News & Announcements

Health and Healthcare Disparities Among Veterans with Serious Mental Illness

Posted: November 08, 2017

The National Veteran Health Equity Report details patterns and provides comparative rates of health conditions for vulnerable Veteran groups. Specifically, this report is designed to provide basic comparative information on the sociodemographics, utilization patterns and rates of diagnosed health conditions among the groups over which the VHA Office of Health Equity (OHE) has responsibility with respect to monitoring, evaluating and acting on identified disparities in access, use, care, quality and outcomes. The report allows the VA, Veterans, and stakeholders to monitor the care vulnerable Veterans receive and set goals for improving their care. Chapter 7 of the Report focuses on Health and Healthcare Disparities Among Veterans with Serious Mental Illness (SMI).

Compared to the general population, individuals with SMI have between 14-30 years shorter life expectancy, depending on the study. Individuals with SMI who are treated in VA are on the lower end of this mortality gap with between 14-18 years shorter life expectancy compared to the general US population.  SMI as a category has been variably defined across studies. For the purposes of this chapter, and in line with the most typical definitions of SMI, the SMI group included schizophrenia, schizoaffective disorder, bipolar disorders, major depression with psychosis, and psychotic disorders not otherwise specified. Schizophrenia is considered the hallmark disorder of SMI.

As a group, mental and substance use disorders have been the leading cause of non-fatal global disease burden and fifth in overall disease burden, which includes impact from both mortality and morbidity as measured in disability-adjusted life years (DALYs).  Although depressive and anxiety disorders are more prevalent and carry higher global burden, SMI accounts for the highest disability weights.  Despite the low prevalence of SMI (approximately 4% of the U.S. population),  they account for the majority of patients treated at outpatient public mental health clinics, including VA.

Some of the implications for veterans spelled out in the chapter include:

  • Not only is the rate of mental illness diagnoses, and SMI in particular, higher in VA compared to the general adult population, the VA numbers here only include those Veterans with the diagnosis who are also in care in a particular fiscal year. This means the numbers in this chapter are an underestimate of the diagnoses in the Veteran population at large and indicates a higher burden of mental health disorders in Veterans.
  • There is considerable burden in this population with SMI of several comorbid mental health diagnoses with at least a quarter also having PTSD or a substance use disorder. There is expertise to be shared across clinicians regarding treatment of Veterans with SMI, substance use disorders, and PTSD. These illnesses are often treated in clinics that are siloed from one another (e.g., specialized PTSD clinic, dual diagnosis clinic) and formal Standards of Practice (SOPs) for consultation across experts of specific mental health diagnoses could improve outcomes and treatment compliance.
  • The gender representation of women in the SMI, mood/anxiety, and other mental health groups compared to the overall VA population in care in FY13 highlights the need for VA healthcare services that are gender sensitive within the mental health services care line.  It also indicates a need for training in the care of SMI for staff and clinicians in the VA women’s clinics.
  • African American Veterans, compared to White Veterans, are more likely to depend on VA to provide at least some of their healthcare and these groups were overrepresented in the population of Veterans with Serious Mental Illness-Patient-Aligned Care Teams (SMI-PACT), or substance abuse. Since African Americans have been shown to have poorer clinical outcomes in hypertension, cardiovascular care, and diabetes care and these physical illnesses are higher in those individuals on second-generation antipsychotics, there is particular concern that gaps in care for these illnesses may exist for the Veteran population with SMI. 
  • Urban locales allow for easier access to in-person VA care, including both physical and mental health services, but those with SMI often live in parts of the city populated by those with limited income. For this reason, VA research should continue to examine the effects of social determinants of health and health behavior.
  • With between a quarter and a third of all Veterans, including those with mental illness, living in rural locales, there needs to be continued support of tele-mental health services.

In order to reduce mortality and disability in SMI, efforts should address provider attitudes towards SMI, quality of care, access to preventative medical care, and help managing chronic comorbid medical conditions. Clinicians, outside of specialty mental health, often have limited experience, discomfort, and a lack of familiarity with evidence-based practices for this population. At the organizational level, systems may lack protocols for care management, shared treatment arrangements, and effective partnerships between primary care and mental health staff. The core difficulty with treating comorbid medical and mental health is the mismatch between the patient, in whom medical and mental conditions and their treatments are interrelated, and a healthcare system with separate services for each disorder; though in VA, primary care-mental health integration is designed to address part of this concern. However, even in VA, a large, quasi-integrated system, the experience of the patient with SMI and their providers is often that of a fragmented healthcare system.

Read more from the National Veterans Health Equity Report.



Following Violent Events: How To Deal With Stigmatizing Remarks About Mental Illness

Posted: November 07, 2017

Research shows that people living with mental health issues are more likely to be victims of a violent crime as opposed to the ones committing them. Yet a formulaic response tends to follow tragedies: Mental illness is bad and it’s what caused this to happen.

Experts say a drawing a simplistic connection between mental illness and severe violence not only sends the wrong message about psychological disorders, it stigmatizes the millions of people who live with mental health conditions.

“It’s important not to link these kinds of heinous crimes with mental illness unless one knows for sure what was a cause and effect,” Dr. Michelle Riba, the associate director at the University of Michigan’s Comprehensive Depression Center, told HuffPost. “Most people with mental illness are wonderful citizens and have an illness that’s treatable. They don’t behave in a way that leads to what happened [in Texas].”

A 2016 Johns Hopkins University study found that more than a third of all news stories about mental health conditions were linked with violence toward other people. This figure doesn’t accurately reflect the actual rates of violence where mental illness is involved.

Assigning blanketed blame to mental illness can have long-term consequences, Riba said. It further alienates people with mental health issues and makes them feel like their experience isn’t understood. That could ultimately lead them to not reach out for help: Research shows negative attitudes surrounding mental illness often prevent people from seeking treatment.

Regardless of whether mental health issues are at play during tragedies, the way they are discussed publicly is a huge problem ― especially for those who live with these disorders.

If you’re living with a mental health issue, here’s how to take care of yourself today (and moving forward):

Reach out to someone you trust: This could be a family member, friend or significant other. Leaning on people who love and support you is vital during times of distress, Riba said. “Ask people to have a conversation about how you’re feeling,” she said. “Getting some input from people you trust and value is helpful.”

Take social media and news breaks if you need them: Riba said that staying informed and plugging into uplifting resources can be critical when you’re feeling alienated. However, it’s also important to take breaks. Research shows negative news can have a damaging effect on mental health. It’s okay to unplug from the noise for a little while.

Do a calming activity: Working out ― even if it’s just going for a long walk ― can do wonders for your mental wellbeing. Research shows physical activity can boost your mood, and taking a stroll in nature has been shown to reduce symptoms of depression. Not in the mood to exercise? Try one of these other expert-backed self-care activities.

Check in with a professional: If you’re already in therapy, Riba recommends reaching out to your therapist if the rhetoric is starting to bother you. If you’re not currently seeking treatment, consider contacting a professional if your well-being is at stake. “Make an appointment to talk about this,” Riba said. “It’s important to straighten out these kinds of feelings and issues with a clinician.”

Remember that your condition is not a character flaw: Mental health is just as important as physical health. Take a moment to remind yourself that having a mental illness doesn’t make you a bad person, nor does it define you, Riba said. “Mental illness is like any other health condition,” she stressed. “It’s treatable and people with the conditions have quality lives.”

Read more at HuffingtonPost.com.



America’s 8-Step Program for Opioid Addiction

Posted: November 06, 2017

Drug overdoses, nearly two-thirds of them from prescription opioids, heroin and synthetic opioids, killed some 64,000 Americans last year, over 20 percent more than in 2015. That is also more than double the number in 2005, and nearly quadruple the number in 2000, when accidental falls killed more Americans than opioid overdoses.

Here are eight steps to take — to work to end the dispair and devistation of addiction now. They include some of the recommendations of the president’s commission.

Save Lives: Active users need to be kept alive long enough to seek treatment. First responders and emergency rooms lack adequate supplies of naloxone, the medication that can save someone who has overdosed on opioids, particularly fentanyl, a drug so toxic it requires multiple doses of naloxone to reverse. In addition, needle exchange and clean syringe programs can be supported to combat the infectious diseases that are associated with sharing needles.

Treat, Don't Arrest: Nearly 300 law enforcement agencies in 31 states now participate in the Police Assisted Addiction and Recovery Initiative, which offers treatment for drug users who ask the authorities for help, an approach inspired by a program established in Gloucester, Mass. Officers work the phones to get addicts into treatment and recovery networks, in an effort that costs less and promises more lasting results than repeatedly arresting them.

Fund Treatment: Repealing Obamacare would eliminate Medicaid-funded treatment for thousands of addicts. Focus efforts to convince more states to adopt a Medicaid expansion, which has helped save lives in the states worst affected by the opioid crisis.

Combat Stigma: Misunderstanding of opioid addiction shrouds nearly every effort to reduce its toll. To help Americans — and even some physicians — appreciate the crisis, Dr. Kelly Clark, addiction psychiatrist and president of the American Society of Addiction Medicine, is calling for an effort like that used by the federal Centers for Disease Control and Prevention to fight AIDS. In the 1980s, the agency sent a brochure, “Understanding AIDS,” to every residential mailing address in the United States to dispel myths and help Americans seeking treatment. Right now, addiction medicine is a desperately needed but relatively low-status specialty. The federal government could provide tuition incentives for medical students to enter addiction-related specialties and work in underserved communities.

Support Medication-Assisted Treatment: One of the most effective methods of treating drug addiction is through continuing medication therapies like methadone, naltrexone and buprenorphine. Multiple studies suggest these medications help guard against relapse as well as addiction-related medical problems, allowing people to return to work and rebuild their lives.  The federal government can encourage broader acceptance of this treatment by requiring that staff physicians, physician assistants and nurse practitioners in Veterans Health Administration hospitals and federally qualified health centers receive training; that Medicaid and Medicare expand coverage of continuing medication treatment; and that medication options approved by the Food and Drug Administration be available at treatment centers that receive federal funding.

Enforce Mental Health Parity: Half to 70 percent of people with substance abuse problems also suffer from depression, post-traumatic stress or other mental health disorders, John Renner, president of the American Academy of Addiction Psychiatry, told the president’s commission in June. The Mental Health Parity and Addiction Equity Act of 2008 prohibits insurers that cover behavioral health from providing less-favorable benefits for mental health and addiction treatment than they offer for other medical therapies or surgery. Some insurers defy the law, imposing arbitrary treatment limits or onerous authorization requirements. The federal government needs to strictly enforce the mental health parity law, a job now left largely to the states, and educate Americans about their legal rights in dealing with insurers that cheat.

Teach Pain Management: The opioid crisis is rooted in our health care system: American physicians prescribe opioids for pain management at far higher rates than physicians prescribe them in any other nation. Addiction to those drugs can lead to the use of heroin and fentanyl when prescriptions run out. In California, a recent investigation by The Sacramento Bee found at least five counties in which there were more prescriptions filled for opioid painkillers last year than there were people. In Massachusetts, the state worked with dental and medical schools to ensure that all students received training in the management of prescription opioids and prevention of their misuse. The federal Department of Education could make this a national requirement for all medical students. Meanwhile, states and the federal government must continue to pursue legal action against the drugmakers whose irresponsible practices laid the foundation for this crisis.

Start Youth With Prevention: A 2015 study by the National Institute on Drug Abuse found that “Life Skills Training” for seventh graders helped them avoid misusing prescription opioids throughout their teenage years. Research suggests that life skills programs work better than traditional antidrug abuse lectures by strengthening children’s self-esteem, decision making and communication skills. In Kentucky, a state with one of the highest opioid death rates, health officials point to programs like Metamorphosis, in which counselors work with kids outdoors, using the life cycle of the Monarch butterfly to discuss choices children face as they mature.

Read more at NYTimes.com.



A Quarter of Students Report Being Bullied, Survey Finds

Posted: November 03, 2017

A quarter of students in grades five through twelve report being bullied, a survey by San Francisco-based YouthTruth Student Survey finds.

Drawing on anonymous responses from a 180,000 students in thirty-seven states, the report, Learning From Student Voice: Bullying, found that 22 percent of males, 30 percent of females, and 44 percent of students who identify in another way reported being bullied. While the findings are consistent with previous research, the report provides insights into how student experiences vary across demographic groups.

Across all demographic groups, 73 percent of students who were bullied also reported being verbally harassed. In addition, female students and those born female but who identify otherwise were more likely to be bullied socially and socially harassed, compared to 45 percent of male students.

The survey also found that almost half of all bullied students — 44 percent — cite appearance as the reason they were bullied, while 17 percent report being bullied because of their race or skin color and 15 percent report being bullied because of their perceived sexual orientation. Male students and those who identify as other than male or female were slightly more likely to report being bullied for their perceived sexual orientation, with 20 percent of male and 45 percent of students who identify in another way being bullied for how they were perceived by others, compared to 9 percent of female students.

"Bullying is an issue that can often be difficult for students to talk about, which heightens the importance of anonymous, candid student feedback," said YouthTruth executive director Jen Wilka. "These findings illustrate that bullying is prevalent in the lives of many students, and that some students may be experiencing bullying differently than their peers. All students have the right to feel safe at school. We hope that this data helps to spark conversations and inform anti-bullying efforts."

Read more at PhilanthropyNewsDigest.org, or learn more about the survey at YouthTruthSurvey.org.

Thousands of schools nationwide have made Anonymous Alerts® their tool of choice to combat bullying and safety concerns. Anonymous Alerts® is the first and only truely anonymous two-way communications service that empowers students to 'stand up and report it' by engaging in trusted, private, and encrypted school staff communications. Students can submit safety concerns related to bullying, cyberbullying, cyber harassment, mental health, drug and alcohol use/dealing, depression, weapons on campus, or other issues which may warrant immediate attention.

Learn more about the Anonymous Alerts anti-bullying app at PRNewswire.com.



AJPH’s Improving Population Mental Health in the 21st Century Call for Papers

Posted: November 02, 2017

The American Journal of Public Health (AJPH) will devote a Special Section on the theme of improving population mental health in the 21st century.

Psychiatric and behavioral disorders, and their underlying mental health dimensions, remain among the most disabling health conditions worldwide with significant burdens on individuals and societies. Population based efforts to prevent disorders from occurring, identify those with disorder, and provide accessible and effective treatments, should be important global health priorities.

AJPH invites submissions of innovative research that uses rigorous epidemiological methods, ranging from experimental to quasi-experimental and observational studies, to identify appropriate levers for prevention and efficacious treatments applicable in both wealthy and/or resourcepoor settings.

Reports that focus on evaluation of policies and legal changes that stand to either improve or exacerbate mental health conditions, targeted and global service delivery models, and technological advances that hold promise for prevention at a population level, are particularly welcome and timely.

Areas for the special section can include, but are not limited to:

  • Analyses that inform descriptive epidemiology regarding the changing prevalence of population distributions of psychiatric and neurodevelopmental disorders
  • Applications of causal inference approaches
  • Examination of challenges in implementation and program evaluation
  • How local, state, and national policy and legal changes (e.g., Affordable Care Act in the US, shifting marijuana laws across the globe, immigration and migration policies worldwide) influence mental health incidence, persistence, prevention, and treatment.

The special section plans to publish 5-6 empirical papers, as well as a series of invited editorials, on topics related to population mental health. 

Abstracts should be sent to AJPH.MentalHealth@mcgill.ca and are due by January 2, 2018.

Learn more on the call for papers flyer from AJPH.org



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