Category Archives: Behavioral/mental health
While behavioral and physical health have generally been separate entities in the United States, new rules under the Affordable Care Act are bringing them together—both to reduce costs and to integrate care in millions of people who face behavioral and physical health issues.
Experts at last week’s Healthy Communities Initiative forum, convened by the National Association of Counties (NACo), and this week’s AcademyHealth National Policy Conference, meeting in Washington D.C., presented strategies for combining the two. Some pilot projects are beginning. The pace is picking up largely because many people now covered under the states that have created Medicaid expansion have a range of behavioral and physical health needs. They will benefit from integration because the two are often connected—for example, diabetes has been linked to depression—and because connecting the two can reduce health care costs and reduce the number of provider visits a patient has to make.
“Behavioral health is a driving force in why people don’t get where they want to be,” said Donna Skoda, Assistant Health Commissioner of Summit County, Ohio, who spoke at the NACo forum.
Several public health officers at the forum presented ideas of what works in their communities, including:
- Hiring nurses to be care providers to assess both behavioral and physical health needs
- Retraining behavioral health specialists, including psychiatrists, to use blood pressure cuffs and other medical equipment
- Integrating patient files with information on mental and physical health baselines and changes
- Opting, when possible, to deliver care in physical health offices rather than counseling offices, since physical practitioner clinics already have devices needed such as scales
Presenters at the AcademyHealth policy conference stressed cost savings. For example, Washington state will participate in a federal demonstration project for beneficiaries dually eligible for Medicare and Medicaid. Under the demonstration, the health plans will be responsible for a full range of services—including mental health; chemical dependency; long-term services and supports; and medical care—under a single capped rate.
“Integrated care needs to be the rule, not the exception,” said Charlene Le Fauve, a deputy director of the National Institute of Mental Health.
Le Fauve said new technologies can be an important factor in delivering care including mobile devices and internet tools, which can be used at provider offices, clinics, and in homes if communities provide those services.
Other ideas being funded include training community workers for brief interventions which may be able to keep many people with mental illness out of both the emergency room and the hospital. Phone intervention is also being studied, said Le Fauve.
A presentation at the recent American Public Health Association (APHA) annual meeting, held last week in Boston, reported on the Gun Shop Project. The program of the New Hampshire Firearm Safety Coalition shares guidelines on how to avoid selling or renting a firearm to a suicidal customer with gun advocates, gun shop owners, mental health professionals and public health professionals. The Gun Shop Project also encourages gun stores and firing ranges to display and distribute suicide prevention materials tailored to their customers
“The science shows us that not only is suicide the leading type of death from a firearm, but having a gun in the home increases the incidence of suicide, femicide [shooting a woman], and the likelihood that people in the community will be shot. Many mass shootings, like those at Sandy Hook Elementary School in Newtown, involve the suicide of the shooter,” said David Hemenway, who spoke about the Gun Shop Project at the APHA meeting. “One way to prevent the shootings may be to prevent the suicide.”
He is a member of the Project’s team as director of the Injury Control Center at the Harvard School of Public Health, as well as a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
The ultimate goal of the coalition is to change social norms around gun use and to see the Gun Shop Project achieve results similar to the national effort to stop drunk driving.
“We want to work with the gun-owning community to create reasonable norms about when to get the guns out of the house,” Hemenway said. “If a neighbor is also a gun owner, for example, that neighbor could be asked to hold the firearms until another neighbor’s difficult period has passed. It’s the same idea as the ‘don’t let a friend drive drunk’ campaign. This can make a difference…”
Hemenway says the efforts of the Gun Shop Project are a growing national effort and partners include the U.S. Army, the American Foundation for Suicide Prevention and other groups working to reduce suicides by limiting access to lethal means at critical periods.
Read more about the Gun Shop Project.
It’s been more than forty years since a U.S. vice presidential candidate, Senator Thomas Eagleton, was forced to withdraw his name from the ticket after it was revealed he’d been treated for depression. Medical science and understanding have come a long way since then. Still, for many there is still a stigma surrounding mental illness—a stigma that can leave people, already hurting, feeling even more alone.
This is a clear and major public health issue which dramatically reduces the likelihood that someone with a mental health condition will seek out and have access to effective health care and social services. In fact, only 38 percent of U.S. adults with diagnosable mental illnesses receive the treatment they need. The numbers are even worse for children and adolescents, with less than 20 percent getting treatment.
September is Suicide Prevention Month and Sept. 10 is the 11th-annual World Suicide Prevention Day. This year’s theme is “Stigma: A Major Barrier for Suicide Prevention.” Suicide is one of the top ten leading causes of death in the United States—with more than 38,000 deaths each year—and many of those people suffered in silence rather than reaching out to loved ones and available avenues of help.
As part of the collective effort to combat this barrier to full and compassionate care, the American Psychiatric Association (APA) is working to raise awareness so that people with mental illnesses and substance use disorders can feel more confident in seeking treatment, just as anyone with most any other medical concern would be.
APA’s new Public Service Advertisements (PSAs) series, called “A Healthy Minds Minute,” features a number of celebrities and prominent figures calling for equal access to quality care and insurance coverage for people with mental illness and substance use disorders. Below is a video with Former Congressman Patrick Kennedy.
>>Watch the APA’s “A Healthy Minds Minute” online video series.
In several recent and upcoming posts, NewPublicHealth is connecting with communities that have faced severe weather disasters in the last year. New York City, for example, is continuing to regroup and rebuild after Hurricane Sandy struck the region eight months ago. The city, and its health department, recently announced several initiatives aimed at “building back better” while supporting residents still facing housing as well as mental health problems since the storm last October. Some examples are detailed below.
- The New York City Building Resiliency Task Force, an expert panel convened after Hurricane Sandy to help strengthen buildings and building standards, recently issued a report with recommendations for buildings and homes of all sizes in the city. The report recommends establishing backup power in the event that primary networks fail; protecting water supplies and stabilizing interior temperatures if residents need to shelter in place. ”Making our city’s buildings more resilient to coastal flooding and other climate hazards is a challenge that requires collaboration among government, designers, engineers, and building owners, among others,” said City Planning Commissioner Amanda M. Burden. “The Task Force's work exemplifies the kind of innovation and cooperation necessary to prepare our city for a changing climate.” To create the report, the Task Force convened over 200 volunteer experts in architecture, engineering, construction, building codes and real estate.
A new American Public Health Association (APHA) Press book, “Veteran Suicide: A Public Health Imperative,” addresses the critical and growing issue of suicide among military veterans. The book is a collaboration between the APHA and the Department of Veterans Affairs. Both organizations previously partnered on a supplement to the American Journal of Public Health on suicide risks among veterans.
Topics addressed by the book include
- suicide prevention,
- substance abuse, and
- suicide surveillance.
The new book includes very recent research on suicide among veterans. "The research represented by the collection of manuscripts included in this volume is an important step towards addressing the national problem of suicide and a reminder that even one death by suicide is too many," said Janet Kemp, RN, PhD, Department of Veterans Affairs National Mental Health Program Director for Suicide Prevention.
“Veteran Suicide: A Public Health Imperative” is available for purchase online.
>>Bonus Link: This week the Huffington Post published an article by Kimberly Williams, Director of the Center for Policy, Advocacy, and Education of the Mental Health Association of New York City, pointing out that the connectedness members of the military feel with each other often disappears when they return to their communities, which may be a factor in the rising suicide rates among veterans.
Each year, the March of Dimes National Communications Advisory Council, which includes journalists from many websites and magazines that cover pregnancy and early childhood, holds a reporters’ luncheon to share information that can lead to healthier births, babies and mothers. This year’s luncheon, being held tomorrow, focuses on treating mental health conditions in mothers during and after pregnancy. The issue is important for many reasons, in particular because many women have been taking prescription medications for depression, anxiety, panic attacks, ADHD, and other mental health issues since adolescence and may need to change or stop the medicines in order to have a healthy baby, yet run the risk of a relapse or worsening of their health condition.
NewPublicHealth recently spoke with, Siobhan Dolan, MD, a consultant to the March of Dimes and an obstetrician gynecologist and clinical geneticist at Montefiore Medical Center/Albert Einstein College of Medicine about communicating information about treating mental health during pregnancy to both mothers and health care professionals.
NPH: For the upcoming luncheon, the March of Dimes has singled out mental health medications. Why that area of health?
Dr. Dolan: There is a huge overlap between women of reproductive age who are dealing with becoming pregnant and having families and caring for families and women who have mental health issues and may be entering their reproductive years already on medication.
And we know that bonding and creating a family and getting your family life off to a good start in the early postpartum period is much, much better when a woman is in a balanced mental health state. So if there’s either a preexisting depression or a postpartum depression, we need to pay attention to that.
CDC Issues First Comprehensive Report on Children’s Mental Health in the United States
As many as one in five American children under the age of 17 has a diagnosable mental disorder according to a new report from the Centers for Disease Control and Prevention. The report is the first expansive report on children's mental health ever done by the U.S. government and looked at six conditions:
- attention-deficit/hyperactivity disorder (ADHD)
- behavioral or conduct disorders
- mood and anxiety disorders
- autism spectrum disorders
- substance abuse
- Tourette syndrome
The most common disorder for children age 3 through 17 is ADHD (7 percent) followed by behavioral or conduct problems (3.5 percent), anxiety (3 percent), depression (2 percent), and autism spectrum disorders (1 percent).
Five percent of teens reported abusing or being dependent on illegal drugs, 4 percent abused alcohol and 3 percent reported smoking cigarettes regularly. Boys were more likely than girls to have the disorders. Read more on mental health.
New PSAs Help Parents Talk to Younger Kids about the Dangers of Underage Drinking
“Talk. They Hear You,” is a new national public service announcement (PSA) campaign from the Substance Abuse and Mental Health Services Administration (SAMHSA) to empower parents to talk to children as young as nine about the dangers of underage drinking. SAMHSA research shows that more than a quarter of American youth engage in underage drinking, and though there has been progress in reducing the extent of underage drinking in recent years, particularly among those aged 17 and younger, the rates of underage drinking are still unacceptably high, according to SAMHSA. A report from late last year shows that 26.6 percent of 12-20 year-olds report drinking in the month before they were surveyed and 8.7 percent of them purchased their own alcohol the last time they drank, despite the fact that all fifty states and the District of Columbia currently have laws prohibiting the purchase and use of alcoholic beverages by anyone under age 21.
“Even though drinking is often glamorized, the truth is that underage drinking can lead to poor academic performance, sexual assault, injury, and even death,” said said SAMHSA Administrator Pamela S. Hyde.
The goal of the new PSA is to help parents start a conversation about alcohol before their children become teenagers. Read more on addiction.
Advocacy Groups Petition FDA to Ban Menthol Flavored Cigarettes
In response to a Citizen Petition by close to twenty health and tobacco control advocacy groups, the Food and Drug Administration has opened a docket for public comment on banning menthol in cigarettes. In 2009, according to the Tobacco Control Legal Consortium, the lead group on the petition, Congress banned all flavors in cigarettes except menthol, and directed the FDA to decide whether continued sale of menthol cigarettes is “appropriate for public health." According to the petition, menthol cigarettes are the source of addiction for nearly half of all teen smokers. Read more on tobacco.
Psychiatrist "Bible" Gets a Numeric Overhaul
The American Psychiatric Association will release the latest version of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) this Saturday at its annual meeting, according to Reuters. The current version is the DSM-IV, which was released a full 10 years ago -- the new version will be recast as DSM-5 (not DSM-V), with an eye toward updating the catalog of psychiatric conditions much more frequently with intermediate versions (DSM-5.1, DSM-5.2 and so on). The newest version also aims to introduce more scientific rigor and clinical confirmation of mental illness, such as, "using neuroscience in particular to tell the difference between, say, normal sadness and major depression." Though some criticize that the science just isn't there yet, and that the current version could lead to overdiagnosis. Read more on mental health.
Most Adults Enforce Smoke-Free Rules in Homes, Cars
Four out of five U.S. adults report having voluntary smoke-free rules in their homes and three out of four report having voluntary smoke-free rules in their vehicles, according to a study published in the journal Preventing Chronic Disease, a publication of the Centers for Disease Control and Prevention. Despite the high prevalence of voluntary smoke-free rules in homes and vehicles, the study found that almost 11 million non-smoking adults continue to be exposed to secondhand smoke in their home, and almost 17 million non-smoking adults continue to be exposed to secondhand smoke in a vehicle. The study also showed that voluntary smoke-free rules were more prevalent in states with comprehensive smoke-free laws and tobacco control programs. Read more on tobacco.
Living Near Fast-Food Outlets Might Boost Obesity Risk
Black Americans who live within two miles of a fast food outlet have a higher body-mass index than those living farther away -- and that link especially holds true for those with lower incomes, according to a new study published in the American Journal of Public Health. The study involved more than 1,400 black adults divided into two groups: those making less than $40,000 per year and those making $40,000 or more per year. Read more on what it takes to create healthy communities.
Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages.
Yesterday, NPR reported that business owners near the blast site are beginning to return and reopen their doors.
"They fled in a panic last week and returned both eager and anxious," said NPR reporter Tovia Smith. The piece describes how business owners returned to find food left half-eaten and rotting, because so many left in such a hurry, and blood splattered in some spots from those who were injured.
To help make sure businesses get the help they need to reopen safely, public health inspectors played a role in visiting every building on every block. "They also stood ready with trauma counselors, pro-bono attorneys and clean-up crews," said Smith.
But the public health response to any disaster goes beyond helping to restore normalcy in the immediate aftermath. An earlier interview with John Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, about the sustained response to Hurricane Sandy also applies here:
We saw with Katrina and are seeing again now with Sandy, [public health officials] are not only concerned with food, air, and water during and immediately after an emergency, but also with ensuring that services related to health care delivery and mental health are provided when and where they’re needed. It’s an interesting statistic, for instance, that the demand for mental health services was higher five years after Hurricane Katrina than it was immediately after the hurricane hit.
The Boston Public Health Commission announced this week, for example, that the organization has opened a new drop-in center to continue to provide emotional support to anyone affected by the Boston Marathon attack.
"While the physical injuries and destruction that resulted from the bombings might be the most visible signs of trauma, many people experience serious emotional distress based on what they saw, heard, and felt during and after the attack. Sometimes these symptoms do not surface immediately," according to the Commission release. "Understanding the deep impacts of this emotional distress, city officials opened the drop-in center as a safe place for people to come together and talk about their experiences over the past week."
>>Read more about building community resilience to recover from disaster.
An article in the New York Times reports that health departments in some states are increasing their efforts on gun safety and suicide prevention in part because of a startling finding by researchers at the Harvard School of Public Health: far more Americans die from guns they aim at themselves than in mass shootings.
By the numbers:
- Nearly 20,000 of the 30,000 deaths from guns in the United States in 2010 were suicides.
- Wyoming, Montana and Alaska are the states with the three highest suicide rates; they’re also on the list of top gun owning states.
- The national suicide rate has climbed by 12 percent since 2003.
- Suicide is the third-leading cause of death for teenagers.
- Suicide attempts using a gun are fatal 85 percent of the time; suicide attempts with pills are successful 2 percent of the time.
State health departments in Missouri, North Carolina and Wyoming, the state with the highest suicide rate, are giving out gunlocks. In New Hampshire some gun shops post flyers with warning signs for suicide and a recommendation to keep guns from people who are at risk of harming themselves. Some gun owners in Maryland are considering a similar outreach project.
>>Read the article.
>>Bonus Link: Read a NewPublicHealth post about the Surgeon General’s National Strategy for Suicide Prevention, launched last year.