CEO Update | 67

SAMHSA Highlights Disaster Distress Line Following Recent Spate of Shootings Following mass shootings in California, Texas, and Ohio within one week, the Substance Abuse and Mental Health Services Administration (SAMHSA) urged survivors and first responders to use the agency’s Disaster Distress Hotline Helpline for immediate crisis counseling. The helpline is available 24 hours a day, seven days a week, to anyone dealing with the traumatic effects of a natural or human-caused disaster. “People who have been through a traumatic even can experience anxiety, worry, or insomnia,” Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use and the head of SAMHSA, said in a statement. “People seeking emotional help in the aftermath of a disaster can call 1-800-985-5990 or can text ‘TalkWithUs’ to 66746—and can begin the process of recovery.” NABH thanks its members and their teams for providing life-saving, behavioral healthcare services during and after disasters. Medical and Public Health Groups Urge Policymakers to Take Action on Gun Violence Seven medical and public health organizations this week called on policymakers to implement specific policy recommendations they say can reduce firearm-related injuries in the United States. The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Surgeons, the American Medical Association, the American Psychiatric Association, and the American Public Health Association—which together represent 731,000 U.S. physicians and 25,000 public health professionals—outlined their requests online in the Annals of Internal Medicine on Aug. 7. In it, the groups covered a range of issues, including background checks for firearm purchases, research on firearm injury and death, safe storage of firearms, and improved access to mental healthcare services. “The great majority of those with a mental illness or substance use disorder are not violent,” the article notes. “However, screening, access, and treatment for mental health disorders play a critical role in reducing risk for self-harm and interpersonal violence,” it continues. “This is particularly of concern for adolescents, who are at high risk for suicide as a consequence of their often impulsive behavior.” New Poll Examines Public Perception of Link Between Gun Violence and Mental Health A new Morning Consult/Politico poll this week found that of 1,960 registered voters, 48 percent place “a lot” of blame on mental illness for mass shootings, while another 35 percent place “some” blame on mental illness. The poll came days after back-to-back shooting sprees in El Paso, Texas, and Dayton, Ohio, and after President Trump referred to the shooters as “mentally ill monsters.” According to the results, the share of voters who blamed mental illness “a lot” is down from 54 percent in a survey taken a year ago, while the share who said mental illness plays “some” roll grew from 28 percent last year, which indicates a significant majority of the U.S. electorate sees a strong connection between mental health and mass shootings. A story about the poll in the Morning Consult said the slight change from last year is driven by a 12-point decrease in the share of Democrats and 9-point decrease in the share of Independents who heavily attribute mass shootings to mental illness. Among Republicans, about three in five place “a lot” of blame on mental illness for mass shootings, making it the No. 1 factor Republicans believe drive mass shootings. “This is a repeated message that is being put out there,” Bandy Lee, a Yale University psychiatrist and specialist in violence prevention programs, told the Morning Consult. “When a president says it, it has far-reaching cultural consequences.” NABH Recommends CMS Rewrite Special Conditions of Participation NABH on Thursday sent CMS a comment letter requesting the agency help reduce the administrative burden for providers. The letter is a response to CMS’ Request for Information (RFI) last month that seeks ideas on how to enhance the agency’s Patients Over Paperwork initiative. Launched in 2017, Patients Over Paperwork has worked to streamline regulations in healthcare that often take clinicians away from their primary purpose of caring for patients. NABH’s comment letter focuses on the psychiatric hospital Conditions of Participation (CoP) and the 60 distinct compliance elements referred to as “B-tags”. “These rules are intended to serve the important goal of ensuring patient safety and high-quality care. However, some of these requirements are now outdated,” NABH President and CEO Mark Covall writes in the letter.” In addition, many surveyors apply these criteria indiscriminately in the field, exposing providers to unpredictable citations and requiring costly alterations in their procedures, equipment, and facilities.” NABH also submitted a copy of The High Cost of Compliance, the association’s report that assesses the regulatory burden on the nation’s inpatient psychiatric facilities. The report, which address the B-tags, ligature risk and the Emergency Medical Treatment and Labor Act, found that these three regulatory areas impose $1.7 billion in compliance costs each year nationwide, which represent 4.8 percent of an average facility’s annual revenue for all inpatient psychiatric services from all sources. Click here to read NABH’s letter to CMS. CDC Highlights How Naloxone Can Help End the Opioid Crisis in Vital Signs Report The Centers for Disease Control and Prevention said this week the overdose-reversing drug naloxone saves lives—but only if it’s readily available when an overdose happens. CDC researchers reported in the latest Vital Signs study that despite a huge increase in naloxone prescribing in recent years, far too little naloxone is being dispensed in many areas of the United States that need it most. “Moreover, too few doctors are prescribing naloxone to patients receiving high-dose opioids or opioids plus benzodiazepines or to those with a substance use disorder as recommended by CDC’s Guideline for Prescribing Opioids for Chronic Pain,” the Atlanta-based agency said in a news release. According to the study, the number of naloxone prescriptions dispensed doubled from 2017 to 2018, and only one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions nationwide. Meanwhile, about 71 percent of Medicare prescriptions for naloxone required a copay, compared with 42 percent for commercial insurance. O’Neill Institute Reviews How States Support OUD Treatment Medication in Jails and Prisons A blog post from the O’Neill Institute for National and Global Health Law at Georgetown University Health Center this week explored recent state laws and appropriations on how different states are supporting opioid use disorder (OUD) treatment in their jails and prison systems. According to the blog, state legislators passed laws expanding access to treatment medications for OUD. In some states, legislators targeted their efforts to populations most at risk, including those who are incarcerated. “Upon leaving incarceration, an individual’s overdose risk skyrockets. Despite this, too few correctional institutions provide OUD treatment medications,” researchers Regina LaBelle (a 2019 NABH Annual meeting speaker) and Shelly Weizman, director and associate director, respectively, of the Addiction and Public Policy Initiative at Georgetown University Law Center, wrote. “In some cases, policymakers and jail administrators fear misuse of opioid treatment medications.” In Connecticut, Ohio, and Oklahoma, legislators have appropriated new funds to establish treatment programs using OUD medications for their incarcerated populations, while states such as Colorado and Maryland also passed legislation requiring county jails to phase in OUD medication treatment programs, LaBelle and Weizman noted. For questions or comments about CEO Update, please contact Jessica Zigmond.