Week of July 31–August 4, 2023

General Articles

• More Americans across age, gender and race are seeking mental health treatment than they were just two decades ago. Why it matters: The boom in demand reflects a growing mental health crisis and a national uptick in anxiety and depression — but also reflects healthier attitudes about therapy and more honest conversations about mental health. Read more here.
• It’s hard to imagine a less therapeutic environment for a person in crisis than an emergency department: crowded and windowless rooms; harsh fluorescent lights; the ceaseless ping of alarms; this patient retching, that one screaming. And yet, for every eight patients who present at an emergency department, one is there for a behavioral crisis such as psychosis, suicidality, mania, aggression, or substance use. Often these conditions have a years-long history and can’t be treated quickly or straightforwardly, in the way that a broken bone or a knife wound might be. Read more here.
• The Biden administration on Monday rolled out a new Medicare pilot program aimed at improving the quality of life for people with dementia and reducing the burden on unpaid caregivers. Driving the news: The new payment model from Medicare's innovation lab will test a standardized approach to providing coordinated care to patients with dementia, who often have complex health care needs. Read more here.
• California has one of the highest rates of Alzheimer's disease in the country, according to a new study. Why it matters: It's critical for public health officials, policymakers and others to have a clear look at the number of Alzheimer's cases in a given area, the authors say — in part because caring for those with the disease cost an estimated $321 billion nationwide last year, much of which came via Medicare and Medicaid. Read more here.
• Providers insist that what are known as child and adult outreach triage teams were saving some of L.A. County’s sickest residents by closing a gap in care. Officials with the Los Angeles County Department of Mental Health, however, said they were underwhelmed by the teams’ performance. The program was funded with a pair of state grants totaling roughly $30 million — money from the tax on millionaires levied by the voter-passed Mental Health Services Act. The grants expired in June. The county declined to use its own funds to continue the services. Read more here.
• A Mister Rogers-like approach to being a neighbor could be good for you. Why it matters: The U.S. is experiencing an epidemic of loneliness, and studies suggest that cultivating better relationships with the people who live nearby is crucial for your happiness. By the numbers: 17% of American adults said they felt lonely "a lot of the day yesterday" in an early 2023 Gallup survey. Read more here.
• I lived with depression. I tried every treatment I could get my hands on — more than 10 medications, constant therapy, residential treatment facilities, intensive outpatient programs, ketamine, cannabis, transcranial magnetic stimulation, and electroconvulsive (shock) therapy. I even stopped drinking alcohol. Nothing worked. I’m among the roughly 30% of people with depression for whom medications don’t work, known as treatment-resistant depression. There are more than 2 million other people like me, just in the U.S. Read more here.

Youth Mental Health

• Children in mental health crisis in Connecticut can now go to one of the state’s four urgent crisis centers to get help rather than risking an hours-long wait in the emergency room for care, officials said Wednesday. Wednesday marked the grand opening of The Village for Families and Children‘s urgent crisis center in Hartford. The centers are designed as walk-in, outpatient clinics for kids who are having behavioral health crises such as thoughts of suicide or self-harm, depression, anxiety or out-of-control behavior, among other mental health issues. Read more here.

Gun Safety

• At work as a pediatrician, Annie Andrews sees firearm injuries as a “huge public health crisis.” When she ran to represent South Carolina in the U.S. House, Andrews routinely heard from mothers on the campaign trail about their feelings of helplessness and hopelessness about what to do about gun violence. And as a mom to three children — ages 6, 8 and 11 — she sees how simple parent-to-parent interactions are key to reducing potential harm to children. Given the rates of accidental shooting deaths among children, something as simple as a text message could literally save lives. Read more here.

988 Hotline

• Only about 16% of Georgia residents have a complete understanding of the national suicide prevention hotline a year after it launched, according to a new survey conducted by the Georgia Department of Behavioral Health and Developmental Disabilities. Driving the news: The survey, which was conducted in May, shows 31% of respondents were aware of the 9-8-8 number while 54% "correctly understood its role as the Suicide and Crisis Lifeline," the agency said Tuesday. Read more here.
• A year after it went live, the 988 national mental health hotline is still working out some issues — and Colorado needs a huge increase in staff to meet the 24/7 demands. For starters, when people dial the three-digit number, their call is routed to the state call center that matches their area code, not their location. This is particularly bad for Colorado, which has a high number of transplants who moved here with out-of-state area codes and a large military population. Read more here.

The Opioid Crisis and Addiction Issues

• Policies intended to discourage or criminalize drinking while pregnant have no effect on infant health, or in some cases can actually be harmful, a new JAMA Network Open study finds. Why it matters: The study is the latest research supporting evidence that criminalizing alcohol and drug use during pregnancy is leading to worse outcomes among newborns, experts say. Read more here.
•  American women have a problem with booze. A new study from The Journal of the American Medical Association (JAMA) shows that alcohol-related deaths are rising generally, but are rising more quickly among women than among men. These findings go hand-in-hand with other indicators of physical and social decline for women and men: a decrease in life expectancy more broadly, and particularly among working-class White Americans; elevated rates of suicide and drug overdoses; and upticks in depression and anxiety. Read more here.
•  The Food and Drug Administration on Thursday gave a North Carolina biotech company the go-ahead to test if a monoclonal antibody can prevent people from overdosing on fentanyl. Why it matters: The synthetic opiate is becoming a leading cause of death for people under 50. Naloxone is currently the most widely used drug to reverse an overdose, but researchers are looking at other treatments, including an experimental vaccine. Read more here.
• Deaths related to excessive alcohol consumption are rapidly rising in the United States, especially among women, a new study finds. While drinking is still killing more men than women, the rate of alcohol-related deaths is rising faster among women, according to the report published Friday in JAMA Network Open. Previous studies found that women are drinking greater amounts of alcohol, with binging becoming increasingly common, and that may at least partially explain the rising rates of complications like cirrhosis, he said. Read more here.
• The U.S. Food and Drug Administration has approved the prescription-free sale of the second opioid overdose reversal drug, its manufacturer Harm Reduction Therapeutics said on Friday.  The approval of the drug, called RiVive, will provide patients with another over-the-counter option in the United States, where drug-related overdose deaths surpassed 100,000 in 2021. Harm Reduction said it anticipates that RiVive will be available early next year, primarily to harm-reduction organizations and state governments. The not-for-profit drugmaker said it would make at least 200,000 doses available for free. Read more here.

Climate Change and Mental Health

• Even in the best of times, farming in New England can be a profession full of anxiety and uncertainty. But Eve Klotz, a mental health care provider and farmer in Effingham, says she’s seen this year’s erratic weather take an especially big toll on her fellow farmers’ mental health. “There's a lot of depression and despair right now with what's going on in Vermont and the Connecticut Valley in New Hampshire with the flooding,” she said. “Some of these farmers are just losing everything.” Read more here.
• Virtual doctor’s appointments are helping healthcare companies reduce carbon emissions, though sustainability is mostly seen as a side benefit of telehealth rather than its main driver. The use of telehealth picked up considerably during the Covid-19 pandemic, with virtual visits increasing 38 times from their prepandemic levels and then largely stabilizing, according to 2021 figures provided by McKinsey. Read more here.

Social Determinants

• Some Americans are being hit harder than others by the extreme heat wave baking swaths of the country because they can't get enough to eat or drink. The big picture: Food-insecure households are among the most at risk of health and financial hardships during blistering temperatures. They face unique exposure to dehydration and costly relief that further strains dwindling food budgets. Read more here.

Health Insurance

• The uninsured rate hit an all-time low in early 2023 with just 7.7% of Americans without health coverage, new data from the CDC's National Center for Health Statistics show. Yes, but: Medicaid disenrollments that accompanied the end of the COVID-19 public health emergency could quickly throw that trend in reverse. Nearly 3.8 million Americans have been kicked off Medicaid rolls since states began redetermining eligibility in April, per KFF. Read more here.

Medicaid Redetermination

• The nation’s top health official implored states to do more to keep lower-income residents enrolled in Medicaid, as the Biden administration released figures Friday confirming that many who had health coverage during the coronavirus pandemic are now losing it. Though a decline in Medicaid coverage was expected, health officials are raising concerns about the large numbers of people being dropped from the rolls for failing to return forms or follow procedures. Read more here.
• More than 32,000 Missourians — half of them children — lost Medicaid coverage in June during Missouri’s first round of eligibility checks after the COVID public health emergency. According to a Department of Social Services announcement Thursday, out of the roughly 116,000 Medicaid recipients who had their eligibility checked in June, around 43% retained coverage, 28% lost coverage and 29% have their determinations pending. Read more here.
• State officials are reporting around 120,000 Iowans have been disenrolled from Medicaid since April. The Iowa Department of Health and Human Services is four months into Medicaid unwinding, the process of redetermining thousands of Iowans’ eligibility for Medicaid following the end of the national public health emergency this spring. Read more here.
• For three years during the COVID-19 pandemic, people did not have to go through any kind of renewal process to stay on Medicaid. That changed in April, and now every state is winnowing its rolls — some much more quickly than others. Texas reported disenrolling 82% of its Medicaid recipients, while Wyoming shed just 8% of its rolls, according to an analysis by KFF, a health policy research organization. Read more here.

State Bans on Gender-Affirming Care and Related Issues

• The American Academy of Pediatrics reaffirmed its support for gender-affirming medical care for transgender children on Thursday, even as the treatments face a growing push for bans and restrictions from Republican lawmakers across the U.S. The board of directors for the group, which represents 67,000 pediatricians, unanimously voted to reaffirm its 2018 position on the treatments. The board also voted to provide additional documents to support pediatricians, including clinical and technical reports, and to conduct an external review of research regarding the care. Read more here.
• Days before a state agency began researching whether transgender medical care for Floridians should be covered by Medicaid, officials started lining up experts known for going against the scientific mainstream. The resulting report and state rule revoked Medicaid coverage of treatments for gender dysphoria, like puberty blockers and hormone therapy. It was thrown out by a federal judge, who in his June order called the rule an “exercise in politics, not good medicine.” Read more here.

Federal and State Policy

• Hospitals secured a $2.2 billion increase in Medicare payments for inpatient services in 2024, according to a final rule issued Tuesday. Why it matters: The 3.1% increase is slightly higher than the rate the Centers for Medicare and Medicaid Services proposed in April. However, the agency did not grant hospitals' request to raise payments further to account for previous underestimates in hospitals costs. Read more here.
• Lobbying groups representing different camps of the healthcare industry have come together to urge the Centers for Medicare & Medicaid Service (CMS) to reconsider “conflicting regulatory proposals” that require different electronic standards for electronic data exchanges during prior authorization. The American Hospital Association, the American Medical Association and the Blue Cross Blue Shield Association’s joint letter to CMS Administrator Chiquita Brooks-LaSure addresses proposed rule-making released by the agency in December 2022. Read more here.
• The Centers for Medicare & Medicaid Services (CMS) today approved proposals from California and Kentucky for community-based mobile crisis intervention teams to provide Medicaid crisis services. This marks six states that have expanded access to community-based mental health and substance use crisis care through President Biden’s American Rescue Plan. California and Kentucky will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year. Read more here.