What Syria’s war has to teach about mental health

PROGRAMMING NOTE: We’ll be off tomorrow and Friday for Thanksgiving but back to our normal schedule on Monday, Nov. 28.

As deputy coordinator for countering violent extremism and terrorist detentions at the State Department, Ian Moss is working to repatriate foreign terrorist fighters and their family members, which includes providing them with social and mental health resources.

The work he does is complex and involves not only finding homes and jobs for people previously involved in terrorist organizations, but also providing the communities they’re reintegrating into with the right tools to support them. Moss says the lessons learned in dealing with the mental health problems of foreign fighters could inform efforts to combat violent extremism and mass violence in this country.

In a similar way to what the State Department has done abroad, the Department of Homeland Security is starting to invest in domestic mental health programs.

Moss talked to Ruth about his work. The interview has been edited for length and clarity.

Can you talk a bit about what you do? 

One of the issues that I focus a significant amount of my time on is related to repatriation of foreign terrorist fighters and associated family members out of northeast Syria — so making sure that individuals have appropriate educational opportunities, psychosocial support.

What is psychosocial support?

It’s access to mental health care. It’s access to and support in identifying appropriate job skills training, in general, support that one would need navigating a return to society. Access to medical care or social workers or folks who can help address trauma in, say, children — an acute issue for kids coming out of northeast Syria who may have seen family members die or who may have been a part of violence.

We’re talking about repatriation and rehabilitation, but has your work given you any insight into how we can prevent violent extremism in the first place?

Absolutely. Someone has to be vulnerable and susceptible to radicalization, and a lot of the time that is a result of marginalization or other kind of disconnection between groups in a particular place. That just feeds a cycle of extremism and division within a community.

One of our efforts is to work through international entities like the Global Community Engagement and Resilience Fund. It’s an international, nongovernmental body that is comprised of advisers from various governments and civil society that engages at a hyperlocal level to try to create greater resilience and understanding in and among communities that may be susceptible to or already experiencing strife and division that can lead to radicalization and recruitment.

It is at the local level that the indicators are going to first be seen. And so it’s at the local level that you have the first opportunity to intervene.

What role does the internet play in radicalization?

Racially or ethnically motivated, violent extremism is something that is transnational and affects us all. It demands that the steps that we take to address the issue domestically need to be in concert with the steps that we take to address the issue internationally.

There are no shortages of links. They learn from one another, they consult one another, they inspire one another, they vie to recruit from the same pools. They learn from one another; they are inspired by the manifestos that proliferate across the internet.

This is where we explore the ideas and innovators shaping health care. 

From rancorous political debates to Covid-19, the family Thanksgiving has taken a hit in recent years. To add to that maelstrom, the CDC has some dispiriting advice for this year’s meal: Explore your family’s history of cancer.

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Today on our Pulse Check podcast, Carmen talks with Alice Miranda Ollstein about her report on abortion opponents’ new strategy — using environmental laws to curb abortion. The approach comes at a time when the pills mifepristone and misoprostol, taken at home during the first 10 weeks of pregnancy, have become the most common abortion method in the U.S.

The race is on to test an Ebola vaccine in Uganda.

At the auspices of the World Health Organization, the first shots arrive in the central African country this week to combat a two-month-old outbreak of the hemorrhagic fever that’s killed at least 55 people.

A new vaccine would add to the arsenal against one of the world’s most frightening diseases. If the vaccine proves effective, the U.S. will likely stockpile it to protect against a potential outbreak or bioterror attack.

Deadline pressure: The human trials might not be speedy enough. Vaccines can only be tested for efficacy when the disease is spreading, and the outbreak may be fading too quickly to complete human trials.

If the window closes, it may not reopen anytime soon. The variant at work, the Sudan strain, had previously been dormant for a decade.

What’s next: Public health officials will use a ring-vaccination strategy, in which contacts of those who test positive are vaccinated at staggered times.

Some will get the real shot at the outset, while others will receive a placebo. If those vaccinated earlier don’t catch Ebola, the vaccine is working.

But the ring-vaccination approach depends on having a sufficient number of people to test. Right now, it’s thought there are only 4,000 possible participants.

Slow start: If public health officials miss their window, it may be because they were caught off guard when the first cases were reported in September. The developers of vaccine candidates didn’t have enough doses to be distributed right away, and the WHO and Ugandan officials took weeks to work out regulatory and logistical matters.

“We’re unfortunately in this situation again where we’re racing against time when we could have been more prepared,” said Mark Feinberg, the president and CEO of IAVI, a nonprofit research organization working on the most promising of three vaccines the WHO hopes to test.

Health care for “dual eligibles” who qualify for both Medicare and Medicaid — people with low incomes who are elderly or have a disability — is expensive, disjointed and doesn’t serve patients well.

That’s the situation a bipartisan group of senators described in an open letter today asking for advice on how to reform care for 12.2 million people.

Sen. Bill Cassidy (R-La.), the incoming Senate Health, Education, Labor and Pensions Committee ranking member, as well as Sens. Tim Scott (R-S.C.), Tom Carper (D-Del.), Bob Menendez (D-N.J.), John Cornyn (R-Texas) and Mark Warner (D-Va.) want to know your opinion on:

• The shortcomings of the current system
• Other care models that might work better
• What a new unified system might look like
• How geography can play a role in coverage and care
• How coverage could be improved to prevent disease severity

The senators noted that dual eligibles were more likely to contract Covid-19 and three times as likely to be hospitalized from it than Medicare-only patients.

From a cost perspective, dual eligibles constitute 34 percent of Medicare spending, despite comprising only 19 percent of enrollees.

The senators said part of what makes treating this population challenging is that they often suffer from multiple chronic conditions and physical and mental disabilities.

The letter asks for responses to be sent to [email protected] by Jan. 13, 2023.