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Day: July 20, 2026
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Cancer survivors often experience cognitive, visual or physical challenges that hinder software use. Better designs can help.
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Allegheny County can now order treatment for people with serious mental illness. But what’s driving results – the order itself or the services behind it?
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Amy Duggar recently spoke at length about her extended family’s latest scandal.
She has expressed, among other things, a belief that perhaps Josh and Joseph were victims themselves as kids.
Her mom, Deanna, joined in for part of the interview.
Together, the two called for every member of their extended family to be investigated. Good idea?
‘They should be investigated’
During another portion of Amy’s interview with The Sarah Fraser Show, her mom participated in the call.
“In my opinion, I do believe that they should be investigated,” Deanna Duggar expressed.
She explained that she believes that an investigation would be appropriate “just because of everything that has happened.”
Deanna confirmed: “Everybody should be checked out in that family.”
Amy chimed in to agree, suggesting that Josh and Joseph’s evil may be informed by their life experiences. “It stems from somewhere,” she shared.
Deanna also added that she believes that her niblings “should be in therapy.”
Amy shared that her coucins have probably “suppressed a whole lot” of what they have endured.
She then admitted: “I don’t understand how someone becomes a monster overnight.”
That is another clear reference to Josh and to Joseph.
“It blows my mind when I hear about these double lives and how quickly they can make a decision that’s so heartbreaking,” Amy stated, echoing similar remarks that she has made.
‘You don’t protect children’
Additionally, Amy confirmed that she has a lot of distance with most of her extended family.
She explained that this is because Jim Bob and most of his kids still believe “in IBLP and you don’t protect children.”
For this reason, they cannot be in her life.
Deanna, meanwhile, said that she’s relatively open to communicating with Jim Bob again. But she’d need “boundaries” in place, and it would need to be on her terms.
She also shared that her brother tried to make nice last year. “I said, “It’s not the time or place to talk right now,’” Deanna revealed.
There is sometimes a concept that suggests that all who prey upon children were once victims of such crimes themselves.
This is not only untrue, but has the pernicious effect of making society suspicious of survivors of childhood sexual abuse. (In reality, the vast majority of survivors do not commit such offenses as adults.)
We would not expect Amy or Deanna to know this. Though they are not part of the family cult, they are still part of society’s fringes. Amy herself holds extreme and bigoted beliefs and this surely clouds the lens through which she views the world, including her disgraced cousins.
An investigation into the welfare of the children of that family would be a good idea. It would be an even better one if we lived in a society with laws that actually protect children more effectively. But then, if we did, the Duggars as we know them wouldn’t exist in the first place.
Amy’s right about her cousins needing to be in therapy. Real therapy. Even if Josh and Joseph were innocents, all of those children have suffered from growing up in an abusive cult.
Deanna Duggar Calls for Jim Bob, Whole Family to Be Investigated was originally published on The Hollywood Gossip.
The Hollywood Gossip
Pittsburgh-area courts have a new tool for people in mental health crisis: the power to order treatment instead of incarceration or hospitalization.
Between 2015 and 2022, more than 5,000 people a year were evaluated for involuntary hospitalization in Allegheny County, and roughly 3,700 were committed. Fewer than half got follow-up outpatient care afterward, and 20% died within five years of that first evaluation. These deaths often trace to more than psychiatric illness – untreated medical conditions, substance use, unstable housing, poverty and limited care access all raise mortality risk too.
Assisted outpatient treatment is a shift from the county’s existing process for mental health crises, known as a 302 commitment.
A 302 is Pennsylvania’s process for involuntary emergency psychiatric evaluation and short-term hospitalization. Someone with firsthand knowledge – a family member, clinician or other person – can petition, describing behavior showing the person is a danger to themselves or others due to mental illness.
In Allegheny County, a mental health delegate typically authorizes the petition, though police or physicians can act directly in some cases. Once authorized, a physician examines the person and decides whether to admit them. If admitted, they can be held up to 120 hours. Extending treatment beyond that requires a separate court hearing. The process doesn’t require any follow-up care after release.
Not everyone qualifies for assisted outpatient treatment. To meet Pennsylvania’s criteria, a person generally must have a serious mental illness that significantly impairs daily functioning. Or they must have a history of repeated hospitalizations, incarceration or behavioral health crises and difficulty staying engaged in voluntary treatment.
I study poverty, mental health and access to social services among vulnerable populations, with a focus on racial justice and health equity, and I know that asking whether someone meets that bar is only the first question. What happens next depends on whether the services their plan calls for actually exist and are accessible. That’s not always the case.
How assisted outpatient treatment is supposed to work
Pennsylvania has allowed counties to adopt assisted outpatient treatment since 2018, but nearly all of the state’s 67 counties have opted out every year, citing cost and staffing concerns. Aside from Allegheny, only five counties – Bucks, Dauphin, Carbon, Monroe and Pike – have operational assisted outpatient treatment programs.
Allegheny County describes assisted outpatient treatment as a “step down” from inpatient care, a “step up” before a 302 becomes necessary, or a “step over” from the criminal justice system into civil treatment. It carries no criminal penalties – a judge can hold a review hearing, change the plan or order a new evaluation, but the person can’t be jailed for noncompliance alone. If someone becomes an immediate danger, the county can still use the 302 process.
Assisted outpatient treatment is intended to help people remain safely in their community while a court keeps the case open. An assisted outpatient treatment petition can be filed by a family member, provider or other concerned party. If a petition is granted, the order lasts up to 90 days.
A service coordinator tracks whether appointments, medication management, peer support and housing referrals are actually happening during this period. At the end of 90 days, the order can end or be extended if the person still meets the criteria. The need for treatment isn’t always just psychiatric. Other common needs include financial support, medical care, stable housing, financial support and transportation.
A person may leave the hospital with a referral, miss an appointment, stop medication or deteriorate again. Assisted outpatient treatment is meant to keep a team attached after the crisis passes: A coordinator reports to a judge, and missed appointments can trigger more hearings. Nonadherence alone can’t lead to jail, but a separate emergency commitment can still be filed if the person becomes a danger to themselves or others.
Jeff Greenberg/Universal Images Group via Getty Images
On paper, Allegheny County has hundreds of mental health providers ready to see Medicaid patients. In practice, most of them aren’t reachable at all. Public funding – state, federal and county – covers most mandated psychiatric care, and most people leaving involuntary hospitalization rely on Medicare or Medicaid. Yet many still struggle to find care.
In a University of Pittsburgh simulated-patient study, 279 outpatient mental health providers in Allegheny County listed as accepting adult Medicaid. Out of that number, only 34 had available appointments, and more than 50% of patient calls went unreturned.
In other words, roughly 1 in 8 listed providers could actually see a new patient.
Even among Medicaid clients who eventually secured care, patients spent an average of 28 days searching for an appointment and another 19 days waiting to be seen.
Fewer hospitalizations, but why?
Allegheny County’s assisted outpatient treatment program is too new to evaluate on its own, but Pennsylvania isn’t the first state to try this approach to helping people with mental illness. California and New York have run similar programs for years. Their results, which depend heavily on whether people get timely community services, offer the best preview of what to expect.
MediaNews Group/Reading Eagle via Getty Images
Most people referred under Laura’s Law in California never had to appear in court. Over 80% instead accepted voluntary services in 2023. Even those who went through the court process improved: Homelessness, hospitalizations, police contact, violent behavior and substance use all declined, while employment rose.
Still, a 2020 state audit found that many Californians cycled through repeated involuntary hospitalizations without ever being connected to ongoing care.
On the other side of the country, Kendra’s Law in New York showed similar gains: lower hospitalization and treatment costs in its first two years, as crisis use fell and outpatient care rose. But a 2024 state audit found the program was often slow to check on people and get them into treatment, with some court orders lapsing before renewal.
Several studies suggest people’s daily functioning often improves once assisted outpatient treatment begins. They have fewer hospitalizations, less crisis-service use, fewer interactions with law enforcement and stronger connections to care providers and community supports.
A 2025 peer-reviewed evaluation followed 392 clients in federally funded assisted outpatient treatment programs across several states. The evaluation found that participants were more likely to attend appointments and take medications. They reported improved symptoms, life satisfaction and stronger relationships with their care teams. They also had fewer hospitalizations and arrests, and they reported less illicit drug use, homelessness, suicidal thoughts and violent behavior.
What to watch
Assessing the success of assisted outpatient treatment in Pennsylvania requires asking not just whether it “works,” but which part is doing the work. A typical plan is a bundle of legal pressure, service coordination, provider accountability and community supports, and these vary widely by location.
Before assisted outpatient treatment launched, Allegheny County gathered feedback from 58 people with lived experience of the behavioral health or justice systems. Participants saw potential value in assisted outpatient treatment as a way to help people stay in or return to the community instead of cycling through jail or inpatient care – but also raised concerns about service speed and deepening contact with police.
Gene Puskar/AP
Allegheny County’s public dashboards offer a way to monitor what’s changing as assisted outpatient treatment rolls out. Suicides were 14% lower from January through June 2026 compared to the same months in 2025. At the same time, however, 302 petitions rose 5.3% year over year and upheld petitions rose 2%.
None of this shows the direct impact of assisted outpatient treatment. The program launched in January, and there’s likely an adjustment period as professionals, families and community members learn how to use it. For now, these are early indicators worth continuing to track.
Assisted outpatient treatment may help some people avoid incarceration, hospitalization or other restrictive measures, but only if Allegheny County addresses the severe shortages of community mental health services and supports.
Erica Maloney does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Politics + Society – The Conversation
In a time of political polarization, it’s easy to forget that the vast majority of Americans of all backgrounds and beliefs – 80% or more, depending on the poll – value environmental conservation. However, this support is not easily or often translated into successful, popular initiatives.
One success story is the Great Lakes Restoration Initiative. Since 2010, it has provided over US$5 billion to improve the quality of the region’s environment, with an overarching goal of cleaning up the water in the Great Lakes watershed. And it has survived multiple attempts to reduce its funding or eliminate it altogether.
As a water policy and politics expert and a former leader in the Great Lakes advocacy community who has worked on and analyzed the initiative, I worked with environmental historian and Great Lakes expert Marc Gaden along with a team of graduate students to comprehensively assess the initiative and determine useful lessons learned for other projects in conservation and beyond.
A bit of background
The Great Lakes contain approximately 20% of the world’s available surface freshwater, providing drinking water to over 40 million people in the U.S. and Canada and billions of dollars annually in economic activity and ecological productivity.
Throughout most of the 20th century, the ecosystem in and around the lakes was degraded and contaminated due to raw sewage, industrial waste, invasive species, loss of natural habitats and runoff pollution from development, among other issues.
Many problems remained even after the major environmental and Great Lakes laws of the late 20th century took effect. The Great Lakes Restoration Initiative has funded more than 8,000 specific projects, focusing on cleaning up especially toxic locations, controlling invasive species, restoring natural habitat and educating the next generation of leaders.
Government reports, public opinion polls, economic analysis and many other accounts suggest that the initiative has not only been successfully implemented and popular but has led to positive results for water quality, habitat restoration and wildlife while boosting the local and regional economy.
AP Photo/John L. Russell
Deep connection
But these results didn’t happen by accident, and they weren’t inevitable. Our research team identified converging forces, some unique to the Great Lakes but many broadly applicable, that led to this success.
Underlying each force is the iconic status of the waters themselves. People in the region feel a deep attachment to the lakes and the quality of life they enable, with more than 50% of residents engaging in walking/hiking, swimming, boating or simply being with family and friends along the lakes. As U.S. Rep. Bill Huizenga, Republican co-chair of the Great Lakes Congressonal Task Force, said in mid-July 2026: “The Great Lakes aren’t a Republican issue or a Democratic issue. They’re an economic engine, a source of drinking water for millions of people, and part of our way of life here in Michigan. Protecting them is something we can all rally around.”
A 2024 poll of a random sample of more than 2,500 Americans and Canadians found 96% of the region’s residents think it’s important for governments to invest in protecting the Great Lakes – a level of near-unanimity unheard of for other issues.
A prominent launch
Shared identity and popular support are not enough to launch a major government effort without a spark and a plan.
In 2004, President George W. Bush – in part driven by the swing state electoral power of the Great Lakes region – signed an executive order declaring the Great Lakes to have “national significance” and launching the Great Lakes Regional Collaboration Strategy. Developed over the course of a year through work groups involving more than 1,500 people combined with public input sessions, the strategy laid out common goals for restoration and prioritized a list of needs, such as funding to clean up toxic hot spots and sewage overflows, which was critical to securing congressional support for funding.
AP Photo/Nam Y. Huh
Diverse allies
A plan for restoration – even for an iconic resource – will not garner billions of dollars in federal funding without significant bipartisan support from all levels of government and strong community support.
Those speaking up for the new program were “not simply one group or one voice. It was governors, mayors, the NGO community and tribes,” David Naftzger, executive director of the Great Lakes St. Lawrence Governors & Premiers, which works with all the chief state and provincial executives across the region, told our research team.
Business leaders have been particularly crucial backers. They relay to lawmakers the economic value of restoration projects, providing political cover for a program that increases government spending.
The broad range of support continues today and has helped the initiative weather various efforts to reduce or eliminate its funding.
Most famously, in 2019, President Donald Trump proposed cutting the initiative’s funding by 90%. Three weeks later, while traveling with Trump to a political rally in Michigan, three Michigan congressional Republicans explained how critical the Great Lakes Restoration Initiative is to the region’s identity and economy, and how popular it is. At the rally, Trump reversed course and announced he would support keeping funding levels at US$300 million per year, promising to “make the Great Lakes great again.”
At a Washington, D.C., event celebrating the Great Lakes in 2023, I saw JD Vance, then a Republican U.S. senator from Ohio, and U.S. Sen. Debbie Stabenow, a Michigan Democrat, proclaim that while they may not agree on much, they are united in their support for the Great Lakes Restoration Initiative.
AP Photo/Haraz N. Ghanbari
Clear communication
Our analysis found that initiative supporters have been organized and disciplined about how they talk about the program and the overall goals. State officials, local leaders, tribal nations, nonprofit groups and businesses all deliver a “coordinated, consistent kind of beating of the drum,” Erika Jensen, executive director of the Great Lakes Commission, told our research team.
This includes not only the many positive stories of success but also the economic benefits. A University of Michigan study that showed the Great Lakes Restoration Initiative boosts the region’s economic output by more than $3 for every dollar of federal spending is used often to make this case.
These coordinated messages allow political leaders to tie the initiative into their priorities and build support across diverse audiences. One key reason for this kind of powerful communication is that the initiative funds work in every congressional district in the Great Lakes watershed, so every member of Congress in the region can say they brought home federal money to make significant improvements in their own districts.
‘Secret sauce’
The Great Lakes Restoration Initiative pays for community-based work on local lands and waterways – it does not regulate industries or tread into particularly controversial territory.
Everywhere has places that need help, cleanup and care. These ecosystems are relatively easy to build support for, and when connected with other projects across a wide region, these smaller efforts can make a significant difference in environmental quality and quality of life while building political and community support for even bigger undertakings.
I believe that many of the core lessons and converging forces that make up the Great Lakes Restoration Initiative’s “secret sauce” can be applied not only to the future of the Great Lakes but to conservation initiatives across the U.S. and the world. And they may even be able to help restore bipartisanship to at least some parts of U.S. politics.
Mike Shriberg previously worked at the National Wildlife Federation, which received external funding from foundations and private donors to work on the Great Lakes Restoration Initiative. The research highlighted in this article is supported by grants from the Wege Foundation and the Joyce Foundation.
Politics + Society – The Conversation