. . .trivializes anguish

Just how much should depression, alcoholism, anxiety, loss of appetite or suicide matter when assessing the impact of the BP oil spill? Apparently not very much, said Kenneth Feinberg, the man who has control of the $20 billion set aside in an escrow fund by BP.

"If you start compensating purely mental anguish without a physical injury -- anxiety, stress -- we'll be getting millions of claims from people watching television," Feinberg told Rep. Bobby Scott (D-Va) during the House Judiciary Committee hearings in July. (See video of hearings here.)

This contrasted sharply with the assessment of Surgeon General Regina Benjamin, who visited the Gulf the week before Feinberg's appearance. She said some people, "may not be able to bounce back, it may trigger a deeper depression, or thoughts of harming themselves or someone else, or turning to alcohol or substance abuse. . .so those are the people that we have to look out for."

Feinberg said his staff does not know how to address "mental damage, alleged damage, without a signature physical injury as well." They are trained to compare inventories of fish from one year to another, the wages of ship captains, or the receipts from a restaurant or hotel.

The lawyers who will settle claims for conventional business losses will not assess acute stress reactions found in people who suffer from depression, social isolation, agitation, anxiety, or intoxication.

Nor, apparently, do they care to learn or to employ people who can.

The immediate reaction of Mr. Feinberg's response to Rep. Scott's question has a disturbingly familiar ring. After other disasters producing dislocation, or military combat resulting in trauma, doubts were cast on those who reported anxiety, stress, sleep disturbances. If those in charge could not measure these indicators of stress, somehow they didn't exist. Blaming the victim was easier. Feinberg's reply falls into that category.

Advocates angry
Advocates from the fields of mental health and addiction disorders responded to this profound ignorance and seemingly callous disregard for behavioral health. Twenty-eight of the nation's leading advocacy and service organizations for behavioral healthwrote to Feinberg expressing "grave concern" for a policy

"that perpetuates a damaging and false dichotomy between brain and other physical illnesses and continues an ill informed and stigmatizing public impression that these conditions are matters of volition.

Someone should inform Mr. Feinberg that anguish comes not from watching television but from the sudden collapse of a way of life, from the loss of work, hope, and identity, from the inability to feed oneself or one's children, from the disappearance of a community for support. This has been seen following disasters such as the Exxon Valdez oil spill, 9.11, or Katrina. In the Gulf it is already visible. A study of residents conducted by the National Center for Disaster Preparedness in July showed that one child in five was manifesting some of the signs of distress.

An article in this week's (August 11) New England Journal of Medicine, written by noted mental health experts, including Pam Hyde, notes that conventional broken bones, infections, and contamination are incomplete markers of disasters. Public health models, and research in the past six decades, stress the importance of planning to respond to disasters. "Early action to help people cope with the disaster's emotional impact may decrease long-term behavioral health problems," they write.

Feinberg refused to budge. When asked by MIWatch whether the above would influence his earlier position, his spokesperson Amy Weiss replied (in an email), "Mr Feinberg's statement in front of Congress is still accurate." That seemed to reiterate what he said in the hearings: "You have to draw the line in the sand somewhere."

History of neglect
BP already shelled out more than $200 million to assist residents of Alabama, Florida, Louisiana, Mississippi and Texas, Feinberg said in prepared remarks. "My job will be made much easier because of these preliminary efforts," he said.

But mental health was not among the priorities. After ignoring pleas since early July, today the oil giant announced it would contribute $52 million for behavioral health issues in four states and to help SAMHSA. Although this represents a turn-about from earlier positions, the amount falls short of what some have said they need.

Five weeks into the disaster Louisiana health officials asked the for $10 million to deploy teams of counselors for six months. Timing was urgent to provide outreach, especially in areas where the effects were compounded by previous disasters. That amount was less than estimates of a day's clean-up costs of $16 million for the giant with $14 billion in profits in 2009.

To lay out the picture for BP execs, the Louisiana officials pointed to the 1989 Exxon Valdez spill with a decade or more consequences for mental health. In the Gulf, indicators of stress were already apparent with increases in applications for social supports and reports of domestic violence, increased anxiety, depression, agitation, and helpless anger.

BP never answered, wrote Alan Levine of Louisiana's Department of Health and Hospitals in a letter to Secretary Kathleen Sebelius in early July. Levine presented the sequence:

"On May 28, we asked British Petroleum to fund mental health services to the affected region. Again, on June 28, we reiterated this request for $10 million in a letter to BP's COO, Doug Suttles. As of writing this, I have not heard one word, not even a courtesy call acknowledging receipt of our request, from BP."

Levine renewed the request to BP at the end of July, this time requesting $28.9 million through October 2011. The amount was based on consolidating support services. "We are providing the consolidated request to ensure you have a full picture of the need and comprehensiveness of our coordinated response," he wrote. Levine wrote that Feinberg's decision not to fund mental health, "further intensifies the urgency of this request."

The $15 million earmarked for Louisiana in today's announcement is roughly half of what it said it needed. Alabama will received $12 million, BP announced. In July it asked for $5.7 million immediately and another $20 over five years. According to BP,

"The funding will help residents link up with support that is available through providers in their communities, through a variety of local outreach programs and a special toll free phone line where people can turn for information on available services."

It's unclear whether Feinberg will follow BP's lead and now reconsider a decision that originally paid scant attention to anguish. And when he did, he trivialized it. In the meantime, the response of advocates has been fierce. Mental Health America's David Shern said: "Mental Health America finds this appalling."