Study: College Presidents Prioritizing Student Mental Health

Jeremy Bauer-Wolf
InsideHigherEd.com
Originally posted August 12, 2019

With college students reporting problems with anxiety and depression more than ever before, and suicides now a big problem on campuses, university presidents are responding accordingly.

More than 80 percent of top university executives say that mental health is more of a priority on campus than it was three years ago, according to a new report released today by the American Council on Education.

"Student mental health concerns have escalated over the last 10 years," the report states. "We wanted to know how presidents were responding to this increase. To assess short-term changes, we asked presidents to reflect on the last three years on their campus and whether they have observed an increase, decrease, or no change in how they prioritize mental health."

ACE, which represents more than 1,700 college and university presidents, surveyed more than 400 college and university leaders from two- and four-year public and private institutions. About 78 percent of those surveyed were at four-year universities, and the remainder led two-year institutions.

The association found 29 percent of all the presidents surveyed received reports of students with mental health issues once a week or more. About 42 percent of the presidents reported hearing about these problems at least a few times every month. As a result, presidents have allocated more funding to addressing student mental health problems -- 72 percent of the presidents indicated they had spent more money on mental health initiatives than they did three years ago. One unnamed president even reported spending $15 million on a new “comprehensive student well-being building.”

The info is here.

Why parents are struggling to find mental health care for their children

Bernard Wolfson
Kaiser Health News/PBS.org
Originally posted May 7, 2019

Here is an excerpt:

Think about how perverse this is. Mental health professionals say that with children, early intervention is crucial to avoid more severe and costly problems later on. Yet even parents with good insurance struggle to find care for their children.

The U.S. faces a growing shortage of mental health professionals trained to work with young people — at a time when depression and anxiety are on the rise. Suicide was the No. 2 cause of death for children and young adults from age 10 to 24 in 2017, after accidents.

There is only one practicing child and adolescent psychiatrist in the U.S. for about every 1,800 children who need one, according to data from the American Academy of Child & Adolescent Psychiatry.

Not only is it hard to get appointments with psychiatrists and therapists, but the ones who are available often don’t accept insurance.

“This country currently lacks the capacity to provide the mental health support that young people need,” says Dr. Steven Adelsheim, director of the Stanford University psychiatry department’s Center for Youth Mental Health and Wellbeing.

The info is here.

The U.S. Healthcare Cost Crisis

Gallup
Report issued April 2019

Executive Summary

The high cost of healthcare in the United States is a significant source of apprehension and fear for millions of Americans, according to a new national survey by West Health and Gallup.

Relative to the quality of the care they receive, Americans overwhelmingly agree they pay too much, and receive too little, and few have confidence that elected officials can solve the problem.

Americans in large numbers are borrowing money, skipping treatments and cutting back on household expenses because of high costs, and a large percentage fear a major health event could bankrupt them. More than three-quarters of Americans are also concerned that high healthcare costs could cause significant and lasting damage to the U.S. economy.

Despite the financial burden and fears caused by high healthcare costs, partisan filters lead to divergent views of the healthcare system at large: By a wide margin, more Republicans than Democrats consider the quality of care in the U.S. to be the best or among the best in the world — all while the U.S. significantly outspends other advanced economies on healthcare with dismal outcomes on basic health indicators such as infant mortality and heart attack mortality.

Republicans and Democrats are about as likely to resort to drastic measures, from deferring care to cutting back on other expenses including groceries, clothing, and gas and electricity. And many do not see the situation improving. In fact, most believe costs will only increase. When given the choice between a freeze in healthcare costs for the next five years or a 10% increase in household
income, 61% of Americans report that their preference is a freeze in costs.

West Health and Gallup’s major study included interviews with members of Gallup’s National Panel of Households and healthcare industry experts as well as a nationally representative survey of more than 3,537 randomly selected adults.

The report can be downloaded here.

As calls to the Suicide Prevention Lifeline surge, under-resourced centers struggle to keep up

Vivekae Kim
PBS.org
Originally posted August 5, 2018

Here is an excerpt:

To accommodate the rising call volume, Dr. Draper, the director of the Lifeline, says local crisis centers need more resources–and that a lack of resources contributes to centers leaving the network or shutting down. From 2008-2012, nine centers dropped out of the network and from 2013-2017, 23 centers dropped out. Just this year, three centers shut down.

Remaining centers do what they can to stay functioning. This often means taking on extra contracts, like running local crisis lines, to support their suicide prevention work.

Crisis Call Center, a Lifeline backup center in Nevada, operates a sexual assault support service program and a substance abuse hotline. They also provide child protective service reports and take elder protective service reports after hours. Rachelle Pellissier, its executive director, says they have to “cobble together” these different funding streams to offset the costs of the suicide prevention calls they take.

“We really need about $1.1 million to run this organization,” said Pellissier.

Centers like Provident in Missouri rely on their local United Way. The money they receive from the Lifeline, even as a backup center with more support, “pays for maybe two salaries of my 15 person team,” said Jane Smith, the director of life crisis services for Provident. “We’re a money-losing entity at Provident.”

If backup centers are unable to take a call, that call is routed from one backup center to the next, until a counselor can talk. “All the calls can be answered. The only question is, how long do people wait?” Draper said.

The info is here.

Culture and Moral Distress: What’s the Connection and Why Does It Matter?

Nancy Berlinger and Annalise Berlinger
AMA Journal of Ethics. June 2017, Volume 19, Number 6: 608-616.

Abstract

Culture is learned behavior shared among members of a group and from generation to generation within that group. In health care work, references to “culture” may also function as code for ethical uncertainty or moral distress concerning patients, families, or populations. This paper analyzes how culture can be a factor in patient-care situations that produce moral distress. It discusses three common, problematic situations in which assumptions about culture may mask more complex problems concerning family dynamics, structural barriers to health care access, or implicit bias. We offer sets of practical recommendations to encourage learning, critical thinking, and professional reflection among students, clinicians, and clinical educators.

Here is an excerpt:

Clinicians’ shortcuts for identifying “problem” patients or “difficult” families might also reveal implicit biases concerning groups. Health care professionals should understand the difference between cultural understanding that helps them respond to patients’ needs and concerns and implicit bias expressed in “cultural” terms that can perpetuate stereotypes or obscure understanding. A way to identify biased thinking that may reflect institutional culture is to consider these questions about advocacy:

1. Which patients or families does our system expect to advocate for themselves?
2. Which patients or families would we perceive or characterize as “angry” or “demanding” if they attempted to advocate for themselves?
3. Which patients or families do we choose to advocate for, and on what grounds?
4. What is our basis for each of these judgments?

The article is here.

Health Insurers Are Still Skimping On Mental Health Coverage

Jenny Gold
Kaiser Health News/NPR
Originally published November 30, 2017

It has been nearly a decade since Congress passed the Mental Health Parity And Addiction Equity Act, with its promise to make mental health and substance abuse treatment just as easy to get as care for any other condition. Yet today, amid an opioid epidemic and a spike in the suicide rate, patients are still struggling to get access to treatment.

That is the conclusion of a national study published Thursday by Milliman, a risk management and health care consulting company. The report was released by a coalition of mental health and addiction advocacy organizations.

Among the findings:

• In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.


• Insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.


• State statistics vary widely. In New Jersey, 45 percent of office visits for behavioral health care were out-of-network. In Washington, D.C., it was 63 percent.

The researchers at Milliman examined two large national databases containing medical claim records from major insurers for PPOs — preferred provider organizations — covering nearly 42 million Americans in all 50 states and D.C. from 2013 to 2015.

The article is here.

Physician licensing laws keep doctors from seeking care

Bab Nellis
Mayo Clinic New Network

Despite growing problems with psychological distress, many physicians avoid seeking mental health treatment due to concern for their license. Mayo Clinic research shows that licensing requirements in many states include questions about past mental health treatments or diagnoses, with the implication that they may limit a doctor's right to practice medicine. The findings appear today in Mayo Clinic Proceedings.

“Clearly, in some states, the questions physicians are required to answer to obtain or renew their license are keeping them from seeking the help they need to recover from burnout and other  emotional or mental health issues,” says Liselotte Dyrbye, M.D., a Mayo Clinic physician and first author of the article.

The researchers examined the licensing documents for physicians in all 50 states and Washington, D.C., and renewal applications from 48 states. They also collected data in a national survey of more than 5,800 physicians, including attitudes about seeking mental health care.

Nearly 40 percent of respondents said they would hesitate in seeking professional help for a mental health condition because they feared doing so could have negative impacts on their medical license.

The article is here.

The target article is here.

Jimmy Kimmel Monologues on Health Care Legislation

Jimmy Kimmel keeps it simple on Graham-Cassidy healthcare legislation.

Study suggests why more skin in the game won't fix Medicaid

Don Sapatkin
Philly.com
Originally posted July 19, 2017

Here is an excerpt:

Previous studies have found that increasing cost-sharing causes consumers to skip medical care somewhat indiscriminately. The Dutch research was the first to examine the impact of cost-sharing changes on specialty mental health-care, the authors wrote.

Jalpa A. Doshi, a researcher at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, has examined how Americans with commercial insurance respond to cost-sharing for antidepressants.

“Because Medicaid is the largest insurer of low-income individuals with serious mental illnesses such as schizophrenia and bipolar disorder in the United States, lawmakers should be cautious on whether an increase in cost sharing for such a vulnerable group may be a penny-wise, pound-foolish policy,” Doshi said in an email after reading the new study.

Michael Brody, president and CEO of Mental Health Partnerships, formerly the Mental Health Association of Southeastern Pennsylvania, had an even stronger reaction about the possible implications for Medicaid patients.

The article is here.

Taking Single-Payer Seriously

Dave Kamper
Jacobin Magazine
Originally published May 28, 2017

Here is an excerpt:

Medicare for All wouldn’t just scrap Obamacare — it would uproot the entire industry. It would be a huge efficiency savings. But it would also be devastating in the short term for hundreds of thousands of working people whose only crime was getting a job at an insurance company, and the hundreds of thousands more who work as billing specialists for clinics and hospitals (the number of medical assistants shot up 44 percent between 2011 and 2016). Yes, the CEO of United Health Group made $101 million in 2011. But few of the 230,000 other people working for the company saw money like that.

Bernie Sanders’s recently announced Medicare for All plan asserts that we “need a health care system that significantly reduces overhead, administrative costs, and complexity,” and projects that his plan would save $6 trillion over ten years.

The article is here.

Crowdfunding FOR MEDICAL CARE: Ethical Issues in an Emerging Health Care Funding Practice

Jeremy Snyder
The Hastings Center Report
November 22, 2016

Abstract

Crowdfunding websites allow users to post a public appeal for funding for a range of activities, including adoption, travel, research, participation in sports, and many others. One common form of crowdfunding is for expenses related to medical care. Medical crowdfunding appeals serve as a means of addressing gaps in medical and employment insurance, both in countries without universal health insurance, like the United States, and countries with universal coverage limited to essential medical needs, like Canada. For example, as of 2012, the website Gofundme had been used to raise a total of 8.8 million dollars (U.S.) for seventy-six hundred campaigns, the majority of which were health related. This money can make an important difference in the lives of crowdfunding users, as the costs of unexpected or uninsured medical needs can be staggering. In this article, I offer an overview of the benefits of medical crowdfunding websites and the ethical concerns they raise. I argue that medical crowdfunding is a symptom and cause of, rather than a solution to, health system injustices and that policy-makers should work to address the injustices motivating the use of crowdfunding sites for essential medical services. Despite the sites’ ethical problems, individual users and donors need not refrain from using them, but they bear a political responsibility to address the inequities encouraged by these sites. I conclude by suggesting some responses to these concerns and future directions for research.

The article is here.

State mental hospitals were closed to give people with mental illness greater freedom

but it increased the risk they’d get no care at all.

By The Spotlight Team
The Boston Globe
Originally posted August 28, 2016

Here is an excerpt:

The result is a system that’s defined more by its gaps and gross inadequacies than by its successes — severely underfunded, largely uncoordinated, often unreliable, and, at times, startlingly unsafe. It is a system that prizes independence for people with mental illness but often ignores the accompanying risks to public safety. A system that puts blind belief in the power of antipsychotic drugs and immense trust in even the very sickest to take them willingly. A system that too often leaves people in mental health crisis with nowhere to turn.

It was never supposed to be this way. President Kennedy and his allies recognized the grim state of America’s mental institutions — which at their peak housed nearly 560,000 people — and promised a robust, humane system of community-based treatment in their place.

The article is here.

South Dakota Wrongly Puts Thousands in Nursing Homes, Government Says

By Matt Apuzzomay
The New York Times
Originally posted May 2, 2016

When patients in South Dakota seek help for serious but manageable disabilities such as severe diabetes, blindness or mental illness, the answer is often the same: With few alternatives available, they end up in nursing homes or long-term care facilities, whether they need such care or not.

In a scathing rebuke of the state’s health care system, the Justice Department said on Monday that thousands of patients were being held unnecessarily in sterile, highly restrictive group homes. That is discrimination, it said, making South Dakota the latest target of a federal effort to protect the civil rights of people with disabilities and mental illnesses, outlined in a Supreme Court decision 17 years ago.

The Obama administration has opened more than 50 such investigations and reached settlements with eight states. One investigation, into Florida’s treatment of children with disabilities, ended in a lawsuit over policies that placed those children in nursing homes. With its report Monday, the Justice Department signaled that it might also sue South Dakota.

The article is here.

Identifying mentally ill 'frequent fliers' first step to reducing police contact

Press Release
Oregon State University
Originally published February 11, 2015

Identifying the population of people with mental illness who have frequent contact with police could help law enforcement officials and community agencies allocate limited resources to those with the highest needs, new research from Oregon State University indicates.

These individuals, often referred to as “frequent fliers” because of their repeated interaction with law enforcement, can consume a large amount of police time and resources, according to researchers in the School of Public Policy in OSU’s College of Liberal Arts.

Identifying and understanding the population can aid policymakers as they work to reduce the frequent and time-consuming interactions, sociologists Scott Akins and Brett Burkhardt said.

“This contact is rarely criminal in nature at the outset,” said Burkhardt, an assistant professor of sociology. “It’s usually a peace officer custody arrest, which is a type of arrest that occurs because a person is believed to be a danger to themselves or others due to a suspected mental illness. But there’s a limited amount of resources, so if we identify people with the highest needs, we can focus resources on those folks.”

Once a local region has identified its population of frequent fliers, community agencies and policy-makers can use the information to change or implement policies to assist those with the highest needs, the researchers said.

“It’s a strategic way to create a more cost-effective and humane way to assist the mentally ill,” said Akins, an associate professor of sociology.

The entire press release is here.

Medical Necessity and Unnecessary Care

By Paul Keckley
The Health Care Blog
Originally posted January 29, 2015

Unnecessary care that’s not evidence-based—usually associated with excess testing, surgical procedures or over-prescribing—accounts for up to 30% of what is spent in healthcare. In recent months, enforcement actions against physicians and hospitals have gained increased attention. But unnecessary care and over-utilization is not a new story or one that’s easy to understand.

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What does it mean?

Documentation is key. Accurate clinical documentation across sites and systems of care is table stakes.

Transparency about medical necessity and unnecessary care is assured. Data about the performance of every practitioner, hospital, and health system will be widely accessible.

The entire blog post is here.

Dilemma over deductibles: Costs crippling middle class

By Laura Ungarand Jayne O'Donnell
The Battle Creek Enquirer
Originally published January 2, 2015

Here are two excerpts:

A recent Commonwealth Fund survey found that four in 10 working-age adults skipped some kind of care because of cost. The portion of workers with annual deductibles — what consumers must pay before insurance kicks in — rose from 55% eight years ago to 80% today, according to research by the Kaiser Family Foundation.

A Mercer study showed that 2014 saw the largest one-year increase in enrollment in “high-deductible plans” — from 18% to 23% of all covered employees.

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Doctors and doctor groups say such individual coping strategies can be helpful, but action is needed on a national level. The American Academy of Pediatrics recently came out with a policy statement saying high-deductible plans “may be a less desirable way to lower health care costs than other means … even if ‘other means’ require more work by government, insurance companies and other health policy participants.”

The entire story is here.

Early Death for Severe Mental Illness?

By Allen Frances
The Huffington Post Blog
Originally published December 30, 2014

People diagnosed with serious mental illness -- schizophrenia, bipolar disorder, or severe depression -- die 20 years early, on average, because of a combination of lousy medical care, smoking, lack of exercise, complications of medication, suicide, and accidents. They are the most discriminated-against and neglected group in the U.S., which has become probably the worst place in the developed world to be mentally ill.

In many previous blog posts I have bemoaned the shameful state of psychiatric care and housing for people with severe mental illness. My conclusion was that the United States has become the worst place, and now the worst time ever, to have a severe mental illness. Hundreds of thousands of the severely ill languish inappropriately in prisons. Additional hundreds of thousands are homeless on the street.

The entire blog post is here.