Category Archives: Mental Health

Rising Tide of Suicides in US Adults

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GunThe United States is experiencing a rising tide of suicides in middle-aged and older adults, driven by the country’s economic downturn, new research suggests.

Investigators found that suicide rates among men and women aged 40 to 64 years have been increasing since 1999, with a sharp escalation since 2007.

via Rising Tide of Suicides in US Adults.

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States gear up to help Medicaid enrollees beat addictions

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CocaineBy Chrisine Vestal
Stateline

Under the Affordable Care Act, millions of low-income adults last year became eligible for Medicaid and subsidized health insurance for the first time.

Now states face a huge challenge: how to deal with an onslaught of able-bodied, 18- to 64-year olds who haven’t seen a doctor in years.

“It took a lot of time and effort to enroll everyone, particularly those who were new to the system,” said Matt Salo, director of the National Association of Medicaid Directors. “The next big step, and the biggest unknown, is finding out exactly how this newly insured population will use the health care system.”

In addition to increasing the number of people with health insurance, the Affordable Care Act for the first time made coverage of addiction services mandatory for all insurers, including Medicaid.

Until now, the vast majority of Medicaid beneficiaries were pregnant women, young children, and disabled and elderly adults. Relatively few able-bodied adults without children qualified, so states did not set up their Medicaid programs to treat them.

The newly insured, most of them young adults, have different needs. Though not as sick as existing Medicaid beneficiaries, the newcomers are more likely than the general population to have undiagnosed and untreated chronic illnesses such as diabetes and heart disease.

The starkest difference between the new population and the old one, however, is that the new enrollees have much higher rates of drug and alcohol addiction and mental illness.

The number of Medicaid enrollees receiving addiction services is expected to skyrocket over the next two years.

Of the estimated 18 million adults potentially eligible for Medicaid in all 50 states, at least 2.5 million have substance use disorders. Of the 19 million uninsured adults with slightly higher incomes who are eligible for subsidized exchange insurance, an estimated 2.8 million struggle with substance abuse, according to the most recent national survey by the U.S. Substance Abuse and Mental Health Services Administration.

In addition to increasing the number of people with health insurance, the ACA for the first time made coverage of addiction services and other behavioral health disorders mandatory for all insurers, including Medicaid. As a result, the number of Medicaid enrollees receiving addiction services is expected to skyrocket over the next two years.

Although Medicaid and other state and federal programs historically have provided care for people with serious mental illness, coverage of addiction treatments has been spotty. Optional under Medicaid until now, coverage in most states was limited, typically just for pregnant women and adolescents.

“It’s the biggest change in a generation for addiction services,” said Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors. “Comprehensive addiction programs didn’t exist in Medicaid until now.” Continue reading

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Locking up firearms to prevent suicide

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GunBy Tony Gomez, BS, RS, Manager, Violence and Injury Prevention
Public Health — Seattle & King County

I’ve worked on Violence and Injury Prevention for over thirty years. I consistently notice in the media and in conversations about firearms that usually the discussion focuses on tragic homicides.

But, the truth is that most firearm deaths are suicides—often hidden from the public conversation. In King County, nearly 70% of firearm deaths being suicides, it’s crucial we come together despite different ideologies.

The truth is that most firearm deaths are suicides.

There are numerous entities including King County that have a deep commitment to suicide prevention and are working together to address this “silent” killer of our residents.

With firearm ownership so prevalent in King County (~25%) – and some estimated 30,000 households that keep at least one firearm loaded and unlocked – we can’t afford to wait any longer to get those easily stolen and accessed firearms locked up.

We know that impulsivity plays a significant role in suicide attempts; easy access to highly lethal means, such as firearms, increases risk.  Strong evidence exists, both in the United States and abroad, that restricting access to lethal means is an effective way to reduce suicide.

Suicide prevention efforts in King County and elsewhere in the United States now champion safe storage of firearms. Continue reading

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Some states retreat on mental health spending

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By Michael Ollove
Stateline

Fewer states increased their spending on mental health programs this year compared to last year, when a spate of horrific shootings by assailants with histories of mental illness prompted a greater focus on the shortcomings of the country’s mental health system.

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From State Mental Health Legislation 2014 Trends, Themes & Effective Practices – NAMI

Some states slashed their mental health budgets significantly this year. At the same time, however, a number of states adopted mental health measures in 2014 that won plaudits from behavioral health advocates.

survey of state spending published last week by the National Alliance on Mental Illness (NAMI) found that 29 states plus the District of Columbia increased their spending on mental health in fiscal year 2015. A year earlier, 37 states plus D.C. increased their mental health budgets.

NAMI warned that the momentum to improve state mental health services, which was especially powerful after the December 2012 Sandy Hook massacre in Connecticut, has slowed.

Continue reading

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Mental health report ranks Washington 48th in the US

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A report by Mental Health America, a mental health advocacy group, ranks Washington state the 48th in the nation because of its high prevalence of mental illness and poor access to mental health services.

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The report found that the states with the lowest prevalence of mental illness and highest rates of access to care include:

  • Massachusetts
  • Vermont
  • Maine
  • North Dakota
  • Delaware

States with the highest prevalence of mental illness and lowest rates of access to care include:

  • Arizona
  • Mississippi
  • Nevada
  • Washington
  • Louisiana

States that rank in the top ten are in the Northeast and Midwest, while states that rank in the bottom ten are in the South and the West.

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Health news headlines – October 24th

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Silhouettes of U.S. Soldiers at night in Iraq

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Kreidler calls for insurers to review mental health denials back to 2006

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MKreidlerPhotoFrom the Office of the Insurance Commissioner

Insurance Commissioner Mike Kreidler is directing all health insurers in Washington state to identify any policyholders who had mental health services denied because of a blanket or categorical exclusion since Jan. 1, 2006 and notify them of their right to have their claim re-evaluated.

The Washington State Supreme Court recently ruled that Washington’s Mental Health Parity Act prevents insurers from using blanket exclusions for mental health services that may be medically necessary.

Kreidler sent a letter to the insurers today (PDF, 371KB), outlining his expectations for how to implement the court’s decision and what steps he expects them to take on behalf of consumers.

“The court ruled decisively on behalf of Washington consumers, and I intend to see that insurers doing business in our state follow through on this decision,” Kreidler said.  “I expect the insurers to do a thorough review of all policyholders who may have current and past claims that may be impacted by this decision and to start the process immediately.” Continue reading

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For those who were once obese, stigma often remains

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Carlos Romero and girlfriend Kate Rowe sit down for a meal that they cooked together at Romero's apartment in Seattle (Photo by Mike Kane/NPR).

Carlos Romero and girlfriend Kate Rowe sit down for a meal that they cooked together at Romero’s apartment in Seattle (Photo by Mike Kane/NPR).

This KHN story also ran on NPR

SEATTLE — Carlos Romero’s apartment is marked with remnants from his former life: a giant television from his days playing World of Warcraft and a pair of jeans the width of an easy chair. The remnants of that time—when he weighed 437 pounds—mark his body too: loose, hanging skin and stretch marks.

“I lift weights and work out and work hard, but there’s lasting damage,” said Romero.

Yet for all the troubles he had dating when he was obese—all those unanswered requests on dating web sites—shedding weight left him uneasy about how much to reveal.

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Romero once weighed 437 pounds. (Photo by Sarah Varney/KHN).

“If you were to say to someone on the first date, ‘I lost 220 pounds,’ you’re indicating that you had a very serious issue at one point and that you may still have that issue,” he said. “So it’s not something I put on a dating profile because I don’t want people to judge me for it.”

Indeed, the stigma of obesity is so strong that it can remain even after the weight is lost. Holly Fee, a sociologist at Bowling Green State University, has conducted some of the only research on dating attitudes toward the formerly obese. In 2012, Fee published her findings in the journal Sociological Inquiry.

She found that potential suitors said they would hesitate to form a romantic relationship with someone who used to be heavy. “The big dragging factor in why they had this hesitation in forming this romantic relationship was that they believed these formerly obese individuals would regain their weight,” Fee said. Continue reading

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Medicaid ADHD treatment under scrutiny

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Amid national concerns that too many children are being medicated for Attention Deficit Hyperactivity Disorder (ADHD), some state Medicaid programs are stepping up oversight of diagnoses and treatments.

By Christine Vestal
Stateline

ATLANTA – Attention Deficit Hyperactivity Disorder, or ADHD, affects one in every seven school-aged children in the U.S., and between 2003 and 2011 the number of children diagnosed with the condition rose by more than 40 percent.

Doctors have considerable leeway in deciding the best course of treatment for a child with the condition, no matter who is paying the bill.

But children covered by Medicaid, the joint federal-state health care program for the poor, are at least 50 percent more likely to be diagnosed with the disorder.

Children covered by Medicaid are at least 50 percent more likely to be diagnosed with the disorder.

Georgia alone spends $28 million to $33 million annually on these treatments out of its $2.5 billion Medicaid budget, according to the Barton Child Law and Policy Center here at Emory University.

That is partly because of the toll poverty takes on kids and a lack of resources in poorer schools. But some states believe there are other factors at work.

Several have begun to investigate whether doctors and mental health providers who bill Medicaid for ADHD are rigorously using evidence-based guidelines when diagnosing and treating it.

ADD by state

In Georgia, state Medicaid officials are working with the Centers for Disease Control and Prevention to improve the accuracy of diagnoses and the efficacy of treatments for the ailment.

Missouri and Vermont have also sought the CDC’s help in analyzing Medicaid claims data to determine how best to improve care for what has become the most commonly diagnosed childhood behavioral disorder. Continue reading

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California to broaden autism coverage for kids through Medicaid

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This KHN story also ran in the .

Maria Cruz had never heard the word autism until her daughter, Shirley, was diagnosed as a toddler.

“I felt a knot in my brain. I didn’t know where to turn,” recalled Cruz, a Mexican immigrant who speaks only Spanish. “I didn’t have any idea how to help her.”

No one in her low-income South Los Angeles neighborhood seemed to know anything about autism spectrum disorder, a developmental condition that can impair language, learning and social interaction.

Starting Monday, Sept. 15, thousands of children in California from low-income families who are on the autism spectrum will be eligible for behavioral therapy under the state’s health plan for the poor.

Years passed as Shirley struggled through school, where she was bullied and beaten up. Now 9, Shirley aces math tests but can barely dress herself, brush her teeth or eat with utensils.

Shirley is like many autistic children from poor families: She hasn’t gotten much outside help. The parents often lack the know-how and means of middle-class families to advocate for their children at schools and state regional centers for the developmentally disabled.

A new initiative seeks to help level the playing field. Starting Monday, Sept. 15, thousands of children from low-income families who are on the autism spectrum will be eligible for behavioral therapy under Medi-Cal, the state’s health plan for the poor. Continue reading

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Urgent care centers opening for people with mental illness

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BrainBy Anna Gorman
KHN / 
AUGUST 28TH, 2014

LOS ANGELES, Calif. — Hoping to keep more people with mental illness out of jails and emergency rooms, county health officials opened a mental health urgent care center Wednesday in South Los Angeles.

The goal of The Martin Luther King, Jr. Mental Health Urgent Care Center is to stabilize and treat people in immediate crisis while connecting them to ongoing care.

Run by Exodus Recovery, it will be open 24 hours a day, seven days a week and can serve up to 16 adults and six adolescents.

During their stay of up to one day, patients will undergo a psychiatric evaluation, receive on-the-spot care such as counseling and medication and be referred for longer-term treatment. Continue reading

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Federal officials order Medicaid to cover autism services

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Jigsaw puzzle with one piece to add

Photo: Willi Heidelbach

When Yuri Maldonado’s 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California’s Medicaid plan for low-income children was going to be tough.

Medi-Cal, as California’s plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage.

But Maldonado’s son was approved for 30 hours a week of applied behavioral analysis (ABA), a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn’t enough.

So she and her husband, neither of whose jobs offered health insurance, bought an individual private policy for their son, with a $900 monthly price tag, to get him more of the comprehensive therapy.

“I don’t know any family that can really afford that,” says Maldonado. “We made some sacrifices.”

That should be changing soon. In July, the Centers for Medicare & Medicaid Services announced that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans, another federal-state program that provide health coverage to lower-income children. Continue reading

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‘Pastoral counselors’ help fill mental health gap in rural states

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Mental health therapists most often leave issues of faith outside their office doors, even for patients who are religious. But one class of counselors believes a nonsectarian model doesn’t serve everyone equally well.

“On a feeling level, people want a safe, respectful place, to ponder the tons of questions that come begging in hard times,” said Glenn Williams, a pastoral counselor in Kentucky and chair of the Kentucky Association of Pastoral Counselors. “Where is God?  Why did this happen?  Is it karma, sowing-reaping, happenstance?  What purpose does this suffering serve?”

Six states allow these counselors – who include faith and spirituality in their work – to be licensed mental health counselors, which can make it easier for them to get health insurance reimbursements.

Williams, who works at the St. Matthews Pastoral Counseling Center outside Louisville, said many of his patients are quite “intentional” about their preference for pastoral counselors over other mental health professionals.

Kentucky recently became the sixth state (joining Arkansas, Maine, New Hampshire, North Carolina and Tennessee) to allow pastoral counselors to become licensed mental health counselors. Continue reading

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San Antonio police take radical approach to mental illness — Treat It

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Officers Ned Bandoske, left, and Ernest Stevens  (Photo by Jenny Gold/KHN).

This KHN story also ran on NPR.

SAN ANTONIO — It’s almost 4 p.m., and Officers Ernest Stevens and Ned Bandoske have been driving around town in their black unmarked SUV since early this morning.

When it first came out, I was very skeptical. I thought, well this is ridiculous.

The officers are part of San Antonio’s mental health squad – a six-person unit that answers the frequent emergency calls where mental illness may be an issue.

The officers spot a call for help on their laptop from a group home across town.

“A male individual put a blanket on fire this morning, he’s arguing with them, and is a danger to himself and others, he’s off his medications,” Stevens reads from the blotter.

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Officer Stevens talks to a young man named Mason, who has set his blanket on fire and says he is hearing voices (Photo by Jenny Gold/KHN)

A few minutes later, the SUV pulls up in front of the group home in a run-down part of the city.  A thin 24-year-old sits on a wooden bench in a concrete lot out back, wearing a black hoodie. His bangs hang in damp curls over his forehead.

“You’re Mason?” asks Bandoske. “What happened to your blanket?”

Eight years ago, a person like Mason would have been heading to the emergency room or jail next. Continue reading

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Six tips for college health and safety – CDC

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Tips for the US Centers for Disease Control and Prevention

BooksGoing to college is an exciting time in a young person’s life. It’s the end of one chapter and the beginning of another. College is a great time for new experiences, both inside and outside the classroom. Here are a few pointers for college students on staying safe and healthy. Continue reading

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