Week of March 20–24, 2023

Week of March 20–24, 2023

General Mental Health Articles 

• Mental health providers are demonstrating their opposition to a proposed state rule that would require them to share patient names and diagnoses information to regulators and other health professionals through a health information exchange. About 500 providers and patients gathered Saturday at noon outside of the Oklahoma Health Care Authority, which will consider adopting a revised rule that would require those disclosures when it meets at 2 p.m. on March 22. Read more here.  
• The 10th annual World Happiness Report, published Monday to coincide with the International Day of Happiness, surveyed over 100,000 people and found that Finland was the happiest country for the sixth straight year. The U.S. was ranked the 15th happiest nation. Afghanistan was the least happy, with the Taliban-controlled nation ranking last at No. 137. Meanwhile, the report found global misery declined slightly during the pandemic. Read more here.
• Fictional soccer coach Ted Lasso used a White House visit Monday to encourage people, even in politically divided Washington, to make it a point to check in often with friends, family and co-workers to “ask how they’re doing, and listen, sincerely.” Comedian Jason Sudeikis, who plays the title character — an American coaching a soccer team in London — and other cast members were meeting with President Joe Biden and first lady Jill Biden to talk about how mental health contributes to overall well-being. Read more here. 
  

Youth Mental Health

• Utah on Thursday became the first state to bar minors from using social media without consent from a parent or guardian after Gov. Spencer Cox (R) signed two bills aimed at regulating how minors interact online in the state — one requiring companies to verify the age of users before they can create accounts. Read more here.
• Readers had many questions after my column this week linking worsening mental health in teens to social media use. Of course, they certainly are correct that covid was extremely disruptive to many young people. And some individuals could be experiencing anxiety or depression as a reaction to other things happening in the news. But on a population level, the clearest correlation is between smartphone and social media use and mental distress, self-injuring behavior and suicidality. Read more here. 
• The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the availability of approximately $25 million to expand primary health care, including mental health services, in schools. For the first time, applicants will be required to add or expand mental health services to receive school-based funding. HRSA-funded health centers currently operate more than 3,400 school-based service sites in schools across the country. Read more here.
• The US Congress temporarily expanded the Child Tax Credit (CTC) during the COVID-19 pandemic to provide economic assistance for families with children. There has been little research evaluating the effect of the policy expansion on mental health. Using data from the Census Bureau’s Household Pulse Survey and a quasi-experimental study design, we examined the effects of the expanded CTC on mental health and related outcomes among low-income adults with children, and by racial and ethnic subgroup. Read more here.
• Three quarters of US high school students didn't get enough sleep, and two-thirds had difficulty completing schoolwork, in 2021 amid the pandemic, according to a survey study published late last week in Preventing Chronic Disease. Researchers at the Centers for Disease Control and Prevention (CDC) analyzed Adolescent Behaviors and Experiences Survey data collected from 7,705 students in grades 9 to 12 from January to June 2021. The American Academy of Sleep Medicine recommends that adolescents aged 13 to 18 sleep 8 to 10 hours a night. Read more here.
• As evidence mounts that law students suffer through outsized mental health challenges, some law schools are experimenting with a new tactic to identify struggling students and get them help. At least five U.S. law schools have adopted a service first developed for medical schools, called Early Alert, that sends one text message a week to students asking them to rate how they feel about a specific topic. Read more here. (A free account is required to read this article.) 
• Rates of mental health emergencies are increasing among teenagers around the world, according to a new study from the University of Calgary. It found an increase in pediatric emergency room visits for suicide attempts, suicidal ideation, and self-harm during the first year of the pandemic. It’s a particular concern because for teenagers, suicide can be contagious. Teenagers with a friend or family member who died of suicide were at significantly higher risk of suicide than those without, according to a 2016 review published by the American Association of Suicidology. Read more here. 

Gun Violence

• More than two-thirds of parents worry a shooting could happen at their children’s school, according to a recent Pew Research Center survey. But home is a far more dangerous place for kids. In the five years ending in 2022, at least 866 kids ages 17 and younger were shot in domestic violence incidents, according to an analysis by The Trace of data from the nonprofit Gun Violence Archive; 621 of them died. Read more here. 
  

Mental Health and Aging

• Connecticut’s elder care system is at a precipice. Nursing homes, for decades the final destination for many older adults and people with disabilities, are being squeezed at both ends as state officials increase oversight of the industry while funneling millions into programs that aim to keep residents in their homes and communities. The state’s aging nursing facilities, beset by staffing problems, outdated infrastructure and dwindling financial support, are facing an identity crisis. Occupancy, which plunged steeply during the pandemic, has yet to fully recover. Read more here.
• Social frailty is a corollary to physical frailty, a set of vulnerabilities (including weakness, exhaustion, unintentional weight loss, slowness, and low physical activity) shown to increase the risk of falls, disability, hospitalization, poor surgical outcomes, admission to a nursing home, and earlier death in older adults. Those who are socially frail similarly have fewer resources to draw upon, but for different reasons — they don’t have close relationships, can’t rely on others for help, aren’t active in community groups or religious organizations, or live in neighborhoods that feel unsafe, among other circumstances. Read more here. 

Impact of the Pandemic

• The pandemic experience varied sharply from state to state, with some of the highest adjusted death rates reported in Arizona, the District of Columbia and New Mexico, according to an analysis published in The Lancet. Why it matters: It's among the first deep dives to explore the social and economic factors at play during the pandemic in the U.S., and found a nearly four-fold variation in COVID infection and death rates between states. Read more here. 
  

The Opioid Crisis and Addiction Issues

• The United States is facing a crisis of overdose deaths. In 2021, more than 106,000 Americans lost their lives to drug-involved overdoses — including more than 1,100 teens that year alone. Synthetic opioids, primarily involving the powerful drug fentanyl, are the main driver of overdose deaths, with nearly a 7.5-fold increase overall from 2015 to 2021, according to the US Centers for Disease Control and Prevention. Overdoses and poisoning are the third leading cause of death in kids and adolescents age 19 and younger. Read more here.
• Overdose deaths associated with fentanyl have surpassed those due to heroin or other opioids. In 2022, the Drug Enforcement Administration seized 50.6 million fentanyl-laced pills masquerading as regulated prescription pills like Xanax or oxycodone and more than 10,000 pounds of fentanyl powder. But there isn’t a federal mandate that emergency rooms test specifically for fentanyl. Shamash is now working with other families who have suffered a similar loss in hopes of enacting federal legislation. Read more here.
• Fentanyl drug overdoses kill more than a hundred thousand people every year across America. In New Orleans, Coroner Dr. Dwight McKenna says the loss is great. “It’s a catastrophe of the highest order,” says Dr. McKenna. Dr. McKenna says of the nearly 500 drug overdose death in New Orleans last year, 95% of them were from fentanyl. This year, he says it could be worse. “We’re losing them on a daily basis. At that rate we’re going, it’s going to be greater than a loss a day,” says Dr. McKenna. Read more here.
• Oregon lawmakers are considering a bill that would increase the penalties for people in possession of more than a gram of fentanyl or for those dealing the drug. There has been plenty of debate about Oregon’s voter-approved Measure 110, which decriminalized low-level drug possession, even for hard drugs. House Bill 2645 would make possession from one to five grams of fentanyl a misdemeanor and anything more a felony. Read more here. 
• Fentanyl is now a leading cause of death for Americans under the age of 40. Even when people survive, addiction is breaking up families, as far more parents lose custody of their kids. The Cherokee nation's Principal Chief Chuck Hoskin says the drug crisis here is so intense, it threatens efforts to strengthen his people's way of life. "That's such an important mission for the Cherokee nation, [restoring] our language and culture, and yet this drug problem is really hampering it." Read more here.
• Mexican President Andrés Manuel López Obrador harshly criticized Republican lawmakers introducing legislation to authorize the use of military force against Mexican drug cartels in an attempt to stem the flow of fentanyl into the U.S., Carmen reports. “It’s very irresponsible for these lawmakers that, for propagandistic purposes — because it’s worrisome what’s happening in the U.S., because many young people are losing their lives due to fentanyl — but it’s scummy to use that to say that Mexico is guilty,” López Obrador told reporters Thursday. Read more here.
• Mexico’s president said Friday that U.S. families were to blame for the fentanyl overdose crisis because they don’t hug their kids enough. The comment by President Andrés Manuel López Obrador caps a week of provocative statements from him about the crisis caused by the fentanyl, a synthetic opioid trafficked by Mexican cartels that has been blamed for about 70,000 overdose deaths per year in the United States. López Obrador said family values have broken down in the United States, because parents don’t let their children live at home long enough. Read more here.
• The U.S. State Department has issued a travel warning about dangerous counterfeit pills being sold at pharmacies in Mexico that often contain fentanyl. The travel alert posted Friday says Americans should “exercise caution when purchasing medication in Mexico.” Small pharmacies in tourist areas and border regions sometimes sell medications advertised as OxyContin, Percocet, Xanax and others without a prescription. The State Department warned that such pills are often counterfeit and “may contain deadly doses of fentanyl.” Read more here.
• The US Drug Enforcement Administration issued an alert Monday about the widespread threat of fentanyl mixed with xylazine, a veterinary tranquilizer also commonly known as “tranq” or “tranq dope.” “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” DEA Administrator Anne Milgram said in the alert. Read more here.
• Prescription opioid use could have a negative effect on cognitive function in older adults, according to a recent Mayo Clinic study published in the Journal of the American Geriatrics Society. The population-based observational study used data from the Mayo Clinic Study of Aging, a research initiative examining the cognitive decline in older people for nearly 20 years. Read more here.
• State lawmakers nationwide are responding to the deadliest overdose crisis in U.S. history by pushing harsher penalties for possessing fentanyl and other powerful lab-made opioids that are connected to about 70,000 deaths a year. Imposing longer prison sentences for possessing smaller amounts of drugs represents a shift in states that in recent years have rolled back drug possession penalties. Proponents of tougher penalties say this crisis is different and that, in most places, the stiffer sentences are intended to punish drug dealers, not just users. Read more here.
• While the face of the opioid crisis has predominantly been considered white and rural, overdose deaths among Latinos have skyrocketed in recent years, with experts attributing the growing numbers to the rise of fentanyl, especially mixed with other drugs. Overdose deaths among Latinos have nearly tripled since 2011, according to a report published this month in the American Journal of Epidemiology. Read more here.
• The states that have legalized sports betting are reporting record levels of wagering and revenues, but with that growth comes questions about gambling addiction and whether regulators and sportsbooks are doing enough to fight it. Two dozen states have active online sports betting, and other states are on the verge of joining them. As legalized gambling spreads, state legislatures, regulatory agencies, addiction experts, sportsbook operators and sports leagues all say they are working to address gambling addiction. Read more here.
• Legal sports betting has surged in the US since the Supreme Court paved the way for it in 2018. As of March, it's legal to bet on sports in 33 states and is legal but not yet operational in three others. In a July Pew Research Center survey of US adults, one in five respondents said they bet on sports in the prior 12 months. And based on its March survey of US adults, the American Gaming Association estimated over 30 million Americans planned to bet on March Madness through an online betting platform or at a physical sportsbook. Read more here. 

988 Hotline

• Community leaders around the country have heralded the arrival of 988—the 3-digit code for people to reach the National Suicide & Crisis Lifeline—as an essential new resource to shift people in crisis toward appropriate care. However, important design and operational questions are emerging about how new 988 processes will interface with existing law enforcement and crisis responses, including: How should behavioral health-related calls be triaged by 911 and correctly routed to 988, and vice versa? If a response is needed, how can leaders ensure it is timely and appropriate? What steps are needed to establish trust in the new dialing code? Read more here. 

Medicaid Redetermination

• Health officials are bracing for chaos as states begin to determine — for the first time in three years — who is eligible for Medicaid, as a key pandemic policy of guaranteed eligibility ends. Advocates warn that without a safety net, millions of vulnerable people will fall through the cracks and lose coverage.  The Biden administration is giving states a year to go through the once-routine process of sorting through Medicaid rolls, though some are moving much faster. Read more here. 

Gender-Affirming Care Legislation

• Iowa Gov. Kim Reynolds (R) on Wednesday signed into law two bills that will restrict the rights of transgender young people in the state. One of them, Senate File 538, prohibits doctors from providing gender-affirming health care, including puberty blockers, hormones and surgeries, to transgender minors. The other, Senate File 482, bars transgender students from using school restrooms or locker rooms that are consistent with their gender identity. Read more here. 
• The world’s leading medical experts in transgender health took aim Thursday at a proposed emergency regulation that would restrict gender-affirming medical care for minors in Missouri. Missouri Attorney General Andrew Bailey’s proposed rules are “based upon manipulated statistics, flawed reports, and incomplete data, and prevents the provision of medically-necessary care,” read a statement from the World Professional Association for Transgender Health. Read more here. 

Federal and State Policy

• 911 Community Crisis Responders Act introduced by Rep. Adam Smith (WA-09) & Rep. Brian Fitzpatrick (PA-01) Background: 911 receives more than 240 million calls every year. The overwhelming majority these calls involve nonviolent, non-criminal incidents such as neighbor disputes, nuisance complaints, truancy, reports of “suspicious” activity, requests for wellness checks, and mental health crises. The 911 Community Crisis Responders Act creates a grant program for states, tribes, and localities to create and expand mobile crisis response programs. Read more here. 
• Thousands of people struggle to access mental health services in Florida. The treatment system is disjointed and complex. Some residents bounce between providers and are prescribed different medications with clinicians unaware of what happened. Jails and prisons have become de facto homes for many who need care. What’s most troubling about the group’s findings? They aren’t new. More than 20 years ago, the Florida Legislature set up a commission with the same name to examine the same issues and publish recommendations on how to improve mental health care in the publicly funded system. Read more here. 
• California voters would decide whether to fund a major expansion of housing and treatment for residents suffering from mental illness and addiction, under the latest proposal by Gov. Gavin Newsom to address the state’s homelessness crisis. Newsom announced Sunday that he will ask allies in the Democratic-controlled Legislature for a measure on the 2024 ballot to authorize funding to build residential facilities where up to 12,000 people a year could live and be treated. Read more here. 
• State efforts to control health costs through public options are stalling in the face of resistance from providers and lackluster enrollment, even as talk of a federal version recedes. Why it matters: The states' underwhelming attempts offer an ominous warning for lawmakers seeking to lower health costs: Insurers and providers aren't going to willingly cooperate with programs that threaten their profits and revenues. And lower health care costs are, in the end, a hit to someone's profits and revenue. Read more here.