFA-LD
Evidence Set
***Complementary and Alternative Medicine

NEG – Index***
***Complementary and Alternative Medicine NEG – Index***..............................114
CAM K Shell 1/3.......................................................................115
CAM K Shell 2/3.......................................................................116
CAM K Shell 3/3.......................................................................117
CAM Solvency Takeout 1/2..............................................................118
CAM Solvency Takeout 2/2..............................................................119
Extensions 1/3........................................................................120
Extensions 2/3........................................................................121
Extensions 3/3........................................................................122
2010 NFA-LD
Evidence Set
CAM K Shell 1/3
A. Framework – The overriding framework of policy debates is found in the

ability to debate at all. The preservation of “Stasis,” or the point at which we
know how we can disagree, is what we must have to communicate and argue at
all.
Timothy M. O’Donnell, Director of Debate at University of Mary Washington. 2004 [“And the Twain Shall Meet:
Affirmative Framework Choice and the Future of Debate.” Blue Helmet Blues: United Nations Peacekeeping and the United States.
Debaters’ Research Guide. 2004http://groups.wfu.edu/debate/MiscSites/DRGArticles/DRGArtiarticlesIndex.htm.]
When we
According to the Oxford English Dictionary, a framework consists of “a set of standards, beliefs, or assumptions” that govern behavior.
speak of frameworks in competitive academic debate we are talking about the set of standards, beliefs, or
assumptions that generate the question that the judge ought to answer at the end of the debate. Given that
there is no agreement among participants about which standards, beliefs, or assumptions ought to be
universally accepted, it seems that we will never be able to arrive at an agreeable normative assumption about
what the question ought to be. So the issue before us is how we preserve community while agreeing to
disagree about the question in a way that recognizes that there is richness in answering many different
questions that would not otherwise exist if we all adhered to a “rule” which stated that there is one and only one
question to be answered. More importantly, how do we stop talking past each other so that we can have a genuine conversation about the
substantive merits of any one question?
The answer, I believe, resides deep in the rhetorical tradition in the often-overlooked notion of stasis. Although the
concept can be traced to Aristotle’s Rhetoric, it was later expanded by Hermagoras whose thinking has come down to us through the Roman
rhetoricians Cicero and Quintillian. Stasis is a Greek word meaning to “stand still.” It has generally been considered by argumentation
scholars to be the point of clash where two opposing sides meet in argument. Stasis recognizes the fact that
interlocutors engaged in a conversation, discussion, or debate need to have some level of expectation
regarding what the focus of their encounter ought to be. To reach stasis, participants need to arrive at a
decision about what the issue is prior to the start of their conversation. Put another way, they need to mutually
acknowledge the point about which they disagree.
What happens when participants fail to reach agreement about what it is that they are arguing about? They
talk past each other with little or no awareness of what the other is saying. The oft used cliché of two ships passing in the
night, where both are in the dark about what the other is doing and neither stands still long enough to call out to the other, is the image most commonly
used to describe what happens when participants in an argument fail to achieve stasis. In such situations, genuine engagement is not possible because
participants have not reached agreement about what is in dispute. For example, when one advocate says that the United States should increase
international involvement in the reconstruction of Iraq and their opponent replies that the United States should abandon its policy of preemptive military
engagement, they are talking past each other. When such a situation prevails, it is hard to see how a productive conversation can ensue.
I do not mean to suggest that dialogic engagement always unfolds along an ideal plain where participants always can or even ought to agree on a
mutual starting point. The reality is that many do not. In fact, refusing to acknowledge an adversary’s starting point is itself a powerful strategic move.
However, it must be acknowledged that when such situations arise, and participants cannot agree on the issue about which they disagree, the chances
that their exchange will result in a productive outcome are diminished significantly. In an enterprise like academic debate, where the goals of the
encounter are cast along both educational and competitive lines, the need to reach accommodation on the starting point is urgent. This is especially the
case when time is limited and there is no possibility of extending the clock. The sooner such agreement is achieved, the better. Stasis helps us
understand that we stand to lose a great deal when we refuse a genuine starting point.
So in essence, we must agree upon what we are disagreeing upon, this is the
heart of all academic debate.
2010 NFA-LD
Evidence Set
CAM K Shell 2/3

Link –
1.The affirmative argument is advocating for the use of complimentary and

alternative medicine.
2. CAM is not logically based—it is illogical, vacuous, nonsensical, and not

accountable to facts and systematic research. It fails to participate in a medical
or scientific dialogue that the resolution suggests.
Stephen Barrett, M.D., June 8, 2010. [“Be Wary of "Alternative" Health Methods”
http://www.quackwatch.org/01QuackeryRelatedTopics/altwary.html] Garcia JG
Under the rules of science, people who make the claims bear the burden of proof. It is their responsibility to
conduct suitable studies and report them in sufficient detail to permit evaluation and confirmation by others.
Instead of subjecting their work to scientific standards, promoters of questionable "alternatives" would like to
change the rules by which they are judged and regulated. "Alternative" promoters may give lip service to these
standards. However, they regard personal experience, subjective judgment, and emotional satisfaction as
preferable to objectivity and hard evidence. Instead of conducting scientific studies, they use anecdotes and
testimonials to promote their practices and political maneuvering to keep regulatory agencies at bay. As noted in a
1998 New England Journal of Medicine editorial: What most sets alternative medicine apart . . . is that it has not been scientifically tested and its
advocates largely deny the need for such testing. By testing, we mean the marshaling of rigorous evidence of safety and efficacy, as required by the
Food and Drug Administration (FDA) for the approval of drugs and by the best peer-reviewed medical journals for the publication of research reports. Of
course, many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges
that this is a failing that needs to be remedied. Many advocates of alternative medicine, in contrast, believe the scientific method is simply not applicable
to their remedies
Alternative medicine also distinguishes itself by an ideology that largely ignores biologic mechanisms, often
disparage modern science, and relies on what are purported to be ancient practices and natural remedies
(which are seen as somehow being simultaneously more potent and less toxic than conventional medicine).
Accordingly, herbs or mixtures of herbs are considered superior to the active compounds isolated in the
laboratory. And healing methods such as homeopathy and therapeutic touch are fervently promoted despite
not only the lack of good clinical evidence of effectiveness, but the presence of a rationale that violates
fundamental scientific laws—surely a circumstance that requires more, rather than less, evidence [5].
D. Implication – Debatability suffers as a result of this abhorrent lack of stasis.

Having been deprived of any entry point into a conversation of medicine or
science, the stasis point about which the resolution refers is lost.
2010 NFA-LD
Evidence Set
CAM K Shell 3/3
E. Alternative – As a policy maker, you have an alternative: Reject CAM and find
stasis though the AMA code of medical ethics, which is a systematic and widely
accepted code that explicitly rejects CAM practices.
Kimball C Atwood, IV, MD., March 2004 [“Naturopathy, Pseudoscience, and Medicine: Myths and Fallacies vs. Truth”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140750/?tool=pubmed] Garcia JG
The argument that the best way for MDs to deal with pseudoscientific practitioners is to collaborate with them,
and thus coax them to become more responsible, has been made before. [57] It is blind to the history of medicine and to the
nature of pseudoscience. It is likely to do far more harm than good, because it is perceived as an endorsement of
pseudoscientific practices and of the practitioners who perform them. Members of the public who are scientifically naive can't
be faulted for concluding, after hearing opinions such as those of Drs. Katz and Jacobson, that naturopathic claims are every bit as valid as anything in
medicine proper. Members of the public who are scientifically sophisticated are left scratching their heads, wondering why medicine has suddenly
squandered its hard-won scientific and ethical underpinnings. Either way, these dalliances undermine good medicine and public health.
For those reasons, such collaboration is a direct violation of at least 2 formal, modern statements of medical ethics. The recently published
Medical Professionalism in the New Millennium: A Physician Charter requires a Commitment to scientific
knowledge. Much of medicine's contract with society is based on the integrity and appropriate use of scientific
knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to
create new knowledge and ensure its appropriate use. [58]
The American Medical Association Code of Medical Ethics is even more explicit:
E-3.01 Nonscientific Practitioners.
It is unethical to engage in or to aid and abet in treatment which has no scientific basis and is dangerous, is
calculated to deceive the patient by giving false hope, or which may cause the patient to delay in seeking
proper care.
E-3.04 Referral of Patients.
A physician should not so refer a patient unless the physician is confident that the services provided on referral
will be performed competently and in accordance with accepted scientific standards…
E-8.20 Invalid Medical Treatment.
(1) Treatments which have no medical indication and offer no possible benefit to the patient should not be used (Opinion 2.035).
(2) Treatments which have been determined scientifically to be invalid should not be used (Opinion 3.01).
E-9.132 Health Care Fraud and Abuse.
The following guidelines encourage physicians to play a key role in identifying and preventing fraud:
(1) Physicians must renew their commitment to Section II of the AMA's Principles of Medical Ethics which states that “a physician shall deal honestly
with patients and colleagues, and strive to expose those physicians deficient in character, competence, or who engage in fraud or deception.”
V. A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the
public, obtain consultation, and use the talents of other health professionals when indicated. [59]
Physicians who consider naturopaths to be their colleagues thus find themselves in opposition to one of the
fundamental ethical precepts of modern medicine. If naturopaths aren't to be judged “nonscientific practitioners,” the term has no
useful meaning. An article by a physician exposing quackery, moreover, does not identify its author as “biased,” but simply as fulfilling one of his ethical
obligations as a physician.
Voting in such a manner (specifically for a system that does not allow for
illogical nonsense) will allow you as a policy-maker to explore the merits of
various policies on an equal playing field.
2010 NFA-LD
Evidence Set
CAM Solvency Takeout 1/2
A) Interpretation: The affirmative has a burden to meet solvency

requirements.
From the NFA-LD Rules:
“The affirmative must prove:

 The harm of the present system or that a comparative advantage or
goal can be achieved over the present system;
 The inherency which prevents solving those harms or achieving
those advantages or goals; and,
 The proposed plan's ability to solve the harm or achieve the
advantage or goal claimed by affirmative.
The negative may attack any of these issues, but need only win one to
win the debate.”
B) Violation:
1) The affirmative utilizes CAM to attempt to solve chronic mental illness
2) CAM lacks solvency because it is not based on evidence & lacks
credible research.
Alternative medical methods are not scientifically proven
Stephen Barrett, M.D June 8, 2010. [“Be Wary of "Alternative" Health Methods”
http://www.quackwatch.org/01QuackeryRelatedTopics/altwary.html] Garcia JG
Under the rules of science, people who make the claims bear the burden of proof. It is their responsibility to
conduct suitable studies and report them in sufficient detail to permit evaluation and confirmation by others.
Instead of subjecting their work to scientific standards, promoters of questionable "alternatives" would like to
change the rules by which they are judged and regulated. "Alternative" promoters may give lip service to these
standards. However, they regard personal experience, subjective judgment, and emotional satisfaction as
preferable to objectivity and hard evidence. Instead of conducting scientific studies, they use anecdotes and
testimonials to promote their practices and political maneuvering to keep regulatory agencies at bay. As noted in a
1998 New England Journal of Medicine editorial: What most sets alternative medicine apart . . . is that it has not been scientifically tested and its
advocates largely deny the need for such testing. By testing, we mean the marshaling of rigorous evidence of safety and efficacy, as required by the
Food and Drug Administration (FDA) for the approval of drugs and by the best peer-reviewed medical journals for the publication of research reports. Of
course, many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges
that this is a failing that needs to be remedied. Many advocates of alternative medicine, in contrast, believe the scientific method is simply not applicable
to their remedies
Alternative medicine also distinguishes itself by an ideology that largely ignores biologic mechanisms, often
disparage modern science, and relies on what are purported to be ancient practices and natural remedies
(which are seen as somehow being simultaneously more potent and less toxic than conventional medicine).
Accordingly, herbs or mixtures of herbs are considered superior to the active compounds isolated in the
laboratory. And healing methods such as homeopathy and therapeutic touch are fervently promoted despite
not only the lack of good clinical evidence of effectiveness, but the presence of a rationale that violates
fundamental scientific laws—surely a circumstance that requires more, rather than less, evidence [5].
2010 NFA-LD
Evidence Set
2010 NFA-LD
Evidence Set
CAM Solvency Takeout 2/2
C) Standards
1) Rules
The NFA-LD Rules state that the affirmative must prove the
plan’s ability to solve.
2) Education
By advocating for unproven and unscientific methods, the aff
plan degrades the inherent pedagogical value of debate.
3) Literature Base
Because the world of CAM lacks any objective over-sight and
does not follow logical research methods, the evaluation of
good vs. bad evidence in the literature base is impossible,
making debating its merits essentially futile.
4) Real-world policymaking
The resolution is meant to prompt plan-texts that can actually

solve real-world problems related to chronic mental illness.
Plan-texts that advocate CAM methods are unable to meet this
mandatory burden.
2010 NFA-LD
Evidence Set
Extensions 1/3
CAM ignores reasonable and logical research.

Kimball C Atwood, IV, MD., March 2004 [“Naturopathy, Pseudoscience, and Medicine: Myths and Fallacies vs Truth”
When these ordinary

These are the sorts of judgmental errors that have convinced followers of every ineffective healing claim throughout history.
effects are weighed against the extraordinary nature of those healing claims, it becomes clear which are more
likely to be real. Thus, we needn't invoke fantastic theories such as “water memory” (in violation of the second law of
thermodynamics), “toxin” cleansing programs, Qi, meridians, psychokinesis, “applied kinesiology,” “craniosacral rhythms,” “unruffling the human energy
field,” or “align[ing] the individual's body in a more true balance”[17] to explain why a patient feels better, when mundane
explanations will do. To ignore this sort of analysis is to ignore one of the fundamental truths of patient care.
Some, but not all, of these sources of error can be eliminated by randomized, controlled trials (RCTs). But
RCTs are subject to additional errors, including confounding biases, cuing and other subtle, unconscious
biases, post-hoc analyses, multiple testing artifacts, noncomparable study and control groups, other statistical
errors, erroneous conclusions, fraud, and more. That is why it is a fool's errand for advocates to perform
clinical trials of highly implausible claims. This has been discussed elsewhere, but in summary such research
inevitably results in equivocal, rather than merely negative, conclusions. “Further research” is invariably called
for, with no end in sight.
A basic definition
National Center for complimentary and Alternative Medicine, April 2010 [“What Is Complementary and Alternative
Medicine?” “http://nccam.nih.gov/health/whatiscam/] Garcia JG
NCCAM defines CAM as a group of diverse

Defining CAM is difficult, because the field is very broad and constantly changing.
medical and health care systems, practices, and products that are not generally considered part of
Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O.
(doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The
boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over
time, become widely accepted. "Complementary medicine" refers to use of CAM together with conventional
medicine, such as using acupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific
points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow
of qi and restore and maintain health. in addition to usual care to help lessen pain. Most use of CAM by Americans is complementary.
"Alternative medicine" refers to use of CAM in place of conventional medicine. "Integrative medicine" (also
called integrated medicine) refers to a practice that combines both conventional and CAM treatments for which
there is evidence of safety and effectiveness.
2010 NFA-LD
Evidence Set
Extensions 2/3
Despite well-funded governmental research, no concrete alternate treatment

methods have been found
AP Staff Writer, 6/10/2009 [“$2.5 billion spent, no alternative cures found“ http://www.msnbc.msn.com/id/31190909/]
Garcia JG
Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that
work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do. Echinacea
for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate
problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center
for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.
As for therapies, acupuncture has been shown to help certain conditions, and yoga, massage, meditation and other relaxation methods may relieve
symptoms like pain, anxiety and fatigue.
However, the government also is funding studies of purported energy fields, distance healing and other
approaches that have little if any biological plausibility or scientific evidence.
Taxpayers are bankrolling studies of whether pressing various spots on your head can help with weight loss,
whether brain waves emitted from a special "master" can help break cocaine addiction, and whether wearing
magnets can help the painful wrist problem, carpal tunnel syndrome.
The acupressure weight-loss technique won a $2 million grant even though a small trial of it on 60 people
found no statistically significant benefit — only an encouraging trend that could have occurred by chance. The
researcher says the pilot study was just to see if the technique was feasible. "You expect scientific thinking" at a federal science
agency, said R. Barker Bausell, author of "Snake Oil Science" and a research methods expert at the University
of Maryland, one of the agency's top-funded research sites. "It's become politically correct to investigate
nonsense."
Spending money on researching CAM is financially irresponsible

David Brown Washington Post Staff Writer Tuesday March 17, 2009 [“Critics Object to 'Pseudoscience' Center”
http://www.washingtonpost.com/wp-dyn/content/article/2009/03/16/AR2009031602139.html?hpid=sec-health] Garcia JG
The impending national discussion about broadening access to health care, improving medical practice and
saving money is giving a group of scientists an opening to make a once-unthinkable proposal: Shut down the
National Center for Complementary and Alternative Medicine at the National Institutes of Health.
The notion that the world's best-known medical research agency sponsors studies of homeopathy,
acupuncture, therapeutic touch and herbal medicine has always rankled many scientists. That the idea for its
creation 17 years ago came from a U.S. senator newly converted to alternative medicine's promise didn't help.
Although NCCAM has a comparatively minuscule budget and although it is a "center" rather than an "institute," making it officially second-class in the
NIH pantheon, the principle is what mattered. But as NIH's budget has flattened in recent years, better use for NCCAM's money has also become an
issue.
"With a new administration and President Obama's stated goal of moving science to the forefront, now is the
time for scientists to start speaking up about issues that concern us," Steven Salzberg, a genome researcher
and computational biologist at the University of Maryland, said last week. "One of our concerns is that NIH is
funding pseudoscience."
Salzberg suggested that NCCAM be defunded on an electronic bulletin board that the Obama transition team set up to solicit ideas after November's
election. The proposal generated 218 comments, most of them in favor, before the bulletin board closed on Jan. 19.
NCCAM has grown steadily since its founding in 1992, largely at the insistence of Sen. Tom Harkin (D-Iowa), as the Office of Alternative Medicine
(OAM) with a budget of $2 million. In 1998, NIH director and Nobel laureate Harold Varmus pushed to have all alternative medicine research done
through NIH's roughly two dozen institutes, with OAM coordinating, and in some cases paying for, the studies. Harkin parried with legislation that turned
OAM into a higher-status "center" (although not a full-fledged "institute"), and boosted its budget from $20 million to $50 million. NCCAM's budget this
year is about $122 million.
Research in alternative medicine is done elsewhere at NIH, notably in the National Cancer Institute, whose Office of Cancer Complementary and
Alternative Medicine also has a budget of $122 million.
2010 NFA-LD
Evidence Set
The entire NIH alternative medicine portfolio is about $300 million a year, out of a total budget of about $29 billion. (NIH will get an additional $10.4
billion in economic stimulus money over the next two years, of which $31 million is expected to go to NCCAM.)
2010 NFA-LD
Evidence Set
Extensions 3/3
CAM ignores reasonable and logical research.

Kimball C Atwood, IV, MD., March 2004 [“Naturopathy, Pseudoscience, and Medicine: Myths and Fallacies vs Truth”
When these ordinary

These are the sorts of judgmental errors that have convinced followers of every ineffective healing claim throughout history.
effects are weighed against the extraordinary nature of those healing claims, it becomes clear which are more
likely to be real. Thus, we needn't invoke fantastic theories such as “water memory” (in violation of the second law of
thermodynamics), “toxin” cleansing programs, Qi, meridians, psychokinesis, “applied kinesiology,” “craniosacral rhythms,” “unruffling the human energy
field,” or “align[ing] the individual's body in a more true balance”[17] to explain why a patient feels better, when mundane
explanations will do. To ignore this sort of analysis is to ignore one of the fundamental truths of patient care.
Some, but not all, of these sources of error can be eliminated by randomized, controlled trials (RCTs). But
RCTs are subject to additional errors, including confounding biases, cuing and other subtle, unconscious
biases, post-hoc analyses, multiple testing artifacts, noncomparable study and control groups, other statistical
errors, erroneous conclusions, fraud, and more. That is why it is a fool's errand for advocates to perform
clinical trials of highly implausible claims. This has been discussed elsewhere, but in summary such research
inevitably results in equivocal, rather than merely negative, conclusions. “Further research” is invariably called
for, with no end in sight.[18-23]
2010 NFA-LD
Evidence Set
***Community Base Care CP – Index***

***Community Base Care CP – Index***..................................................123
Community Based Care CP 1NC Shell.....................................................124
Extensions – Federal Programs Bad.....................................................125
Extensions – Community Solutions Good 1/3.............................................126
AFF Answers 1/2.......................................................................129
AFF Answers 2/2.......................................................................130
2010 NFA-LD
Evidence Set
Community Based Care CP 1NC Shell
A. CP Text:
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Will be Implemented by Community-Based mental healthcare outreach centers in the United States.
B. The CP is not topical: community-based centers are NOT the USFG.
C. Competition: The CP will compete through the net benefit.
D. CP Solvency – 1. Community-Based Care is struggling, and a revamp is

critical to achieving more effective mental health care in the United States
Seven Sharfstein, president and medical director of Sheppard Pratt Health System, American
Psychiatric Association, 2000 [“Whatever Happened to Community Mental Health?” Available Online
http://psychservices.psychiatryonline.org/cgi/content/full/51/5/616] SWD/Boyer
Community mental health battles for survival in the rapidly changing public and private marketplace. Many of the
old federally initiated community mental health centers are now called community behavioral health care organizations, or CBHOs, with a principal
function of coordinating and integrating aspects of mental health treatment, addiction treatment, and primary care.
The success of psychosocial rehabilitation approaches coupled with supervised housing stands in contrast to
the continuing public health disaster of seriously mentally ill persons who are homeless or in prison. Dorothea Dix
would be shocked if she revisited America today. As Geller (1) understates, "We remain entrenched in our concerns about locus of
care, confusing it with the humaneness, effectiveness, and quality of care." Because most care will take place in the
outpatient arena, a great challenge for community mental health in the 21st century is to address the issue of
people who are not in treatment, who resist treatment, and who become marginalized and destitute.
Without reinventing asylums or discovering a magic bullet or cure for schizophrenia and other serious mental illnesses, we must rely on mental
health policies and services with adequate financial support for community care. Barton's "service follows the dollar"
maxim is important if managed care is a temporary aberration in mental health policy, as I believe it to be. We still must find a way to set priorities,
allocate resources, and ensure delivery of high-quality scientific and humane care to people in need
2. Bureaucracy Expansion Accelerates the Problems of Severe mental illness,

Turning AFF Solvency
Jack Scott, ScD and Lisa Dixon MD, Medscape Mental Health eJournal, April 1, 2002 [“Community-Based
Treatment for Severe Mental Illness: What are the Benefits and Costs?” Available Online at
http://www.medscape.com/viewarticle/430885] SWD/Boyer
People with severe mental illness need access to treatment, rehabilitation, and support services within the
community. These services can be provided through a variety of social, health, and mental health agencies, each with its own eligibility criteria and
application and monitoring processes. Gaining access to the right agency is often a frustrating and time-consuming task,
especially for people with mental illness. Because of the severe cognitive and motivational impairments common to mental
illnesses (eg, schizophrenia), this task is especially intimidating, and many (if not most) patients simply stop trying. This
invariably accelerates the revolving cycle of hospital discharge, return to the community, abandonment,
relapse, and return to the psychiatric hospital.
2010 NFA-LD
Evidence Set
Extensions – Federal Programs Bad
The AFF can only achieve “formal equality” with their statute, substantive
equality comes only through the CP
Jonathan Kenneth Burns, writer for Health and Human Rights International Journal, 2009 [Volume 11, No.2,
Mental health and inequity: A human rights approach to inequality, discrimination, and mental disability,
http://www.hhrjournal.org/index.php/hhr/article/viewArticle/170/255] SWD/Boyer
Thus, legislation
may be enacted to reduce or eradicate inequalities in health care, but statutes on their own
often introduce only “formal equality” — that is, the law treats all individuals or health conditions alike. This is a
superficial and deceptive form of equality, however, as there are many social, economic, and political factors at
play that obstruct the translation of a law into the real, individual experience of equality. Formal equality alone gives an
illusion that all are equal and that fairness exists, without addressing underlying inequalities in power, access, and socioeconomic and political
circumstances. In this way, formal equality alone tends to perpetuate discrimination and inequality because it often
fails to address real inequality in circumstances. Under a seemingly progressive veneer of respectability, disparities grow unchecked
as public advocacy groups relax their activist efforts. Thus, far from bringing about progressive change, the introduction of equality legislation can have
reactionary effects, exacerbating existing disparities in health access and care. Within the human rights framework , it is imperative that we
strive to achieve “substantive equality,” defined here as equality of opportunity, within the context of structural
inequalities present in society. This means that circumstances that prevent the individual from achieving equality of opportunity must be
addressed and that barriers to access and empowerment must be removed. Within health care, substantive equality does not
guarantee equality of treatment outcomes, but it does guarantee equality of opportunity in trying to achieve
those best outcomes. Mental disability and mental health care are surprisingly overlooked within the global
discourse on health equality, and mental health has always appeared to be a side issue in both the public and academic health debate.
There appears to be social distaste for issues pertaining to mental health and disability.
States are cutting mental health spending and focus – now is the time for
community based plans
Christine Vestal, Stateline Staff Writer, Stateline.org, July 19, 2010 [“As economy takes toll, mental health budgets
shrink” Available Online at http://www.stateline.org/live/details/story?contentId=499181] CF/Boyer
For the first time in more than three

Now, as states face their biggest fiscal challenge in modern history, the trend has reversed.
decades, mental health funding is declining. The drop-off is translating into a reduction in the number of
psychiatric hospital beds, as well as fewer services for mental health emergencies and longer waiting lists for
housing for the chronically mentally ill. The cuts are coming just as some experts say economic pressures are
creating an increase in mental illness. Although no national numbers are available, hospital emergency rooms, juvenile courts, child
welfare agencies, local jails and homeless shelters are reporting bulges in the number of mentally ill people who end up on their doorsteps after failing to
get help elsewhere.
In addition, a recent national survey showed that the weak economy is taking a toll on the mental health of Americans, with unemployed people four
times as likely as those with jobs to report symptoms of severe mental illness.
“States are chipping away at their already very fragile mental health system,” says Michael Fitzpatrick, executive director of National Alliance on Mental
Illness, which advocates for improved mental health care. “ More people will be unable to find even basic services that
allow them to stay out of the hospital or involvement with police. It’s a dire situation that we’ve never seen
before.”
2010 NFA-LD
Evidence Set
Extensions – Community Solutions Good 1/3
Community-based Care preserves Human Rights

Jonathan Kenneth Burns, writer for Health and Human Rights International Journal,2009 [Volume 11, No.2,
Mental health and inequity: A human rights approach to inequality, discrimination, and mental disability,
http://www.hhrjournal.org/index.php/hhr/article/viewArticle/170/255] SWD/Boyer
Service systems reform to move away from institutional care toward providing treatment, care, rehabilitation,
and reintegration within the community. As Alicia Ely Yamin and Eric Rosenthal state, “From a human rights perspective,
people are entitled to live in and receive care in the community not because it is more efficient, but because all
human beings develop their identities within social contexts, and have rights to work and study, as well as be with family and
friends.” Furthermore, planning and decision-making power related to care in the community needs to be
transferred to “the individuals and communities that the health system is supposed to serve.” This means the
integration of “users” and family members into both national and local decision-making structures.
Studies prove that Community-based care models are beneficial

Elizabeth Wiley-Exley, Health Policy and Administration, University of North Carolina, Social Science &
Medicine, March 2007 [“Evaluations of community mental health care in low- and middle-income countries: A 10-year review of
the literature”Evaluations of community mental health care in low- and middle-income countries: A 10-year review of the literature
Available Online at http://www.sciencedirect.com/] BF/Boyer
Community-based models of providing mental health services are widely considered effective ways of serving
individuals diagnosed with mental illness, but more comprehensive literature on these models in low- and middle-income countries is
needed. This study is a systematic review of the effects of community-based models on health outcomes of adults with depression, schizophrenia, panic
disorder, or bipolar disorders in middle- and low-income countries. PubMed, PsycINFO, and Cochrane Reviews were searched, returning 500 articles.
The seventeen interventions included in this review in 14 countries show us that community-based mental health services can
provide improvements in mental health outcomes, and the limited cost analyses suggest cost savings
associated with community models of care. These findings are in line with much of the research on higher income countries. In addition,
the studies also point to the gaps in the literature on costs, rural areas, bipolar disorders, and panic disorders, and note the need for further reviews of
interventions targeting additional diseases, children, and adolescents as well as studies published in languages other than English. This review of the
literature serves as a stepping stone for further research in community-based mental health services in low- and middle-income countries. The works
reviewed here provide a base of knowledge that will assist us in taking the important next steps in program implementation and evaluation.
2010 NFA-LD
Evidence Set
Community-based care is more effective and needed Globally
Shekhar Saxana, for World Health Organization, June 1, 2007. [Community Mental Services will lessen social
exhaustion, says WHO. http://www.who.int/mediacentre/news/notes/2007/np25/en/index.html] CG/Boyer
The World Health Organization (WHO) signalled the urgent need for countries to provide a network of community mental health services at its Global
Forum for Community Mental Health (Geneva, 30-31 May 2007). For the first time, WHO invited people living with mental disorders to attend the Forum,
sending a message to countries that it is important to give a voice to this excluded group to claim their rights and secure their participation in society.
"Not only are community mental health services more accessible to people living with severe mental
disabilities, these are also more effective in taking care of their needs compared to mental hospitals.
Community mental health services are also likely to have less possibilities for neglect and violations of human
rights, which are too often encountered in mental hospitals" said Dr Benedetto Saraceno, Director of the WHO Mental Health and
Substance Abuse. There are nearly 54 million people around the world with severe mental disorders such as schizophrenia and bipolar affective
disorder (manic-depressive illness),. In addition, 154 million people suffer from depression. People living in developing countries are disproportionately
affected. Mental disorders are increasingly prevalent in developing countries, the consequence of persistent poverty-driven conditions, the demographic
transition, conflicts in fragile states and natural disasters. At the same time, more than 50% of developing countries do not provide any care for persons
with mental disorders in the community. These disorders bring significant hardship not only to those who suffer from them, but also to their caregivers --
often the family, given the lack of mental health resources found in developing countries. As a result, 90% of people with epilepsy and more than 75% of
people with major depressive disorder in developing countries are inadequately treated. The call for community mental health services
is especially timely since, in spite of a clear message from WHO in 2001, only a few countries have made
adequate progress in this area. Also, in many countries, closing of mental hospitals is not accompanied by the
development of community services, leaving a service vacuum.
2010 NFA-LD
Evidence Set
Community-Based models are effective, but often overlooked

Henry J. Kaiser Foundation, Medical News Today, Dec. 23, 2009 [“Opinions: Community-Based Health Care Models;
U.S. Leadership In Reproductive Health Care” Available Online http://www.medicalnewstoday.com/articles/174738.php] CF/Boyer
"We don't need to start fresh to create patient-centered medical homes. We just need to look to community-based models of care
that are effective but often go unrecognized," according to aBoston Globe opinion pieceby Heidi Behforouz, the director of the
Prevention and Access to Care and Treatment project, which is based on "a model that Partners in Health pioneered to fight HIV in rural Haiti and drug-
resistant tuberculosis in Peru." According to Behforouz, community-based models of care might be overlooked "because
much of the care is being delivered by 'paraprofessionals'' who have not been extensively schooled in the
biomedical model and don't practice office-based care." She notes that community health workers' "schooling and
expertise is in the art and science of what we call 'accompaniment.'"
"What do we mean by accompaniment? We mean that you walk with the patient - not behind or in front of her - lending
solidarity, a shoulder, a sounding board, a word of counsel or caution. Empowering not enabling." According to
Behforouz, "Accompaniment is a beautiful thing. As practiced in the central plateau of Haiti, the shantytowns of Peru, or Boston, it may just be
what is needed to reform health care, here and abroad" (12/21).
2010 NFA-LD
Evidence Set
AFF Answers 1/2
Perm – Only a combination of Federal and community programs can hope to

succeed. Merging the CP and the Plan is both feasible and necessary.
European World Health Organization, August 2003. [What are the arguments for community based health-care?,
http://www.euro.who.int/__data/assets/pdf_file/0019/74710/E82976.pdf] BF/Boyer
There are no persuasive arguments or data to support a hospital-only approach. Nor is there any scientific
evidence that community services alone can provide satisfactory comprehensive care. Instead, the weight of
professional opinion and results from available studies support balanced care. Balanced care is essentially
community-based, but hospitals play an important backup role. This means that mental health services are provided in
normal community settings close to the population served, and hospital stays are as brief as possible, arranged promptly and
employed only when necessary. It is important to coordinate the efforts of various mental health services,
whether governmental, nongovernmental or private, and to ensure that the interfaces between them function
properly. Cost–effectiveness studies on deinstitutionalization and of community mental health care teams have demonstrated that quality of care is
closely related to expenditure. Community-based mental health services generally cost the same as the hospital-based services they replace.
Community Mental Health Centers are no longer capable of meeting the needs of
the mentally ill. Federal support is necessary.
David Hartley et. al, PhD, Maine Rural Health Research Center, November 2002 [“The Role of Community
Mental Health Centers As Rural Safety Net Providers” Available Online http://muskie.usm.maine.edu/Publications/rural/wp30.pdf]
By consolidating federal mental health funding into block grants administered by the state mental health agencies, the Omnibus Budget Reconciliation
Act of 1981 hastened the transition of CMHCs away from their safety net roles. Since 1981, CMHCs have received no direct federal
operating grants, and indeed, the title “community mental health center” is no longer an official federal
designation, although many mental health clinics continue to use it. Experts in rural mental health have argued
that the inadequacy of the CMHCs’ response to the farm crisis of the 1980s and other comparable community
traumas was the result of this shift away from meeting the mental health needs of the whole community and
toward meeting the needs of priority populations (Beeson, Johnson, & Ortega, 1991; Cecil, 1988).
People are already on waiting lists or turned away from CMHCs, expanding their
responsibilities will help no one
David Hartley et. al, PhD, Maine Rural Health Research Center, November 2002 [“The Role of Community
Mental Health Centers As Rural Safety Net Providers” Available Online http://muskie.usm.maine.edu/Publications/rural/wp30.pdf]
Community mental health centers remain the only real option for mental health treatment for low income
uninsured people, yet the availability of services for this population have steadily decreased in the last twenty
years. These individuals often sit on CMHC waiting lists for extended periods or are turned away due to a lack
of funds for services other than those targeted to priority populations. While Medicaid provides financial access to mental
health services for people poor enough to qualify, CMHCs still are caught between state priorities and local need with limited
staff and resources. Understanding this background and context, this study was undertaken to learn more about the role that CMHCs are playing
in serving as a rural safety net. We decided to use interviews and a comparative case study approach to provide an in depth look at services and
populations served by three rural CMHCs.
2010 NFA-LD
Evidence Set
AFF Answers 2/2
CMHCs are affected by many factors, leaving hope of success up to them would
severely gut the opportunity to Solve
Steven S. Sharfstein, M.P.A., 132nd President M.D. May 2000 [“Whatever Happened to Community Mental Health?”
Available online http://psychservices.psychiatryonline.org/cgi/content/full/51/5/616] SB, Boyer
There are several critical factors in clinical practice that continue to have a major influence on the success or
failure of services provided in the community: need for active aftercare and aggressive placement of patients
discharged from acute care hospitals. The need for long-term administration of antipsychotic medications for
persons with serious and persistent mental illness. The need for additional acute care hospital beds to treat
short-term episodes. The inadequate prescribing patterns of family physicians and the need for more clinicians
to work in the community. These issues continue today to bedevil practice as the availability or lack of
insurance benefits to pay for outpatient services remains a critical element in community mental health.
2010 NFA-LD
Evidence Set
***Funding File – Index***

***Funding File – Index***............................................................131
Solvency Defense – Treatment is Expensive.............................................132
Solvency Defense – Misappropriation...................................................133
Solvency Defense – Inefficient........................................................134
Solvency Offense – Ineffective........................................................135
Public vs. Private Spending...........................................................136
Solvency Defense – Costs Increasing...................................................137
Inherency – Status Quo Increasing Investment 1/2......................................138
Inherency – Status Quo Increasing Investment 2/2......................................139
State Spending Good 1/2...............................................................140
State Spending Good 2/2...............................................................141
State Spending Bad....................................................................142
Medicaid Must Come First..............................................................143
State and Local Spending Good.........................................................144
States Have No Money..................................................................145
Federal Spending Good.................................................................146
SAMHSA Bad............................................................................147
Health Care Spending Risks Economic Stability.........................................148
2010 NFA-LD
Evidence Set
Solvency Defense – Treatment is Expensive
Full economic costs of mental disorders far outstrip “direct” costs

Thomas Insel, M.D., National Institute of Mental Health, The American Journal of Psychiatry, 2008.
[“Assessing the Economic Costs of Serious Mental Illness, Google.com, http://ajp.psychiatryonline.org/cgi/reprint/165/6/663] TV Boyer
What do mental disorders cost the nation? The costs of health care are considered one of the greatest challenges in U.S. public policy
(2). In 2006, health care costs reached 16% of the nation’s gross domestic product, on a path to reach 20% by
2016 (3). While mental disorders contribute to these costs at an estimated 6.2% of the nation’s spending on
health care (4), the full economic costs of mental disorders are not captured by an analysis of health care costs.
Unlike other medical disorders, the costs of mental disorders are more “indirect” than “direct.” The costs of care
(e.g., medication, clinic visits, or hospitalization) are direct costs. Indirect costs are incurred through reduced labor supply,
public income support payments, reduced educational attainment, and costs associated with other
consequences such as incarceration or homelessness. Another kind of indirect cost results from the high rate
of medical complications associated with serious mental illness, leading to high rates of emergency room care,
high prevalence of pulmonary disease (persons with serious mental illness smoke 44% of all cigarettes in the United States), and early
mortality (a loss of 13 to 32 years) (5). While indirect costs have been challenging to quantify, they are critical for informing public policy. Once we
assess the key components of the economic burden of mental disorders, we can have a more informed discussion about what should be invested to
prevent and treat these illnesses. This issue of the Journal includes an important report by Kessler et al. (6) that focuses on one source of indirect costs:
the costs from loss of earnings. The analysis is based on the National Comorbidity Survey Replication (NCS-R), a population-based epidemiological
study of mental disorders. In this survey, data from nearly 5,000 individuals were used to estimate loss of earnings by
comparing earnings in the previous 12 months of persons with mental disorders with 12-month earnings of
persons without mental disorders. The analysis focused on individuals with serious mental illness. The results,
based on a generalized linear model analysis, demonstrate a mean reduction in earnings of $16,306 in
persons with serious mental illness (both with and without any earnings) and also that about 75% of the total reduction in earnings came
from individuals who had some earnings in the prior year (versus those who did not have any earnings at all). By extrapolating these
individual results to the general population, the authors estimated that serious mental illness is associated with
an annual loss of earnings totaling $193.2 billion.
In total, mental illness costs the United States $317 billion annually; this is
$1,000 for every man, woman, and child in the United States
While $193.2 billion seems enormous, it is important to recognize that the NCS-R yields a conservative sample
for estimating economic impact. As a door-to-door survey, NCS-R did not assess individuals hospitalized in
institutions, incarcerated in prisons or jails, or who are homeless. Indeed, NCS-R had so few subjects with schizophrenia or
autism that these diagnoses were not part of the original epidemiological analysis, even though both are associated with chronic disability and lifelong
loss of income on a far greater per capita basis than mood or anxiety disorders. Accepting this conservative estimate of a loss of
$193.2 billion in earnings each year from serious mental illness, can we estimate the total economic impact of
serious mental illness. In Table 1 we begin to answer this question, adding the new estimates of income loss to
data from 2002 on the direct costs of health care and disability benefits, including Social Security Disability
Insurance (SSDI) and Supplemental Security Income (SSI) cash assistance, food stamps, and public housing
financed by federal and state revenues. Missing are the costs of health care for comorbid conditions. Missing are estimates for the loss of
productivity due to premature death and the loss of productivity of those with serious mental illness who are institutionalized, incarcerated, or homeless.
Missing is the cost of incarceration, although as many as 22% of individuals in jails and prisons have been diagnosed with mental illness (9). Missing is
the cost of homelessness, although approximately one third of adult homelessness is associated with serious mental illness(8). And, of course, missing
from any such tabulation is the cost to family members who bear much of the emotional and financial burden of these illnesses. The $317 billion
estimated economic burden of serious mental illness in Table 1 excludes costs associated with comorbid
2010 NFA-LD
Evidence Set
conditions, incarceration, homelessness, and early mortality, yet this sum is equivalent to more than
$1,000/year for every man, woman, and child in the United States.
Solvency Defense – Misappropriation
We spend too much on mental illness in all the wrong places

A little more than 5 years ago, Dr. Michael Hogan, chair of the President’s New Freedom Commission on
Mental Health, noted that “we are spending too much on mental illness in all the wrong places” (1). This is
even more true in 2008 than in 2002. The costs of social services for persons with these chronic, disabling
illnesses will likely continue to climb. The questions we must ask ourselves are not new, but they remain
urgent: How can we ensure that mental health care is cost-efficient as well as effective for patients?
How will we reduce homelessness, job loss, and incarceration? And perhaps most importantly, how much
should we invest in disseminating effective treatments and finding better treatments in order to reduce these
costs?
2010 NFA-LD
Evidence Set
Solvency Defense – Inefficient
Estimation of the cost of health care is difficult; this leads to spending

inefficiency
Victor R. Fuchs, Ph.D., Stanford University, The New England Journal of Medicine, March 10th, 2010
[“How to Think about Future Health Care Spending,” Google.com, http://healthcarereform.nejm.org/?p=3141] TV Boyer
Estimating how much the nation will spend on health care is difficult, but in many ways, it is even more difficult
to say how much the nation should spend on health care, because the answer depends on values as well as on data
related to health, medical technology, and the economy. This is the conceptual problem related to health care spending. A
useful way to think about this “should” question is to imagine a family with a limited income trying to decide how much to spend on food, clothing,
entertainment, and other activities. In principle, the family will get the most satisfaction from its income if it allocates it among the various goods and
services in such a way that the last dollar spent in each category brings the same amount of satisfaction. If the family cannot achieve such equality, the
total satisfaction could be increased by switching some spending from categories in which the last dollar spent provided less satisfaction to those in
which the last dollar spent provided more satisfaction.
The same principle holds in deciding how much society should spend on health care, except that applying the principle is much more difficult.
Decisions about health care spending are made at many levels — by individuals, families, philanthropic
organizations, state and local governments, and numerous federal programs. Also, the estimation of benefits
from health care spending is fraught with problems. What is the effect on health of additional expenditures for diagnosing and treating
heart disease, or cancer, or mental illness, or other diseases? Moreover, even if the effect of medical care on health were
known with certainty, the problem of putting a value on the change in health would remain. For some,
estimating the value of additional health care seems so formidable that it is tempting to just walk away from it.
But to do that would be to abandon the “should” question to the vagaries of drug-company advertising, political payoffs, and media ideologues. It would
result in the achievement of less social benefit than the maximum possible for any given level of health care spending or in spending more than is
necessary to achieve any given level of health.
2010 NFA-LD
Evidence Set
Solvency Offense – Ineffective
Spending on mental health treatment is ineffective, even worsens condition for

some
Robert Preidt, ABC News.com Staff Writer, May 6, 2010 [“U.S. Mental Health Spending Rises, But Many Still Left Out,”
Google.com, http://abcnews.go.com/Health/Healthday/story?id=7511270&page=1] TV Boyer
Mental health spending in the United States increased 65 percent in the past decade, and many more Americans are using mental health services, but
there's still a big difference between access to care and quality of mental health care received, new research shows.
In a special edition of the May/June issue of Health Affairs focusing on mental health care in the United States,
one study found that about half of Americans suffering from mental illness in a given year don't receive
treatment, and another 25 percent receive treatment that's not consistent with evidence-based guidelines.
Some patients may receive inappropriate treatments, simply because doctors lack the evidence to make an
informed decision about appropriate care, noted Philip Wang, acting deputy director of the National Institute of Mental Health, and
colleagues.
Another study suggested that even when doctors have information about best practices, patients don't always
receive the correct treatments. That's because financial incentives, regulations, the quality of the mental health
workforce, and drug company marketing strategies have a major impact on doctors' treatment decisions, said
Marcela Horvitz-Lennon, of the Western Psychiatric Institute and Clinic in Pittsburgh, and colleagues.
They said underuse of effective treatments and overuse of ineffective treatments undermine the quality of care
and lead to poor patient outcomes. For people with severe mental illness, that can result in increasing isolation,
repeated hospitalizations, inability to get or hold a job, and even suicide.
Another study found that the number of seniors receiving psychotropic drugs to treat Alzheimer's and other mental health disorders doubled between
1996 and 2006, and the number of adults and children using the drugs increased by 73 percent and 50 percent, respectively.
The use of psychotropic drugs has increased, because primary-care doctors have become more familiar with these types of drugs and lower-cost drugs
have become more available, said Sherry Glied, chair of health policy and management at the Mailman School of Public Health at Columbia University,
and colleague Richard Frank.
The researchers also found that access to mental health care has improved for many Americans, but challenges persist for many groups of people.
Between 1996 and 2006, treatment declined for elderly people with mental limitations that make it difficult for them to do daily living tasks such as
dressing, eating and bathing without assistance.
Glied and Frank also found that more people with serious mental illnesses are being imprisoned or incarcerated. About 7 percent of people with
persistent mental illnesses are put in jail or prison every year.
Another study found that many members of the military and veterans get inadequate treatment or no care at all for post-traumatic stress disorder (PTSD)
and depression. The Rand Corp. researchers said more needs to be done to better prepare community health providers to help veterans with mental
health problems when they return home.
In addition, the Department of Defense needs to reduce institutional and cultural barriers to seeking mental health care, especially for active-duty military
personnel.
A study by Robert Drake, a psychiatry professor at Dartmouth Medical School, and colleagues concluded that a national program to help mentally ill
people on Social Security disability programs find jobs could save the federal government $368 million a year.
The researchers noted that about 27 percent of people receiving Social Security Disability Insurance benefits are mentally ill, and that up to 70 percent
of people with mental illnesses want to work.
"Giving people with mental disabilities the power to build financial security will help improve their quality of life significantly by encouraging self-
sufficiency and building self-esteem, which can ultimately help move their treatment forward as well," Drake said.
2010 NFA-LD
Evidence Set
Public vs. Private Spending
Choices must be made between public and private spending

Victor R. Fuchs, Ph.D., Stanford University, The New England Journal of Medicine, March 10th, 2010
[“How to Think about Future Health Care Spending,” Google.com, http://healthcarereform.nejm.org/?p=3141] TV Boyer
What about the notion that the level of spending should be high enough to meet the public’s need for medical
care? This notion is simple enough but simply impossible to fulfill.
To paraphrase Abraham Lincoln, it is possible to meet all people’s needs for medical care some of the time,
and it is possible to meet some people’s needs all the time, but no nation can meet all people’s needs all the
time. Choices must be made.
I suggest that in dealing with this problem, we think of the “should” question in two parts — public and private. The
public part consists of deciding how much health care should be available to everyone (universal coverage),
financed by dedicated taxes. This decision is a political one that requires weighing the benefits of additional
care against the cost of additional taxes. Weighing benefits and costs simultaneously is the only sure way of keeping public expenditures
from outpacing public revenues and thus adding to the deficit. It is also the only way of keeping “deficit hawks” from withholding financial support for
health care when the public believes that the benefit of the additional care is worth its costs. The private part of the “should” decision
could be made in much the same way as private decisions about any other form of consumption or investment:
individual families should weigh the expected costs and benefits of additional expenditures.
Funding for mental health places an enormous financial burden on the public
sector
Cheryl A. Kassed, Research Leader at Thomson Reuters. Health Affairs, October 2008
[“Future Funding For Mental Health And Substance Abuse: Increasing Burdens For The Public Sector,”
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.6.w513 ] SB Boyer
Spending on mental health (MH) and substance abuse (SA) treatment is expected to double between 2003 and 2014, to
$239 billion, and is anticipated to continue falling as a share of all health spending. By 2014, our projections of
SA spending show increasing responsibility for state and local governments (45 percent); deteriorating shares
financed by private insurance (7 percent); and 42 percent of SA spending going to specialty SA centers. For
MH, Medicaid is forecasted to fund an increasingly larger share of treatment costs (27 percent), and
prescription medications are expected to capture 30 percent of MH spending by 2014.
2010 NFA-LD
Evidence Set
Solvency Defense – Costs Increasing
Diagnoses of mental illnesses have skyrocketed, resulting in higher costs

Associated Press, WashingtonTimes.com, December 31, 2009. [“Mental health Trojan horse,” Google.com,
http://www.washingtontimes.com/news/2009/dec/31/mental-health-trojan-horse/print/] TV Boyer
The American Psychiatric Association (APA) claims that more than 50 percent of Americans are mentally ill in
their lifetime - and recent APA studies dwarf that statistic. Moreover, the problems that qualify as "mental
disorders," all those listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), are virtually
without limit.
Significantly, the new coverage of mental illness covers a vast array of the "worried well," who have no
neurological or mental disorders but simply have problems in living. Support for mental health parity in the new health reform
bills relies on the public's false inference that the prototypical mental disorder is dementia or some other organically based brain disease, which
constitute only a tiny percentage and atypical sampling of the hundreds of "mental disorders" listed in DSM-IV.
Typically, psychiatrists label those unhappy people they concede have no physical illness as having "social
anxiety disorder" or some other equally benign "disorder." Such people can be in costly, insurance-covered
therapy indefinitely. As one psychologist told us, "Anyone who comes in with any problem can be diagnosed as
having 'adjustment disorder.' " (e.g., "with anxiety," DSM-IV Code 309.24).
There are many such diagnoses of easily applicable disorders, including "antisocial personality disorder" (DSM-IV Code 301.7), "avoidant personality
disorder" (DSM-IV Code 301.82), and others vague enough to be applied to almost anyone. This is one of the reasons that the
American Psychiatric Association claims that in a lifetime far more than a majority of citizens will suffer from a
mental disorder, and the estimates are increasing.
In the December 2008 APA's Archives of General Psychiatry, there is a report that "almost half of college-aged
individuals had a psychiatric disorder in the past year [emphasis added]," and this includes heavy drinking,
categorized as "alcohol use disorder" (DSM-IV Code 305.00).
When everyone is sick, what is normal? "What is healthy?"
2010 NFA-LD
Evidence Set
Inherency – Status Quo Increasing Investment

1/2
USFG has and continues to invest in mental health services
Psychiatric Services News, American Psychiatric Association, February 2010 [“2010 Federal Budget Boosts
Funding for Mental Health and Substance Abuse Programs,” http://psychservices.psychiatryonline.org/cg/content/short/61/2/210?rss=1]
SB Boyer
Appropriations for the Center for Mental Health Services (CMHS) topped $1 billion for the first time (Table 1).
Congress doubled the administration's request for a $17 million increase and approved a $36 million increase.
The largest percentage increase is for Children's Mental Health Services, which provides grants to states and
localities to support the development of comprehensive community-based systems of care. In fiscal year 2010,
this program is expected to serve more than 13,000 youths with serious emotional disturbances. Another critical
CMHS program that garnered strong support in the 2010 budget (an 8.4% increase) is Projects for Assistance in Transition From Homelessness
(PATH), which provides a flexible funding stream allowing local programs to use funds in ways most appropriate for their communities. Among
CMHS programs of regional and national significance, grants for Primary and Behavioral Health Care
Integration received a substantial boost—funding was doubled from $7 million in 2009 to $14 million in 2010.
The program seeks to improve the physical health status of people with serious mental illnesses by helping
communities to integrate primary care services into publicly funded community mental health and other
community behavioral health settings. Another program of regional and national significance to receive strong support was Project
LAUNCH (Linking Actions for Unmet Needs in Children's Health), introduced in fiscal year 2008 at a funding level of $7.4 million. The 2010 appropriation
more than triples support for this program ($25 million), which is designed to promote wellness of children up to eight years of age by addressing
physical, emotional, social, and behavioral aspects of their development.
The substantial increases of the past two years were achieved after more than five years of Bush administration funding that either remained flat—in the
case of the Substance Abuse and Mental Health Services Administration—or failed to keep up with the rate of inflation—in the case of the National
Institutes of Health (NIH).
For fiscal year 2010 Congress exceeded the Obama administration's request for a 2% increase in the NIH
budget and provided $31 billion, or 2.3% more than in 2009. At nearly $1.49 billion, funding in 2010 for the
National Institute of Mental Health (NIMH) is $38.9 million higher than in 2009. In 2009 the American Recovery
and Reinvestment Act provided NIMH with an additional $366 million. "In a typical year, NIMH invests $180 million in new
research grants," noted NIMH Director Thomas Insel, M.D.s
2010 NFA-LD
Evidence Set
Inherency – Status Quo Increasing Investment

2/2
Obama’s 2011 budget allocates billions for mental health care

Rich Daly, Psychiatric News, March 19, 2010 (American Psychiatric Association,
http://pn.psychiatryonline.org/content/45/6/6.2.full) Boyer/Derrick CAF
Although many federal mental programs get funding boosts under the proposed 2011 budget, lingering concerns include
static funding for the mental health block grant program that benefits cash-strapped states.
Mental health funding largely escaped a government-wide halt in new spending under President Obama's proposed $3.8 trillion budget for the next fiscal
year, which begins on October 1.
The mental health program winners in the new budget—released in February—include the National Institutes of Health (NIH),
the Substance Abuse and Mental Health Services Administration (SAMHSA), and community health centers. The increases in those
areas came despite Obama's promise to flatline most federal discretionary spending in the Fiscal 2011 budget as part of a three-year freeze in new
spending.
“We're very, very encouraged,” said Lizbet Boroughs, associate director of APA's Department of Government Relations, about the proposed mental
health funding.
The NIH would get a $1 billion boost in Fiscal 2011, to $32.3 billion, under the president's budget. That
increase would benefit research funding at NIH's three mental-health related institutes—the National Institute of Mental Health,
National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism.
The SAMHSA budget, which provides the bulk of the federal government's funding for mental health services, also would grow by $110
million, or 3.2 percent under the Obama budget. Additionally, mental health programs at community health centers would
receive $25 million of a $290 million overall increase proposed for the centers.
Medicaid—the biggest single payer for mental health care nationwide—would also see significant increases in
its funding under Obama's budget. The president proposed $26 billion in new spending to extend a Medicaid
funding increase provided under the 2009 economic stimulus law (PL 111-5). That measure provided states with $87 billion in
additional funding for their portion of the joint federal-state program, but the stimulus money runs out at the end of Fiscal 2010. State governments made
numerous cuts to Medicaid in 2009 and were concerned that the end of the stimulus assistance would force them to implement further cuts.
The budget came up short, however, in some other areas, according to Boroughs, including its call for continued static funding for the mental health
block grant program. The program is seen as a critical source of funding for states looking to bolster mental health care within their Medicaid programs.
Rural states with the least tax revenues to afford Medicaid spending on their own would be the most impacted by static block grant budgets.
Although the Mental Health Liaison Group, an umbrella mental health advocacy organization to which APA belongs, has not yet prepared a formal
mental health funding request, mental health advocates are expected to request additional spending beyond that requested by the Obama
administration. Specifically, these advocates plan to request an additional $20 million, or a 20 percent increase, for the mental health block grant
program.
2010 NFA-LD
Evidence Set
State Spending Good 1/2
State spending on mental health improves quality, federal cuts intervene in this
process
Erin Dubois, Associate Editor, Montgomery News, July 19, 2010 [“Mental health providers glad state budget passed
without cuts,” http://www.montgomerynews.com/articles/2010/07/19/perkasie_news_herald/news/doc4c3d59ecb1946352750295.txt]
SB Boyer
With Gov. Ed Rendell’s signing of the 2011 state budget, providers of mental retardation services in the Indian Valley can breathe what David Crosson,
executive director of Indian Creek Foundation in Souderton, called a “cautionary sigh of relief.” The budget for Pennsylvania, which
Rendell signed July 6, did not include a proposed 1 percent rate reduction for agencies serving people with
intellectual disabilities under a Medicaid. Home and Community Based Waiver. Medicaid waivers for those with mental retardation
provide funding so that these individuals can receive services in their own homes instead of in institutions, according to information found at
www.par.net. Providing services in the home is a more cost-effective solution than residential placement, said Bill Eisen, a board member for Indian
Creek Foundation. The budget, as proposed by Rendell in February 2010 and passed by the House of
Representatives, called for a $6.1 million cut in state funding to community mental retardation service
providers, according to www.par.net. The loss in state funding would have meant the loss of another $11.2
million in federal matching funds, said Shirley Walker, president and CEO of the Pennsylvania Association of
Resources. PAR is a service network and advocacy organization in Harrisburg for people with intellectual disabilities and autism. “When you take
out $6 million and another $11 million, that hurts,” said State Rep. Paul Clymer, R-145, who voted against the bill. “I know all of us are concerned about
community mental retardation services. I have Penn Foundation in my backyard. I like to consider myself to be a good friend of them.” he budget
assumes that the federal government will approve an $850 million extension of enhanced Medicaid matching funds which were part of the stimulus
package, Crosson said. The enhanced Federal Medical Assistance Percentages increased the federal government’s
match of the state Medicaid dollars from 55.64 percent to 68.37 percent, according to the FMAP table found at
http://aspe.hhs.gov/health/fmap10.htm. The enhanced match is set to expire Dec. 31, 2010, unless state officials can convince
Washington to extend it to June 30, 2011, Crossan said. If the extension is not passed by the end of July, the governor will
need to take steps to reduce the budget further, Crossan said. One of the biggest costs of providing services is
the staff that actually work with the disabled, Eisen said.
2010 NFA-LD
Evidence Set
State Spending Good 2/2
States are key to the provision of health care services; they succeed even when
the federal government fails
CAROL S. WEISSERT, LeRoy Collins Eminent Scholar Chair of Civic Education and Political Science at
Florida State University, Journal of Health Care Law & Policy, 2004 [SYMPOSIUM: "STATE EFFORTS TO
EXPAND HEALTH CARE COVERAGE: CURRENT REALITIES, FUTURE POSSIBILITIES?": ARTICLE: Promise and Perils of State-
Based Road to Universal Health Insurance in the U.S., l/n.] Boyer/Derrick CAF
The states' legacy in provision of health care services is strong. States are responsible for the funding and
coordination of public health functions, the financing and delivery of personal health services (including Medicaid,
mental health, public hospitals, and health departments), environmental protection, the regulation of medical care providers and
the technology that they employ, the regulation of the sale of health insurance, rate setting, licensing, and cost control. In addition,
states provide health insurance for their own employees and retirees and play a pivotal role in educating and credentialing health
care professionals.
Similarly, states are the primary innovators in health policy, serving as what Justice Brandeis is credited as dubbing, "laboratories of
democracy." This role goes back a long way in American history. The 1921 Sheppard-Towner Act, which provided social and medical
assistance to pregnant women and babies, was copied from a Connecticut law. States also provided models for the 1935 Social Security
Act, the 1973 Supplemental Security Income program, and other health measures. More recently, Medicare's Diagnosis Related Group (DRG)
payment system was based on a program in New Jersey, and the 1997 State Children's Health Insurance Program (S-CHIP) was based on programs in
Washington and New York.
Following the failure of comprehensive federal health reform, states have continued to be innovative. For example,
between 1997 and 1999, thirty-five states enacted new restrictions on managed care organizations, usually under the guise of a patients' bill of rights.
States also launched innovative programs to provide coverage for the working poor, to reform small-group health
insurance, and establish risk pools for those who found insurance difficult to obtain. Other programs were developed to mandate community rating, to
create new ways of delivering services to Medicaid recipients and state employees, and to hold down the costs of prescription drugs, especially for the
elderly.
2010 NFA-LD
Evidence Set
State Spending Bad
State funding for mental health is decreasing and inefficient

David Ormsby, Public Relations Consultant and Political Strategist, Huffington Post, July, 2010
[“A National Mental Health Funding Crisis, And Pat Quinn's Budget Isn't Helping,” Google.com, http://www.huffingtonpost.com/david-
ormsby/a-national-mental-health_b_659061.html] SB Boyer
According to the National Association of State Mental Health Program Directors, state mental health care
spending fell 4% between 2008 and 2009 and it appears to have fallen yet again in 2010, this time nearly 5%
compared to 2009.
"States are chipping away at their already very fragile mental health system," says Michael Fitzpatrick,
executive director of National Alliance on Mental Illness, which advocates for improved mental health care.
"More people will be unable to find even basic services that allow them to stay out of the hospital or
involvement with police." Additionally, state mental health budgets may sink by 8% or more in 2011. These
cuts are coming as a recent national survey showed that the economy crisis is battering the mental health of
Americans, with the unemployed four times as likely as those with jobs to report symptoms of severe mental
illness.
In 2008, U.S. states spent $36 billion on mental health services for 6.4 million people. Of the total,
approximately $17 billion came from Medicaid, $500 million from federal grants, and the rest state general
revenues.
Underfunded mental health care will suffer more cuts
Christine Vestal, Stateline.org, July 19, 2010. [“As economy takes toll, mental health budgets shrink,”
http://www.stateline.org/live/details/story?contentId=499181 ] AP Boyer
“States are chipping away at their already very fragile mental health system,” says Michael Fitzpatrick, executive director of
National Alliance on Mental Illness, which advocates for improved mental health care. “More people will be unable to find even basic
services that allow them to stay out of the hospital or involvement with police. It’s a dire situation that we’ve
never seen before.”
In 2008, states spent $36 billion on mental health services to care for 6.4 million people, about half the number
of people advocates say are in need of care. Of the total, about $17 billion came from Medicaid, the federal-
state health care program for the poor, $500 million came from federal grants and the balance was funded
through state general revenues. Not counted in the total is funding from county and local budgets, much of
which also sits on the chopping block.
2010 NFA-LD
Evidence Set
Medicaid Must Come First
Medicaid must be the preeminent issue for federal and state government
SARA ROSENBAUM, Hirsh Professor and Chair of the Department of Health Policy at The George
Washington University Medical Center's School of Public Health and Health Services, Journal of Health
Care Law & Policy, 2006 [SYMPOSIUM: BRIDGING THE RACIAL DIVIDE IN HEALTH CARE: ELIMINATING RACIAL AND
ETHNIC DISPARITIES IN HEALTH STATUS: SYMPOSIUM: Medicaid at Forty: Revisiting Structure and Meaning in a Post-Deficit
Reduction Act Era, l/n.] CF Boyer
Medicaid is a vital program. . . . Medicaid is a huge program. . . . Medicaid is in many ways the most direct
involvement with the provision of medical care undertaken by either the federal government or the states. ... In
some ways, the Medicaid program has been phenomenally successful. . . . Yet Medicaid has come under increasing fire ... Its cost
increases, coupled with persistent budget overruns, have focused Congressional attention on rising medical prices, on inefficient program management,
and on waste and sometimes deceit . . . . Medicaid has moved from a glittering symbol of the "Great Society" to a problem
to be tackled by the "New Federalism."
Robert and Rosemary Stevens wrote this passage over thirty years ago, ten years after Medicaid's 1965 enactment, in the prologue to their
landmark Welfare Medicine in America: A Case Study of Medicaid. By its tenth anniversary, Medicaid already was considered "huge," accounting for
some $ 9 billion in federal/state public spending and covering of 23 million persons.
Three decades later, Medicaid expenditures stood at nearly $ 300 billion, making it the nation's single largest
insurer, n4 with enrollment ranging from 37.5 million to 52 million n6 children and adults, depending on the source of data used. Medicaid is the
largest source of coverage for children, enrolling one in four. Medicaid covers one-third of all U.S. births and is the principal source of
public funding for family planning services. Medicaid covers more than half of all persons living with AIDS, is the largest source of
public funding for mental illness treatment, and pays for nearly half of all long-term care costs. Without
Medicaid revenues, the nation would witness the collapse of an already burdened system of publicly-supported
clinics and public hospitals and health systems that serve the poor, including a substantial number of program beneficiaries. In
sum, Medicaid's role in financing health care for low-income and seriously and chronically ill and disabled
populations makes it an essential part of the U.S. health care landscape.
2010 NFA-LD
Evidence Set
State and Local Spending Good

Public spending on mental health occurs primarily at the state and local levels
NewsRx.com, American Psychological Association, July 29, 2010 [“Mental health woes grow while spending
declines,”Google.com, http://www.apa.org/news/psycport/PsycPORTArticle.aspx?id=newsrx_2010_07_29_eng-newsrx_eng-
newsrx_053255_7910775961987734140.xml] TV Boyer
In the U.S., public spending on mental health services occurs primarily at the state and local levels. According
to study author Dominic Hodgkin, associate professor at the Heller School for Social Policy and Management
at Brandeis, states and counties are now cutting this funding to deal with their budget crises. One survey found
that 32 state mental health agencies reported budget cuts in 2009; on average, the cuts tallied 4.9 percent of
the budget. The programs most affected by the cuts were inpatient adult services, clinic adult services, inpatient children's services, clinic services
for children, and targeted case management services for children, according to the survey.
2010 NFA-LD
Evidence Set
States Have No Money
Yet, Failing to Extend Federal Fiscal Relief to States Will Create New Budget
Gaps, Forcing Cuts and Job Loss
Michael Leachman, Senior Policy Analyst at the Center of Budget and Policy Priorities, June 2010
[Failing to Extend Fiscal Relief to States Will Create New Budget Gaps, Forcing Cuts and Job Loss in at Least 34 States.
http://www.cbpp.org/cms/index.cfm?fa=view&id=3207] SB Boyer
If Congress does not extend the enhanced Medicaid matching funds in last year’s Recovery Act, most states
will cut public services or raise taxes for the fiscal year that begins July 1 by even more than they are already
planning – laying off tens of thousands more teachers and other public employees, cutting education funding
more sharply, and further reducing payments to health care providers and other private firms. Without more
federal aid, state budget-closing actions could cost the national economy 900,000 public- and private-sector
jobs.
States are required by law to balance their budgets and have limited ability to borrow funds. At this point in the
recession, virtually no states have large reserves. Thus, large budget shortfalls force them to lay off workers,
cancel contracts with vendors, and raise taxes, fees, and user charges. These actions ripple through the
economy by reducing the purchasing power of businesses and families. They may also have long-term
economic effects as they reduce states’ investments in human capital (e.g., education) and infrastructure.
The importance of the state and local sector to the recovery is underscored by new economic data from two federal agencies.
 New data from the Bureau of Labor Statistics show that state and local governments, including school districts, have cut 100,000 education
jobs and 231,000 other jobs since mid-2008, including 22,000 jobs lost in May 2010 alone.
 Newly revised data from the Bureau of Economic Analysis for the first quarter of 2010 show that contraction in the state and local government
sector reduced the growth of Gross Domestic Product by one-half of one percentage point, from 3.5 percent to 3.0 percent.
States’ aggregate budget shortfall for 2011 is likely to reach $140 billion (excluding any new federal funds) — a
gap equal to nearly one percent of GDP. Standard economic multipliers suggest that the spending cuts
necessary to close a budget gap of that magnitude would cost the economy 900,000 private- and public-sector
jobs.
2010 NFA-LD
Evidence Set
Federal Spending Good
Federal spending veterans’ mental health programs reduces the need for state
facilities
Rani A. Desai and Robert A. Rosenheck, The Journal of Mental Health Policy and Economics, 2000.
[“The Interdependence of Mental Health,” J. Mental Health Policy Econ. 3, 61–67, http://www.icmpe.org/test1/journal/issues/v3pdf/3-
061_text.pdf] CF Boyer
higher expenditures on mental healthcare need not translate into higher availability, or utilization, of
In principal,
mental health services if care is delivered inefficiently. However, data from the national VA mental health monitoring system indicate
that in 1998 the total VA mental health expenditures per eligible veteran in the population was correlated at 0.30 with the proportion of eligible veterans
who were seen in VA mental health programs.14 These analyses suggest that the higher availability of VA mental health
services does in fact decrease the likelihood that veterans will use state hospitals. Taking New York and
Oklahoma as two extreme examples, New York VA hospitals spent the most per veteran on mental health care
and had the lowest proportion of veterans in state facilities, while the Oklahoma VA system spent the least per
veteran and had the highest proportion of veterans in the state system.
2010 NFA-LD
Evidence Set
SAMHSA Bad
Billions have been spent on drug prevention interventions, yet little focus has
been placed on the effectiveness of these programs
Richard J. Bonnie, Harrison Foundation Professor of Law and Medicine, Journal of Health Care Law &
Policy in 2010. [Professor of Psychiatry and Neurobehavioral Sciences, and Director of the Institute of Law, Psychiatry and Public
Policy at the University of Virginia, SYMPOSIUM: THE VIRTUES OF PRAGMATISM IN DRUG POLICY, l/n.) Boyer/Derrick CAF
After twenty years, the pendulum is finally swinging away from the uncompromising ideologically-driven premise of the war on drugs and zero tolerance.
The costs of the war in lives as well as treasure have been very high, and the benefits are at best difficult to assess. In 2001, the National
Research Council, an arm of the National Academy of Sciences, issued an important report on drug policy. The study committee, on which I
served, had been directed to assess the adequacy of the data and research for making informed drug policy. The committee pointed out that the
evidence base for policy-making was relatively strong on the demand side because the pertinent National Institutes of
Health and other federal agencies, especially the Substance Abuse and Mental Health Services Administration ( SAMHSA), had invested a
great deal of funding to assess the efficacy and effectiveness of prevention interventions and treatments for
addiction. In contrast, the committee pointed out that virtually no evidence exists with respect to the effectiveness
of measures being taken on the supply side, not only regarding the effects of enforcement on price and
availability but also regarding the effects of locking up hundreds of thousands of people who sell or use drugs. There was, and is, very little
research and very little evidence of effectiveness of the drug policies on which billions of dollars are spent
every year.
Opportunities exist within with mental health care but funding and treatment
opportunities are not on scale with the demand
Richard J. Bonnie, Harrison Foundation Professor of Law and Medicine, Journal of Health Care Law &
Policy in 2010. [Professor of Psychiatry and Neurobehavioral Sciences, and Director of the Institute of Law, Psychiatry and Public
Policy at the University of Virginia, SYMPOSIUM: THE VIRTUES OF PRAGMATISM IN DRUG POLICY, l/n.) Boyer/Derrick CAF
Public policy needs to create incentives and opportunities for people addicted to drugs to choose treatment.
Treatment can work, as shown by the abundant evidence of cost-effectiveness. n136 The legal structure that is needed for increasing access has been
in place since 1972. n137 The Drug Abuse Office and Treatment Act was probably the most important statute enacted during the short era of
enlightened [*25] and progressive drug policy. n138 Yet most people who need treatment are not seeking it. SAMHSA has
estimated that about one-in-ten people with serious substance abuse problems (2.3 million of 21.2 million) received
treatment in 2007. n139 The available services are not easily accessible to those who do seek it due to waiting lists
and inconvenience, n140 and the services offered are typically too thin and therefore not as effective as they
could be. n141 The simple fact is that funding has never been sufficient and addiction treatment has never been
adequately mainstreamed as a component of health care, a problem also associated with mental health care.
2010 NFA-LD
Evidence Set
Health Care Spending Risks Economic Stability
U.S. health care spending is higher than any other country in the world and
controlling this spending is key to economic stability; new programs are run at a
risk
The Kaiser Family Foundation, U.S. Health Care Costs on March 2010 (Eric Kimbuende, Usha Ranji, Janet
Lundy, and Alina Salganicoff, http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358) Boyer/Derrick CAF
Health care costs have been rising for several years. Expenditures in the United States on health
care surpassed $2.3 trillion in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253
billion spent in 1980. Stemming this growth has become a major policy priority, as the government, employers, and consumers
increasingly struggle to keep up with health care costs.
In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP);
this is among the highest of all industrialized countries. Total health care expenditures grew at an annual rate of 4.4 percent in 2008, a
slower rate than recent years, yet still outpacing inflation and the growth in national income. Absent reform, there is general agreement that health costs
are likely to continue to rise in the foreseeable future. Many analysts have cited controlling health care costs as a key tenet for
broader economic stability and growth, and President Obama has made cost control a focus of health reform
efforts under way.
Although Americans benefit from many of the investments in health care, the recent rapid cost growth, coupled with an overall economic slowdown and
rising federal deficit, is placing great strains on the systems used to finance health care, including private employer-sponsored health insurance
coverage and public insurance programs such as Medicare and Medicaid. Since 1999, family premiums for employer-sponsored health coverage have
increased by 131 percent, placing increasing cost burdens on employers and workers. With workers’ wages growing at a much slower pace than health
care costs, many face difficulty in affording out-of-pocket spending.
Government programs, such as Medicare and Medicaid, account for a significant share of health care
spending, but they have increased at a slower rate than private insurance. Medicare per capita spending has grown at a slightly lower rate, on
average, than private health insurance spending, at about 6.8 vs. 7.1% annually respectively between 1998 and 2008. Medicaid expenditures, similarly,
have grown at slower rate than private spending, though enrollment in the program has increased during the current economic recession, which may
result in increased Medicaid spending figures soon.
2010 NFA-LD
Evidence Set
***Generic Negative Evidence – Index***
***Generic Negative Evidence – Index***...............................................149

AT – Equality ADV.....................................................................150
Treatment Bad – Racism Turn 1/2.......................................................151
Treatment Bad – Racism Turn 2/2.......................................................152
Treatment Bad – Gender Turn...........................................................153
Mental Health Courts Turn.............................................................154
AT – Szasz/Myth.......................................................................155
AT – ADHD.............................................................................156
Solvency – Insurance Companies Bad....................................................157
Stigma Evidence 1/3...................................................................158
Stigma Evidence 2/3...................................................................159
Stigma Evidence 3/3...................................................................160
2010 NFA-LD
Evidence Set
AT – Equality ADV
Legislating equality only masks the inequality that exists, and exacerbates the
problem. Mental health has so far avoided this fate, but the AFF changes the
trend and actually perpetuates the very impacts they claim to solve.
Jonathan Kenneth Burns, Chief Specialist Psychiatrist at Nelson R Mandela School of Medicine, in
Health and Human Rights International Journal, 2009 [“Mental health and inequity: A human rights approach to
inequality, discrimination, and mental disability” Available Online http://www.hhrjournal.org/index.php/hhr/article/viewArticle/170/255)
SWD/Boyer
Thus, legislation may be enacted to reduce or eradicate inequalities in health care, but statutes on their own
often introduce only “formal equality” — that is, the law treats all individuals or health conditions alike. This is a
superficial and deceptive form of equality, however, as there are many social, economic, and political factors at
play that obstruct the translation of a law into the real, individual experience of equality. Formal equality alone gives an
illusion that all are equal and that fairness exists, without addressing underlying inequalities in power, access, and
socioeconomic and political circumstances. In this way, formal equality alone tends to perpetuate discrimination
and inequality because it often fails to address real inequality in circumstances. Under a seemingly progressive
veneer of respectability, disparities grow unchecked as public advocacy groups relax their activist efforts. Thus,
far from bringing about progressive change, the introduction of equality legislation can have reactionary effects,
exacerbating existing disparities in health access and care. Within the human rights framework, it is imperative that we strive to
achieve “substantive equality,” defined here as equality of opportunity, within the context of structural inequalities present in society. This means that
circumstances that prevent the individual from achieving equality of opportunity must be addressed and that barriers to access and empowerment must
be removed. Within health care, substantive equality does not guarantee equality of treatment outcomes, but it does guarantee equality of opportunity in
trying to achieve those best outcomes. Mental disability and mental health care are surprisingly overlooked within the
global discourse on health equality, and mental health has always appeared to be a side issue in both the
public and academic health debate.6 There appears to be social distaste for issues pertaining to mental health and disability.
2010 NFA-LD
Evidence Set
Treatment Bad – Racism Turn 1/2
Treatment practices in the United States are a form of coercion that simply re-
victimize the treated. The affirmative increases this violence and further
destabilizes the system of care.
Judith A. Cook, Ph.D. and Jessica A. Jonikas, M.A., the University of Illinois at Chicago National
Research and Training Center on Psychiatric Disability, Journal of Disability Policy Studies, 2002 [“Self-
Determination Among Mental Health Consumers/Survivors: Using Lessons from the Past to Guide the Future” Available Online
http://www.psych.uic.edu/uicnrtc/sdconfdoc17.pdf] SWD/Boyer
Prejudice and violence against, and maltreatment of, people with mental disabilities extend beyond civil rights to that
which is done in the name of treatment (NCD, 2000). Every day, individuals with this disability are expected to
trade their freedom in order to receive in-patient treatment, and to submit to medical treatments against their
will. This is increasingly occurring in community-based settings as well (Steadman et al., 2001), as evidenced by the recent passage of "Kendra's Law"
in the state of New York (New York State Office of Mental Health Initiatives, n.d.) and a lessening of the severity of commitment criteria nationwide
Additionally, for some consumers, psychiatric treatment includes coercion, which involves emotional
intimidation, threats, and bullying, as well as forced restraint, forced seclusion, and chemical restraint in in-
patient settings (IAPSRS, 2000; NCD, 2000). Many have argued that such "treatment" victimizes or re-victimizes individuals
by perpetuating illness and internalized oppression rather than enhancing health and well-being (Jennings, 1994).
Others have noted that such coercive treatment prevents many people from seeking formal assistance again, and that
the very notion of self determination within a system that includes forced treatment and loss of basic rights and
freedoms is untenable (Fisher & Ahern, 1999; Unzicker, 1999).
Treatment is historically disproportionate for the female African-American

community. The Aff reinforces these Racial boundaries through their expansion
of status quo treatment policy
George Leary, M.S., Black Women’s Health.com, accessed 8/1/10. [Black Women and Mental Health.
http://www.blackwomenshealth.com/2006/articles.php?id=56] CG/Boyer
It has historically been difficult to treat mental health problems in African American women. One reason for this is that
Black women tend to minimize the serious nature of their problems. Many believe their symptoms are “just the blues” and are not proactive in changing
their condition. There also exists a stigma placed on mental health problems within the African American culture that
they are a sign of personal weakness, not a sickness. African American women tend to rely on supports other than mental health
services. There is a strong reliance on community, the support of family, and the religious community during periods of emotional distress. Black women
seek mental health care less than White women; and, when they do seek it, do so later in life and at later stages of their illness . Part of the
explanation for this is the poor service they often receive from mental health professionals who, historically,
have consistently under-diagnosed disorders like depression and over-diagnosed disorders like schizophrenia
in the African American community. In addition, because of socioeconomic factors Black women have limited
access to health care compared to Whites.
2010 NFA-LD
Evidence Set
Treatment Bad – Racism Turn 2/2
Racism must be addressed – failure to face the reality of racism guarantees our
own destruction
Joseph Barndt, minister and social activist, in the book Dismantling and Understanding Racism in
2006 [pg. 219-220. Available on Google Books] JB
To study racism is to study walls. In every chapter of this book, we have looked at barriers and fences, restraints and limitations, ghettos and prisons,
bars and curtains. We have examined a prison of racism that confines us all—people of color and white people alike. Victimizers as well as
victims are in shackles. The walls of the prison forcibly separate communities of color and white communities from each other, as well as divide
communities of color from each other. The constraints imposed on people of color by subservience, powerlessness, and poverty are inhuman and
unjust; but the effects of uncontrolled power, privilege, and greed that are the marks of our white prison inevitably destroy white people as well .
To dismantle racism is to tear down walls. The walls of racism can be dismantled. We are not condemned to an
inexorable fate, but are offered the vision and possibility of freedom . Brick by Brick, stone by stone, the prison of individual,
institutional and cultural racism can be destroyed. It is an organizing task that can be accomplished. You and I are urgently
called to join the efforts of those who know it is time to tear down, once and for all, the walls of racism.
The walls of racism must be dismantled. Facing up these realities offers new possibilities, but refusing them
threatens yet grater dangers. The results of centuries of national and worldwide colonial conquest and racial
domination, of military buildups and violent aggression, of over-consumption and environmental destruction
may be reaching a point of no return. The moment of self-destruction seems to be drawing ever more near,
nationally and globally. A small and predominantly white minority of the global population derives its power and privilege from the sufferings of the
majority of peoples of color. For the sake of the world and ourselves, we dare not allow it to continue.
2010 NFA-LD
Evidence Set
Treatment Bad – Gender Turn
Gender Stereotypes are common place in the treatment of mental disorders

World Health Organization Fact Sheet on Mental Health, updated 2010 [Available Online
http://www.who.int/mental_health/prevention/genderwomen/en/] SWD/Boyer
Gender bias occurs in the treatment of psychological disorders. Doctors are more likely to diagnose depression
in women compared with men, even when they have similar scores on standardized measures of depression
or present with indentical symptoms. Female gender is a significant predictor of being prescribed mood altering psychotropic drugs.
Gender differences exist in patterns of help seeking for psychological disorder. Women are more likely to seek help from and disclose mental health
problems to their primary health care physician while men are more likely to seek specialist mental health care and are the principal users of inpatient
care. Men are more likely than women to disclose problems with alcohol use to their health care provider. Gender stereotypes regarding
proneness to emotional problems in women and alcohol problems in men, appear to reinforce social stigma
and constrain help seeking along stereotypical lines. They are a barrier to the accurate identification and
treatment of psychological disorder
Gender stereotyping reinforces social identities that cause violence,

discrimination, and war
Betty Reardon, Colombia University, Sexism and the War Machine, 1985 [Available online through the book of
Impacts at http://ceda-ndt.uchicago.edu/BofI/Feminism.pdf] SWD/Boyer
Sexism- the impositionof a specific sex-related identity, a sexually determined set of human attributes, and sex-
prescribed social roles- therefore reduces the significance of nongender criteria in the self-development and definition of all
human beings. So viewed, sexism is equally damaging to both sexes, poses a severe obstacle to the development of a more
synthesized and humane social order and serves as a contributing factor in the maintenance of both the
organized violence of warfare and the structural violence of economic exploitation, political oppression, and
social discrimination.
The Affirmative ignores the gender problems in mental health, and passes on
the opportunity to evaluate treatment institutions. This action solidifies society’s
sexist institutions and traps us in a world of sexism-fueled violence and
discrimination.
Mary-Jo Del Vecchio Good, Professor of Social Medicine, Harvard, UN website, 2000 [“WOMEN AND
MENTAL HEALTH” Available Online http://www.un.org/womenwatch/daw/csw/mental.htm] SWD/Boyer
to ignore the potential

Although the social roots of many of these problems mean that they cannot be simply patched over with medical care,
role of the health care system to attend to needy women would imply that a society does not want to invest its
resources in women's health. Institutions of health education, such as medical schools and training programs for health workers,
need to be evaluated and barriers to treating mental illness and the consequences of violence addressed.
Communication among health workers, physicians, and women patients (and often men as well) is notoriously authoritarian in many places in the world,
regardless of the sex of the physician or health worker, making a patient's disclosure of psychological distress or consequences of sexual violence
difficult, at times stigmatized. Evaluation of training and enhancing the competence of primary care physicians and health workers to treat the
consequences of domestic violence, sexual abuse and psychological distress and mental disorders may occur in tandem with a review of what women
ideally want from health care givers. International and state sponsored health policies must also face the challenge of
formulating moral but "culturally sensitive" responses to practices hazardous to the emotional and physical
health of women and girls (such as female circumcision, female infanticide, gender-specific abortion, and feeding practices that discriminate
against girl children.) Such dilemmas can be partially resolved by offering support to local public health movements and grass-roots efforts.
2010 NFA-LD
Evidence Set
2010 NFA-LD
Evidence Set
Mental Health Courts Turn
Expanding the mental health courts puts more burden upon the police force,
which routinely is unable to handle the mentally ill, and results in excessive
force and racism in dealing with the mentally ill.
Camille Nelson, Professor of Law at Hofstra, Berkeley Journal of Criminal Law, Spring, 2010 , [“ Racializing
Disability, Disabling Race: Policing Race and Mental Status” Available through Lexis] SWD/Boyer
The last two decades have witnessed the creation and proliferation of mental health courts and other initiatives
meant to divert individuals with mental illnesses away from the criminal justice system. Experts increasingly agree that
such diversion is necessary in order to ensure treatment and appropriate
care of the mentally ill. n5 While I applaud these initiatives, the reality
is that police are increasingly asked to undertake the
task of diversion, a role for which they receive little training. Given the minimal progress that has been made in
the policing of the mentally ill, this Article commences where these policing and court-based initiatives have ended. n6 It provides a [*3]
Foucauldian n7 reading of the important triage function police are performing through their interaction with criminal suspects. Through an analysis of civil
suits against police officers regarding their interaction with mentally ill individuals, I theorize not only the persistent criminalization of people with mental
illnesses but also the disparate, yet routine, use of excessive force by police against persons of color with mental
illness. These behaviors are consistent with Michel Foucault's notions of discipline and punishment and are demonstrative of the ongoing
need for policing initiatives regarding encounters with the mentally ill and for maintained vigilance with respect
to racial profiling. While it might be expected that the mentally ill are treated similarly throughout the criminal
justice system irrespective of race, the cases I have reviewed suggest otherwise. By focusing on the triage function
performed by police in their street-level encounters, this project provides insight into the intersecting factors at work in police encounters with the
mentally ill. n8 [*4] Ultimately, this Article calls for renewed attention to the ways in which police exercise their discretion, as it appears that they do so
in markedly different ways depending upon the race of the person deemed mentally ill.
2010 NFA-LD
Evidence Set
AT – Szasz/Myth
Mental Disorders are very real, and encouraging the belief they are not simply
perpetuates the harmful behavior directed at them.
Judith A. Cook, Ph.D. and Jessica A. Jonikas, M.A., the University of Illinois at Chicago National
Research and Training Center on Psychiatric Disability, Journal of Disability Policy Studies, 2002 [“Self-
Determination Among Mental Health Consumers/Survivors: Using Lessons from the Past to Guide the Future” Available Online
http://www.psych.uic.edu/uicnrtc/sdconfdoc17.pdf] SWD/Boyer
Moreover, people with psychiatric disabilities often are not perceived as "legitimately" disabled by large
segments of society, but instead as malingerers or complainers. Their expressions of their discontent and insistence that their
civil rights be protected are viewed by some as evidence of their very insanity. To a large extent, this is due to the well-documented
episodic nature of many severe disorders, making it difficult for lay people to believe that individuals can
decompensate and recover rapidly, and enhancing perceptions that they are "faking" their problems. On top of this, individuals
with psychiatric disorders continue to be objects of socially-acceptable humor, scorn, and humiliation. It is still
acceptable, even at a time when Americans are being called upon to end discrimination against citizens with psychiatric disorders (United States
Department of Health and Human Services, 1999) and in an atmosphere of political correctness in our society at large, to mock people with
psychiatric problems and their symptoms and to use stigmatizing language. Examples of this type of discrimination are
prevalent in the media, and include joking about, imitating, and making light of symptoms and behaviors that are painful and humiliating for those who
experience them (Weinerth, 1993). Institutionalized discrimination against people with mental illness is one of the last
socially-acceptable, government-sanctioned threats to the rights of a large class of citizens, and makes the
realization of self-determination a tenuous and challenging process for many of them (Cook, 2000).
2010 NFA-LD
Evidence Set
AT – ADHD
ADHD is over-diagnoised and can lead to serious side effects

Shannon Polluck, author for EzineArticles.com, January 2010 [The ADHD Over diagnosis Epidemic,
http://ezinearticles.com/?The-ADHD-Overdiagnosis-Epidemic---How-to-Avoid-Becoming-a-Part-of-This&id=3959641] CG/Boyer
ADHD overdiagnosis is a common mistake being made by many professionals. One or two symptoms showing
hyperactivity, impulsivity, and inattention ARE NOT enough to conclude that it is indeed ADHD. The sad truth
is, ADHD overdiagnosis is happening, and on a frequent basis. With regard to the medication of ADHD, stimulants are
usually given to those with moderate to severe ADHD. Examples of common stimulants are Ritalin, Concerta, and Adderall. These
medications work by altering dopamine levels and increasing blood flow to the frontal lobe of the brain to help with the symptoms of
ADHD. Medications used in the treatment of ADHD may be helpful but it can cause disconcerting side effects that range from mild to more severe
ones.Among the common side effects of ADHD prescription medication include nervousness, stomach pain,
restlessness, anxiety, anorexia, loss of weight, insomnia, and stunted growth. More serious side effects
associated with the use of stimulants include psychiatric disorders, cardiovascular problems, and risk for drug
abuse. You should know that medications are not the only solution to ADHD. Before trying out stimulants, it is important to consider other options for
the treatment of ADHD. These include behavioral therapy, diet modification, vitamin supplementation, and homeopathic remedies. Other treatments that
are said to help control symptoms of ADHD include yoga and biofeedback training.
Girls are often under diagnosed with ADHD and can lead to clinical depression
Anita Gurian, Ph.D., NYU Child Study Center, accessed 8/1/10 [Girls with ADHD: Overlooked, Underdiagnosed, and
Underserved http://www.aboutourkids.org/articles/girls_adhd_overlooked_underdiagnosed_underserved] Boyer, CG
What happens to the girls? Because they don't disrupt the rest of the class, it may take longer for girls to get a diagnosis of ADHD and to get the help
they need. Most of the research has been done with boys, and as many as 50 to 75% of girls with ADHD are missed. Those
girls who do get identified are diagnosed on average five years later than boys (boys generally diagnosed at age 7 and girls
at age 12). Thus, they lose five critical years during which they could have been getting help. Here's the good news:
Educators, mental health researchers, and parents are now becoming aware of the unique needs of girls with ADHD Many girls with ADHD
can slip by without notice in the early school years, but they're likely to run into trouble in the middle and high
school years. When they have to deal with increased demands socially as well as in organizational, planning, memory, and independent study,
their psychological problems may become more apparent. According to Kathleen Nadeau, who has studied and written about girls
and women with ADHD, young girls experience social deficits early, but these deficits become more intense during the adolescent years when peer
relationships become important. Older adolescent girls with ADHD have been found to have more depression and
anxiety than girls without ADHD. Adolescence brings challenges for all girls, and even well-adjusted non-ADHD teenage girls report more
stressors in life than boys. So teenage girls with ADHD have a double risk for psychological problems since they have to deal with both social and
academic pressures. Several studies have found that teen girls with ADHD are at risk for a variety of psychological
problems. A study which tracked 140 teenage girls with ADHD from ages 12 through 17, found that by age 17 the ADHD girls were far
more likely than girls without ADHD to be clinically depressed, to have anxiety disorders and to have conduct
disorder. (Biederman, 2005). A five-year follow-up study of the largest number of girls with ADHD ever examined found that not only did
difficulties persist during their teens, but that new problems emerged. The girls with ADHD were significantly more likely to have
problems in academic performance, eating disorders, relationships with peers and teachers, and organizational
skills. The girls with ADHD were also found to have mild depression and risky behaviors, such as substance abuse.
(Hinshaw, 2006).
2010 NFA-LD
Evidence Set
Solvency – Insurance Companies Bad
Both public and private insurance discriminate against chronically mental ill
patients
Linda Rosenburg, MSW President and CEO, National Counsel for Community Behavioral Health. [Equal
Treatment: Mental Illness is a chronic disease, http://www.thenationalcouncil.org/galleries/press-files/LindaEqualTreatment.pdf] Boyer,
CG
Adequate care requires adequate dollars. Public insurance pays for at least 75 percent of treatment services
for people with chronic and serious mental illnesses in community settings. Despite its discriminatory approach, it is the
only option for millions of poor, unemployed, homeless incarcerated, and other vulnerable populations with
mental illness. So we must act to end the discrimination. We must eliminate ongoing and threaten cuts for Medicaid.
And Medicare must stop requiring higher co-pays from people with mental illness, while strengthening its sadly
inadequate mental health benefits package. Private insurances also discriminate mental illness. Currently,
only an estimated one-fifth of U.S. workers with employer-sponsored health insurance are covered by strong
parity laws that mandate mental health benefits, prohibit limits on outpatient visits and inpatient days, and limit
the extent to which the enrollees are burdened with higher cost sharing for mental health services.
2010 NFA-LD
Evidence Set
Stigma Evidence 1/3
1. Ethnically-targeted policies reinforce social stigmas regarding the targeted

group, and perpetuate harmful racist ideologies
Glenn C. Loury, Professor of Economics, Brown University, University of Wisconsin–Madison Institute
for Research on Poverty, Fall 2005 [“Racial stigma and its consequences” Available Online
http://www.irp.wisc.edu/publications/focus/pdfs/foc241.pdf] Boyer/SWD
If the meaning of a policy—job preferences or incarcera-tion—is sensitive to the race of those affected, popular support
for or opposition to the policy will depend upon the explanations ordinary people are inclined to give for the
racial disparities they observe. In the minds of many Americans, the tacit association of “blackness” with “un-worthiness” distorts cognitive
processes and makes it difficult to identify with the plight of people whom they see, mistakenly, as simply “reaping what they have sown.” In turn,
this tendency to see racial disparities as a communal (group) problem rather than a societal problem
encourages the reproduction of inequality through time. Absent intervention, the low social conditions of many blacks
persist, the negative social meanings ascribed to blackness are reinforced, and the racially biased social- cognitive processes are
reproduced.
2. Stigmatization prevents Advocacy and real solutions, gutting any possibility

at AFF solvency
Michael J. Stoil, PHD, Washington Editor, Behavioral Healthcare, April, 2006 [“Seven governing realities of
mental health policy” Available Online at http://behavioral.net/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A
%3AArticle&mid=64D490AC6A7D4FE1AEB453627F1A4A32&id=37F10C0E4AB3476BBEE3041B428C7CAF&tier=4] Boyer/SWD
One aspect of stigma is not controversial: Stigma acts as a potent barrier to becoming an advocate for
behavioral health policy. We have come a long way since the 1970s, when Hughes had to choose between disclosing his alcohol dependence
and running for reelection, and Sen. Thomas Eagleton was dumped from the Democratic presidential ticket after admitting to past treatment for
depression. Nevertheless, many people who have a personal stake in mental healthcare policy continue to be
dissuaded from active advocacy because of the stigma associated with mental and behavioral health
disorders. Survivors of cancer, heart disease, and other conditions can demand attention without fear that they will suffer for recovering from “their”
disease. Survivors of mental illnesses, emotional disorders, and substance abuse know that some people will
treat them with suspicion, fear, and contempt when they relate policy choices to their personal experience.
2010 NFA-LD
Evidence Set
Stigma Evidence 2/3
3. Stigmatization builds upon the Racial Stereotypes in the Squo, and create an
oppressive system of identity
Camille Nelson, Professor of Law at Hofstra, Berkeley Journal of Criminal Law, Spring, 2010 , [“ Racializing
Disability, Disabling Race: Policing Race and Mental Status” Available through Lexis] SWD/Boyer
Recent
Contemporary work on race examines the societal ascriptions and technologies that lead to the social construction of racial difference.
critical race work recognizes that race is founded not upon the inherent, internal differences between whites
and non-whites, but upon the attitudes and corresponding practices of a race-based society. Accordingly, societal
valuations and distributions are manipulated according to racialization. As certain constructed identities are marginalized, the
identities that are the normative reference points are accorded privileged societal statuses. In extrapolating these
critical legal studies insights and critical race theories to the realm of policing, I hypothesize that police, too, struggle with bias. Admittedly, bias might be
a matter of simple ignorance (from lack of exposure or lack of knowledge for example), or it might be rooted in animus or hostility, or even some
sentiment in between these extremes. Either way, the point is to interrogate the consequences of these racialized views for suspects in police
encounters.
This notion of the construction of privilege and the corresponding marginalization of people of color recognizes that in a different world, a world in which
race truly had no consequence, there would simply be no societal significance and no material significance to the various indicators or proxies of race,
be that skin color, facial features, hair texture or speech pattern. Race itself only has the meaning and consequences that we
have given to it. As is the case with being racialized as non-white (that is, negatively racialized), having a physical
impairment becomes socially disabling. n32 Meaningful analogies are drawn when one considers physical disability. Analyzing the
marginalized identity of "disabled" further reveals the advantages accorded to those occupying the normative,
yet often unacknowledged power-position of "ablebodiedness."
In many ways, the movement that identifies physical disability as a socially-contingent identity builds nicely upon the work done by race-critics and
contemporary scientists who debunk the physiological underpinnings of race. Like those recognizing and analyzing the socio-political construction of
race, many disability rights advocates are increasingly acknowledging the systemic constructs that actively disadvantage those with physical challenges
so as to produce "an identifiable class" of people with physical challenges or disabilities. Thus disability rights scholars have
recognized physical disability as a constructed identity. Just as whiteness "is an invisible insignia of the norm, 'ablebodiedness' is
also an unquestioned, unremarked upon state which only becomes notable in its absence." One becomes disabled not so much
because of the existence or non-existence of an actual impairment, but because of the societal overlay which
"others" the impairment to the point of creating an identity which is itself based upon that difference.
An individual's impairment is therefore exacerbated as disabling, or vitiated as innocuous. Depending upon the manner of societal construction, the
external environment presents a sliding scale of disabling potential. In certain contexts, therefore, society may render the impairment benign and
produce no disability; in other contexts societal structures may create profound disability . An analogous notion of the constructedness
of mental illness is also possible. In contemporary discourse, however, mental status is usually analyzed from the perspective of medical
science. But there is also a sociological vantage point of constructedness that is worth considering.
2010 NFA-LD
Evidence Set
Stigma Evidence 3/3
4. No single policy could hope to solve for stigma – only a change in attitudes
can succeed
Nicolas Rüsch, University of Freiburg, European psychiatry 2005 [Science direct, Mental illness stigma: Concepts,
consequences, and initiatives to reduce stigma, http://www.sciencedirect.com/] BF/Boyer
To sum up our overview of different methods to reduce stigma, contact combined with education seems to be the most promising avenue. To end on a
more cautious note, though, one has to bear in mind a limitation of every anti-stigma initiative that focuses on a
specific behavior of a certain group, e.g. local employers and their not offering jobs to persons with mental illness. On the one hand,
prejudices and behavior of one group are an appealing target, because it reduces the complexity of the stigma-phenomenon and focuses on a target
that matters [16]. On the other hand, the areas of individual discrimination, structural discrimination and self-stigma lead
to innumerable mechanisms of stigmatization. If one discriminating mechanism is blocked, a powerful
stigmatizing group can always create new ways to discriminate [63]. If for example persons with mental illness
are protected by new work-legislation, employers can find new, informal ways not to employ or to fire them.
Therefore, to substantially reduce discriminating behavior, stigma-related attitudes of power groups have to be
fundamentally changed.
Aff response – Protesting Stigma only entrenches it further, this means the
active of the negative debater turns the arguments about stigma they read
Patrick W. Corrigan, Amy Kerr, and Lissa Knudsen, Applied and Preventative Psychology, September
2005 [“The stigma of mental illness: Explanatory models and methods for change” Available Online http://www.sciencedirect.com/]
Boyer/SWD
Protest strategies highlight the injustices of various forms of stigma chastising the offenders for their attitudes
and behaviors. Anecdotal evidence suggests that protest can change some behaviors significantly (Wahl, 1995).
For example, in 2000 NAMI StigmaBusters played a prominent role in getting ABC to cancel the program “Wonderland,” which portrayed people with
mental illness as dangerous and unpredictable. StigmaBusters’ efforts not only targeted the show's producers and several management levels of ABC,
they encouraged communication with commercial sponsors including the CEOs of Mitsubishi, Sears, and the Scott Company. Hence, research might
show protest to be effective as a punishing consequence to discriminatory behavior decreasing the likelihood that people will repeat this behavior. The
punishing consequences of protest are especially relevant for examining the effects of legal penalties prescribed by the Americans with Disabilities Act
and the Fair Housing Act. In like manner, research might identify reinforcing consequences to affirmative actions that undermine stigma and encourage
more public opportunities for people with mental illness, e.g., government tax credits for employers who hire and provide reasonable accommodations to
people with psychiatric disabilities. Although organized protest can be a useful tool for convincing television networks to
stop running stigmatizing programs, protest may produce an unintended “rebound” effect in which prejudices
about a group remain unchanged or actually become worse. Protest programs asking people to suppress their
prejudice about a group can promote psychological reactance (do not tell me what to think) and worsen attitudes as a
result (Corrigan et al., 2001; Macrae, Bodenhausen, Milne, & Jetten, 1994; Penn & Corrigan, 2002). Hence, while protest may be a
useful tool for changing the behavior, it may have little or negative impact on public attitudes about people with
mental illness.
2010 NFA-LD
Evidence Set
***Mental Illness Myth Kritik – Index***

Mental Illness Myth Kritik Index......................................................161
K – 1NC shell 1/4.....................................................................162
K – 1NC shell 2/4.....................................................................163
K - 1NC shell (3/4)...................................................................164
K – 1NC shell 4/4.....................................................................165
Link Extension – Rhetoric & Language 1/2..............................................166
Link Extension – Rhetoric & Language 2/2..............................................167
Link Extension – Mental Illness.......................................................168
Impact Calculations...................................................................169
K – Version 2.0 – 1NC Shell...........................................................170
Extensions – Implication – Subjectivity...............................................171
Extensions – Implication – Morality...................................................172
Extensions – Implication – Autonomy 1/2...............................................173
Extensions – Implication – Autonomy 2/2...............................................174
Extensions – Implication – Puppets....................................................175
Extensions – Implication – Freedom of Religion........................................176
Extensions – Implication – Happiness..................................................177
Extensions – Implication – Solvency 1/6...............................................178
Szasz Defense.........................................................................184
AT – AFF Solves K.....................................................................185
AT – You don’t have Evidence..........................................................186
AT – Biology Proves Mental Illness is Real............................................187
AT – Anti-Psychiatry Bad..............................................................188
AT – Schoenfeld.......................................................................189
AFF Answers – Szasz’s Thesis Bad 1/8..................................................190
AFF Answers – Szasz’s Method Bad......................................................198
AFF Answer – Subjectivity.............................................................199
AFF Answers – Permutation.............................................................200
2010 NFA-LD
Evidence Set
K – 1NC shell 1/4
A. Links –
A1. Mental illness is a myth perpetuated to impose social norms.

John Breeding, phd, licensed psychologist Austin, Texas, Jan 1995, [“mental health system as a stop sign on
liberation from other social oppressions” < http://www.oikos.org/breeding.htm>] boyer/ts
The second mechanism by which mhso acts to hold oppression in place involves a trick of magic. A basic principle of magic involves illusion, one piece
of which is called sleight-of-hand. Political versions involve so-called red herrings or straw men. The mechanism is indirection and illusion: "now you see
it, now you don't.". "before you get a glimpse of social injustice, let me show you mental illness." "before you think about
racism and economic injustice, let me show you genetic predisposition to violence in young black males."
Institutional psychiatry has been so successful in their magic show that few people realize that "mental illness" is, at best,
merely a metaphor. To quote peter breggin, foremost writer and outspoken challenger of the tenets of biopsychiatry: " it is scientifically
incontrovertible that there is no convincing evidence that any condition routinely seen by psychiatrists has a genetic or
biological origin." the concept of mental illness was originally created as a metaphor in order to establish medical/scientific
credibility to the accepted practices of responding to people in distress or in deviance from social norms . The agency of
biopsychiatry is performing the greatest magic show on earth. The incredible illusion of biologically caused mental illness serves as a
powerful enforcer of oppression, consistently distracting our attention from the reality of social injustice and the
devastating results on individuals and on society. I'll give you a hint now on one key to see through this illusion. Keep your eye on where the
money goes.
A2. The mere use of these terms construct and reinforce mental illness as myth.
Johnathan Kenneth Burns, mbchb msc fcpsych, senior lecturer and chief specialist psychiatrist dept of
psychiatry Nelson R Mandela school of medicine university 2009 [of kwazulu-natal durban south africa, “mental
health and inequity: a human rights approach to inequality, discrimination, and mental disability” health and human rights, vol 11 no 2 <
http://www.hhrjournal.org/index.php/hhr/article/viewarticle/170/255>] boyer/ts
The institutionalized medical language of mental disability is, at best, pejorative and situates mental conditions squarely within an individual disease
framework. Terms such as “mental disease” and “mental disorder” construct psychological, emotional, and
behavioral conditions as innate, biological, pathological states independent of socioeconomic, cultural, and
political context. Likewise, the prevailing medical model of mental disability — which defines disability as an
individual’s “restriction in the ability to perform tasks” and handicap as “the social disadvantage that could be
associated with either impairment and/or disability” — serves to establish a direct causal relationship between individual impairment
and disability. In contrast, the social model of disability, theorized by disabled activist and scholar michael oliver, views disability as something imposed
upon persons by an oppressive and discriminating social and institutional structure and that is over and above their impairment.
2010 NFA-LD
Evidence Set
K – 1NC shell 2/4
B. Implications –
B1. The act of labeling is a force of violence that dehumanizes and destroys
Diana ralph, phd, associate professor at carlton university and school of social work, 1983 “work and
madness: the rise of community psychiatry” p. 137] boyer/ts
In other words, for all four groups—for the unemployable, the marginally employable, the employed peoples of the developed western nations, and third
world freedom fighters—community psychiatry is not only not helpful; it is actively destructive. In return for quick
addictive “fixes” to ease tensions and depressions, such people pay dearly: in reduced personal and class
awareness; in the debilitating effects and side-effects of treatments; in the neglect of “disposable” friends,
relatives; in the labels of “mad or “disordered” given for behavior never considered crazy before; in taxes and
fees to feed the hungry madness business; and in the threat of severaly authoritarian social control and torture
in the future.
2010 NFA-LD
Evidence Set
K - 1NC shell (3/4)
B2. The mere use of these terms isn’t as important as the action of labeling they
represent. Changing the terms is not a solution, new terms will simply take their
place and create the same social stigma. Only a rejection of the process of
labeling can defeat the threat.
Thomas Szasz, professor of psychiatry suny 1973, [“ideology of insanity: essays on psychiatric dehumanization of man”
p. 57] boyer/ts
soon after psychiatrically stigmaztized disabilities such as

In the history of psychiatry, the process of reconversion took the following form:
“malingering” or “insanity” were renamed as “mental” or “emotional illnesses,” the new labels began to be treated exactly
as the terms they displaced had been treated formerly. People bearing the names of mental illnesses, like jews with
certain distinguishing german names, thus reacquired their former ill repute . And so it has come to pass that the label “mental illness” (and its
variants) has acquired the same meanings and social functions as those possessed by previously abandoned terms of psychiatric denigration. To be sure, in the context of
some psychiatric and psychoanalytics writings, certain words like “hysteria” or “schizophrenia” may have some descriptive value. My point here is not to deny this, but to
psychiatric diagnostic terms do not describe identifiable disease entities, but instead degrade and
emphasize that, as generally used,
demean the person to whom they are attached.
Although this characteristic of the language of psychiatry has until now not been clearly identified, i believe it has been widely recognized. How else can we explain the
periodic renaming of the “diseases” from which “mental patients” suffered, and the institutions in which they were “treated”? In the relatively short, three-hundred-
year history of psychiatry, the condition now called mental illness has been labeled and relabeled as madness, lunacy, insanity, idocy, dementia,
dementia praecox, neurasthenia, psychopathy, mania, schizophrenia, neurosis, psychoneurosis, psychosis, ego failure, ego dyscontrol, emotional
illness, emotional disorder, psychological illness, psychological disorder, psychiatric illness, psychiatric disorder, immaturity, social failure, social
maladaptation, behavior, disorder, and so forth. Similarly, the institution for the confinement of such “patients” has been called madhouse, lunatic
asylum, insane asylum, state hospital, state mental hospital, mental hospital, psychopathic hospital, psychiatric hospital, psychiatric institute, psychiatric
institute for research and learning, psychiatric center, and community mental health center . Since each one of these terms is intended to
identify and at the same time conceal a bad person (that is, one who is mad, or does mad things), or a bad place (that is, an institution where
such persons are incarcerated), no single term can fulfill these contradictory functions, except temporarily. With persistent
usage-often after only a decade or two-the pejorative meaning of the term becomes increasingly apparent and its value as
semantic camouflage diminishes and disappears. New psychiatric terms of “mental illness” and “mental hospital” are then
coined, giving the public-and usually the medical and psychiatric professions as well-the impression that an important new psychiatric
discovery has been made. When the fresh terms become familiar, they, in turn, are discarded and a new crop of
Therapeutic sounding words is introduced. This process has been repeated several times during the past centruy, most
recently in the the early 1960s, when mental hospitals were renamed as community mental health centers.
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K – 1NC shell 4/4

C. Alternative – join the negative in recognizing the dehumanizing & violent
nature of psychiatry and reject its use of
Thomas Szasz, professor of psychiatry suny 1965“the myths of mental illness” p. 85] boyer/ts
I submit that the classical models of hysteria and conversion are no longer useful either for nosology or for therapy. Today, however, there may be social and institutional
grounds for adhering to this theory. The notion of hysteria as mental illness and the psychoanalytic theory of hysteria (especially the idea of conversion), have become social
symbols for psychoanalaysis as a medical technique and guild. The original psychoanalytic theory of hysteria—and of neurosis, following more or less closley on the same
scheme—made it possible for physicians (and allied scientists) to retain a fairly homogenous picture of “diseases.” According to this scheme, diseases could be divided into
somatic and psychical, the latter retaining a large measure of apparent simplicity, borrowed from the former. In this way, too, psychotherapy could be regarded as an
The alternative to this familiar and comfortable point of
enterprise similar in all essentials to established modes of medical and surgical treatments.
view is to abandon the entire physicalistic-medical approach to mental illness and to substitute novel theoretical
viewpoints and models, appropriate to psychological, social, and ethical problems. Explicit recognition of the social
institution function of certain present-day psychiatric ideas should prove helpful in keeping an open mind toward a
searching analysis of the roots of the notion of mental illness .
Framework- Prior to policy, prior to “treatment,” we must question the nature of

the labels & relationships we produce.
Thomas Szasz, professor of psychiatry suny 1973, [“ideology of insanity: essays on psychiatric dehumanization of man”
p. 57] boyer/ts
Understanding, the transformations of persons into patients is crucial for our proper grasp of medicine and
allied fields as practical endeavors. For only in theory do physicians deal with diseases. In practice they, deal with
persons, who may or may.not be ill and who, may or may not be patients. To put it differently, the practicing
physician deals with diseases, only through patients, Sick persons are, as it were, the, carriers Of diseases, or
more specifically, of diseased bodies or body, parts. We must therefore now ask: Who owns—a person's or, patient's—
illness? The patient himself, his family, his physician, or the State? Similarly, if. we view treatments not abstractly as chemotherapy or
psychotherapy, but concretely as interventions performed by physicians on the bodies or minds of patients, we must ask: Who owns—medical or
psychiatric—treatment? The physician himself, his patient, his patient's fam¬ily, or the State? Although these questions are about diseases and
treat¬ments, they are not medical questions. They are economic, moral, legal, and political questions.
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Link Extension – Rhetoric & Language 1/2
The language of “mentally ill” furthers this dichotomy

Murray Edelman, policy and society, 1974 [“the political language of the helping professions”, Available Online
http://www.brown.uk.com/brownlibrary/edelman.pdf] mf boyer
In the symbolic worlds evoked by the language of the helping professions speculations and verified fact readily
merge with each other. Language dispels the uncertainty in speculation, changes facts to make them serve
status distinctions, and reinforce ideology. The names for forms of mental illness, forms of delinquency, and for
educational capacities are the basic terms. Each of them normally involves a high degree of unreliability in
diagnosis, in prognosis, and in the prescription of rehabilitative treatments; but also entail unambiguous
constraints upon, clients, especially their confinement and subjection to the staff and the rules of a prison, school, or hospital. The confinement
and constraints are converted into liberating and altruistic acts by defining them as education, therapy, or rehabilitation and by other linguistics forms by
examined shortly. The arbitrariness and speculation in the diagnosis and the prognosis, on the other hand, are
converted into clear and specific perceptions of the need for control. Regardless of the arbitrariness or
technical unreliability of professional terms, their political utility is manifest; they marshal popular support for
professional discretion, concentrating public attention upon procedures and rationalizing in advance any
failures of the procedures to achieve their formal objectives.
Language creates an us them dichotomy

http://www.brown.uk.com/brownlibrary/edelman.pdf]
Social scientists, and large segment of the public, have grown sensitive and allergic to agitation political
rhetoric and to the ambiguities of such labels “democracy,” ‘communists,” and “law and order.” The
fundamental and last-lasting influences upon political beliefs flow, however, from language that is not
perceived as political at all, but nonetheless structures of status, authority, merit, deviance, and the causes of
social problems. Here is a level of politics, and analysis, that conventional political science rarely touches, but on that explains a great deal of the
overt political maneuvering and control upon which people normally focus. The special language of the helping professional which
we are socialized to see as professional and as non-political , is a major example of this level of political
though not the only one. Through devices i explore here, these professions create and reinforce popular
beliefs about which kinds of people are worthy and which ones are unworthy: about who should be rewarded
through governmental action and who controlled or repressed. Unexamined language and actions can help us
understand more profoundly than legislative histories or administrative or judicial proceedings how we decide upon status, rewards,
and controls for the wealthy, the poor, women, conformists, and non-conformists.
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Link Extension – Rhetoric & Language 2/2
Language is essential to our social relationships.

Language is the distinctive characteristics of human beings. Without it we could not symbolize: reason,
remember, anticipate, rationalize, distort, and evoke belief and perceptions about matters not immediately
before us. With it we not only describe reality but we create our own realities . By naively perceiving it as a tool, we
mask its profound part in creating social relationships and in evoking the roles and “selves” of those involved in
the relationships.
The categorization creates a power hierarchy.

Because the helping professionals define other people’s statues (and their own), the special terms they employ
to categorize clients and justify restrictions of their physical movements and their moral and intellectual
influence are especially revealing of the political functions language performs and of the multiple realities it
helps create. Just as any single numeral evokes the whole number scheme our mind, so a term, a syntactic form, or a
metaphor with political connotations can evoke and justify a power hierarchy in the person who used it and in
the groups that respond to it.
Language is a symbol of how we think

We normally fail to recognize this catalytic capacity of language because we think of linguistic terms and
syntactical structures as signals rather than symbols. If a word is a name for a specific thing or action then
terms like “mental illness,” “delinquency prone,” or “schizophrenic” have narrowly circumscribed meanings. But
if a word is beliefs, and expectations, then it evokes a particular structuring of beliefs and emotions, a
structuring that varies with people’s social situation. Language as symbol catalyses a subjective world in which
uncertainties are classified and appropriate courses of action become clear. Yet this impressive process of symbolic
creation is not self-conscious . On the contrary, our naive view holds that linguistics terms stand for particular objects or behaviours, and so we do not
ordinarily recognize that elaborate cognitive structures are built upon them.
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Link Extension – Mental Illness
Link – Mental Illness is a Myth

Lawrence Stevens, J.D., backwash.com, 1996 [Available Online http://www.antipsychiatry.org/exist.htm “Does mental
illness exist”] TF/Boyer
All diagnosis and treatment in psychiatry, especially biological psychiatry, presupposes the existence of something
called mental illness, also known as mental disease or mental disorder. What is meant by disease, illness, or disorder? In a semantic
sense disease means simply dis-ease, the opposite of ease. But by disease we don't mean anything that causes a lack of ease,
since this definition would mean losing one's job or a war or economic recession or an argument with one's spouse qualifies as "disease". In his book is
alcoholism hereditary? Psychiatrist donald w. Goodwin, m.d., discusses the definition of disease and concludes "diseases are something
people see doctors for. ... Physicians are consulted about the problem of alcoholism and therefore alcoholism
becomes, by this definition, a disease" (ballantine books, 1988, p. 61). Accepting this definition, if for some reason people consulted
physicians about how to get the economy out of recession or how to solve a disagreement with one's mate or a bordering nation, these problems would
also qualify as disease. But clearly this is not what is meant by "disease". In his discussion of the definition of disease, dr. Goodwin acknowledges there
is "a narrow definition of disease that requires the presence of a biological abnormality" (ibid). In this pamphlet i will show that there are no
biological abnormalities responsible for so-called mental illness, mental disease, or mental disorder, and that
therefore mental illness has no biological existence. Perhaps more importantly, however, i will show that mental illness also
has no non-biological existence - except in the sense that the term is used to indicate disapproval of some
aspect of a person's mentality.
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Impact Calculations
The calculation of life makes the devaluation of life and extermination possible.
Dillon, Professor of Politics and IR at Lancaster University, 1999 (Political Theory vol. 27 n. 2)
The subject was never a firm foundation of justice, much less a hospitable vehicle for the reception of the call of another Justice. It
was never in posession of that self-posession which was supposed to secure the certainty of itself, of a self-posesssion that would enable it ultimately to
adjudicate everything. The very indexicality required of sovereign subjectivity gave rise rather to a commensurability
much more amenable to the expendability required of the political and material economies of mass societies
than it did to the singular, invaluable, uniquenss of the self. The value of the subject became the standard unit
of currency for the political arithmetic of states. They trade in it still to devestating global effect. The technologisation of the
political has become manifest and global.
HE CONTINUES…
Economies of evaluation necessarily require calculability. Thus no valuation without mensuration without
indexation. Once rendered calculable, however, units of account are necessarily submissible not only to valuation, but
also, of course, to devaluation. Devalution, logically, can extend to the point of counting as nothing. Hence, no
mensuration without demunsaration either. There is nothing abstract about this: the declension of economies of value leads to the
zero point of the holocaust. However liberating and emancipating systems of value rights may claim to be, for
example, they run the risk of counting our the invaluable . Counted out, the invaluable then loses its purchase on life. Herewith the
necessity of championing the invaluable itself. For we must never forget that, “we are always dealing with whatever exceeds measure.”
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K – Version 2.0 – 1NC Shell
A. Thesis – The concept of mental illness falsely claims an abstract idea is real
Thomas Szasz, psychiatrist, American Psychologist 1960 [“The Myth of Mental Illness”
http://psychclassics.yorku.ca/Szasz/myth.htm google scholar] McNabb Sk
Since the notion of mental

My aim in this essay is to raise the question "Is there such a thing as mental illness?" and to argue that there is not.
illness is extremely widely used nowadays, inquiry into the ways in which this term is employed would seem to
be especially indicated. Mental illness, of course, is not literally a "thing" -- or physical object -- and hence it
can "exist" only in the same sort of way in which other theoretical concepts exist. Yet, familiar theories are in
the habit of posing, sooner or later -- at least to those who come to believe in them -- as "objective truths" (or
"facts"). During certain historical periods, explanatory conceptions such as deities, witches, and
microorganisms appeared not only as theories but as self-evident causes of a vast number of events. I submit
that today mental illness is widely regarded in a somewhat similar fashion, that is, as the cause of innumerable
diverse happenings. As an antidote to the complacent use of the notion of mental illness -- whether as a self-evident phenomenon, theory, or
cause--let us ask this question: What is meant when it is asserted that someone is mentally ill? In what follows I shall describe briefly the main uses to
which the concept of mental illness has been put. I shall argue that this notion has outlived whatever usefulness it might have had and that it now
functions merely as a convenient myth.
B. Implications – <Insert from File>
C. Alternative – The term mental illness should be replaced with problems of

living
What is implied in the line of thought set forth here is something quite different. I do not intend to offer a new
conception of "psychiatric illness" nor a new form of "therapy." My aim is more modest and yet also more
ambitious. It is to suggest that the phenomena now called mental illnesses be looked at afresh and more
simple, that they be removed from the category of illness, and that they be regarded as the expressions of
man's struggle with the problem of how he should live. The last mentioned problem is obviously a vast one, its enormity reflecting
not only man's inability to cope with his environment, but even more his increasing self-reflectiveness.
(be carefull this card contains gendered langague)
2. The linguistic change of the Alternative solves the Szasz arguments- language
controls reality
R. E. Vatz & L. S. Weinberg, Thomas Szasz: primary values and major contentions. 1983. [ Introduction , R.
E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books13-14] McNabb SK
For Szasz, the central struggle faced by each human being is to defend against those who would impose upon
him their own definitions of who he is and what constitutes his best interests. The battlefield upon which this
struggle for definition is fought is largely linguistic and the ultimate meaning of behavior and events is
established by the victors in the battle of words. Reality, from the rhetorical perspective of Szasz, is embedded
in the language used to describe it, and one cannot escape from this reality unless one controls the language
itself (Szasz: “the struggle for definition is veritable the struggle for life itself… In ordinary life, the struggle is
not for guns but for words: whoever first defines the situation is the victor; his adversary, the victim… In short,
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he who first seizes the word imposes reality on the other; he who defines thus dominates and lives; and he
who is defined is subjugated and may be killed” [Second Sin]).
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Extensions – Implication – Subjectivity
Treating people as abnormal or sick through mental illness deprives them of

subjectivity. This condition forces people to work for personal identity. The loss
of subjectivity is horror along the lines of the Third Reich.
Geoff Danaher, Tony Schirato, & Jen Webb, Understanding Foucault, 2000. [London: Sage Publications.]
McNabb SK
These examples of the production of subjectivity ( the mad, the insane, the pervert, the outcast) come about by way of what Foucault calls technologies
of classifying, disciplining , analyzing and normalizing; and they depend to a large extent on the process of naming. Human being across cultures and
across history have named themselves , both as communities and as individuals, and have denied names-and hence real subjectivity to slaves and
other non people. So an important precondition for being truly human is having a name , which denotes an identity that is distinct from everyone else .
For people in western cultures, the possibility of losing our particular identities ( our subjectivity) is the stuff of
psychosis or horror. We can find an example of this horror in popular culture: one of the worst enemies in the Star Trek series is the Borg, a collective
consciousness which rampages across the universe assimilating everyone into itself, and destroying an trace of individual character. For a real life
example, we only have to think of the way in which the Third Reich stripped the inmates of its concentration
camps of their names, and tattooed them with numbers. This made them non-human- and therefore easy to
abuse and kill. Our personal names distinguish us from everyone and everything else , and thus allow us to claim an identity as a unique subject.
So we become subject s by naming ourselves as particular individuals, and as the occupiers of particular sets of subject positions (such as mother,
daughter, and worker) The naming process also works to make us subjects by naming and identifying what we are not ( such as mad, old, or sick)- that
is, through technologies of differentiation. Those who are not subjects are those who fail to meet the conditions defined as
normal- because they are mad, old or sick, for instance. It is, in the first instance , these others , these not subjects or not quite
subjects, who are locked up in prisons or mental clinics, trapped in poverty or pensions , numbed by
medication, and shamed in public. These sorts of practices force human beings to work on themselves in order
to meet and comply with the models normalized by the individual’s culture, which they exchange for the
promise of subject status ( that is acceptance as ‘normal human beings).
Pg. 126-127
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Extensions – Implication – Morality
The psychology of mental illness removes people from the province of

responsible moral agents. The insanity defense and commitment prove.
Thomas Szasz, psychiatrist, Thomas Szasz: primary values and major contentions. 1983. [ Foreward , R. E.
Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 10] McNabb SK
Many so-called mental patients engage in disturbing or illegal behavior:

What, then, do mental patients and psychiatrists do?
they starve themselves, attack members of their families, commit arson or theft, kill prominent persons. The
psychiatrists reciprocate with two characteristic acts: they inculpate and imprison the innocent, calling it civil
commitment and psychiatric treatment; and they exculpate and imprison the guilty, calling it the insanity
defense and criminal commitment. Although psychiatrists perform many other acts as well, these two sets of
psychiatric performances stand as important reminders of what I regard as the central moral philosophical act
of psychiatry: transforming individuals from responsible moral agents into non-responsible, insane patients. To
be sure, psychiatrists claim that it is not they but the dreaded illness they call “psychosis” that transforms men
and women from moral agents into organisms that deserve neither blame nor praise but only pity and therapy,
this controversy will not, of course, be further pursued here, especially since the reader will find it amply illuminated in the materials assembled in this
volume. (Pg. 10)
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Extensions – Implication – Autonomy 1/2
Psychiatry uses mental illness to deny autonomy – It twists metaphor

E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 14] McNabb SK
Central to the rhetorical method of Szasz is the concept of metaphor, which he employs in most of his analyses. In stating that “mental illness” is a myth,
therefore, Szasz is not arguing that the behavior labelled “mental illness: does not occur, but rather that “mental illness” and related categories are purely
metaphoric explanations, not medical one. As Szasz states (and states often), we have incorrectly, either innocently or not so innocently, taken this
metaphoric “illness” to be literal illness. The seemingly endless array of categories and sub-categories of mental
“illnesses” and “disorders,” which psychiatrists continue to “discover: and revise, are in fact nothing more than
descriptions of the unlimited variety of human behaviors, especially those violating social or psychiatric norms.
This misleading literalization of metaphor furthers the interests of psychiatrists and society, if not the interests
of the “mentally ill.” To Szasz, the use of strategic metaphors – especially the camouflaged use of such
metaphors – deprives humankind of its greatest freedom: autonomy. Unlike religious and democratic political
persuaders who claim no false identity and implicitly recognize man’s autonomy, psychiatrists present
themselves as scientist and explicitly deny the right of autonomy to those whom they choose to define and
control. (Pg, 14)
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Extensions – Implication – Autonomy 2/2
Autonomy has value – It is freedom

The significance to Szasz of the idea of autonomy can hardly be overstated. In his writings one finds repeated references to the crucial nature of this
value.; numerous policies are supported and justified in its name. Szasz defines autonomy as “… freedom to develop one’s self
– to increase one’s knowledge, improve one’s skills, and achieve responsibility for one’s conduct. And it is
freedom to lead one’s own life, to choose among alternative courses of action so long as no injury to others
results” (The Ethics of Psychoanalysis)(Pg. 21)
Autonomy is the best value

Thomas Szasz, psychiatrist, Thomas Szasz: primary values and major contentions. 1983. [ Autonomy , R. E.
Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books] McNabb SK
Why do I place so much emphasis on autonomy? What is the special merit of this moral concept? Let us define
what we mean by autonomy, and its value will then become evident. Autonomy is a positive concept. It is
freedom to develop one’s self – to increase one’s knowledge, improve one’s skills, and achieve responsibility
for one’s conduct. And it is freedom to lead one’s own life, to choose among alternative courses of action so
long as no injury to others results.
In modern society, based more on contract than on status, the autonomous personality will be socially more competent and useful than its
heteronomous counterpart. Moreover, and very significantly, autonomy is the only positive freedom whose realization does
not injure others. Other freedoms – for example, to struggle for nationalistic or religious goals – are likely to injure others; indeed, many such
goals cannot be pursued meaningfully unless there is opposition to them. To be sure, self-development may also “injure” others; the better bricklayer
might displace the one who is less proficient.
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Extensions – Implication – Puppets
Psychiatry is like religion – It makes humans into puppets

Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 23-25] McNabb SK
Descriptive Autonomy:
Man’s actions represent free choices for which he is responsible, but for which he may
rhetorically seek to avoid responsibility, most prominently through attributing behavior to literal and/or figurative
gods. The traditional Judeo-Christian monotheistic god would be an example of the former, while physicians
might be classified as the latter. The crucial moral characteristic of the human condition is the dual experience of freedom of the will and
personal responsibility. Since freedom and responsibility are two aspects of the same phenomenon, they invite comparison with the proverbial knife that
cuts both ways. One of its edges implies options: we call it freedom. The other implies obligations: we call it responsibility. People like freedom because
it gives them mastery over things and people. They dislike responsibility because it constrains them from satisfying their wants. That is why one of the
things that characterizes history is the unceasing human effort to maximize freedom and minimize responsibility. But to no avail, for each real increase in
human freedom – whether in the Garden of Eden or in the Nevada desert, in the chemical laboratory or in the medical laboratory – brings with it a
proportionate increase in responsibility. Each exhilaration with the power to do good is soon eclipsed by the guilt for having used it to do evil. Confronted
with this inexorable fact of life, human beings have sought to bend it to their own advantage, or at least to what they thought was their advantage. In the
main, people have done so by ascribing their freedom, and hence also their responsibility, to some agency outside themselves. They have thus
projected their own moral qualities onto others – moralizing them and demoralizing themselves. In the process, they have made others into puppeteers
and themselves into puppets. Evidently, the oldest scheme for constructing such an arrangement is religion: only
deities have free will and responsibility; people are mere puppets. Although most religions temper this imagery
by attributing some measure of self-action to the puppets, the importance of the underlying world view can
hardly be exaggerated. Indeed, people still often try to explain the behavior of certain self-sacrificing persons
by saying that they are carrying out God’s will; and, perhaps more important still, people often claim to be
carrying out God’s will when they sacrifice others, whether in a religious crusade or in a so-called psychotic
episode. They important thing about this imagery is that it makes us witness to, and even participants in, a
human drama in which the actors are seen as robots, their movements being directed by unseen, and indeed
invisible, higher powers.If stated so simply and starkly, many people nowadays might be inclined to dismiss
this imagery as something only a religious fanatic would entertain. That would be a grave mistake, as it would
blind us to the fact that it is precisely this imagery that animates much contemporary religious, political,
medical, psychiatric, and scientific thought. How else are we to account for the systematic invocation of divinities by national leaders?
Or the use of the Bible, the Talmud, the Koran, or other holy books as guides to the proper channeling of one’s freedom to act in the world? One of the
universal solvents for guilt, engendered by the undesirable consequences of one’s actions, is God. That is why religion used to be, and still is, an
important social institution. But the belief in deities as puppeteers and in people as puppets has diminished during the past few countries. There has,
however, been no corresponding increase in the human acceptance of, and tolerance for, personal responsibility and individual guilt. People still try to
convince themselves that they are not responsible, or are responsible only to a very limited extent, for the undesirable consequences of their behavior.
How else are we to account for the systematic invocation of Marx and Mao by national leaders? Or the use of the writings of Freud, Spock and other
ostensibly scientific works as guides to the proper channeling of one’s freedom to act in the world? Today, the universal solvent for guilt is science. That
is why medicine is such an important social institution.For millennia, men and women escaped from responsibility by theologizing morals. Now they
escape from it by medicalizing morals. Then, if God approved a particular conduct, it was good; and if He disapproved it, it was bad. How did people
know what God approved and disapproved? The Bible - that is to say, the biblical experts, called priests – told them so. Today, if Medicine approves a
particular conduct, it is good; and if it disapproves it, it is bad. And how do people know what Medicine approves or disapproves? Medicine – that is to
say, the medical experts, called physicians – tells them so. P. 23-25
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Extensions – Implication – Freedom of Religion
The legal status of psychiatry destroys the first amendment- freedom of religon
Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 26-27] McNabb SK
This principle applies, and ought to be applied, to medical or so-called therapeutic interventions as well. I
maintain, in other words, that suffering caused by illness – regardless of whether it is actual bodily illness or
alleged mental illness – cannot be the ground, in American law, for depriving a person of liberty, even if the
incarceration is called hospitalization, and even if the intervention is called treatment. I contend that such use
of state power – whether rationalized as the necessary deployment of the police power or as the therapeutic
application of the principle of parens patriae – is contrary to the ideas and ideals enshrined in the First
Amendment to the Constitution.
To join this argument, we need to consider what the state might do, or ought to do, to citizens who are not suffering in order to do something
for those who are. The recipients of social security or welfare payments are not subjected to the police power of the state: they are not incarcerated and
are not compelled to submit to medical treatments. However, we must consider what is being done in the United States – and, of course, elsewhere too
– to people who are suffering, or who are alleged to be suffering, ostensibly to help them. It is precisely at this point that the theology of medicine – and
especially the theology of psychiatry and of therapy – is writ clear and large. For example, on February 6, 1976, Psychiatric News, the official newspaper
of the American Psychiatric Association, published a front-page interview conducted by Robert Pear of the Washington Star with Dr. Judd Marmor, the
president of the American Psychiatric Association. After alluding to my objections to involuntary psychiatric interventions, Pear asks Marmor, “But if a
person who is supposedly ill doesn’t recognize his illness and doesn’t request treatment – should society intervene?” To which Marmor replies, “Yes,
because these individuals are suffering and it’s in the nature of their suffering very often that they are in no position to evaluate the fact that they are
mentally ill.’”
This modern therapeutic view seems to me identical to the traditional theological view according to which some persons are suffering and it’s
in the nature of their suffering very often that they are in no position to evaluate the fact that they have strayed from the true faith. The framers of the
Constitution opposed such sophistry and such policy. They reasoned – I think rightly – that even if the case were exactly Marmor, for example, presents
it, it should be enough for those solicitous for the welfare of such “sufferers” to offer them their “help.” That would remove the sufferers’ supposed
ignorance about their own suffering and about the help available for its relief. Neither the existence of such suffering, real or alleged, nor the existence of
help for it, real or alleged, could justify, in this view, an alliance between church and state and the use of the state’s power to impose clerical help on
unwilling clients. Just so, I insist, it cannot justify imposing clinical help on them.
How, then, has it come about that medicine has succeeded where religion has failed? How has therapy
been able to breach the wall separating church and state where theology has been unable to do so? Briefly
put, medicine has been able to achieve what religion has not, primarily by a radical violation of our vocabulary,
of our conceptual categories; and secondarily, through the subversion of our ideals and institutions devoted to
protecting us from reposing power in those who would help us whether we like it or not. We have done it before to the
blacks. Now we are doing it to each other, regardless of creed, color, or race. pg 26-27
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Extensions – Implication – Happiness
Mental illness precludes the possibility of universal human happiness

Thomas Szasz, psychiatrist, Thomas Szasz: primary values and major contentions. 1983. [ Mental Illness is
a myth , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books66-67] McNabb SK
Finally, the myth of mental illness encourages us to believe in its logical corollary; that social intercourse would be harmonious, satisfying, and the
secure basis of a good life were it not for the disrupting influences of mental illness or psychopathology. However, universal human happiness, in this
form at least, is but another example of wishful fantasy. I believe that human happiness, or well being, is possible – not just
for a select few, but on a scale hitherto unimaginable. But this can be achieved only if many men, not just a
few, are willing and able to confront frankly, and tackle courageously, their ethical, personal, and social
conflicts. This means having the courage and integrity to forego waging battles on false fronts, finding
solutions for substitute problems – for instance, fighting the battle of stomach acid and chronic fatigue instead
of facing up to a marital conflict. Our adversaries are not demons, witches, fate, or mental illness. We have no
enemy that we can fight, exorcise, or dispel by “cure.” What we do have are problems in living – whether these
are biologic, economic, political, sociopsychological … Mental illness is a myth whose function it is to disguise and thus render
more palatable the bitter pill of moral conflicts in human relations. p.66-67
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Extensions – Implication – Solvency 1/6
Mental Illness is a psychiatric pseudo-science

a myth , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 61-62] McNabb SK
By historical and traditional criteria, “mental illness” is not illness but a bogus invention that allows behavior,
any behavior, to be categorized as “disease.”
Psychiatry is conventionally defined as a medical specialty concerned with the diagnosis and treatment of
mental diseases. I submit that this definition, which is widely accepted, places psychiatry in the company of
alchemy and astrology and commits it to the category of pseudoscience. The reason for this is that there is no
such thing as “mental illness.” Psychiatrists must now choose between continuing to define their discipline in
terms of non-existent entities or substantives, or, redefining it in terms of the actual interventions or processes
in which they engage.
In the history of science, thinking in terms of entities has always tended to precede thinking in terms of
processes. Alchemists and astrologers thus spoke of mysterious substances and concealed their methods
from public scrutiny. Psychiatrists have similarly persisted in speaking of mysterious mental maladies and
have continued to refrain from disclosing fully and frankly what they do. Indeed, whether as theorists or therapists, they may
do virtually anything and still claim to be, and be accepted as, psychiatrists. The actual behavior of a particular psychiatrist may thus be that of a
physician, psychologist, psychoanalyst, policeman, clergyman, historian, literary critic, friend, counselor, or teacher – or sundry combinations of these
roles. A physician is usually accepted as a psychiatrist so long as he insists that what concerns him is the problem of mental health and mental illness.
2010 NFA-LD
Evidence Set
Mental illness means you don’t solve. You confuse metaphor with fact
a myth , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 64] McNabb SK
[The belief in mental illness] rests on a serious, albeit simple, error: it rests on mistaking or confusing what is
real with what is imitation; literal meaning with metaphorical meaning; medicine with morals. In other words, I
maintain that mental illness is a metaphorical disease: that bodily illness stands in the same relation to mental
illness as a defective television set stands to a bad television program. Of course the word “sicK” is often used
metaphorically. We call jokes “sick,” economies “sick,” sometimes even the whole world “sick”; but only when
we call minds sick do we systematically mistake and strategically misinterpret metaphor for fact – and send for
the doctor to “cure” the “illness.” It is as if a television viewer were to send for a television repairman because
he dislikes the program he sees on the screen. p.64
2010 NFA-LD
Evidence Set
Mental illness is not a genuine disease

a myth , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books64-65] McNabb SK
It is widely believed that mental illness is a types of disease and that psychiatry is a branch of medicine; and
yet, whereas people regularly think of and call themselves “sick,” they rarely think and call themselves
“mentally sick.” The reason for this, as I shall try to show, is really quite simple: a person might feel sad or
elated, insignificant or grandiose, suicidal or homicidal, and so forth; he is, however, not likely to categorize
himself as mentally ill or insane ; that he is, is more likely to be suggested by someone else. This, then, is why
bodily diseases are characteristically treated with the consent of the patient, while mental diseases are
characteristically treated without his consent. (Individuals who nowadays seek private psychoanalytic or
psychotherapeutic help do not, as a rule, consider themselves either “sick” or “mentally sick,” but rather view
their difficulties as problems in living and the help they receive as a type of counseling.) In short, while medical
diagnoses are the names of genuine diseases, psychiatric diagnoses are stigmatizing labels. p.64-65
2010 NFA-LD
Evidence Set
Mental illness assumes a neurological model

The notion of mental illness derives it main support from such phenomena as syphilis of the brain or delirious
conditions-intoxications, for instance -- in which persons are known to manifest various peculiarities or
disorders of thinking and behavior. Correctly speaking, however, these are diseases of the brain, not of the mind. According to one school
of thought, all so-called mental illness is of this type. The assumption is made that some neurological defect, perhaps a very
subtle one, will ultimately be found for all the disorders of thinking and behavior. Many contemporary psychiatrists,
physicians, and other scientists hold this view. This position implies that people cannot have troubles -- expressed in what are now called "mental
illnesses" -- because of differences in personal needs, opinions, social aspirations, values, and so on. All problems in living are attributed
to physicochemical processes which in due time will be discovered by medical research.
2010 NFA-LD
Evidence Set
The neurological model is epistemologically flawed. Mental illness cannot be

observed, because it involves a comparison between the patients perceptions
and an observer
The second error in regarding complex psycho-social behavior, consisting of communications about
ourselves and the world about us, as mere symptoms [p. 114] of neurological functioning is epistemological. In
other words, it is an error pertaining not to any mistakes in observation or reasoning, as such, but rather to the way in which we organize and express
our knowledge. In the present case, the error lies in making a symmetrical dualism between mental and physical
(or bodily) symptoms, a dualism which is merely a habit of speech and to which no known observations can be
found to correspond. Let us see if this is so. In medical practice, when we speak of physical disturbances, we
mean either signs (for example, a fever) or symptoms (for example, pain). We speak of mental symptoms, on
the other hand, when we refer to a patient's communications about himself, others, and the world about him.
He might state that he is Napoleon or that he is being persecuted by the Communists. These would be
considered mental symptoms only if the observer believed that the patient was not Napoleon or that he was
not being persecuted[sic] by the Communists. This makes it apparent that the statement that "X is a mental
symptom" involves rendering a judgment. The judgment entails, moreover, a covert comparison or matching of
the patient's ideas, concepts, or beliefs with those of the observer and the society in which they live. The
notion of mental symptom is therefore inextricably tied to the social (including ethical) context in which it is
made in much the same way as the notion of bodily symptom is tied to an anatomical and genetic context
(Szasz, 1957a, 1957b).
2010 NFA-LD
Evidence Set
The medical claim that mental illness exists does not have evidence
Thus, in his best known work, The Myth of Mental Illness, Szasz argues that “mental illness” is a myth; that is, the behaviors that “mental health”
professionals and others define as “mental illness” are simply misunderstood and/or disapproved language and action. This defining, Szasz believes, is
strategic rhetoric that serves the purposes of the definers and those who benefit from the definitions, often at the expense (economic, political, moral, or
otherwise) of the defined. Moreover, he maintains, the labelling of people as “sick” or “disturbed” is successfully accomplished largely because
psychiatry has managed to clothe itself in “the logic, imagery, and the rhetoric of science, and especially medicine” (Ideology and Insanity). Yet
Szasz points out, the connection between psychiatry, science, and medicine is at best tenuous: “Not only is
there not a shred of evidence to support this [connection], but, on the contrary, all the evidence is the other
way, and supports the view that what people now call mental illnesses are, for the most part, communications
expressing unacceptable ideas, often framed in an unusual idiom” (Ideology and Insanity). However, invalid or
misleading, the rhetoric of mental illness is persuasive to many, primarily due to its “scientific” status.
2010 NFA-LD
Evidence Set
Szasz Defense
Szasz’s criticism is rhetorical

E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books13] McNabb SK
Since the publication in 1961 of The Myth of Mental Illness, which served originally to thrust him into the center of the debate over the nature of “mental
illness” and the proper role of psychiatry, the ideas of Dr. Thomas Szasz have enlightened, provoked, inspired, challenged, and angered millions of
readers, not only those within psychiatry but also many outside its confines. Through nearly a score of books and over four hundred articles and reviews,
Szasz has sought to demystify and demythologize the “science” of psychiatry by revealing it as an essentially political and moral enterprise operating
under the mask of medicine. The primary approach taken by Szasz in his voluminous writing might best be
characterized as rhetorical in that he analyzes the ways in which language and symbols have been used by
psychiatry to influence the allocation of power; to control the lives, perceptions, and self perceptions of millions
of people; and to interact with the legal system in the assignment of responsibility for human actions. While
rhetorical analysis constitutes the common methodological thread running through all of Szasz’s work strict libertarianism constitutes the political thread,
and individual responsibility the moral thread. Recognition of this linkage of rhetoric, politics, and ethics provides the starting point for an understanding
of Szasz’s thought. (Pg. 13)
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Evidence Set
AT – AFF Solves K
The kritik does not deny the reality of the problems people have. It argues that
the concepts we use are bad
While I have argued that mental illnesses do not exist, I obviously did not imply that the social and
psychological occurrences to which this label is currently being attached also do not exist. Like the personal
and social troubles which people had in the Middle Ages, they are real enough. It is the labels we give them
that concerns us and, having labelled them, what we do about them. While I cannot go into the ramified implications of this
problem here, it is worth noting that a demonologic conception of problems in living gave rise to therapy along theological lines. Today, a belief in mental
illness implies -- nay, requires--therapy along medical or psychotherapeutic lines.
2010 NFA-LD
Evidence Set
AT – You don’t have Evidence
The demand for evidence makes 2 mistakes. 1, You can not prove the non-
existence of anything. 2. Evidence is not needed for metaphors
L.S. Weinberg & R. E. Vatz, Thomas Szasz: primary values and major contentions. 1983. [ szasz and the law
an alternative view , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 212] McNabb SK
You cannot prove the

Had Schoenfeld understood the foregoing, he would not have asked for “evidence” that mental illness does not exist.
non-existence of anything, and in particular, you cannot, of course, prove the nonexistence of a metaphor. This
confusion in Schoenfeld accounts for his analogizing Szasz’s contention that mental illness does not exist. You
cannot prove the non existence of anything, and in particular, you cannot, of course, prove the nonexistence of
a metaphor. This confusion in Schoenfeld accounts for his analogizing Szazs’s contention that mental illness is
a myth to legislating “black swans out of existence by redefining the word “swan.” Szasz says that mental
illness (unlike swan) is a metaphor. What sorts of evidence does one proffer to disprove a metaphor? Usually,
one does not need any evidence at all since most metaphors are recognized as such. If we say that someone who is
ugly is a “dog” we would not call a kennel since we realize that “dog” here is a metaphor. With mental illness, however, Szasz contends that we mistake
the metaphor for reality and thereby enfranchise the medical field to deal with aberrant behavior. In essence, Szasz doesn’t think that killers are
“normal”; he simply doesn’t think their problem is medical. You don’t prove the inappropriateness of a medical metaphor for understanding unusual
behavior by disputing that the behavior is unusual or abnormal. You show it by fully accounting for the behavior in nonmedical ways.
2010 NFA-LD
Evidence Set
AT – Biology Proves Mental Illness is Real
The presence of physical abnormalities in some people does not prove that all
problems are biological
a myth , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 67] McNabb SK
Nothwithstanding the widespread social acceptance of psychoanalysts in contemporary America, there remains a wide circle of physicians and allied
scientists whose basic position concerning the problem of mental illness is essentially that expressed in Carl Wernicke’s famous dictum: ‘Mental
diseases are brain diseases.” Because, in one sense, this is true of such conditions as paresis and the psychoses associated with systematic
intoxications, it is argued that it is also true for all other things called mental diseases. It follows that it is only a matter of time until the correct
physiochemical, including genetic, “bases” or “causes” of these disorders will be discovered. It is conceivable, of course, that significant
physiochemical disturbances will be found in some “mental patients” and in some “conditions” now labeled
“mental illnesses.” But this does nnot mean that all so-called mental diseases have biological “causes,” for the
simple reason that it has become customary to use the term “mental illness” to stigmatize, and thus control,
those persons whose behavior offends society- or the psychiatrist making the “diagnosis.”
2010 NFA-LD
Evidence Set
AT – Anti-Psychiatry Bad
Szasz rejects the term anti-psychiatry

Thomas Szasz, psychiatrist, Thomas Szasz: primary values and major contentions. 1983. [ three questions
and answers on contentions , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 171] McNabb SK
I reject the term anti-psychiatry because it is imprecise, misleading, and cheaply self-aggrandizing. Chemists
do not characterize themselves as anti-alchemists, nor do astronomers call themselves antiastrologers. If one
defines psychiatry conventionally as the medical specialty concerned with the diagnosis and treatment of
mental diseases, then one is, indeed, committed to “opposing” psychiatry as a specialty – not of medicine but
of mythology. However, since I believe that people are entitled to their mythologies, this opposition must be
clearly limited to the use of force or fraud by the mythologizers in the pursuit of their ersatz religion. This is why I
have always insisted that I am against involuntary psychiatry, or the psychiatric rape of the patient by the psychiatrist – but I am not against voluntary
psychiatry, or psychiatric relations between consenting adults.
Szasz regards anti-psychiatry as absurd

Thomas Szasz, psychiatrist, Thomas Szasz: primary values and major contentions. 1983. [ three questions
and answers on contentions , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books171] McNabb SK
I reject the anti-psychiatry because it is imprecise misleading, and cheaply self-aggrandizing. Chemists do not
characterize themselves as anti-alchemists, nor do astronomers call themselves anti astrologers. If one
defines psychiatry conventionally as the medical specialty concerned with the diagnosis and treatment of
mental diseases, then one is, indeed, committed to “opposing” psychiatry as a specialty – not of medicine but
of mythology. However, since I believe that people are entitled to their mythologies, this opposition must be
limited to the use of force or fraud by the mythologizers in the pursuit of their ersatz religion. This is why I have
always insisted that I am against involuntary psychiatry, or psychiatric relations between consenting adults.
2010 NFA-LD
Evidence Set
AT – Schoenfeld
Schoenfeld misses Szasz’s theoretical density

an alternative view , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 211] McNabb SK
The major problem in Schoenfeld and in many other critiques of Szasz is a failure to perceive the rich
theoretical perspective being offered. Szasz intertwines traditional theories of psychiatry and forensic
psychiatry with theories of semiotic behavior. The problem in Schoenfeld’s critique, however, can be seen in
his reliance on dictionary definitions of “illness,” an approach which ignored all anthropological, rhetorical, and
meta-linguistic analyses of the way in which language functions to create the reality which we “see.” His
derisive reference to “word magic” further reveals his inability to grasp Szasz’s rhetorical perspective. In asserting
that Szasz attempts to achieve the “… philosophically and epistemologically impossible… for example, the action of the American Psychiatric
Association in defining the “disease” of homosexuality out of existence. (Pg. 211)
Schoenfeld uses the same illogic he accuses Szasz of

an alternative view , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books] McNabb SK
To prove the existence of mental illness, Schoenfeld uses the same illogic that he attributes to Szasz; in fact,
he uses the exact such logical fallacies. He accuses Szasz of begging the question that is, proving a
conclusion by assuming it in the premise. He says Szasz attempts to “….define something out of existence.”
This assumes that “mental illness” does exist, which is precisely the point in question. This elementary logical
error is ubiquitous in Schoenfeld’s article, and again results from his lack of understanding of Szasz.
Page 213
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Evidence Set
AFF Answers – Szasz’s Thesis Bad 1/8
Szasz’s disease reasoning is poor for two reasons. 1. He misreads history. 2. He

misreads his own sources.
Ronald Pies, Thomas Szasz: primary values and major contentions. 1983. [ on myths and countermyths , R. E.
Vatz & L.S. Weinber g(Eds) Buffalo NY: Prometheus Books193-194] McNabb SK
To place Szasz’s view of disease in historical perspective, some of its salient features should be noted .
First, it holds that the “original”
meaning of disease entailed the presence of some kind of lesion, and furthermore, that Virchow established
this notion, whereas Bleuler subverted it. Second, Szasz maintains that there is now “no such thing” as
schizophrenia, but that if physicochemical lesions can be correlated with schizophrenia, then it, too, will be a
disease. Let me defer criticism of these claims and examine the notion of disease in historical
perspective.Szasz maintains that “until the middle of the nineteenth century,” illness entailed some visible
deformity or bodily lesion. In fact, however, this pathoanatomic view has been merely one of many competing
notions of disease, most of which date from antiquity. Indeed, a crucial dichotomy in the philosophy of
medicine may be traced to the rival medical academies of Knidos and Kos, in ancient Greece. Knidos, the
school of Aesculapius, recognized only the “disease” – the “separate morbid entity subservient to general rules
of pathology.” The more empirical school of Kos, associated with Hippocrates, emphasized that there existed
only “the sick individual with his particular kind of misery.” In effect, these two schools saw disease either as a
specific lesion, or as a phenomenon whose character was determined by the patient’s manner of presentation.
It should be clear, then, that the former view did not originate with Virchow, and that the latter did not arise from
a “concerted effort” by Bleuler and his cohorts to “change the criteria” of disease. The criteria of disease have
always been in dispute, though theories have waxed and waned in popularity.But what, precisely, did Virchow
say about disease? There is no question that he assumed cellular derangements to be the basis of disease; it
is far less clear that Virchow identified disease with such pathologic processes. Indeed, L.J. Rather notes that
Virchow “violently rejected Rokitansky’s claim that disease were at all times open to morphologic investigation.”
Virchow himself wrote as follows:One can have the greatest respect for anatomical, morphological, and
histological studies … But must one proclaim them, therefore, the ones of exclusive significance? Many important phenomena of the body are of
a purely functional kind.
Szasz mistakenly attributes the criterion of “bodily function” to the influence of “modern psychiatry.”pg 193-194
2010 NFA-LD
Evidence Set
Szasz’s argument is denied by the physical sign of mental illness

C. G. Schoenfeld, Thomas Szasz: primary values and major contentions. 1983. [ an analysis of the views of
Thomas S. Szasz , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 200] McNabb SK
Instead of providing such evidence, Szasz relies upon arguments concerning the words “mental illness” to prove that there is no such thing as neurosis,
psychosis, insanity, “madness,” and so on. In brief, he contends that there cannot be an illness unless physical signs or symptoms of it exist.
And since (in his view) there are no physical signs or symptoms of the so-called mental illnesses, it follows that neurosis, psychosis; insanity, “madness,”
and the like do not exist.
Unfortunately for Szasz’s argument, physical signs or symptoms of mental illness frequently do exist. For
example, electroencephalograms have that the brain wave patterns of many persons whom psychiatrists
regard as seriously ill often are highly erratic and abnormal. Further, a whole range of physical signs or
symptoms ranging from facial tics and allergic reactions to serious gastric and pulmonary disorders have been
shown to reflect the presence of mental disorders. Indeed, the whole area of psychosomatic medicine is
concerned with the very close relationship that has been shown to exist between neurosis and psychosis and
physical and bodily disorders. In fact, it may be contended that the very strange behavior of many neurotics and psychotics is
itself “physical” evidence of mental illness.pg 200
2010 NFA-LD
Evidence Set
Szasz’s evidence is poor and denied by the real world

Thomas S. Szasz , R. E. Vatz & L.S. Weinberg(Eds) Buffalo NY: Prometheus Books 199-200 McNabb SK
Szasz fails to offer what one

To support his thesis that there is no such thing as mental illness- no such thing as neurosis or psychosis –
would suppose to be the “best evidence” of his viewpoint: clinical evidence. That is, he to offer his readers
detailed descriptions, case histories, and the like of a representative cross section of persons whom
psychiatrists usually judge to be neurotic or psychotic, but whom he has interviewed or examined as a
Psychiatrist, and whom he has demonstrated to be completely normal. Persons who are terrified of heights, or
entering small enclosures, or of leaving their home; others who feel compelled, usually in the privacy of their
bedroom or bathroom, to perform certain bizarre rituals; still others who seal things they neither need, use, sell,
nor really want; so-called fetishists who literally worship certain articles of clothing or parts of the body;
masochists who have an overwhelming need to be “disciplined” by being cursed, whipped, and even urinated
and defecated upon; exhibitionists who cannot resist exposing their genitals in public, and particularly in front
of small children. It is clinical evidence (detailed investigative reports, case histories, etc.) showing that a
representative sample of such putative neurotics are completely healthy that Szasz, perhaps understandably,
fails to offer his readers. Persons in a so-called catatonic stupor who are apparently oblivious of the world
around them; others who are convinced that they are being relentlessly persecuted by unidentified enemies out
to poison or otherwise destroy them; still others who believe that they are God’s emissaries or angels – or even
God himself- and that, as such, they have the power to destroy the world; so-called depressives who may
lacerate and maim themselves, and for whom suicide may seem to be the obvious “solution’ to all their
problems; patients who are actively hallucinating and who may be wildly manic and assaultive- it is detailed
reports of interviews and examinations conducted with a representative cross section of these Putative
psychotics which reveal that – mirabile dictu-they are as mentally healthy as you or I, that Szasz fails to offer to his
readers. Pg 199-200
2010 NFA-LD
Evidence Set
Szasz begs the question

Thomas S. Szasz , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books200-201] McNabb SK
(But even if all this were not so, Szasz’s argument in effect assumes, rather than proves, that there is no such
thing as mental illness. That is, he assumes that there cannot be an illness unless physical signs or symptoms
of it exist and having also made the assumption discussed above that there are no signs or symptoms of
mental illness, he concludes that neurosis, psychosis, insanity, “madness,” and the like, do not exist. As a
logician might put it, Szasz’s argument “begs the question.” PG 200-201)
2010 NFA-LD
Evidence Set
Szasz’s requirement for physical symptoms is merely his opinion

Thomas S. Szasz , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books201] McNabb SK
Admittedly-as Szasz emphasizes when he discusses the word “illness”- when there is a physical illness, physical sign or symptoms of it usually appear.
But it
hardly follows that, as Szasz assumes, physical signs or symptoms are needed to prove the existence of
mental illness. Indeed, an analysis of the definition of the word illness offered in the unabridged edition of all
the Merriam Webster and other leading dictionaries soon reveals that Szasz’s belief that physical signs or
symptoms constitute a defining characteristic of the term is clearly idiosyncratic and amounts to an attempt to
create a private definition of it. Pg 201
2010 NFA-LD
Evidence Set
Szasz is impossible. He tries to define something out of existence

attempts
But even if Szasz’s definition of the owrd illness were shared by today’s lexicographers, Szasz’s argument would still be unsound, since it
to do what is philosophically and epistemologically impossible ; to define something out of existence. As
philosophers and logicians have pointed out to generations of students: “ When you have stated that the
defining characteristic of X, you have proved nothing one way or the other about whether X exists….When
you are able to define a word in terms of charecteristics A, B, and C, you have still not shown that there exists
anything in the universe that has charecteristics A, B, and C. You cannot legislate centaurs into existence by
defining a word, any more than you can legislate black swans out of existence by redefining the word swan.
From defining X , you can draw no conclusions whatever about whether about whether there are any X’s in
the world; that is not a matter for definition but for scientific investigation. In short, to determine whether or not
mental illness ( or anything else) exists, empirical evidence is needed. Szasz’s attempt to define mental illness in terms of
physical signs or symptoms- coupled with his assumption that there are no such signs or symptoms and that therefore there is no such thing as mental
illness is an outrageously high handed attempt to do what is philosophically and epistemologically impossible; to define mental illness out of
existence.201
2010 NFA-LD
Evidence Set
Szasz ignores psychiatric evidence to the contrary

What may be the most telling objection to Szasz’s assertion that the conditions psychiatrists label neuroses
and psychoses are not mental illnesses, but are instead “problems in living,” is that this assertion fails to take
into account the huge amount of evidence that has accumulated (particularly during the past hundred years or
so) which certainly seems to reveal that these conditions are indeed mental illnesses. For example, there is a
veritable mountain of evidence – including what are literally tens of thousands of highly detailed clinical reports,
case histories, and the like – which clearly appear to demonstrate that neuroses and psychoses frequently
emerge as a result of the developmental difficulties occurring in infancy and childhood when the problems that
arise can hardly be described as ethical, social, legal, or political. (PG 203)
2010 NFA-LD
Evidence Set
Szasz’z psychiatry bad claims simply do not follow

Examples of this technique of alleging rather than proving abound in Szasz’s book The Manufacture of Madness, in which he presents what he
conceives of as “historical evidence” to justify his charge that psychiatrists are persecutors, oppressors, and torturers. For instance, he
declares that today’s so – called mental patients are the equivalent of or analogous to yesterday’s so called
witches and heretics, and that today’s psychiatrists are the equivalent of or analogous to yesterday’s
Inquisitors who persecuted, oppressed, and tortured by some religious leaders; and it may even be true that
some of the alleged witches and heretics were persons whom some psychiatrists today would be likely to
regard as mentally ill. By no means does it follow, however – as Szasz certainly implies – that most or all
persons alleged in the past to be witches and heretics would be considered mentally ill by most or all of today’s
psychiatrists. And, in addition, it certainly does not follow; indeed, there is not a scintilla of evidence to show
that, as Szasz assert, today’s psychiatrists are the equivalent of yesterday’s Inquisitors. (PG 204)
2010 NFA-LD
Evidence Set
AFF Answers – Szasz’s Method Bad
Szasz’s conception of language is that of a two year old

Thomas S. Szasz , R. E. Vatz & L.S. Weinberg (Eds) Buffalo NY: Prometheus Books 201-202] McNabb SK
To try to determine at this point why as well-educated and philosophically sophisticated a person as Szasz would attempt to define mental illness out of
existence would be to delay unduly consideration of the second element of Szasz’s basic thesis detailed at the beginning of this paper. Still it ought
to be noted that by seeking to define mental illness out of existence, Szasz may be revealing the presence and
influence of a belief that words can actually create or destroy- a possibility that finds considerable support in
numerous statements by Szasz overestimating greatly the power of words, such as: “ In ordinary life, the
struggle is not for guns but for words: whoever first defines the situation is the victor; his adversary, the victim”;
“In the animal kingdom, the rule is, eat or be eaten; in the human kingdom, define or be defined.” In any event,
to believe that words can be used to create or destroy is to believe in word magic: something which, as
psychoanalysis , is typical at the age of two or so, but which becomes increasingly unusual thereafter .
2010 NFA-LD
Evidence Set
AFF Answers – Subjectivity
The subjectivity critique uses Foucaultian social constructionism. Social

constructionism fails for three reasons. 1. Social construction ignores reality
Thes phenomena have consequences regardless of social definition.2 Social
construction is morally repugnant,3. Social construction fails to distinguish
disorders from normal behavior.
A.V. Horwitz, Creating mental illness 2002. [Chicago: The University of Chicago press. 9-10] McNabb SK
.
One problem with constructionist views is that they beg the question of what is being constructed in divergent
views of mental illness. Pure constructionist premises preclude the possibility of defining mental illnesses in
ways that are independent of any particular social context. If all behaviors are constituted by their social
classifications, none have meaning outside of the culture-bound rules that define them. Yet, phenomena such
as the distorted thought processes of schizophrenia, massive and continual alcohol consumption, or depleted
levels of serotonin can have consequences regardless of the social definitions placed on them (Murphy 1976).
Biological dysfunctions can create inherent constrains that limit social variations in constructions of mental symptoms.
Another problem of pure constructionist perspectives lies in their inability to develop standards for comparing
divergent views of mental illness. When mental illnesses are defined solely through culturally specific
definitions, no grounds exist for establishing a concept of mental illness that transcends different context. Yet,
comparison is only possible if something constant serves as a point of reference to observe meaningful variation. For example, the claim that depression
takes on fundamentally different forms in Western and non-Western cultures only coherent if some underlying standard of what constitutes depression is
available to classify both forms as variants of a common underlying category.
The lack of a valid concept of mental disorder that is not reducible to particular cultural categories also precludes the possibility of critiquing any
particular view of mental disorder. Only standards of judgment that stand outside a particular paradigm can say that one model is more or less adequate
than any other. Paradoxically, while constructionists are generally among the most strident critics of the psychiatric profession, the premise that mental
illness is whatever is considered as such in a particular cultural context provides no logical grounds for claiming that any view of mental illness is either
better or worse (Hacking 1999). For example, a constructionist has no justification for replacing a view of homosexuality
as a mental illness with a view that regards it it as an expression of a lifestyle. Nor do constructionists have more warrant
for calling schizophrenics mentally ill than for applying the same designation to the political dissident who shared their hospital wards in the former Soviet
Union. A pure constructionist perspective has no extra-cultural criteria for developing a valid concept of mental illness and therefore cannot judge the
adequacy of any classification of mental symptoms.
Not only can an adequate concept of mental disorder serve as a standard for cross-cultural comparisons and for critiques of the practices of the mental
health professions; it can also distinguish conditions that ought to be called “mental disorders” from those that ought not. Both disease and
constructionist models usually lump all conditions without distinction into a single overall category of mental disorder. The DSM defines all of the many
particular conditions it classifies as mental diseases without seriously considering the fundamental differences among them. Likewise ,
the
constructionist critics often make sweeping claims about “mental illness,” ignoring both the wide variety of
conditions this term encompasses and the features that distinguish them from non-disordered behaviors (see,
for examples, Szasz 1961). Diagnostics psychiatry and its constructionist critics alike often fail to distinguish
serious from less harmful conditions, expectable unhappiness from uncaused depression, or addictions from
culturally normative substance use. One considers all, the other none, of the conditions as mental disorders. In contrast, the use of an
adequate concept of mental disorder can serve to separate the various sorts of problematic psychological conditions that both views no lump together.
2010 NFA-LD
Evidence Set
AFF Answers – Permutation
The permutation solves

Possibly in an attempt to help to overcome this objection, Szasz sometimes tries to be more specific concerning the meaning of “problems in living” by
stating that what he is really talking about are ethical, social, legal, political, and other problems. Unfortunately, however, Szasz assumes- rather than
proves – that what psychiatrists now term mental illness may be some other problem. One looks in vain for evidence (detailed investigative reports, case
histories, and the like) demonstrating that a representative sample of the persons whom psychiatrists now regard as neurotic or psychotic are really
suffering from the effects of ethical, social, legal, political, and other problems. Moreover ,
Szasz seems unable to accept the possibility
that the conditions psychiatrists label neuroses or psychoses may reflect not only ethical, social, legal, or other
“problems in living,” but mental illness as well. As David P. Ausubel has put it: “There is no valid reason why a
particular symptom cannot both reflect a problem in living and constitute a manifestation of disease.” Or as
another analyst of Szasz’s writings has noted, there seems to be a strange quirk in Szasz’s reasoning which
repeatedly leads him to the conclusion that ‘phenomena A belongs either to class (category) X or to class
(category) Y, but never to both.” (PG 202)
2010 NFA-LD
Evidence Set
***State Spending DA***
***State Spending DA***...............................................................201

State Spending DA – Shell 1/3.........................................................202
Extensions – Uniqueness – State Budgets...............................................205
Extensions – Uniqueness – California Budget...........................................206
Extensions – Link – Texas.............................................................207
AT – Raise Taxes......................................................................208
AT – Double Dip.......................................................................209
Answers – Borrowing High Now..........................................................210
Answers – Economy Low Now – Double Dip................................................211
Answers – No Link (Tax Increases).....................................................212
Answers – States Won’t Default........................................................213
2010 NFA-LD
Evidence Set
State Spending DA – Shell 1/3
A. Uniqueness – States are dealing with massive budget deficits in the status
quo as revenue sources dry up - leaving spending cuts as the only option
Nicholas Johnson et al, Center on Budget and Policy Priorities, July 15, 2010 [Nicholas Johnson is Director of
the CBPP’s State Fiscal Project and holds a graduate degree from Duke’s Terry Sanford Institute of Public Policy. Elizabeth McNichol is
a CBPP Senior Fellow specializing in state fiscal issues. Phil Oliff is a Policy Analyst with the State Fiscal Project. “Recession
Continues to Batter State Budgets; State Responses Could Slow Recovery.” http://www.cbpp.org/cms/?fa=view&id=711] Garcia NM
States’ fiscal conditions remain extremely weak this year – fiscal year 2011 – even as the economy appears to
be moving in the direction of recovery. Indeed, historical experience and current economic projections suggest
2011 will be worse than 2010 by the time the year ends due to declining federal assistance. Taking all these factors
into account, it is reasonable to expect that for 2011, shortfalls are likely to exceed $140 billion after taking into account approximately
$40 billion in federal Recovery Act dollars that are likely to remain available for fiscal year 2011. Once employment is growing again, state budget
problems will diminish but it is likely that states will face shortfalls of at least $120 billion in fiscal 2012. This means that states will close shortfalls of
some $260 billion for fiscal years 2011 and 2012 combined. Figure 2 shows the budget shortfalls that states faced and will face after taking into account
the federal recovery act dollars. The recession caused a state fiscal crisis of unprecedented severity. Figure 3 compares the size and duration of the
shortfalls that occurred in the recession of the first part of this decade to shortfalls reported to date this time. In the early 2000s, as in the early 1990s
and early 1980s, state fiscal problems lasted for several years after the recession ended. The same will undoubtedly be the case this time, since the
current recession is more severe — deeper and longer — than the last one, and state fiscal problems have proven to be worse and are likely to remain
so. Unemployment, which peaked after the last recession at 6.3 percent, has already hit 10 percent, and many economists expect it to remain at high
levels throughout 2010 and beyond. Continued high unemployment will keep state income tax receipts at low levels and increase demand for Medicaid
and other essential services that states provide. High unemployment and economic uncertainty, combined with households’ diminished wealth due to
fallen property values, will continue to depress consumption, thus sales tax receipts also will remain low. These factors suggest that state budget gaps
will continue to be significantly larger than in the last recession, and last longer. Estimates from the states, although incomplete, are consistent with this
outlook. Table 1 lists the shortfalls that states dealt with when adopting budgets for 2011. A total of 46 states addressed shortfalls for fiscal year 2011.
This total includes at least 34 of the states that prepare budgets annually and recently addressed deficits for fiscal year 2011. In addition, 11 states that
operate on a two-year budget cycle (known as a biennial budget) adopted budgets a year ago that addressed shortfalls for 2011 totaling at least $25
billion. In total, fiscal year 2011 gaps — which have been addressed in most states — total $121 billion or 19 percent of budgets. In addition, at least 39
states have looked ahead to fiscal year 2012 and anticipate shortfalls totaling $102 billion. (See Table 2.) It is reasonable to expect that it will grow
during the course of the fiscal year if revenues again come in under expectations or spending reductions yield less savings than anticipated. TABLE 1:
These current year shortfalls are in addition to the gaps states closed when adopting their fiscal year 2010 budgets and the mid-year gaps that
developed after these budgets were adopted. Table 3 combines the mid-year gaps with the gaps that were addressed when states wrote their 2010
budgets. In total, 48 states have addressed shortfalls in their budgets for fiscal year 2010, totaling $192 billion or 29 percent of state budgets — the
largest gaps on record. (Table 4 of this paper shows the 2009 budget gaps that were addressed, and Table 5 lists the sources of these shortfall
estimates for each state.) TABLE 2: Of course, a faster-than-expected recovery could reduce the size of future shortfalls. But several factors
could make it particularly difficult for states to recover from the current fiscal situation. Housing markets might
be slow to fully recover; their decline already has depressed consumption and sales tax revenue as people refrain
from buying furniture, appliances, construction materials, and the like. This also would depress property tax revenues, increasing the
likelihood that local governments will look to states to help address the squeeze on local and education budgets. And as the employment situation
continues to be weak, income tax revenues will continue to lag and there will be further downward pressure on sales tax revenues as
consumers are reluctant or unable to spend. Some states have not been affected by the economic downturn, but the number is dwindling. Mineral-rich
states — such as New Mexico, Alaska, and Montana — saw revenue growth in the beginning of the recession as a result of high oil prices. More
recently, however, the decline in oil prices has affected revenues in these states. The economies of a handful of other states have so far been less
affected by the national economic problems. Only two states, Montana and North Dakota, have not reported budget shortfalls, but the recession has
dampened those states’ surpluses, which were largely mineral-driven as well. Two other states – Alaska and Arkansas – faced shortfalls in fiscal year
2010 but are not now projecting gaps for fiscal year 2011. The Consequences of Shortfalls In states facing budget gaps, the consequences are severe
in many cases — for residents as well as the economy. To date, budget difficulties have led at least 45 states to reduce services to their residents,
including some of their most vulnerable families and individuals. Over 30 states have raised taxes to at least some degree, in some cases quite
significantly. If revenue declines persist as expected in many states, additional spending and service cuts are
likely. Budget cuts often are more severe later in a state fiscal crisis, after largely depleted reserves are no
longer an option for closing deficits.
2010 NFA-LD
Evidence Set
B. And, states are cutting mental health funding in order to balance their
budgets – the plan reverses these cuts and forces borrowing
Christine Vestal, Stateline Staff Writer, July 19, 2010 [“As economy takes toll, mental health budgets shrink.”
http://www.stateline.org/live/details/story?contentId=499181] Garcia NM
States have taken the lead role in publicly funded care for the mentally ill, and paid the majority of the expenses. Even through recessions, the states
have steadily increased their mental health budgets every year to meet increasing demand. Now, as states face their biggest fiscal challenge in modern
history, the trend has reversed. For the first time in more than three decades, mental health funding is declining. The
drop-off is translating into a reduction in the number of psychiatric hospital beds, as well as fewer services for
mental health emergencies and longer waiting lists for housing for the chronically mentally ill. The cuts are coming just as some experts say
economic pressures are creating an increase in mental illness. Although no national numbers are available, hospital emergency rooms, juvenile courts,
child welfare agencies, local jails and homeless shelters are reporting bulges in the number of mentally ill people who end up on their doorsteps after
failing to get help elsewhere. In addition, a recent national survey showed that the weak economy is taking a toll on the mental health of Americans, with
unemployed people four times as likely as those with jobs to report symptoms of severe mental illness. “States are chipping away at their
already very fragile mental health system,” says Michael Fitzpatrick, executive director of National Alliance on Mental Illness, which
advocates for improved mental health care. “More people will be unable to find even basic services that allow them to stay out of the hospital or
involvement with police. It’s a dire situation that we’ve never seen before.” Funding fluctuations Since the 1950s, when states cared for more than
500,000 people in psychiatric hospitals, state mental health programs have included more and more community-based services. Those include a wide
array of services, such as suicide prevention and 24-hour crisis centers, treatment for drug and alcohol abuse, housing and work supports, counseling
and violence-prevention programs. Although advocates maintain that only half of those in need are receiving public mental health services, states have
made progress by serving more people in the community at about half the price of committing them to institutions — and with better outcomes. Today,
only 50,000 people reside in state mental hospitals while millions are served on an outpatient basis. Still, states have had to increase their budgets to
keep pace with demand. Despite fluctuations in funding for nearly every other social service, state mental health budgets have increased nationally by
about 6 percent per year for the past 30 years. Now, for the first time, states are pulling back mental health spending. These unprecedented
cuts — nearly 4 percent as a national average between 2008 and 2009 — come at a time when other public
agencies such as child welfare, law enforcement and housing also are experiencing budget cuts and can ill afford to
handle the overflow. According to the National Association of State Mental Health Program Directors, 2010 spending appears to have
fallen nearly 5 percent compared to 2009. Early indications are that 2011 mental health budgets may sink by 8
percent or more. Exacerbating the mental health budget crisis is uncertainty over whether Congress will decide to extend an increase in the
federal match for Medicaid services under the stimulus program, which a majority of states have counted on to stretch their overall health care budgets.
In 2008, states spent $36 billion on mental health services to care for 6.4 million people, about half the number of people advocates say are in need of
care. Of the total, about $17 billion came from Medicaid, the federal-state health care program for the poor, $500 million came from federal grants and
the balance was funded through state general revenues. Not counted in the total is funding from county and local budgets, much of which also sits on
the chopping block. Where the cuts are Although a few states have minimized mental health cuts and targeted less essential services, many states are
closing psychiatric hospitals, eliminating 24-hour crisis centers and tightening eligibility for subsidized medications and services that affect thousands of
adults and children with severe mental illness. Here are some examples of states that have made big cuts: To fill a $1 billion hole in its 2011
budget, Arizona slashed this year’s budget for mental health services by $36 million — a 37 percent cut. As a result,
advocates say 3,800 people who do not qualify for Medicaid are at risk of losing services such as counseling and employment preparation. In addition,
more than 12,000 adults and 2,000 children will no longer receive the name-brand medications they take to keep their illnesses in check. Other services
such as supportive housing and transportation to doctor’s appointments also will be eliminated. Arizona has been considered a progressive state
because it provides the vast majority of mental health services through cost-effective outpatient community programs. By slashing these programs,
experts say the state will force more people to use emergency rooms or end up in the criminal justice system, which will cost the state more. In
Illinois, where Democratic Governor Pat Quinn is trying to bridge a $13 billion budget gap, a proposed mental-health
budget cut of $91 million was reduced to $35 million after patients and practitioners protested at the governor’s mansion earlier this month.
Even so, advocates say more than 70,000 people, including 4,200 children, are in danger of losing basic community services, which may result in more
instances of hospitalization. The cuts come on the heels of a court settlement requiring the state to transfer 4,500 severely mentally disabled patients out
of nursing homes and into community residential facilities following a string of rapes and assaults on elderly residents. Mississippi has cut its
mental health budget by about 8 percent for three consecutive years, resulting in the closure of a residential mental health
facility for adolescents, elimination of 184 beds in one of the state’s biggest psychiatric hospitals and consolidation of six crisis centers with existing
community mental health centers. In the fiscal year that started July 1, the state plans to further cut funding to localities for mental health services. Prior
to the recession, Mississippi lagged far behind most states in funding community services and housed the highest percentage of people with mental
illness in state institutions.
2010 NFA-LD
Evidence Set
C. Unrestrained borrowing causes states to default on their debt

Steven Malanga, Senior Fellow at the Manhattan Institute, Wall Street Journal, July 31, 2010. [“The Muni
Debt Bomb.” http://online.wsj.com/article/SB10001424052748703999304575399591906297262.html] Garcia NM
states and municipalities face growing costs—above all, debt and pension obligations—
Taxpayers are slowly realizing that their
that will be hard to reduce. The squeeze is already forcing cities and states to cut basic services, since they can't
risk defaulting on their debt. But these politically unpalatable moves are troubling more and more observers of
the muni market. Nicole Gelinas has warned in these pages that "once state and local governments have borrowed too
much, they may well find a way not to pay their lenders back" (see "Beware the Muni-Bond Bubble," Spring 2010). Similarly,
Rick Bookstaber, a senior policy advisor to the Securities and Exchange Commission, shook the market
recently by observing that it has all the characteristics in place for a crisis that might unfold like the home-
foreclosure mess: a few municipalities could declare bankruptcy, decline to honor their debts, and unleash "a
widespread cascade in defaults." If that painful scenario emerges, it will be because we have too long ignored how politicians have become
addicted to debt.
D. States defaulting on debt crushes the global economy
Chris Isidore, staff writer, CNN Money December 2009 [ “Bernanke’s biggest fears.” December 3,
http://money.cnn.com/2009/12/02/news/economy/bernanke_worries/] Garcia NM
The panic in financial markets due to fears of a possible default by Dubai World last week could be only the
first warning signs about fears of default on debt. Many other countries are seen as having debt at risk of default. And here at
home, budget crisis in numerous states, most notably California, have raised some worries in the markets as well. A
default on public debt would not just be bad news for the citizens of whatever state or nation can't pay it bills. It could ripple through the
financial markets, and banks and securities firms around the globe. That would force them to write down the
value of much of their holdings by billions again, and causing credit to seize up as badly or worse than it did last
fall. Think of the Lehman Brothers bankruptcy on steroids. Wyss said that while he believes a state default will be avoided, the
risk of such of event "is significant."
E. That causes arms escalation, famine, ethnic wars, and regional conflicts
Bernardo Lopez, BusinessWorld, September 10, 1998 [“Global recession phase two: Catastrophic.” Lexis] Garcia NM
global recession will spawn wars of

What would it be like if global recession becomes full bloom? The results will be catastrophic. Certainly,
all kinds. Ethnic wars can easily escalate in the grapple for dwindling food stocks as in India-Pakistan-Afghanistan,
Yugoslavia, Ethiopia-Eritrea, Indonesia. Regional conflicts in key flashpoints can easily erupt such as in the Middle East,
Korea, and Taiwan. In the Philippines, as in some Latin American countries, splintered insurgency forces may take advantage
of the economic drought to regroup and reemerge in the countryside. Unemployment worldwide will be in the
billions. Famine can be triggered in key Third World nations with India, North Korea, Ethiopia and other African countries as first
candidates. Food riots and the breakdown of law and order are possibilities. Unemployment in the US will be the hardest to cope
with since it may have very little capability for subsistence economy and its agrarian base is automated and controlled by a few. The riots and looting of
stores in New York City in the late '70s because of a state-wide brownout hint of the type of anarchy in the cities. Such looting in this most affluent nation
is not impossible. The weapons industry may also grow rapidly because of the ensuing wars. Arms escalation will
have Primacy over food production if wars escalate. The US will depend increasingly on weapons exports to nurse its economy back
to health. This will further induce wars and conflicts which will aggravate US recession rather than solve it. The
US may depend more and more on the use of force and its superiority to get its ways internationally.
2010 NFA-LD
Evidence Set
2010 NFA-LD
[Evidence–Final]
Extensions – Uniqueness – State Budgets
46 states face budget deficits - a combined $112 billion shortfall
Chris Isidore, staff writer, CNN Money December 2009 [ “Bernanke’s biggest fears.” December 3,
http://money.cnn.com/2009/12/02/news/economy/bernanke_worries/] Garcia NM
Even as the U.S. appears to be on the mend -- gross domestic product has climbed three straight quarters -- finances in
Arizona, Illinois, New Jersey, New York and other states show few signs of improvement. Forty-six states face
budget shortfalls that add up to $112 billion for the fiscal year ending next June, according to the Center on Budget and
Policy Priorities, a Washington research institution. State spending is 12 percent of U.S. GDP. “States are going to have to
cut back spending and raise taxes the same way Greece and Spain are,” says Dean Baker, co- director of the Center for
Economic and Policy Research in Washington. “That runs counter to stimulating the economy and will put a big damper on the recovery in the latter half
of this year.” Stimulus Dries Up State budget woes are a worsening drag on growth as the federal government tries to wean the economy from two
years of extraordinary support. By Jan. 1, funds from the $787 billion federal stimulus bill will dry up. That money from
Washington has helped cushion state budgets as tax revenue has plunged. State leaders won’t be able to ride
out this cycle the way they have in the past. The budget holes are too large. For the first time since 1962, sales
and income tax revenue fell for five straight quarters, through December 2009, according to the Nelson A. Rockefeller
Institute of Government at the State University of New York at Albany.
2010 NFA-LD
[Evidence–Final]
Extensions – Uniqueness – California Budget
California is $19 billion in the hole
BBC News, July 29, 2010 [“California 'fiscal emergency' declared.” http://www.bbc.co.uk/news/business-10802119] Garcia NM
California governor Arnold Schwarzenegger has declared a fiscal state of emergency, putting pressure on lawmakers to pass a state
budget that is now more than a month overdue. California's economy, which is the eighth largest in the world, faces a
budget deficit of $19bn (£12bn). Mr Schwarzenegger said that without a budget in place the state's
government would run out of cash by October. He also ordered most state employees to take three days unpaid leave a month. Earlier
this month, the governor ordered 200,000 state workers to be paid the minimum wage because no budget had been passed. 'Fiscal meltdown' The
"furlough Friday", which will start in August, requires state workers to take three Fridays off a month until a new budget is enacted. In July 2009, Mr
Schwarzenegger also declared a fiscal emergency to address the state's deficit. That also included the furlough Friday, which ran until June 2010.
Employees in agencies involving public safety, including the California Highway Patrol and the Department of Fire and Forestry Protection, and in
revenue generation, such as the Franchise Tax Board, are exempt. “Without a budget in place that addresses our $19bn deficit, every day brings
California closer to a fiscal meltdown," Mr Schwarzenegger said in a statement. "Our cash situation leaves me no choice but to once again furlough state
workers until the legislature produces a budget I can sign." Analysts say it could be several more weeks until a budget is agreed.
2010 NFA-LD
[Evidence–Final]
Extensions – Link – Texas
Texas is cutting mental health funds to balance the budget
Lillian Ortiz, Staff Writer, Houston Chronicle, July 24, 2010 [ “Mental health cuts could be disastrous.”
http://www.chron.com/disp/story.mpl/editorial/outlook/7123337.html] Garcia NM
Like many states, Texas faces a large deficit. And as in many states, state leaders are seeking to slice and
dice programs — including those that serve people with mental illness - just when Texans need them most. The Texas
Department of State Health Services (DSHS) recently released a proposal to eliminate $134 million from its
already underfunded and overburdened mental health programs. Gov. Rick Perry, Lt. Gov. David Dewhurst, and Speaker Joe
Straus ordered the agency to cut its 2012-13 proposed budget by 10 percent. This reduction is in addition to a 5 percent cut that
was recently made to the current DSHS budget. While legislators are expected to face a difficult financial situation during the 82nd Texas
Legislature, our state's leadership needs to fully understand and consider the ramifications of the proposed $134 million in cuts. Untreated mental
illnesses lead many individuals to cycle in and out of homelessness as well as our emergency rooms, jails and prisons. Lack of treatment also leads to
an increase in the utilization of police man-hours since law enforcement personnel are often called in to deal with individuals experiencing a mental
health crisis. Any further erosion of the limited services currently provided to the state's most vulnerable mental health patients will exacerbate what
should already be considered a serious public health and public safety issue. The proposed cuts include $80 million that would be
taken from the state's 39 publicly supported community mental health centers, which provide psychiatric care
for poor or uninsured people. The cuts would also eliminate services to 11,000 adults and 2,000 children across Texas. As it is, more than
900 adults are on a waiting list each day for mental health services from the Mental Health Mental Retardation Authority of Harris County (MHMRA), our
area's public mental health center, for treatment of schizophrenia, bipolar disorder and severe depression. The approximately 400,000 adults in our area
with other mental illnesses have to try and find services elsewhere regardless of their ability to pay for treatment. In addition to the adults waiting for
care, 75 percent of our community's children in need of help from the public mental health system do not receive treatment services. Perhaps this is why
half of the children in the Harris County Juvenile Probation Department have a diagnosable mental illness and 55 percent have been diagnosed with a
substance abuse and/or chemical dependence problem. An additional $44 million in proposed cuts would eliminate 183 beds,
or 12 percent of their total capacity, from five state psychiatric hospitals. These facilities are already unable to take many of
the state's sickest individuals due to a lack of available beds. As a result, the Harris County Jail houses an estimated 80 inmates each day who are
simply waiting for one of these beds, a scenario repeated throughout the state. Eliminating the 183 beds, which have the potential to serve thousands of
individuals, will further contribute to the fact that the Harris County Jail is now the largest provider of mental health services in Texas. To make matters
worse, a $10 million reduction to psychiatric crisis services, which would cut care to 6,000 people statewide, is also included in
the proposal. An overall lack of community based mental health services, which help keep people stabilized and out of expensive crisis care, has
led Texas to rely heavily on its mental health crisis system.
2010 NFA-LD
[Evidence–Final]
AT – Raise Taxes
Raising taxes isn’t politically or economically feasible
Leslie Easton, Staff Writer, Wall Street Journal, April 9, 2009 [“More States Look to Raise Taxes,” WSJ,
http://online.wsj.com/article/SB123923448796803135.html] Garcia NM
Sales-tax revenue has fallen more sharply than at any time in the past 50 years, Mr. Boyd said, and he expects income-tax collections to drop below
levels state officials projected -- though the extent of the damage probably won't become clear until May. Raising taxes is a perilous
proposition for lawmakers, who must balance their states' budgets every year. Not only do they face political
heat for increasing financial burdens during the recession, but added taxes risk worsening their states'
economic problems by, for example, further hobbling consumer spending.
Spending cuts outweigh revenue increases
Alissa Figueroa, Correspondent, Christian Science Monitor, August 2010 [“Will state budget cuts blunt
the recovery?” http://www.csmonitor.com/Money/2010/0802/Will-state-budget-cuts-blunt-the-recovery] Garcia NM
With two years of depressed tax revenues, a third one expected, and rainy day funds all but exhausted, state
and city governments are having to close huge budget gaps. If projections are correct, they could amount to $660
billion from fiscal 2009 through 2012, nearly rivaling the $789 billion stimulus from the federal government. Although these
2010 NFA-LD
[Evidence–Final]
governments are raising some revenues through tax hikes and new fees, mostly they're cutting spending.
That threatens to reduce safety net services, push hundreds of thousands of workers onto unemployment rolls, and derail a fragile recovery . "State
and local governments are going to be a serious drag on the economy over the next 12 to 18 months," said Mark
Zandi, chief economist of Moody's Analytics, a Pennsylvania-based economic research firm. Their budget woes could trim a half percentage point from
the United States' growth rate this year, he estimated. Collectively, states must close a $127 billion shortfall for the 2010-11 fiscal year, says a National
Association of State Budget Officers survey.
2010 NFA-LD
[Evidence–Final]
AT – Double Dip
No double dip – economy is recovering slowly but steadily

Vincent Fernando, CFA, staff writer, The Business Insider, August 1, 2010 [“Why the US economy isn’t in
expansion mode.” http://www.businessinsider.com/why-the-us-economy-isnt-in-expansion-mode-2010-8] Garcia NM
At 2.4% growth for the second quarter of 2010, the latest GDP data was a little softer than consensus had
expected (2.5%), but it basically just told us what we already knew -- That the U.S. economy is still recovering
but still hasn't surpassed its 2007 peak in terms of economic size (total GDP). GDP is expanding year-over-year,
yet it remains lower than it was in 2007. This means that the U.S. economy is still in the process of taking back lost
ground. Thus from a multi-year perspective it remains in 'recovery mode' rather than 'expansion mode': THAT
KIND OF OVERREACTION seems to be occurring now. The slowdown in GDP growth, to an annual rate of 2.4% in second quarter 2010,
tells us nothing decisive about prospects for the second half. Components of the report can be interpreted to mean faster or
slower economic expansion to come, depending on your inclination. What the report does confirm is that the recovery that began
in the third quarter of last year continues, and that a double dip seems increasingly unlikely. In all, there have
been four quarters of consistent growth, accompanied by not-unusual volatility. Based on revised figures released in
Friday's report, real GDP climbed at an annual rate of 1.6% in the third quarter, 5.0% in the fourth and 3.7% in the first, before slowing to 2.4% in the
second. Since this four-quarter performance averages to 3.2%, it would not be surprising if future quarters revert to this trend. While 3.2% would still be
disappointingly subpar, it would at least be fast enough to bring a continued decline in the unemployment rate. For the recovery to end and the
expansion to begin, real GDP must be higher than its previous peak, reached in fourth-quarter 2007, and we are not there yet. For that to happen,
growth in the current quarter must run at annual rate of 4.5%. Things are getting better, GDP-wise, but they still aren't as good as before.
2010 NFA-LD
[Evidence–Final]
Answers – Borrowing High Now
Non-unique - states are borrowing money now
Tammy Luhby, Senior Writer, CNN Money, July 30, 2010 [“States going deeper into debt.”
http://money.cnn.com/2010/07/30/news/economy/state_debt_levels/] Garcia NM
The states are broke, and like many consumers, they're borrowing big time to get out of their fiscal binds. The amount
of debt that states are carrying spiked 10.3% last year to $460 billion, according to Moody's Investors Service. The debt is paid
for through taxes and fees, making residents ultimately responsible. The median personal share of this burden jumped to $936, from $865 in 2008. And
it's likely that states will turn to the bond markets even more this year as federal stimulus money dwindles,
experts said. After all, officials face an additional $12 billion shortfall for the current fiscal year and a $72 billion gap for fiscal 2012, which starts next July
1. Debt "is a tool to help bridge the gap between the downturn and when the economy starts to recover," said Robert Kurtter, a managing director at
Moody's. States are relying on the debt markets in a variety of ways. With less cash on hand, some state officials are borrowing more to fund capital
projects. Other states are engaging in so-called deficit financing, where they issue bonds to cover their budget
shortfalls or restructure their debts to lower their monthly payments.
2010 NFA-LD
[Evidence–Final]
Answers – Economy Low Now – Double Dip
US economy declining - we’re heading towards a double dip recession

James Quinn, US Business Editor, UK Telegrah, July 30, 2010. [“Double-dip feared as US economic growth loses
pace.” http://www.telegraph.co.uk/finance/economics/7919706/Double-dip-feared-as-US-economic-growth-loses-pace.html] Garcia NM
Fears that the world's biggest economy could be heading into a double-dip recession took hold on Friday after US
growth was shown to have contracted sharply in the second quarter. The Dow Jones Industrial Average fell by as much as 120
points after annualised growth in gross domestic product (GDP) was found to have slowed from 3.7pc in the first quarter to 2.4pc in the second. That
came on the back of growth of 5pc in the final three months of 2009. The US was initially thought to have grown by 2.7pc in the first quarter but that was
revised upwards on a day of surprises for economists. The US Commerce Department also revised downwards GDP figures all the way back to the
beginning of 2007. The second-quarter slowdown led economists to question whether the US might be poised to enter a period of negative growth later
in the year, leading to a much-feared double-dip recession. The Dow Jones fell sharply after the release of the GDP data before recovering ground to
settle down 40.72 at 10,426.44 in lunchtime trading. "The post-recession rebound is history," said Bart van Ark, chief economist for the Conference
Board, an economic think-tank. Economists had predicted second-quarter growth of 2.5pc, but their disappointment was compounded by the revised
data for the first three months of 2010. Consumer spending – which accounts for two-thirds of US GDP and is seen as a
lead indicator of economic recovery – slowed, rising by 1.6pc in the quarter, compared with 1.9pc in the prior three months. The
savings rate rose to 6.2pc as consumers instead put money to one side. The biggest factor in the slowdown was the US's
widening trade deficit, following a 28.8pc surge in imports – the sharpest rise in 26 years – against a 10.3pc rise in exports. It was the size of the
downward revisions to previous years' growth which most concerned economists. In 2009 the economy was previously estimated to have declined by
2.4pc, but the figure was revised to a drop of 2.6pc. In 2008, the revision was from 0.4pc to no growth, while 2007's 2.1pc growth rate was revised to
1.9pc. "The prospects of a double-dip or some facsimile thereof were bolstered… by the contours of the
second-quarter GDP report," said David Rosenberg, chief economist at Gluskin Shef. Nigel Gault, chief US economist at IHS Global Insight,
The disappointing
was more wary, saying that a full reversal into a double-dip recession "remains a possibility" but was not his "base case".
growth numbers were compounded by the International Monetary Fund's (IMF) annual report on the US
economy. The IMF said there may be a need for the Obama administration to increase the amount of fiscal stimulus in order to boost the recovery,
warning the "outlook remains uncertain".
2010 NFA-LD
[Evidence–Final]
Answers – No Link (Tax Increases)
No link – states will raise taxes to cover any shortfalls, empirically proven
Nicholas Johnson, Director of the State Fiscal Project, Center on Budget and Policy Priorities, July 9,
2009 [“Tax Measures Help Balance State Budgets “A Common and Reasonable Response to Shortfalls.”
http://www.cbpp.org/cms/index.cfm?fa=view&id=2815] Garcia NM
most states will have employed a combination of budget solutions

By July 1, the start of the fiscal year in all but four states,
that also involves drawing down reserve funds, maximizing the use of federal dollars, and raising taxes. A number
of prominent economists have pointed out that budget cuts are more harmful to state economies during a recession than
properly structured tax increases, so it is good policy to use tax increases to fill a substantial portion of deficits
that exceed the amount that can be closed with reserves or federal funds. Historically, raising taxes in a recession is a common
response by states. During the recession of the early 1990s, 44 states raised taxes by a significant margin (at
least 1 percent). In the recession of 2001, 30 states did so. These actions increased annual revenue
collections by tens of billions of dollars. (States often go in the opposite direction during periods of strong economic growth: 36 states cut
taxes from 1994 to 2001. Contrary to what some consider common wisdom, a tax increase can be good policy during a recession. Tax increases are a
better option than deep spending cuts — better both for families already suffering due to the recession and for state economies. Tax increases can be
designed in such a way that they impose relatively little or no costs on the most vulnerable families; this can be done, for example, by targeting the
increase on households with the highest incomes or on profitable corporations. Moreover, as the economists Joseph Stiglitz and Peter Orszag (among
others) have noted, tax increases take less money out of the economy than spending cuts, for reasons described more fully below.
2010 NFA-LD
[Evidence–Final]
Answers – States Won’t Default
No impact – risk of states defaulting on debt is nonexistent
Tammy Luhby, Senior Writer, CNN Money, July 30, 2010 [“States going deeper into debt.”
http://money.cnn.com/2010/07/30/news/economy/state_debt_levels/] Garcia NM
But despite the states taking on additional debt, they are in no danger of becoming the next Greece or
defaulting on their debt, no matter how poor their fiscal condition, experts said. The median state debt to gross
state product is about 2%, a fraction of the debt burden of Greece, which spooked the world this spring by nearly defaulting,
said Judy Wesalo Temel, director of credit research at Samson Capital Advisors . "No state is in danger of default," she said.
2010 NFA-LD
[Evidence–Final]
***Procedurals – Index***
***Procedurals – Index***.............................................................214
T – Chronically Mentally Ill – Must Be Diagnosed......................................215
T – Chronically Mentally Ill – Prolonged Illness and Treatment........................216
T – Reform – End Abuses...............................................................217
T – Provision – Supply Something......................................................218
Solvency Advocate.....................................................................219
Solvency Advocate (Shorter)...........................................................220
Vagueness.............................................................................221
Agent Specification...................................................................222
2010 NFA-LD
[Evidence–Final]
T – Chronically Mentally Ill – Must Be Diagnosed
A. Interpretation – Chronically mentally ill must be a condition based on a

diagnosis from a licensed mental health professional with at least one
documented hospitalization.
US Code of Federal Regulations, Title 38, Section 61.1 [http://law.justia.com/us/cfr/title38/38-2.0.1.1.28.0.341.2.html]
JH
Chronically mentally ill means a condition of schizophrenia or major affective disorder (including bipolar disorder) or
post-traumatic stress disorder (PTSD), based on a diagnosis from a licensed mental health professional, with at
least one documented hospitalization for this condition sometime in the last 2 years or with documentation of a
formal assessment on a standardized scale of any serious symptomology or serious impairment in the areas of work,
family relations, thinking, or mood.
B. Violation – The affirmative case reforms mental health services to people who
have not received formal diagnosis from mental health professionals or been
hospitalized for their condition.
C. Standards –
1. Context – This definition is from a US government source, making it most relevant to a topic
dealing with USFG policy decisions. As a judge you weight the round in a policy maker paradigm, so
you should uphold the definitions policy makers use.
2. Predictability – This is one of the only definitions that define “Chronically mentally ill” as a
complete phrase. This makes this one of the most predictable and easily found definitions for this
topic. Having a predictable definition allows both debaters to prepare better for the round in advance,
improving education and fairness.
3. Brightline – This definition sets the clearest brightline on what it means to be chronically
mentally ill. Without a brightline, almost any case dealing with some disorder could be arguably
topical, exploding the research burden and the limits on the topic. Narrowing the topic to a clear set of
conditions allows for better researched and more education debates while protecting the negative
from unpredictable affirmatives.
Further, brightlines are essential to the usefulness of definitions in debate. Without a brightline, the
judge can never evaluate if a case meets the T interpretation or not, leading to judge intervention and
messy debates. You should prefer the definition that you as the judge can evaluate.
D. Voters – It’s in the rules that topicality is an a priori voting issue. If the AFF is
not topical, the rules say they lose.
2010 NFA-LD
[Evidence–Final]
T – Chronically Mentally Ill – Prolonged Illness and

Treatment
A. Interpretation – The term chronically mentally ill refers to patients with

prolonged illness and need for long term treatment.
John J. Spollen, MD, MedScape Today, 2003 [Perspectives in Serious Mental Illness,
http://www.medscape.com/viewarticle/455449] JH
The term "serious and persistent mental illness," or "seriously and persistently mentally ill," grew out of the term
"chronically mentally ill." Chronically mentally ill, or CMI, was a term used to identify the patients who lived in state hospitals or other long-term
institutions. With the passage of Kennedy's Community Mental Health Centers Act in 1963, the deinstitutionalization, or "dehospitalization,"[1] and the
advent of widespread use of antipsychotic medications, care for CMI patients moved from institutional settings to community settings. Also, with
successful treatment, some patients with CMI no longer had a "chronic" course of their illness. It also seemed to some that the term
"chronically mentally ill" was a pessimistic and, possibly, pejorative term. Over time, the use of "severely mentally ill"
or "severely and persistently mentally ill" became the accepted term for such patients . But who are these
patients? As psychiatrists who are used to diagnosing people with a standardized DSM method, how does one identify a patient who is "severely and
persistently mentally ill"? In fact, there have been multiple definitions over the years leading to vastly different prevalence rates and confusion about
which services to provide to which patient. One study found prevalence rates of SPMI between 4% and 88% of the population of adult patients treated at
community mental health centers in Philadelphia, depending upon which definition was used.[2] However, the most consistent definitions of
SPMI include a diagnosis of nonorganic psychosis, functional disability in areas of social and occupational
functioning, and a prolonged illness and long-term treatment. It includes many patients with schizophrenia, but also people with
bipolar disorder, severe major depression, and, in some less frequently used definitions of SPMI, substance use and personality disorders.
B. Violation – The affirmative does not deal with patients with long term illness
or treatment.
C. Standards –
1. Limits – This definition limits the resolution to only those patients needing long term psychiatric
treatment. This massively reduces the research burden of the negative, leading to better researched,
deeper debates, as well as preserving fairness for the negative.
2. Historical Context – this definition takes into account the historical development of the term
chronically mentally ill, and presents what the term means in modern literature. Debating with
definitions only relevant to the literature of 50 years ago is counterproductive and damaging to the
educational value of this activity.
D. Voters – It’s in the rules that topicality is an a priori voting issue. If the AFF is
not topical, the rules say they lose.
2010 NFA-LD
[Evidence–Final]
T – Reform – End Abuses
A. Interpretation
Your Dictionary.com, Last Accessed August 3, 2010, [http://www.yourdictionary.com/reform] Gardog SS
Reform: to make better by putting a stop to abuses or malpractices or by introducing better procedures
B. Violation – Your plan must either create a new policy or end a flawed one. You
do neither by changing an existing policy
C. Standards –
Brightline: this definition establishes a clear brightline. Either you end a policy or create one. Without
a brightline, the limits of the topics are exploded thus unfairly increasing the research burden.
Ground: My interpretation is absolutely necessary to preserve uniqueness for disadvantages. If

every aff moved parallel to the status quo, affirmatives could use status quo policies similar to the aff
to prove disads non-unique. Preserving fair and predictable disadvantage ground is critical to
negative strategy and fairness.
D. Voters – Topicality is a voting issue as per the NFA-LD rules. If you find the
aff to be untopical vote it down based on jurisdiction
2010 NFA-LD
[Evidence–Final]
T – Provision – Supply Something
A. Interpretation –
Dictionary.Com, Last Accessed August 3, 2010.
[http://dictionary.reference.com/browse/provision] Gardog SS
Provision: the providing or supplying of something, esp. of food or other necessities.
B. Violation – the affirmative is not providing or supplying a mental health

service they are merely making a reform to a policy
C. Standards (Choose which two apply best in round) –
1. Grammar – Each word of the resolution has meaning, by attempting to get around this word of the
resolution the affirmative is functionally changing the rez and the ground that it provides. This renders the rez
meaningless and thus decreases predictable ground leading to no educational value.
2. Brightline – This definition establishes a clear brightline, either the plan provides or supplies a mental
health service or it does not. Brightlines are the only way for a judge to evaluate Topicality without being
interventionist and thus are the best way to preserve fairness.
3. Limits – You should prefer the interpretation that provides the most fair and predictable limit on the topic.
Limits are good for debate because they make it more predictable which allows for more in depth research and
better debates
4. Effects Topicality is Illegitimate – cases that only effectually reform the provision of mental
health services should be rejected because they allow for nearly any case to become topical which would tank
predictable ground and indepth educational debate. It would also place a completely unfair research burden on
the negative.
D. Voters – The NFA-LD Rules State Topicality is a voting issue.

2010 NFA-LD
[Evidence–Final]
Solvency Advocate
A. Interpretation – The affirmative must prove that the plan as worded can solve
for the harms presented.
From the NFA-LD rules, last accessed August 2010 [http://cas.bethel.edu/dept/comm/nfa/ldrules.html]
The official decision-making paradigm of NFA LD is that of Stock Issues: Harm (Advantage or Goals), Inherency, and
Solvency. The affirmative is required to meet three initial burdens. The affirmative must prove:
The harm of the present system or that a comparative advantage or goal can be achieved over the present system;
The inherency which prevents solving those harms or achieving those advantages or goals;
and,
the proposed plan's ability to solve the harm or achieve the advantage or goal claimed by affirmative.
The negative may attack any of these issues, but need only win one to win the debate. The negative may also challenge the jurisdiction (topicality) of the
affirmative proposal or argue that disadvantages to the proposal outweigh its benefits.
The plan need not be detailed, but should be sufficient to prove a propensity to solve the problem area. The
Solvency is to be a function of the plan's ability to work after
affirmative need only prove that the resolution should be adopted.
the adoption of the policy by the agent/agents of change.
B. Violation – The affirmative has no evidence specific to the exact plan

mandates and wording that proves the plan has been well researched and can
solve for the harms.
C. Standards –
1. Plan in a vacuum – The only thing you as a judge vote for at the end of the
round is the plan – nothing else. If you vote for the AFF, all that gets passed is
exactly what the plan says. Don’t let the AFF justify solvency from mandates and
legislative changes not in the plan.
2. Solvency Takeout – None of the AFF’s solvency evidence talks about the plan,
as worded, to solve. This means you have no idea if the plan proposed by the
AFF can succeed, since none of the literature backs up their mandates.
3. No Literature Base – If the AFF plan is not specifically discussed in the

literature it devastates negative ground, since the plan is impossible to research.
Additionally, the case is unpredictable, because none of the lit on the topic
discusses or mentions the plan. The lack of ground and predictability
undermines fairness in the round.
D. Voters –
1. Stock Issues – This position functions as a solvency takeout, since solvency

is a stock issue, this is a voting issue under the judging paradigm laid out by the
NFA.
2010 NFA-LD
[Evidence–Final]
2. This position is also a voting issue for reasons of fairness and education.
Lack of solvency evidence makes the debate unfair and under-researched.
Evaluate this position before the case debate, since we must determine if the
game is fair, before we can play the game at all.
2010 NFA-LD
[Evidence–Final]
Solvency Advocate (Shorter)
A. Interpretation – The affirmative must prove that the plan as worded can solve
for the harms presented.
From the NFA-LD rules, last accessed August 2010 [http://cas.bethel.edu/dept/comm/nfa/ldrules.html]
The official decision-making paradigm of NFA LD is that of Stock Issues: Harm (Advantage or Goals), Inherency, and
Solvency. The affirmative is required to meet three initial burdens. The affirmative must prove:
The harm of the present system or that a comparative advantage or goal can be achieved over the present system;
The inherency which prevents solving those harms or achieving those advantages or goals;
and,
the proposed plan's ability to solve the harm or achieve the advantage or goal claimed by affirmative.
The negative may attack any of these issues, but need only win one to win the debate. The negative may also challenge the jurisdiction (topicality) of the
affirmative proposal or argue that disadvantages to the proposal outweigh its benefits.
The plan need not be detailed, but should be sufficient to prove a propensity to solve the problem area. The
Solvency is to be a function of the plan's ability to work after
affirmative need only prove that the resolution should be adopted.
the adoption of the policy by the agent/agents of change.
B. Violation – The affirmative has no evidence specific to the exact plan

mandates and wording that proves the plan has been well researched and can
solve for the harms.
C. Standards –
1. Solvency takeout – None of the AFF’s solvency evidence talks about the plan,
as worded, to solve. This means you have no idea if the plan proposed by the
AFF can succeed, since none of the literature backs up their mandates.
2. No literature base – If the AFF plan is not specifically discussed in the

literature it devastates negative ground, since the plan is impossible to research.
Additionally, the case is unpredictable, because none of the lit on the topic
discusses or mentions the plan. The lack of ground and predictability
undermines fairness.
D. Voters –
1. Stock Issues – This position functions as a solvency takeout, since solvency

is a stock issue, this is a voting issue under the judging paradigm laid out by the
NFA.
2. This position is also a voting issue for reasons of fairness. Evaluate this
position before the case debate, since we must determine if the game is fair,
before we can play the game at all.
2010 NFA-LD
[Evidence–Final]
Vagueness
A. Interpretation – The affirmative case must provided sufficient details of plan

implementation to allow me access to negative ground or grant them access to
solvency.
B. Violation – The affirmative case fails to specify sufficient details of plan

implementation, specifically,
______________________<Insert details specific to plan>__________________.
C. Standards –
Ground – My lack of knowledge about plan implementation makes it impossible

for me to make informed decisions about which negative arguments to run in
this round. All links to DAs are speculative at best, making all negative ground
into bad ground, undermining fairness in this round.
Time Skew – The vagueness of the affirmative destroyed my ability to

understand the affirmative case and make strategic decisions during the 1AC.
My preparation and selection of files starts as soon as the AFF begins to be
read. Answers and clarifications given in CX can never check this prep time
abuse.
Solvency Deficit – Due to the vague nature of the plan, you can never evaluate if
the plan will solve. Details of implementation and funding are critical to
evaluations of solvency, as well as to the educational value of the event.
Real World – Policy makers in the real world would never pass a plan will so
many unanswered questions of implementation. There is no educational value to
debating unrealistic cases, since they could never pass in the real world,
undermining the value of the activity.
Voters – All of the above standards are voters for reasons of fairness and
education.
2010 NFA-LD
[Evidence–Final]
Agent Specification
A. Interpretation – the affirmative plan text must specify an agent within the
United States federal government to enact the plan
Adrienne Brovero, debate coach at Wake Forest University, 1994 [“Immigration Regulation : Borderline Policies.”
Wake Forest Debate Site. http://groups.wfu.edu/debate/MiscSites/DRGArticles/Brovero1994Immigration.htm] Garcia NM
The problem is not that there is not a plan; this time there is one. The problem is that there is no agent specified . The
federal government
does not enact policies, agents or agencies within the federal government enact policies. The agent enacting a
policy is a very important aspect of the policy. For some of the same reasons the affirmative team should specify a plan of action, the
affirmative team should specify an agent of action
B. Violation – The aff does not specify an agent within the US federal
government.
C. Standards
1. Ground – lack of specification distorts core negative strategy by nullifying disad and process counterplan
links to specific branches - they can always shift out of a certain part of the USFG
2. Education – the affirmative eliminates education specific to the actor, including separation of powers,
branch interaction, and legislation process. And, ninety percent of policies lie in the procedure of
implementation.
Richard Elmore, Prof. Public Affairs at University of Washington, Politcal Science Quarterly, 1980
[“Backward Mapping: Implementation Research and Policy Decisions.” Vol. 94, No. 4 pp. 65] Garcia NM
Analysis of policy choices matters very little if the mechanism for implementing those choices is poorly
understood. In answering the question, “What percentage of the work of achieving a desired governmental action is
done when the preferred analytic alternative has been identified?” Allison estimated that in the normal case, it was about
10 percent, leaving the remaining 90 percent in the realm of implementation
D. Voters
ASPEC is a voter for fairness and education

2010 NFA-LD
[Evidence–Final]

2010 NFA-LD Cooperative Evidence Pack

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2010 NFA-LD

2010 NFA-LD Cooperative Evidence Set –

1AC 1/8 – Inherency

1AC 2/8 – Plan Text

Therefore I propose the following plan –

1AC 3/8 – Solvency 1/2

1. The IMD exclusion prohibits Medicaid payments for patients receiving

2. The Medicaid IMD Exclusion results in homelessness, incarceration, and

1AC 4/8 – Solvency 2/2

1AC 5/8 – Adv 1 – Prisons 1/2

1AC 6/8 – Adv 1 – Prisons 2/2

1AC 7/8 – Adv 2 – Dehumanization 1/2

Advantage 2 is ending Dehumanization –

1. The mentally Ill frequently become homeless and suffer greatly

2. The IMD exclusion causes deinstitutionalization to homelessness, leading to

1AC 8/8 – Adv 2 – Dehumanization 2/2

Extensions – Explanations of IMD

Extensions – Private insurance can’t solve

The most seriously mentally cannot afford private insurance.

Extensions – Human Rights Impact

Extensions – Moral Imperative

Society has a moral imperative to help the incarcerated mentally ill

Extensions – Soft Power Link

US double standards on human rights have lead to mistrust of US leadership

Deinstitutionalization has political support from both parties, meaning it will

Nothing in the Healthcare reform has solved for mental health.

Extensions – IMD is discriminatory

The IMD exclusion is discriminatory and should be ended.

Extensions – Stigma causes Dehumanization

Stigma against the mentally ill dehumanizes them.

***Native American Mental Health AFF Index***

***Native American Mental Health AFF Index***..........................................22

1AC 1/6 – Inherency and Plan

Observation One – Inherency

1AC 2/6 – Advantage 1/5

Observation Two – the Advantage

A. Native Americans are facing a severe mental health crisis

2. Depression is a dominant concern on the reservation and is growing through

3. Increasing depression on Native American reservations is leading to an

1AC 3/6 – Advantage 2/5

1. Despite high demand, Native Americans go without treatment for mental

2. Cultural barriers prevent American Indian access to mental health services

1AC 4/6 – Advantage 3/5

C. The impact is colonialism

1. The current regime of mental health treatment for Native Americans is

1AC 5/6 – Advantage 4/5

1. Culturally sensitive mental health solutions require a reorientation of our

2. Including ritual and tradition in mental health services provided to Native

1AC 6/6 – Advantage 5/5

3. Collaboration solves for the ideological dangers of colonialism

1AC – Short Version 1/

Observation One – Inherency

Observation Two – Harms

A. Cultural barriers prevent American Indian access to mental health services

1AC – Short Version 2/

C. Depression is a dominant concern on the reservation and is growing through

D. The increasing depression on Native American reservations is leading to an

1AC – Short Version 3/

Observation Three – Solvency

A. Culturally sensitive mental health solutions require a reorientation of our

B. Collaboration with community leaders and spiritual healers will overhaul

Mental health practitioners attempt to assimilate patients to their own cultural

Extensions – Cultural Insensitivity Prevents

Native American Mental Health AFF Index

Native American Mental Health AFF Index..........................................22

Rural Telemental Health Care AFF – Index

PTSD Military AFF – Index