Join this virtual session on Feb. 25, 2022: Mental Health During The COVID Pandemic: A Status Report. 

We will have a dynamic overview of the mental health consequences of the COVID pandemic. First, we present studies on increasing mental illness prevalence and the developing mental health provider gap. Secondly,  Aunt Martha's Health and Wellness, a leading provider in the State of Illinois, will present their experience with the demand and provision of services. Finally, we will examine some of the best emerging practices nationally and regionally implemented by municipal governments, health systems, or other care providers.

Speakers

Maurice Lemon, MD, MPH, Co-Chair of the Program Committee and Billings Fellow 

Wanda Parker, EdD, Clinical Director, Aunt Martha's Health and Wellness 

Karen Batia, PhD, Consultant, Health Management Associates 

More details and to register, visit this page.

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Deaths among middle-age U.S. adults have increased substantially this century, reversing decades of progress. [ Melanie Padgett Powers The Nation's Health January 2022, 51 (10) 16]

Among the primary drivers are drug poisonings, alcohol-related causes, suicide and cardiometabolic diseases, which include cardiovascular disease, diabetes and chronic kidney failure, according to a March consensus study report from the National Academies of Science, Engineering and Medicine.

Life expectancy progress in the U.S. stalled in 2010 then fell between 2014 and 2017, the longest sustained decline in a century.

Report committee members examined mortality trends from 1990 through 2017 for people ages 25-64 by age, sex and geography. While they also looked at information by race and ethnicity, data on mortality trends among Asian Americans and American Indians and Alaska Natives was lacking.

The committee found that since 2010, death rates either leveled off or increased. Three groups had higher all-cause mortality rates in 2017 than they did 27 years before: white males ages 25-44, white females ages 25-44 and white females ages 45-54.

Drug poisonings were the largest contributor to all-cause mortality, according to Darrell Gaskin, PhD, MS, a professor at Johns Hopkins Bloomberg School of Public Health who served on the report committee. They increased in every demographic group studied and in every state, especially in Appalachia and parts of the Northeast. The largest increases were among white males ages 25-44, urban residents, people with lower education levels, and urban Black men ages 55-64.

The committee pointed to two themes underlying the increases: increased availability and increased vulnerability. The rise in drug poisoning deaths — which encompasses drug overdoses — is connected to the emergence of opioids being prescribed for non-cancer pain, coupled with opioid overprescribing and regulatory failures, Gaskin said during APHA’s 2021 Annual Meeting and Expo in October.

“The pharmaceutical industry had convinced the regulators that addiction would not be a problem with this pain treatment,” he said. “Unfortunately, the technology they used to develop these opioid treatments was easily defeated by users.”

The second wave of the opioid crisis began as policymakers and regulators placed restrictions on opioid prescribing, which caused many users to transition to heroin and fentanyl. A third wave of the crisis began when illegal drug suppliers began to mix other drugs with fentanyl. Overdoses spiked, and in 2010, fentanyl deaths surpassed heroin deaths.

Despite all this, the problem is bigger than the opioid crisis, Gaskin said. Deaths from cocaine and methamphetamine use also increased in the 2010s, as did alcohol use, linked to price decreases, increased availability, deregulation and flavored beverages.

“This trend in working-age increased mortality is a uniquely American phenomenon,” said Steven Woolf, MD, MPH, a professor at Virginia Commonwealth University who also served on the report committee. “It’s not happening in other high-income countries, so there’s a real need for cross-national research to understand ‘what is it about America that is responsible for this particular phenomenon?’”

For more information on “High and Rising Mortality Rates Among Working-Age Adults,” visit www.nap.edu.

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Sports betting exploded in Maryland in 2020, thanks to a new state law that allowed a range of online and in-person betting options at sport stadiums, horse racing tracks, state fairgrounds and six casinos, including one on a riverboat. [ Aaron Warnick The Nation's Health January 2022, 51 (10) 20]

The Maryland law is not an outlier. Across the U.S., states are looking for new revenue sources and betting companies are ready to set up shop. But mental health and addiction professionals worry the expansion could create or worsen gambling disorders, which already affect millions of Americans. In a given year, about 2% of people in the U.S. engage in problem gambling behaviors.

“In my view, the relationship between gambling and public health is similar to its relationship with alcohol,” said Rachel Volberg, PhD, a gambling addiction researcher at the University of Massachusetts Amherst’s School of Public Health and Health Sciences. “Gambling for the most part now is a legal but risky consumer product.”

In 2018, the U.S. Supreme Court overturned a federal law that prohibited most states from legalizing sports betting. Since then, all but a few states have considered allowing the practice. In under two years, the number of states with legal sports betting accelerated from one to 31, in addition to the District of Columbia.

Many people who live where sports gambling is now legal are eager to place bets. A September 2021 survey from the American Gaming Association found that a record-high 45.2 million Americans planned to bet on professional football during the 2021-2022 season — an increase of 36% over last season. Nearly 20 million adults planned to place a bet online, a 73% increase from 2020, the survey found.

Sports betting can be done anywhere in a legal jurisdiction, from a sports bar to the dinner table, all on a smartphone or other mobile device. Casino and sports-adjacent brands are investing in internet and mobile platforms as well as sleek advertising campaigns featuring celebrities and professional athletes.

“Everyone now has a casino in their pocket,” Keith Whyte, director of the National Council on Problem Gambling, told The Nation’s Health.

One investor is Caesars Entertainment, which has pledged $1 billion toward its digital products. Much of the spending will be for ads during NFL games. On Nov. 9, the company announced a partnership with former football players Peyton and Eli Manning, who will appear in advertisements and live events promoting sports betting.

One concern is that flashy, high-budget ad campaigns from gambling companies are now more common and targeting youth. According to Yale Medicine, which conducts research on gambling, as many as 7% of youth develop a gambling disorder, compared with about 1% of adults. Gambling can hold a special allure for disadvantaged youth, Volberg said.

Among those that are tackling the problem is the Massachusetts Department of Public Health’s Office of Problem Gambling Services, which funds youth-serving organizations to integrate underage gambling prevention. Youth in the programs are paid to use photography to document how gambling impacts their community.

The program empowers youth to “showcase their findings to community members and influencers to motivate and enact policy change,” according to presenters who spotlighted the work at APHA’s 2021 Annual Meeting and Expo in October.

Casino and sports-adjacent brands are investing in internet and mobile platforms as well as sleek advertising campaigns.

Photo by Hirurg, courtesy iStockphoto

Working to prevent problem gambling

More than a dozen states now receive at least 10% of their general revenue from in-state gambling, according to the National Council on Problem Gambling.

A portion of gambling taxes is directed to preventive organizations, including the National Council on Problem Gambling and its state affiliate associations. The council operates a national gambling hotline, and many state universities and health departments run treatment and prevention efforts, ranging from support groups, addiction treatment centers and outreach to at-risk people.

The most common approach for prevention advocates is not to call for prohibition outright, but rather push for a share of the gaming tax revenue to be directed to treatment and prevention efforts.

Chartered in 2012, the University of Maryland’s Center on Excellence on Problem Gambling has grown with the increasing need, said Blair Inniss, JD, MA, government relations director. And data soon to be published by the center shows that problem gambling has risen in Maryland since 2018, when the federal ban lifted but betting was still illegal in the state, she told The Nation’s Health.

As an example of how widespread sports betting could become in Maryland, Inniss pointed to a survey given three years before the state legalized sports betting. It showed that while the state lottery was No. 1 for gambling, sports betting came in at No. 4.

“And let’s remember, that was in 2017, so respondents were admitting to illegal sports betting,” said Innis, who presented about the Maryland center’s work during APHA’s Annual Meeting. “That’s how we can be so certain that number is going to increase once it becomes legal and easily accessible.”

About 2 million U.S. adults are estimated to have severe gambling problems or addiction, according to the National Council on Problem Gambling. Up to 6 million more may have mild or moderate problems.

According to the American Psychiatric Association, gambling disorder involves “repeated problematic gambling behavior that causes significant problems or distress.” The disorder is classified as a behavioral addiction in the American Psychiatric Association’s diagnostic manual.

Problem gambling is more common in men, people of color and in those with mood or personality disorders. People with psychiatric disorders such as major depression are much more likely to develop gambling problems, according to a 2008 study.

Medication and therapy can help, but fewer than 10% of people with a gambling disorder seek treatment, according to the American Psychiatric Association.

For more on problem gambling, visit www.ncpgambling.org and bit.ly/APAgambling.

• Copyright The Nation’s Health, American Public Health Association

When COVID-19 safety measures led schools and workplaces to close in spring 2020, 25% of households with children experienced food security. [ Mark Barna The Nation's Health January 2022, 51 (10) 17]

In response, the U.S. Department of Agriculture issued a series of waivers and flexibilities that allowed school districts and other local sponsors to continue operating child nutrition programs through school systems. The waivers reduced longstanding barriers in child nutrition efforts, dramatically increasing participation in the summer school meals program, according to research presented at APHA’s 2021 Annual Meeting and Expo in October.

Research conducted in Maryland, North Carolina and New York during the first six months of the COVID-19 pandemic found that participation in school meal programs lagged in spring but increased dramatically in summer. In Maryland, for example, which has about 1,500 schools and 1 million students, school meal programs served 6.5 million additional meals in summer 2020. The increase represented a 210% jump over summer 2019.

Eligibility waivers made the difference, researchers said. USDA waived its requirement that meals be served in group settings, which meant families could take advantage of grab-and-go drive-up services and pre-order meals. The agency also extended the hours meals could be available. Many states, meanwhile, took advantage of the federal option of expanding the geographic region where students could get meals.

USDA eligibility waivers for the federal school meals program increased student participation, serveral studies say.

Photo by Wavebreakmedia, courtesy iStockphoto

The highest increase in summer meal program participation occurred in June and August.

School meal participation is associated with improved food security, dietary quality and academic performance, said Susan Gross, PhD, MPH, an associate scientist and nutritionist at Johns Hopkins Bloomberg School of Public Health who co-authored the Maryland study. USDA waivers allowed for innovation in preparing and distributing meals to meet student needs. Availability and accessibility of meals improved participation.

“We see now that out-of-school meal time is a really crucial time,” said Gross, an APHA member.

APHA has repeatedly called for expanding children’s access to school meals. The Association is a member of the National Alliance for Nutrition and Activity coalition, which advocates for child nutrition programs that protect and strengthen evidence-based nutrition standards for school meals and other foods sold in schools. Through the coalition and separately, APHA has supported strengthening, protecting and expanding access to school nutrition programs.

In April, USDA announced an extension of school meal waivers through the 2021-2022 school year. Four months later, Johns Hopkins and Maryland Hunger Solutions issued a brief saying the USDA waivers issued in response to the COVID-19 pandemic should be made permanent.

“Program flexibilities provided by COVID-19-related nationwide waivers have reduced longstanding barriers to (summer food service program) participation while simultaneously reducing the administrative burden on sponsors, increasing participation numbers and making the SFSP more efficient and effective in addressing food insecurity,” the policy brief said.

• Copyright The Nation’s Health, American Public Health Association

U.S. Sen. Dick Durbin, D-Ill., is calling on the state’s healthcare providers to promote federal scholarship and loan repayment funding for healthcare workers. [Health News Illinois 1.25.2022]

In a letter sent last week to over a dozen state health associations, Durbin said the funding is available as part of $1 billion allocated in the American Rescue Plan’s National Health Service Corps and Nurse Corps programs.

“The pandemic has underscored the long-term challenges in our healthcare delivery system, and it is my hope that this significant new funding and emphasis on recruiting a diverse workforce can help begin to close gaps and promote equity,” Durbin said in the letter.

There were more than 800 trained professionals providing care in urban and rural parts of Illinois through the programs last fall, according to Durbin’s office. 

 The programs provide scholarship and loan repayment options to qualified primary care medical, dental and behavioral health clinicians.

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Disasters are an important public health issue; however, there is scarce evidence to date on what happens when communities and populations experience more than one disaster. This scoping review identifies literature on the effects of multiple disasters published until Aug 2, 2021, 1425 articles were identified, of which 150 articles were included. We analysed direct and indirect public health implications of multiple disasters. Our analysis suggests that exposure to multiple disasters can affect mental health, physical health, and wellbeing, with some evidence that the potential risks of multiple disaster exposure exceed those of single disaster exposure. We also identified indirect public health implications of multiple disaster exposure, related to changes in health-care facilities, changes in public risk perception, and governmental responses to multiple disasters. We present findings on community recovery and methodological challenges to the study of multiple disasters, and directions for future research.  [Lancet Public Health 1.19.2022] 

Download full article here> 

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NEW YORK (AP) — Three studies released Friday offered more evidence that COVID-19 vaccines are standing up to the omicron variant, at least among people who received booster shots.

[The Journal of the American Medical Association published the third study, also led by CDC researchers. It looked at people who tested positive for COVID-19 from Dec. 10 to Jan. 1 at more than 4,600 testing sites across the U.S.] 

They are the first large U.S. studies to look at vaccine protection against omicron, health officials said.

The papers echo previous research — including studies in Germany, South Africa and the U.K. — indicating available vaccines are less effective against omicron than earlier versions of the coronavirus, but also that boosters doses rev up virus-fighting antibodies to increase the chance of avoiding symptomatic infection.

The first study looked at hospitalizations and emergency room and urgent care center visits in 10 states, from August to this month.

Full article here> 

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Omicron and staffing constraints pushed hospitals and health systems to once again suspend nonurgent, elective procedures — a move that hurts patients and their care teams.

Physicians told The Washington Post that notifying patients of their surgeries being postponed is one of the most difficult things they do during the pandemic, and the idea of prolonging patients' suffering is anguishing. In interviews, a patient rated the pain he felt from a ruptured cervical disk — for which his surgery has been indefinitely postponed at Mercy Health-St. Rita's Medical Center in Lima, Ohio — as a 12 out of 10. 

In addition to extended pain, pushed back surgeries leave more time for disease advancement. Certain cancers can advance to later stages in four to eight weeks, for instance. Even procedures considered low acuity, such as joint replacements or bariatric cases, will have material implications from delays through reduced activity, mobility and quality of life for patients. Delays in surgery have also been shown to result in higher rates of surgical site infections.

"I'd say it's a bona fide mess right now," Kenneth Kaufman, chair and founding partner of Kaufman Hall, told The Washington Post. "We seem to be back to square one. Omicron has significantly compounded staffing shortages in a very profound way."

Full article here>

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Chicago's top doctor said Wednesday the city has passed the peak of the current omicron-fueled COVID-19 surge, while state officials said they were "cautiously optimistic" Illinois has done so as well. [Health News Illinois 1.20.2022] Department of Public Health Director Dr. Allison Arwady said new cases peaked on Dec. 27, while test positivity peaked on Jan. 1. “We are a long way from being out of the woods," she said. "However, I'm really pleased to have seen this turnaround." The seven-day average for new daily cases in Chicago is 2,819, a 50 percent decrease from the prior week. The seven-day test positivity rate is 11.9 percent, a 5.5 percentage point decrease from the prior week. Omicron makes up 99.3 percent of new cases being reported, Arwady said. Hospitalizations have slowly started to plateau, though she said they remain concerned with the overall high number. Chicago is averaging 203 COVID-19-related hospitalizations per day, down six from the prior week. “I want to emphasize we probably will continue to see hundreds of Chicagoans being admitted to the hospital, so the threat is in no way over,” Arwady said. About 78.6 percent of eligible Chicagoans have received at least one dose of vaccine, while 70.1 percent are fully vaccinated. State officials said at a later press conference they were hopeful that Illinois has seen the worst of the current surge. “I am cautiously optimistic in reporting the decreasing trends in the number of cases and the number of emergency department visits, as well as the number of hospitalizations over the past week,” Illinois Department of Public Health Director Dr. Ngozi Ezike told reporters, noting there still are more people in Illinois hospitals during this surge than at any other point in the pandemic. Gov. JB Pritzker said they look at hospitalization, ICU bed and ventilator usage to determine whether Illinois has passed its peak, and those "all seem to be going the right direction." As of Tuesday, 6,507 Illinoisans were in the hospital with COVID-19, down 188 from Monday and down 712 from the prior week. Of the patients in the hospital, 1,085 were in intensive care units, down 35 from Monday and down 46 from the prior week. There were 608 patients on ventilators, down 20 from Monday and down 42 from the prior week. There were 26,491 new COVID-19 cases and 160 deaths reported on Wednesday. The new cases bring the state total to 2,709,474, while the death toll increased to 29,510. The seven-day average for new cases on Friday was 26,646, down 5,855 from the prior week. The seven-day average for daily deaths is 101, up eight from the prior week. The seven-day statewide positivity rate for cases as a percent of total tests is 12 percent. The seven-day statewide test positivity using the number of COVID-19 positive tests over total tests is 15 percent. About 78.9 percent of eligible Illinoisans ages 5 and older have received at least one dose of a COVID-19 vaccine, while 69.4 percent are fully vaccinated. Illinois vaccinators have administered 20,110,501 COVID-19 vaccines, per state data, including 3,657,437 booster doses. The seven-day average of doses administered is 46,866. ###

Months after stakeholders publicly said they were getting close to an agreement to reform the Medicaid reimbursement system for Illinois’ long-term care facilities, a schism has developed between the state and Illinois’ largest nursing home association on how to go forward during the spring session. [Health News Illinois 1.13.2022] Legislation supported by the Department of Healthcare and Family Services was filed last week. It includes many of the details laid out last fall during multiple legislative hearings, including a patient-driven payment model and dedicated funding for staffing increases and workforce transformation. It would also reward providers for achieving higher levels of care. But, a spokesman for the Health Care Council of Illinois said this week they are opposed to the HFS-backed plan. They are behind a separate proposal filed Monday that calls for increasing the skilled nursing facility bed tax to the federal maximum, which the association says will allow facilities to increase wages, hire additional staff and expand access to care for underserved communities. It also distributes additional funding to facilities that primarily serve Medicaid members. Additionally, the measure creates a committee appointed by the four legislative leaders that would oversee, assess and provide direction to HFS on long-term care services. Health Care Council of Illinois Executive Director Matt Pickering said their plan is a “common-sense” approach toward addressing funding and staffing shortages in the nursing home industry. “By increasing Medicaid funding for skilled nursing facilities with high percentages of low-income residents, we can prioritize quality care for our state’s most vulnerable residents - especially those in minority communities, increase wages, create more jobs and ultimately stabilize the Illinois long-term care safety net system,” he said in a statement. HFS Director Theresa Eagleson told Health News Illinois Wednesday the Health Care Council of Illinois-backed plan is a "distraction" from the work that has been done over the past 18 months to pass agreed-upon language. “We're going to focus our efforts on continuing to move the language that's already been out there, that language that's been vetted and discussed with not only legislators, but many interest groups for months,” she said. “We've said for 18 months now that we don't think the industry should get any more money that's not tied to actual improvements in quality and stuff.” Eagleson said stakeholders have been negotiating in recent months with the idea they had a "conceptual agreement" in place on the key issues. “Most of what we've seen, unfortunately, has been ways to elongate movement on the reform side or to continue to stall reforms,” she said. Illinois’ two other nursing home associations said this week they support the HFS-backed plan. “​​There's a lot that gives me concern in the HCCI approach,” said Matt Hartman, executive director of the Illinois Health Care Association. Among those concerns is allowing a bed tax to be implemented without corresponding rate reform. Such a move would lead to the postponement of funding and accountability for staffing and quality, said LeadingAge Illinois CEO Angela Schnepf. “To increase the tax on quality providers, particularly nonprofits that reinvest money back into resident care, and not require rate reform, is similar to taking money away from resident care and putting it into the pockets of private owners and shareholders,” she said. The Health Care Council of Illinois is concerned about how the HFS-backed plan could affect certain nursing homes. The association reiterated Wednesday that the HFS-backed plan will put up to 50 nursing homes, predominantly those that serve Medicaid populations, at risk of closing. “Closure at this scale would displace an estimated 5,000 nursing facility residents located mostly in rural areas and communities of color,” they said. Andy Allison, HFS’ deputy director for strategic planning and analytics, said Wednesday they disagree with that analysis. He said assuming those 50 homes are at risk of closures means their management would not adapt to changes in the rate reform proposal, such as additional funding to support staffing. “That's not the business of the state, to spend billions of dollars on naive assumptions about the future,” he said. ###