Several months ago, I interviewed the late Sally Zinman, a heroine of our mental health movement of people with lived experience. I asked what changes she would like to see in the mental health system in the future. Without hesitation she said that the system should value and encourage self-determination and totally voluntary, noncoercive services. [MedPage]

I will discuss here the dangers of involuntary commitment, and demonstrate the ways that I believe Emotional CPRopens in a new tab or window (eCPR), which I will define below, contributes to Zinman's vision.

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Since the end of the US Public Health Emergency on May 11, 2023, there has been a desire from elected officials and the public to put COVID-19 in the rearview mirror. However, the emergence of new variants and a summer wave of infections remind us that SARS-CoV-2 is here for the foreseeable future. This Viewpoint addresses the current state of COVID-19 in the US and summarizes key clinical information for health care professionals and patients. [JAMA Network]

Current State of COVID-19 in the US

With the end of the Public Health Emergency, COVID-19 surveillance in the US is no longer performed using case counts. Instead, wastewater surveillance and tracking of hospitalizations and deaths are the major indicators being used to understand trends. Since late June 2023, there has been a steady increase in the detection of SARS-CoV-2 in wastewater, a change that correlates with a bump in reported hospitalizations and deaths.

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Chicago Mayor Brandon Johnson and city council members unveiled an ordinance Thursday that would pave the way for implementing his plan to expand mental health clinical services and non-police responses for those experiencing behavioral and mental health crises. [Health News Illinois] The ordinance would establish a working group to develop a suggested framework for how to implement the Johnson administration’s plan. Members would look at budgetary needs, sources of revenue, staffing recruitment, retention strategies, capital and facility needs, and metrics to evaluate success. The group would include Chicago Department of Public Health staff as well as stakeholders from other city organizations. "Together, we will work to implement more holistic, collaborative solutions for the mental health crisis we face and ensure all Chicagoans have access to necessary resources and care,” Johnson said. The working group would be tasked with submitting its recommendations to city leaders by the end of May. Johnson’s mental health plan consists of several components, including the reopening of city-run mental health clinics that were closed under former Mayor Rahm Emanuel and the hiring of community health workers. ###

Some Chicago-area residents will be able to test the water quality in their homes as part of a Northwestern study that will begin providing free test kits later this year. [Chicago Tribune]

Awarded a $3 million federal grant, researchers plan to phase in testing over several years in 350 households, where residents will be able to begin testing immediately for lead. In subsequent years, they will also be able to test for other contaminants such as PFAS, or perfluoroalkyl and polyfluoroalkyl substances.

“The end goal is to empower people with knowledge: the knowledge of whether or not lead is in their water,” said Sara Young, who is leading the project with her husband, Julius Lucks, in a statement from Northwestern. “These tests do this by offering the same certainty and simplicity found in at-home COVID-19 and pregnancy tests.”

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A “critical problem” related to receiving additional Medicaid matching dollars led to the recent decision to suspend copays in the program that provides Medicaid-like coverage to undocumented individuals, an official from the Department of Healthcare and Family Services said Tuesday. [Health News Illinois] 

Omar Shaker, an attorney for the department, told members of the Joint Committee on Administrative Rules that the existing system did not allow them to receive matching federal dollars when a non-citizen requires an emergency room visit.

He said the department chose to suspend the copay rule until it can “draw in as much federal matching as possible in these situations.”

HFS sent a notice last week to providers saying they should not charge cost-sharing for the population “until further notice.” Any cost-sharing that providers may have already collected must be returned.

Shaker told lawmakers he could not pinpoint when it was decided to suspend the rule, but added conversations began about two weeks ago on whether the department could implement the match into their system without the need for a suspension.

He added there is no timeline for when copays may be reinstated, nor is there an estimate for how much could be recouped through the federal match.

 The rules, unveiled earlier this summer, include a pause on new enrollees between 42 and 64 and copays for hospital services not eligible for a federal match. Seniors can still join the program until their enrollment reaches 16,500, a threshold that officials recently said has yet to be reached.

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Over the past several years, many health care organizations — especially in response to the Black Lives Matter movement and the murders of George Floyd, Breonna Taylor, and others — made strong public declarations of their commitment to advance equity and racial justice. [ Beckers]

This attention was long overdue. Some have described this as the largest groundswell of energy focused on racial justice in decades.

This racial reckoning touched every industry, and health care systems were no exception. Yet, while many companies rushed to hire chief diversity officers, chief equity officers, and similar positions several years ago, the Wall Street Journal recently reported that many organizations are now shedding these positions or rolling back their initial commitments. In too many cases, positions created to advance equity were neither adequately resourced nor given clear and specific objectives. As a result, the top-tier talent who filled these roles were not set up to achieve the results that people have hoped for, leading to much frustration.

This is a troubling development and should be seen as a call to recommit ourselves to advancing equity, diversity, and inclusion. Some organizations may simply be recalibrating or rethinking how they want to do this work. But others may be abandoning these equity leadership roles and initiatives because the effort is more difficult, more complex, and takes longer than they expected. Instead of pulling back, individual organizations should consider how taking part in coordinated and collective action could strengthen their anti-racism and equity efforts.

Don’t Go It Alone

The Institute for Healthcare Improvement (IHI), the organization that I lead, has joined with the American Medical Association (AMA), in collaboration with Race Forward and a growing list of organizations, to create the Rise to Health Coalition. The Coalition brings together individuals and organizations committed to equity and justice within the health ecosystem to build, lead, and advance shared solutions and collective actions to transform and strengthen health care. We have invited a coalition of individual practitioners, health care organizations, professional societies, payers, and pharmaceutical, research, and biotechnology organizations to deliver more equitable care outcomes to patients, families, and entire communities. 

The theory behind the Rise to Health Coalition is that no individual or single organization can advance equity and justice alone, and three years into our equity commitments, many organizations are now at an inflection point. This is neither the first nor the last time we will face such a moment. But, as we have in the past, we must now commit ourselves anew to taking action with colleagues and communities to build a future where health and care are better, fairer, and more equitable. 

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A summer COVID-19 wave may have already crested in Illinois. [Health News Illinois] 

Dr. Arti Barnes, chief medical officer for the Department of Public Health, told officials late last week that hospital admissions for COVID-19 are falling, and that while pediatric intensive care unit capacity is down, it’s not being driven by COVID-19.

“I'm not going to go as far as to say that we're not going to see another second wave coming up deeper into the winter, but at least it looks like this is one slightly reassuring piece of news,” Barnes said at a State Board of Health meeting.

Low takeup of COVID-19 booster shots this fall, coupled with inequitable access to treatments, could lead to a higher rate of hospitalizations for high-risk groups, according to Barnes. But, she expects that the booster shots will be effective against the mix of variants they’ve recently seen in Illinois. 

“No one variant is dominating any more in this new COVID era,” Barnes said. “Which, again, means we're heading towards endemicity to some part.”

Meanwhile, Barnes is hopeful that new vaccines and treatments will mitigate respiratory syncytial virus cases this fall and that the flu season will be more moderate than last year, based on a gentler and faster than expected peak in the Southern Hemisphere. 

 “Of course, you know all predictions come back to bite you, so hopefully this will hold true,” she said.

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The COVID-19 pandemic has led to unprecedented mental health disturbances, burnout, and moral distress among health care workers, affecting their ability to care for themselves and their patients. [Science Direct]

RESEARCH QUESTION: In health care workers, what are key systemic factors and interventions impacting mental health and burnout?

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Download PDF of white paper here>

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Addressing the Mental Health Crisis in Youth—Sick Individuals or Sick Societies? | The prevalence of anxiety and depression has been increasing in the US as well as in many other parts of the world. This trend, beginning in the 2010s, has largely been concentrated among adolescents and youth.1 [JAMA Network]

At least 2 broad sets of characterizations have been proposed in the scientific literature and lay press, the first viewing this increase as an epidemic of psychiatric disorders2 while the other seeing the increase in psychological distress in youth as reflective of sociopolitical adversity and disorganization.3

At the risk of oversimplification, this contrast may be viewed as a sick individuals vs sick society polarity. Such explanatory dualities present clinicians with the challenge of how to navigate concerns about excessive medicalization and address complex social determinants of health in clinical settings. Moving past conceptual binary constructs fueling this polarization can be an important first step in addressing the mental health crisis in youth. Herein, we discuss the reasons for this polarization, strategies to overcome it, and how these insights should inform clinical practice.

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The Department of Healthcare and Family Services said Tuesday it will delay implementation of copays for healthcare services provided to those in the state program that provides Medicaid-like coverage for undocumented individuals. [Health News Illinois] 

Medicaid Administrator Kelly Cunningham said in a notice that providers should not charge cost-sharing for the population “until further notice.” Any cost-sharing that providers may have already collected must be returned.

“HFS will issue a provider notice with implementation guidance when the necessary provider reimbursement programming is in place,” she said.

The department did not return a request for additional comment.

The rules, unveiled earlier this summer, include a pause on new enrollees between 42 and 64 and copays for hospital services not eligible for a federal match. Seniors can still join the program until their enrollment reaches 16,500, a threshold that officials recently said has yet to be reached.

Tovia Seigel, director of the Healthy Illinois Campaign, said in a statement they are relieved by Tuesday’s decision as copays significantly burden individuals seeking care.

“We stand ready to work with (the department) to find fiscally responsible ways to make this delay a permanent policy and protect the … programs that thousands of immigrants rely on for critically important healthcare services,” she said.

HFS’ announcement comes as advocates for the program renewed their call for the Pritzker administration to reverse its decision to place restrictions on the program.

Nadeen Israel, senior vice president of policy and advocacy at AIDS Foundation Chicago, said at a public hearing that they understand the state faces financial challenges, but ensuring access to healthcare services is a necessity for the undocumented population.

“Investing in this care now will help save the state money in the long run,” she said, noting her organization is also part of the Healthy Illinois Campaign that has advocated for the expansion of the program. “We are ready to work with you to calculate and identify those cost savings.”

Advocates said Tuesday that the copays for hospital services not eligible for a federal match, such as $250 for inpatient hospitalizations and $100 for emergency room visits, could drive immigrants away from receiving healthcare.

“Therefore, immigrants will be less likely to even seek preventive care, which ultimately drives up the cost of emergency room visits,” said Edith Avila Olea, policy manager at the Illinois Coalition for Immigrant and Refugee Rights.

Additionally, she said several questions remain unanswered, such as whether enrollment will reopen after the planned transfer of members to Medicaid managed care occurs next year.

Others remain concerned that the agency has yet to provide a customer notice for individuals enrolled in the program as well as a provider notice to better clarify the copay process, specifically to aid individuals for whom English may not be a first language.

Andrea Kovach, an attorney at the Shriver Center for Poverty Law, said the current language does not ensure enrollees are informed if they will incur cost-sharing before receiving services, nor which services will be covered.

If the department will not pull the language related to cost-sharing, Kovach suggested they amend it to include an annual cap on the amount incurred by an enrollee.

 HFS Chief of Staff Ben Winick said the goal of Tuesday’s hearing is to take public feedback before the filing of a second notice of the rules to the Joint Committee on Administrative Rules.

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