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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Drug overdose deaths are continuing to rise in Illinois, specifically among Black and older residents, according to a newly published database by Northwestern University. [ Health News Illinois] 

Per the data, 729 adults between 55 and 64 died from overdose in 2021, compared to 473 in 2019. Of those, about 80 percent were opioid-related. 

Meanwhile, 610 Black Illinoisans died from overdose in 2021, compared to 357 in 2019.

Comparably, 426 white Illinoisans died from overdose in 2021, compared to 347 in 2019.

Maryann Mason, an associate professor of emergency medicine at Northwestern University Feinberg School of Medicine and lead faculty member behind the dashboard, said it's a “call for all hands on deck.”

“The dashboard gives a 10,000-foot view of how the illicit drug market has changed in Illinois,” she said. 

Additionally, the data show that heroin-related deaths dropped, while those related to fentanyl, cocaine and xylazine increased.

The Centers for Disease Control and Prevention and the Illinois Department of Public Health are funding the dashboard. 

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Bicycle Health is partnering with Albertsons to allow its patients with an opioid addiction to receive a buprenorphine injection from pharmacists at more than 700 of the grocery and pharmacy chain's locations. [Modern Healthcare]  

Opioid use disorder patients of the telehealth company in 17 states must first have a virtual visit with Bicycle Health before being prescribed the medication, which helps reduce people's dependence on opiates. Previously, the company's patients were only able to get prescriptions for oral buprenorphine at pharmacies including Albertsons.

The partnership does not include any financial agreement, a Bicycle Health spokesperson said.

 A study published in JAMA Network in June 2021 found patients prefer injectable buprenorphine to oral buprenorphine medication. 

“In the past, if a patient was a better fit for injectable medication, we would have to refer them to a local provider," said Bicycle Health CEO Ankit Gupta. "And it was almost impossible to find a local provider who was an expert in injectable buprenorphine, could administer it and manage all of the logistics required [around receiving the medication]." 

The move comes as the Drug Enforcement Agency scrutinizes the virtual prescribing of controlled substances. In May, the DEA extended until November flexibilities that allow telehealth companies to remotely prescribe certain controlled substances without an in-person visit. Earlier this year, the agency proposed that Schedule III-V substances like buprenorphine could only be prescribed via telehealth for an initial 30-day dose.

As the DEA figures out next steps, virtual companies like Bicycle and Talkiatry are pushing the agency for permanent flexibilities around remote prescribing. They’re also working on contingency plans. 

“A lot of our work does take into account what the DEA might or might not do,” Gupta said. “We’re always planning for contingencies because of the regulatory uncertainty we live in now." 

Albertsons did not respond to an interview request.

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Illinois Attorney General Kwame Raoul joined more than 30 colleagues this week to urge the Food and Drug Administration to take further steps to protect minors from e-cigarettes. [Health News Illinois]

Thirty-two attorneys general and one deputy attorney general wrote a letter commenting on a five-year strategic plan by the FDA’s Center for Tobacco Products. They recommended prohibiting all non-tobacco flavors in e-cigarettes, enacting limits on nicotine in e-cigarettes, restricting marketing and closing a “loophole” where disposable e-cigarettes are not subject to the same, existing enforcement guidance as cartridge e-cigarettes.

“The FDA is a critical partner in this effort, but it can and must do more,” Raoul said in a statement. “That is why we are urging the FDA to take additional steps to protect young people from nicotine addiction through e-cigarette usage.”

A spokesman for the FDA said they will respond directly to the attorneys general.

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Elected officials and advocates called for empathy Monday toward people with substance abuse disorders and increased options for treating and preventing opioid overdoses. [Chicago Tribune]

In his address to the crowd of volunteers, supporters and onlookers in Chicago’s Federal Plaza ahead of International Overdose Awareness Day on Thursday, Mayor Brandon Johnson repeated his campaign promise on so-called Treatment Not Trauma and called for a “public health approach” to reduce opioid deaths in Chicago.

“We must not criminalize and further harm our brothers and sisters in need,” Johnson said before dozens of volunteers and bystanders. “Substance use and abuse ... creates a ripple effect of devastation in our families and neighborhoods.”

“We must extend care,” he added, “not judgment.”

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Chicagoans with confirmed and probable cases of mpox have a high rate of co-infections with other sexually transmitted infections, according to an analysis by the Chicago Department of Public Health. [Health News Illinois]

The analysis also found racial disparities, with Black individuals being twice as likely than white individuals to have mpox and HIV co-infections. Latinx individuals had a 34 percent increase and Asian individuals had a 90 percent increase in HIV co-infection compared to white people.

Kara Herrera, an epidemiologist at the department, said the analysis highlights their ability to leverage surveillance and case management data to identify vulnerable populations that may need additional care. 

She said that at the time of mpox diagnoses, “we strongly encourage HIV-negative individuals to get on PreP for HIV and encourage healthcare providers to utilize the syndemic approaches by offering testing and prevention (for) STIs, HIV and infections such as mpox.”

Additionally, the agency suggested further investigation into the association between positive syphilis serology and HIV co-infection among people with mpox.

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As the Biden administration makes billions of dollars available to remove millions of dangerous lead pipes that can contaminate drinking water and damage brain development in children, some states are turning down funds. [PBS News Hour and the Chicago Tribune]. A cut pipe is pulled from a dig site for lead testing in Royal Oak, Michigan. Lead can lower IQ and create behavioral problems in children. 

Picture: Carlos Osorio AP2021

Washington, Oregon, Maine and Alaska declined all or most of their federal funds in the first of five years that the mix of grants and loans is available, The Associated Press found. Some states are less prepared to pay for lead removal projects because, in many cases, the lead must first be found, experts said. And communities are hesitant to take out loans to search for their lead pipes.

States shouldn’t “shrug their shoulders” and pass up funds, said Erik Olson, a health and food expert at the environmental group Natural Resources Defense Council.

“It’s troubling that a state would decide to take a complete pass on the funding because part of the reason for the funding is to figure out whether you even have lead,” Olson said.

The Biden administration wants to remove all 9.2 million lead pipes carrying water to U.S. homes. Lead can lower IQ and create behavioral problems in children. The 2021 infrastructure law provides $15 billion to find and replace them. That money will help a lot, but it isn’t enough to get all the toxic pipes out of the ground. State programs distribute the federal funds to utilities.

READ MORE: Officials test Yellowstone River water where train carrying hazardous materials fell in

The Environmental Protection Agency said it is reviewing state requests to decline funds but did not provide a full list of states that have said no so far. That information will be available in October, officials said. States that declined first-year funds can still accept them during the remaining four years.

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The number of people experiencing homelessness in Chicago increased between 2020 and 2021, according to a new estimate from Chicago Coalition for the Homeless. [Chicago Tribune-Lizzie Kane; Photo -Brian Cassella -Chicago Tribune]

The group finds that 68,440 people experienced homelessness in 2021, a 2,829 increase from the previous year, according to the coalition’s report published Thursday. The research shows shifts in the way people experienced homelessness, citing that 7,985 more people were staying on the street or in shelters as opposed to those temporarily staying with others compared with 2020 data.

The majority of people experiencing homelessness are people of color, with African American Chicagoans ending up homeless more because of racist economic, educational and housing practices, according to the coalition. The coalition finds that Latino Chicagoans are more likely to experience homelessness by doubling up with others. Most families who are experiencing homelessness, as well as many unaccompanied youth — those ages 24 and younger — are temporarily staying with others too.

The new estimate comes as Chicago Coalition for the Homeless is steering its Bring Chicago Home plan — a proposal to raise the real estate transfer tax on properties worth $1 million or more to pool additional funds to fight homelessness — through a City Council meeting and discussions with Mayor Brandon Johnson.

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 Tonjanic Hill was overjoyed in 2017 when she learned she was 14 weeks pregnant. Despite a history of uterine fibroids, she never lost faith that she would someday have a child. [KFF Health News]

But, just five weeks after confirming her pregnancy, and the day after a gender-reveal party where she announced she was having a girl, she seemed unable to stop urinating. She didn’t realize her amniotic fluid was leaking. Then came the excruciating pain. 

“I ended up going to the emergency room,” said Hill, now 35. “That’s where I had the most traumatic, horrible experience ever.”

An ultrasound showed she had lost 90% of her amniotic fluid. Yet, over the angry protestations of her nurse, Hill said, the attending doctor insisted Hill be discharged and see her own OB-GYN the next day. The doctor brushed off her concerns, she said. The next morning, her OB-GYN’s office rushed her back to the hospital. But she lost her baby, Tabitha Winnie Denkins.

Black women are less likely than women from other racial groups to carry a pregnancy to term — and in Harris County, where Houston is located, when they do, their infants are about twice as likely to die before their 1st birthday as those from other racial groups. Black fetal and infant deaths are part of a continuum of systemic failures that contribute to disproportionately high Black maternal mortality rates.

“This is a public health crisis as it relates to Black moms and babies that is completely preventable,” said Barbie Robinson, who took over as executive director of Harris County Public Health in March 2021. “When you look at the breakdown demographically — who’s disproportionately impacted by the lack of access — we have a situation where we can expect these horrible outcomes.”

In fact, Harris County ranks third, behind only Chicago’s Cook County and Detroit’s Wayne County, in what are known as excess Black infant deaths, according to the federal Health Resources and Services Administration. Those three counties, which also are among the nation’s most populated counties, account for 7% of all Black births in the country and 9% of excess Black infant deaths, said Ashley Hirai, a senior scientist at HRSA. The counties have the largest number of Black births but also more deaths that would not occur if Black babies had the same chance of reaching their 1st birthdays as white infants.

No known genetic reasons exist for Black infants to die at higher rates than white infants. Such deaths are often called “deaths of disparity” because they are likely attributable to systemic racial disparities. Regardless of economic status or educational attainment, the stress from experiencing persistent systemic racism leads to adverse health consequences for Black women and their babies, according to a study published in the journal Women’s Health Issues.

These miscarriages and deaths can occur even in communities that otherwise appear to have vast health resources. In Harris County, for example, home to two public hospitals and the Texas Medical Center — the largest medical complex in the world, with more than 54 medical-related institutions and 21 hospitals — mortality rates were 11.1 per 1,000 births for Black infants from 2014 through 2019, according to the March of Dimes, compared with 4.7 for white infants.

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