Week of May 22–26, 2023

Week of May 22–26, 2023

General Articles

• The state health department on Friday announced plans to stop holding psychiatric patients in hospital emergency departments by 2025 — two days after a federal judge said the practice must end by May 2024. In a news release, the New Hampshire Department of Health and Human Services outlined a series of planned expansions to community-based services, inpatient psychiatric treatment and transitional housing options. Officials said those investments will fully eliminate the waitlist for inpatient psychiatric care over the next two years. Read more here.
• The school shooting at Covenant School in Nashville has generated a wide range of emotions and reactions in our city. There is much public focus on those with mental illness with calls to increase funding for mental health resources. Mental illness does not equate with danger to others. It is shaming and marginalizing to talk of mental illness and “evil” in the same sentence. I trust that we all have good intentions when referencing mental illness after a school shooting. Those good intentions may be a starting point for common ground in our discourse. Read more here.
• After a dip during the first year of the pandemic, suicide rates in Minnesota rose again during 2021 and 2022. Suicide rates in Minnesota, and across the country, have been on the rise over the past 20 years. The state saw a high in 2019, where the suicide rate reached 14.4 suicides per 100,000. The rate in 2022 neared that number, with 14.3 suicides per 100,000. State officials say suicide could be one reason why overall life expectancy may be declining. Read more here.
• May is both peak seasonal allergy time and mental health awareness month and research shows the two may be linked. Doctors said the more severe your allergy symptoms are, the more they see increased rates of depression and anxiety. Researchers said this may be due to how inflammation chemicals impact the emotion centers of our brain. They do not believe allergies can cause depression or anxiety, but the mixed signals can heighten any pre-existing feelings. Allergy medicine can also make people feel foggy or drowsy, adding another layer of impact to your mental health. Read more here.
• Feeling down? Forget your usual comfort foods. Try eating your greens instead.
• Years of research underscores that eating more vegetables is not only good for your physical health, but it can improve mental health as well. It doesn’t take much. Even adding just one more serving of fruit or vegetables to your plate each day can improve your mood. Here are some of the recent findings. Read more here.
• There is a mental-health crisis in science — at all career stages and across the world. Graduate students are being harassed and discriminated against, paid meagre wages, bullied, overworked and sometimes sexually assaulted. It doesn’t get much better for early-career researchers struggling to land long-term employment. Scientists have raised concerns for years about the impacts of all these pressures on mental health. But a series of studies in the past few years are now providing hard data. And the findings show that the situation is dire. Researchers are much more likely than the general population to experience depression and anxiety. Read more here.

Youth Mental Health

• Adolescent depression and suicidality have quickly become the “bread and butter” of pediatrics. Teens without signs of depression or suicidal thoughts or attempts are so rare in our well-visit clinic that they are memorable. I can’t recall a single shift in our emergency room without multiple listings of “intentional overdose” or “behavioral/mental health problem” on the patient tracking board. I am a pediatrician in an underserved, poverty-stricken community in Philadelphia. But I am not alone in what I’m seeing. According to the World Health Organization, the fourth leading cause of death in 15- to 29-year-olds is now suicide. Read more here.
• Among about 1.7 million US youths, both girls and boys experienced increases in some common mental illnesses during the COVID-19 pandemic, but girls were particularly affected, with more than a doubling of eating disorders among adolescent girls, according to a study published yesterday in JAMA Network Open. The researchers noted that the pandemic disrupted daily life, increased isolation and social media use, lowered access to care, and exacerbated the financial situations of many families—all which could have influenced children's mental health. Read more here.
• Every day, it seems, is mental health awareness day. In the U.S., there’s Eating Disorders Awareness Week in February. May is National Mental Health Awareness Month, which includes National Children’s Mental Health Awareness Day. Mental health awareness campaigns work on a key principle, applied to everything from exam stress to suicidal thoughts: If we can get people to identify and understand their mental health problems, then they can access effective help and treatment. Awareness is good, in other words, because it should ultimately alleviate people’s distress. The trouble is, no one really knows if awareness initiatives actually work in this way. Read more here.
• Dr. Vivek Murthy, the U.S. surgeon general, is calling for “immediate action” by tech companies and lawmakers to protect kids’ and adolescents’ mental health on social media. But after years of middling and insufficient action by both social media platforms and policymakers, parents and young people still bear most of the burden in navigating the fast-changing, often harmful world of secretive algorithms, addictive apps and extreme and inappropriate content found on platforms such as Instagram, TikTok and Snapchat. So what can parents and young people do now? The surgeon general has some tips. Read more here.
• These types of stories have become increasingly common, and mental health issues in youth have exploded in the last decade. There is no single cause and countless factors contribute to someone’s mental health; but research has been growing around what seems to be the concurrent rise in social media and smartphone use by children at younger ages. But there are steps parents can take to protect their children from those risks. Murthy’s advisory is the latest of many reports linking increased usage of social media with a heightened risk of mental health issues. Read more here…
• The US Surgeon General is clear: Get your kids off social media. And while he didn’t say as much, maybe spend less time on it yourself. In a dire report, Dr. Vivek H. Murthy warned of myriad dangers from social media platforms designed to be as addictive as possible, and laid out just how little we know about their potential harms. Read more here.

Impact of the Pandemic

• A study including all Danish adults published yesterday in JAMA Psychiatry suggests an increased risk of new-onset mental illness only in SARS-CoV-2–positive patients aged 70 and older. It also finds that worsened mental health after COVID-19 hospitalization is common but no more so than after other, similarly severe respiratory infections. Read more here.

Gun Violence

• When mass shootings make headlines, you may feel a range of emotions, from anxiety to fear or even a sense of numbness over yet another tragedy. You're not alone. Experts say even from a distance, gun violence can take a toll on your mental health. There have already been over 230 mass shootings in the U.S. this year, according to the Gun Violence Archive — defined as incidents with four or more people shot, not including the attacker. Read more here.
• President Joe Biden plans on Wednesday to call on Republicans in Congress to act to end the "epidemic" of gun violence in the United States, the White House said. The remarks are expected during an afternoon speech marking a year since the deadly school shooting in Uvalde, Texas.  Nineteen fourth graders and two teachers were killed when a gunman stormed Robb Elementary School on May 24, 2022. Seventeen others were injured. Read more here.
• The highest percentage of Americans in a decade say they think it's more important to curb gun violence than protect gun rights, according to a new NPR/PBS NewsHour/Marist poll. 6 in 10 say controlling gun violence is more important than protecting gun rights The finding comes a year after the mass shooting at an elementary school in Uvalde, Texas, the second-deadliest in American history. But the survey of almost 1,300 adults also shows Americans' views on guns are mixed, with little consensus on what to do about gun violence. Read more here.
• State legislators around the country have passed more laws expanding gun access than they have measures on gun control in the year since the Uvalde, Texas, mass shooting that left 19 children and two teachers dead, according to an Axios analysis of data provided by the Giffords Center. Read more here.

The Opioid Crisis

• U.S. health regulators on Monday approved a new easy-to-use version of a medication to reverse overdoses caused by fentanyl and other opioids driving the nation’s drug crisis. Opvee is similar to naloxone, the life-saving drug that has been used for decades to quickly counter overdoses of heroin, fentanyl and prescription painkillers. Both work by blocking the effects of opioids in the brain, which can restore normal breathing and blood pressure in people who have recently overdosed. Read more here.
• The Biden administration called on Congress Monday to pass a bill aimed at tackling fentanyl trafficking in the U.S., which would see the synthetic opioid raised to the highest classification of illegal drugs. Why it matters: The administration's public support for the Republican-led Halt All Lethal Trafficking of (HALT) Fentanyl Act comes amid a growing synthetic opioid crisis in the U.S. A report published earlier this month found the U.S. overdose death rate involving fentanyl nearly quadrupled from 2016 to 2021. Read more here.
• House Republicans' first major attempt to address the opioid crisis since taking power is resurfacing a long-running debate over the role of law enforcement in drug policy. Driving the news: The GOP-sponsored HALT Fentanyl Act is up for a House vote on Thursday, marking the 117th Congress' first substantive response to the epidemic. It’s also backed by President Biden, who said it's critical to fighting the supply of fentanyl-related substances reaching the U.S. Read more here.
• Legally prescribed fentanyl was introduced in the U.S. in the 1960s. It works by blocking pain signals in a patient's brain and is used to treat severe pain, typically for post-surgery or advanced-stage cancer. The CDC says fentanyl is up to 50 times stronger than heroin and up to 100 times more potent than morphine. Its extreme potency means that only very small doses are needed for its effects to be felt.
• Driving the news: The U.S. is awash in illegally produced fentanyl. Last year, the Drug Enforcement Administration seized enough fentanyl to kill every American. Read more here.

Climate Change

• His findings were nothing to sleep on: Humans are already losing shut-eye in warm environments, especially at the beginning of the night. Models predict a solid sleep will further decrease as temperatures rise, especially in lower-income and elderly communities. In his study looking at 47,000 adults in 68 countries, Obradovich and his colleagues found a notable change in sleep duration when nighttime temperatures rose above 50 degrees (10 degrees Celsius). Read more here. (Free registration is required to read this article.)

 Health Insurance

• Medicare Advantage plans lure customers with television ads promising plans with dental, vision and hearing benefits that traditional Medicare doesn’t offer. But in a series of reports, experts and advocates question the actual value of those benefits to enrollees, who often find they still have to pay significant amounts out of pocket. “They’re expecting to be able to get dentures or crowns or bridges — really expensive dental work — and they might end up in a plan that covers cleaning and an X-ray and that’s it,” said Julie Carter, senior federal policy associate for the Medicare Rights Center. Read more here.
• The share of Americans who skipped medical treatment last year because of costs rose substantially from the lows of 2020 and 2021, per a Federal Reserve Survey out Monday. Why it matters: The ability to afford health care often translates into better health. The survey also found that in families with income less than $25,000, 75% reported being in good health, compared with 91% for those with income of $100,000 or more. Read more here.

Gender-Affirming Care Bans and LGTBQ Issues

• At least 17 states have enacted laws restricting or banning gender-affirming care for transgender minors, though judges have temporarily blocked their enforcement in some, including Arkansas. An Associated Press analysis found that often those bills sprang not from grassroots or constituent demand, but from the pens of a handful of conservative interest groups. The AP obtained the texts of more than 130 bills in 40 state legislatures from Plural, a public policy software company, and analyzed them for similarities to model bills peddled by the conservative groups Do No Harm, which also criticizes efforts to diversify staffing in medicine, and the Family Research Council, which has long been involved in abortion restrictions. Read more here.
•  Do No Harm, a nonprofit that launched last year to oppose diversity initiatives in medicine, has evolved into a significant leader in statehouses seeking to ban gender-affirming care for transgender youths, producing model legislation that an Associated Press analysis found has been used in at least three states. The nonprofit, not widely known outside conservative medical and political circles, describes itself on its website as a collection of doctors and others uniting to “protect healthcare from a radical, divisive, and discriminatory ideology.” Read more here.
• Florida Gov. Ron DeSantis signed bills Wednesday that ban gender-affirming care for minors, target drag shows, restrict discussion of personal pronouns in schools and force people to use certain bathrooms. Read more here.
• A law that Gov. Ron DeSantis signed this month states that only doctors can prescribe these treatments moving forward. It’s one of several new requirements posing challenges for transgender patients and forcing some health centers in the state to pause providing gender-affirming hormones and surgeries. The new law, which also criminalizes providing gender-affirming care to most youth, went into effect as soon as the governor signed it. Although adults can still legally access care, the law immediately caused problems for thousands of patients and the health professionals who treat them, says Samantha Cahen, program director for trans and nonbinary care at Planned Parenthood of South, East and North Florida. Read more here.
• Tennessee’s decision to exclude gender-affirming care for its employees is unconstitutional and discriminatory, according to a federal lawsuit brought by two people who were denied such services while working for the state. Attorneys representing Gerda Zinner, 30, and Story VanNess, 38, say the two were denied even though their medical teams deemed the services medically necessary. Zinner still works for the state as an academic adviser but VanNess has since left her position as a special education teacher after unsuccessfully appealing her case. Read more here.

Medicaid Redetermination

• About 1 in 4 Medicaid enrollees don't know where to look for other coverage if they drop off the safety net program's rolls, and 15% say they'll be uninsured, according to a new KFF survey. Why it matters: The findings begin to quantify how unprepared many enrollees are for the emergency. 65% of recipients say they didn't have a change in income or other change that would make them ineligible for the program, underscoring the importance of navigating the renewal process and not getting lost in bureaucratic churn. Read more here.
• There are about 250,000 people who have lost Medicaid coverage since Florida began its redetermination process this month, however, many of those people could still be eligible. In April, state governments were allowed to begin checking people's eligibility for Medicaid due to the expiration of the continuous enrollment provision, which ended on May 1. However, 82% of people lost coverage for procedural reasons, also known as "red tape" reasons, such as not having responded to mail, having outdated contact info or computer glitches. Read more here.

Federal and State Policy

• As Washington struggles to reach a debt ceiling deal with little more than a week until potential default, a key hangup in the negotiations is turning out to be -- "work requirements." A long-sought effort by Republicans to impose stricter conditions on recipients of Medicaid and other federal assistance programs is now front-and-center in the debt ceiling standoff. House Speaker Kevin McCarthy has described tougher work requirements as a "red line" in his ongoing negotiations with President Joe Biden to reduce federal spending in exchange for addressing the debt ceiling. Read more here.