MHA News Now

Department of Mental Health announces Mississippi Suicide Prevention Plan

The Mississippi Department of Mental Health (DMH) has released its first state plan for suicide prevention, making an important step in efforts to prevent the loss of lives by suicide in Mississippi.

Though the agency and its partners in the community have worked for years at suicide prevention efforts and to fight the misconceptions of mental illness, the Mississippi Suicide Prevention Plan marks the first time a comprehensive plan has been formalized and adopted. It is available on the DMH web site. Its release in September carries special significance as September is Suicide Prevention Awareness Month.

“Whether we realize it or not, many of our friends and neighbors have been affected by suicide or mental illness,” DMH Executive Director Diana Mikula said. “Suicide affects people across all ages, races, and backgrounds, but through collaboration, sharing resources, and working towards common goals, we can prevent the tragedy of suicide.”

The plan contains three core sections: Assessment, Capacity, and Goals and Objectives. The Assessment section addresses demographics and trends in the mental health field. The Capacity section examines resources that are currently available to help address suicide. The Goals and Objectives section are the specific targets DMH is working towards with the plan.

Also included throughout the plan are a series of stories written by people who have been affected by suicide, either as loved ones or friends of someone who took his or her own life, or as people who have attempted suicide or had suicidal thoughts themselves. Though some names have been changed, they are all the experiences of Mississippians who have faced tragedy.

Mississippi Board of Mental Health member Teresa Mosley shared her own personal experiences in the story, telling of the loss of her daughter Elisabeth.

“There was such a stigma attached to suicide and I wanted to share Elisabeth’s story in an attempt to start a conversation with individuals whose lives had been touched by this tragedy,” she writes in her story in the plan.

She said that unless someone is a suicide survivor, others have no idea how it feels to lose someone to the tragedy of suicide.

“When studying suicide, we like to look at statistics,” Mosley said. “However, those statistics don’t really make it real. It’s real when you love one of the numbers.”

Suicide is the 12^th leading cause of death overall in Mississippi, but among people aged 10 to 24-years-old, it is the third leading cause of death. Suicide rates also increase with age, and older adults have the highest suicide rates.

The plan’s four goals hope to address those statistics, leading to greater coordination of suicide prevention activities, increase partnerships between public and private organizations, and promoting and improving mental health literacy and attitudes about mental health.

Mississippi’s First Lady, Deborah Bryant, shared a letter in the plan mentioning how she had been affected by suicide.

“I have seen first-hand the effect that suicide has on people’s lives, and my hope is that we do all we can to prevent unnecessary deaths by suicide,” she said.

She also notes that suicide affects people in all walks of life.

“People from all populations – young adults, military, older adults, males, and females – will be impacted by the goals and objectives in this Plan. An integrated and coordinated effort is essential to prevent suicide attempts and deaths, and to save the lives of those we love,” she wrote.

One thing all Mississippians should be aware of now is the National Suicide Prevention Lifeline. DMH is the statewide provider for this lifeline in Mississippi, and the line is staffed 24 hours a day, seven days a week. It can be reached at 1-800-273-8255. DMH also operates a toll-free helpline available at all hours by calling 1-877-210-8513.

Anyone who feels they need help, or who knows someone who appears to need help, is encouraged to call one of those numbers any time of the day and any day of the week. All calls are confidential and help is available at all times.

The Mississippi Suicide Prevention Plan is available on the DMH web site, www.dmh.ms.gov, located in the Resource Library.

Clinton Proposes Plan to Address Mental Health Treatment

Hillary Clinton rolled out a comprehensive plan to address millions of Americans coping with mental illness, pointing to the need to fully integrate mental health services into the nation's health care system. Clinton's campaign released a multi-pronged approach to mental health care on Aug. 29, aimed at ensuring that Americans would no longer separate mental health from physical health in terms of access, care and quality of treatment.

Read more here.

Influx of Fentanyl-laced counterfeit pills and toxic Fentanyl-related compounds further increases risk of Fentanyl-related overdose and fatalities

Health care professionals, first responders, medical examiners and coroners are being updated to new developments that have placed more people at risk for fentanyl-involved overdoses from IMF and may increase the risk of non-fatal and fatal overdose. These developments include the following: (1) a sharp increase in the availability of counterfeit pills containing varying amounts of fentanyl and fentanyl-related compounds (e.g., labeled as Oxycodone, Xanax, and Norco), (2) the potential for counterfeit pills containing fentanyl and fentanyl-related compounds to be broadly distributed across the United States which could impact states not previously impacted by IMF and persons using diverted prescription pills (i.e., licit drugs diverted for illicit purposes and involves the diversion of drugs from legal and medically necessary uses towards uses that are illegal and typically not medically authorized or necessary) the widening array of toxic fentanyl-related compounds being mixed with heroin or sold as heroin, including extremely toxic analogs such as carfentanil, and (4) continued increases in the supply and distribution of IMF.

In July 2016, the Drug Enforcement Administration (DEA) issued a nationwide report indicating that hundreds of thousands of counterfeit pills have been entering the U.S. drug market since 2014, some containing deadly amounts of fentanyl and fentanyl analogs. Traditionally, fentanyl and fentanyl analogs in the illicit market have been mixed into heroin or sold as heroin, often without the knowledge of the consumer, and have primarily impacted areas where white powder heroin is prevalent, including the Northeast, Midwest, and Southeast regions of the United States.

The influx of counterfeit pills, which closely resemble oxycodone, Xanax, and Norco, has increased the chance of fentanyl-involved overdoses among persons misusing prescription opioids or benzodiazepines who seek diverted medications on the illicit market, in addition to persons who inject, sniff, or snort drugs. Persons who misuse prescription pills are geographically widespread; thus, the potential risk for fentanyl overdose has spread beyond those regions previously known to be impacted by IMF, and could intensify the impact in regions already affected by IMF.

The supply, distribution, and potency of illicitly manufactured fentanyl and fentanyl-related compounds in the U.S. drug market is evolving. Carfentanil, an extremely potent fentanyl analog, has been detected in at least one state and is currently being investigated as a possibility in a few other locations.

Designed in 1974, carfentanil was previously used exclusively for veterinary use with large animals and is not approved for use in humans, as it has been shown to be 100 times more potent than fentanyl in animal studies. Other fentanyl-related compounds have been reported by the DEA National Forensic Laboratory Information System (NFLIS), which systematically collects drug identification results from drug cases submitted for analysis to forensic laboratories (referred to as drug submissions).

From 2014 to 2015 the number of drug submissions testing positive for acetyl fentanyl increased substantially, rising from 463 in 2014 to 1,870 in 2015, and in 2016, NFLIS reported increasing drug submissions testing positive for furanyl fentanyl (244 drug submissions from January to July 2016). States should be vigilant about the possibility of highly toxic fentanyl-related compounds becoming available in the illicit drug market, as well as other highly toxic synthetic opioid derivatives, such as U47700.
 

NFLIS has reported that the overall supply of illicitly manufactured fentanyl appears to have substantially increased from 2014 to 2015, with the number of drug submissions testing positive for illicitly manufactured fentanyl doubling during this period (from 5,343 to 13,882). The number of states reporting more than 100 fentanyl submissions also increased during this period from 11 to 15 .

Recently, according to NFLIS and National Seizure System (NSS) reports, the amount of fentanyl seized in the United States has nearly doubled; from October 2014 to September 2015, federal, state, and local law enforcement agencies seized a total of 167.7 kilograms of fentanyl, and through June, 2016, they seized 363.8 kilograms of fentanyl. CDC suggests the following actions in response to the increased risk of fentanyl overdose from IMF due to the influx of fentanyl-laced counterfeit pills, the widening array of highly toxic fentanyl-related compounds, and the continued expansion and geographic spread of the IMF supply:  

• Multiple dosages of naloxone may need to be administered per overdose event, because of fentanyl’s increased potency relative to other opioids. Orally-ingested counterfeit pills laced with fentanyl may require prolonged dosing of naloxone in the ED/hospital setting due to a delayed toxicity that has been reported in some cases.
• Facilitate access to Medication-Assisted Treatment (MAT). MAT is a comprehensive approach to addressing the needs of persons with opioid use disorders that combines the use of medication with counseling and behavioral therapies.  Providers should discuss treatment options with persons who have an opioid use disorder, and persons who have experienced an opioid-related overdose once they are stabilized.

For more information:     

CDC Health Advisory: Recommendations for Laboratory Testing for Acetyl Fentanyl and Patient Evaluation and Treatment for Overdose with Synthetic Opioid  

SAMHSA Opioid Overdose Toolkit

CEPOP Salutes: Hospital Networks Lead Efforts to Reduce Opioid-Related Injuries

The Collaborative for Effective Prescription Opioid Policies (CEPOP) is  hosting a webinar on August 15 that highlights innovators and leaders in the fight against the opioid epidemic. In the first installment of the CEPOP Salutes Award initiative, CEPOP will be highlighting Hospital Engagement Networks (HENs) for their efforts to combat prescription opioid misuse, abuse and diversion beginning with pain management in the inpatient setting.

Learn more and register online here.

Congress approves legislation that would allow nurse practitioners to prescribe buprenorphine

The Senate recently approved comprehensive legislation to address the opioid epidemic through education, prevention, treatment and rehabilitation. Among its provisions is one allowing nurse practitioners to prescribe buprenorphine.

The bill allocates $181 million in new spending on opioid programs this year and the expectation of $500 million in future spending. The bill establishes a multi-agency task force to develop best practices for prescribing and pain management, along with stringent pre-market review of new opioids by the Food and Drug Administration and increased access to opioid overdose reversal drugs and medication-assisted treatment.

President Obama is expected to sign the legislation, now approved by both the houses of Congress.

Medicaid plans can now pay mental health institutions. Most won't until 2017

A policy that lifts a 50-year ban on Medicaid pay for mental health institutions kicked in on July 5, but it may be months before many enrollees can take advantage of the new coverage. In April, the CMS finalized a policy allowing Medicaid managed-care plans to pay the facilities for short-term stays lasting 15 or fewer days in a month.

Learn more from Virgil Dickson for Modern Healthcare here.

CDC Launches Webinar Series on Revised Opioid Prescribing Guidelines

The Centers for Disease Control and Prevention (CDC) recently announced a webinar series to explore in detail its recently released opioid prescribing guidelines. More information about these webinars can be found on CDC's website here.

Below are the first four scheduled webinar topics and dates in the series.

• June 22 - Webinar 1: Overview of the CDC Guideline for Prescribing Opioids for Chronic Pain (Addressing Recommendations 1-12)
• July 27 - Webinar 2: Non-opioid treatments (Addressing Recommendation 1)
• August 3 - Webinar 3: Assessing benefits and harms of opioid therapy (Addressing Recommendations 1, 2, 7, 8)
• August 17 - Webinar 4: Dosing and titration of opioids (Addressing Recommendations 4, 5, 7) 

Click here for more information about this webinar series.

AHA report offers guidance to strengthen behavioral health workforce

A new report prepared by the American Hospital Association (AHA) Workforce Center offers information and guidance to help hospitals and health systems develop their behavioral health care workforce to meet future needs. Based on a literature review, the report looks at how hospitals and health systems are bridging the gap between the need for behavioral health care in their communities and a shortage of trained specialists. It also offers examples of how to integrate behavioral and physical health in new and innovative ways and spur dialogue among internal and external stakeholders on the issue.

In an AHASTAT blog post by Pamela Thompson, AONE CEO and AHA senior vice president, nursing/CNO, Thompson highlights specific advice from the report, including seven steps hospital leaders can take to strengthen their behavioral health workforce.

AHA, CDC Unveil Resource to Promote Conversations About Prescription Opioids

The American Hospital Association joined with the Centers for Disease Control and Prevention on June 7 in releasing a new resource to help clinicians and their patients communicate about the risks of prescription opioids. The one-page handout, “Prescription Opioids: What You Need to Know,” describes the risks of side effects of opioid use, along with safety tips for those using prescription opioids and alternative options for pain relief.

“Every day, hospitals see how misuse of and overdose from prescription opioids affects patients’ families, loved ones and communities,” said AHA President and CEO Rick Pollack. “We want patients to have open, honest conversations with their care providers about the best way to manage pain.”

The tool comes as the nation continues to confront an epidemic of opioid addiction and overdose. More than 1,000 people are treated in emergency departments each day for misusing prescription opioids.

Additional resources are available from both the AHA and the CDC.

Providers still burdened by separate privacy laws for substance abuse records, AHA says

Proposed changes to laws providing separate, strict privacy protection to substance abuse records won’t go far enough to help providers offer the best care to patients, according to the American Hospital Association. The AHA released a letter April 5 in response to proposed changes to the Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2, which currently requires providers to obtain explicit permission from patients to share substance abuse records with other providers.

Learn more here.