Category: Mental Health Awareness

(The following transcript was provided by the American Hospital Association’s Advancing Health podcast.
You can listen to this podcast here – https://player.captivate.fm/episode/03ef93c9-9d1a-4f26-8c81-e6abffd44265)

Advancing Health – May 21, 2024

Tom Haederle

According to the World Health Organization, behavioral health conditions among older people are often under-recognized and undertreated, and the stigma surrounding these conditions can make people hesitant to seek help when they need it. West Virginia-based Broaddus Hospital, a critical access hospital that is part of the Davis Health System, has created Senior Life Solutions, an intensive outpatient program designed to fit the needs of patients 65 and older.

Welcome to Advancing Health, a podcast from the American Hospital Association. I’m Tom Haederle with AHA Communications. Although the overall population of Broaddus Hospital’s rural community has decreased over time, the population of older adults has steadily increased. What wasn’t increasing, however, was the availability of behavioral health services for this population. Recognizing that there were many older community members who needed help managing depression, anxiety, social isolation and grief, the team at Broaddus Hospital decided to get to work to create a treatment program that address their unique needs.

In this podcast, hosted by Jordan Steiger, senior program manager of Clinical Affairs and Workforce with the AHA, she is joined by two leaders who share how this hospital-based program has benefited not only patients who seek care through their program, but the community overall. Dana Gould is CEO, Broaddus Hospital, and Donetta McVicker is program director of Senior Life Solutions with Broaddus Hospital.

Jordan Steiger

Dana and Donetta, thank you so much for being with us today on our AHA Advancing Health podcast. We’re really excited to talk to you today and to hear your perspective about some of the work that you’ve been doing.

Dana Gould

Thank you for having us.

Jordan Steiger

So tell us a little bit about Broaddus Hospital and the community that your hospital is in.

Dana Gould

It’s a critical access hospital, 72-bed facility. We have 12 acute care swing beds as well as a 60 bed nursing home. We’re located in Philippi, West Virginia, a pretty rural area. And so this is a nice facility to have here in our small community.

Jordan Steiger

It’s great. And you know, how many communities does your hospital serve? Is it just in your town or does it kind of serve a bigger, rural population?

Dana Gould

We serve our surrounding counties there, about five different surrounding counties that we serve, in addition to Barbara County, West Virginia.

Jordan Steiger

You know, that’s really nice to hear. And I think something that other, you know, rural listeners can resonate with, you know, serving that big population, that big, area, you know, in your community and not just the people that may be live next door to you, but also the people that kind of live just in your region. And, we know that a lot of communities really depend on the work of rural and critical access hospitals to get care.

Jordan Steiger

So, we’re really excited to learn more today. What are some of the common, you know, kind of like population health issues that face your community, especially related to behavioral health and substance use?

Dana Gould

Well, we do our annual community – not annual, and we do it every three years – our community health needs assessment. And so for the last several years when we’ve completed that, we’ve found that behavioral health is one of the areas of greatest need in our community. We also have a pretty large percentage, around 20 some to 22% of population that’s over 65 years of age. And we’re finding that even though the population of our county has decreased or remained relatively flat, the population of those 60 and 65 or older, have has increased. So, there is of an increasing need for behavioral health in our community.

Jordan Steiger

I think that leads us into exactly what we’re here to talk about today. So, your hospital has a really strong, geriatric, intensive outpatient program. And I think that’s really unique and something that our listeners are going to be really interested in just because, as you mentioned, a lot of communities I think, are kind of facing that same issue of aging populations and maybe not having enough care in the area to help them with their behavioral health issues.

And it sounds like what you’ve done has really enhance the quality of life for the older adults and their families in your community. So I’d love if you could tell us a little bit more just about your program.

Donetta McVicker

Okay, I guess I will step in there. My name is Donetta McVicker. I am the program director here at Senior Life Solutions at Broaddus Hospital. Senior Life Solutions is an outpatient behavioral health program here at Broaddus Hospital. It’s designed to meet the unique needs of older adults, typically 65 and older, who are experiencing issues such as depression, anxiety, or other mental health challenges associated with the changes that accompany the aging process.

Our services include group therapy, individual therapy, family therapy, and medication management.

Jordan Steiger

That’s great. Can you tell us more about maybe some of the skills that patients learn? Maybe in group therapy or individual therapy?

Donetta McVicker

Yeah, absolutely. Our therapy sessions occur in small groups and are facilitated by our licensed therapist. Patients typically attend group sessions three days a week, at first, and then they titrate to two or one day per week as they progress through the program. The program usually uses various skills to support patients in achieving their personal therapy goals, such as mindfulness, grounding skills, progressive muscle relaxation, self-care, social and communication skills.

Jordan Steiger

That’s great. And you know, I know, one thing that we talked about when I initially learned about your program is that you’ve seen maybe that there’s been an increase in, you know, socialization of the older adults in your community from meeting each other in this program. And can you talk about maybe some of kind of the positive byproducts that have come out of having this kind of group therapy setting?

Donetta McVicker

Our patients typically experience a lot of isolation and loneliness. So once they engage in the program, they meet new people who are experiencing similar issues that they are currently experiencing themselves. So they relate with one another, and they become friends. A lot of times, once they’re discharged, they still remain in contact with the people that they met in group.

Donetta McVicker

They’ve created these relationships with the other clients, and they will call each other on the weekends, or they’ll arrange an outing and have coffee together or something like that. And that really increases their socialization and, really improves, some of their mental health issues.

Jordan Steiger

I think that is an incredible thing to highlight here because obviously, you know, we’re looking for in a program like this, you know, positive clinical outcomes, reduced depression, reduced anxiety, things like that. But, you know, really having that decreased loneliness and socialized relation, especially in older adults, I mean, we know that that has so many positive mental and physical health outcomes.

So I think the fact that you’re providing that in your community is such a great thing.

Donetta McVicker

Yeah, absolutely I agree.

Jordan Steiger

So one thing that we know is on everyone’s mind across the country, whether it’s, you know, small critical access hospital or a big health system is workforce. And having the right workforce available in the community and in the hospital to fulfill and, you know, continue programs like this. So who do you need to be successful in this program?

Jordan Steiger

Do you have, you know, a psychiatrist? Do you have social workers? Tell the audience a little bit more about who’s on your team.

Donetta McVicker

Yeah. Our program is made up of multidisciplinary cast or, staff. We have a registered nurse. We have a licensed social worker. We have a psychiatrist and other clinical staff that support the patients such as CNAs and things like that, NAs.

Jordan Steiger

I think that multidisciplinary approach is always helpful in behavioral health and, you know, gives our listeners an idea maybe what it would take for them, you know, to put something like this in place, knowing that they’re going to need lots of different people, lots of different moving parts to kind of make this a success.

Donetta McVicker

Yeah.

Jordan Steiger

So one thing I know, we hear a lot about and, you know, the behavioral health world in general, and especially with aging adults and rural communities is stigma. You know, stigma around seeking care, stigma about actually admitting that you need help with your mental health. is this something that you found to be true, when you’re seeing people coming into your geriatric IOP program?

Donetta McVicker

Yes. Of course. You know, one thing that we tell our patients or anyone considering the program is that there is no shame or stigma in providing good self-care. Mental health care should be no different than physical health care. There are nearly 58 million adults aged 65 and older living in the United States, yet we continue to lack services specifically for that population.

Unfortunately, the aging process does not come with an instructional manual. However, our program helps to provide resources and the tools, both emotionally and socially, to be better equipped on ways to overcome some of these challenges that often accompany this journey.

Jordan Steiger

I love what you said about aging doesn’t come with the manual. I think that’s, you know, something to keep in mind, you know, here and nobody knows exactly how it feels as people are getting older. It’s a really great thing I think, that you have something in your community to provide some structure and provide some guidance.

And, like you said, there is no stigma. There should be no stigma around seeking care, especially when it can improve the quality of your life as much as you’ve seen for your patients. So that’s really, really great. Speaking of that, how has your geriatric IOP program positively impacted your patients, families and community?

Donetta McVicker

I actually have a few testimonials if I may be permitted to read some of them.

Jordan Steiger

Absolutely.

Donetta McVicker

All right. So I have: “Since retirement, I needed to reassess who I am and how I occupy my mind. I found the direction and the support with this program.” Another client wrote, “I lost my grandchild and found myself in a dark place. I didn’t know how I would make it through without the support that I needed. With the help of this program

I have made friends and found ways to celebrate her life.” And then lastly, one client stated, “I have learned a lot about myself and how to cope with my current health conditions.” So as you can see, there are many different ways that patients have experienced an increase in their knowledge of themselves, of their, newly occurring health conditions, which seems like once you’re 65 or older, those seem to be more rapidly occurring in their life.

And then, you know, losing a loved one seems to happen more frequently in the ages of 65 and older. And unfortunately, it doesn’t just stop with the spouse or a friend or a relative or something like that. What we’re seeing a lot here is they’re losing their adult children or even their grandchildren to things like substance abuse and accidents and things like that.

So we’re seeing a lot of grief in our program. It’s really nice that, you know, that testimony about losing her grandchild. It’s really nice to hear that we were able to help her really change her perspective on that grief and flip it around to say how she now has found ways to celebrate that life instead of mourning the loss of that individual.

Jordan Steiger

Yeah. I mean, we know that community is such a powerful tool in addressing grief. And, I love that you brought in some patient perspective and you know, testimonial. I think that really kind of brings to life the importance of this program in your community. And I’m sure our listeners are also going to be really impacted by those testimonials as well.

So as we kind of wrap up our conversation today, if there is another rural or critical access hospital out there who, you know is hearing the work that you’re doing and hearing your story and is like, wow, I would love to have something like that in my community. What advice would you give them as they were getting started?

Donetta McVicker

You know, honestly, I would start off and say, take a look around your community. Do you have resources readily available for your most vulnerable populations? The aging process has a host of challenges. So the population often experiences things like grief and financial struggle, isolation, loneliness, chronic health conditions, and just an overall lack of support. A program like Senior Life Solutions can help accommodate those needs.

I know that through our program, it didn’t take a whole lot to get started here. It’s a small staff. Like I said, we have a registered nurse, a CNA, a licensed therapist, and a psychiatrist. And with that small multi-disciplinary staff, we’re able to, you know, do really big, important things for our clients.

Jordan Steiger

That’s great. And I think, you know, the message that it doesn’t maybe take a lot to get this off the ground, I think is important. And, you know, of course it’s going to take effort to start a new program or something like that. But I think the payoff from what you’ve said is totally it’s worth the work, right, to provide those services to your community.

Dana, any closing thoughts from an administrative perspective?

Dana Gould

Sure. Financially, the program has been beneficial for us. Since we are a critical access hospital, our reimbursement is, at least for Medicare, is primarily based on our cost. So this allows you to be fully reimbursed for the cost of the program because the majority of the patients are Medicare patients and then also assist with some of the allocated costs that go to the program.

Some of your overhead costs can be allocated and reimbursed. So financially, it is a very good program for critical access hospital.

Jordan Steiger

That’s great. That’s really important to mention I think, because of course we can’t avoid that conversation talking about the finances and how to keep these programs running. So I’m glad that it has been a financially viable program for you and that it continues to be successful. So thank you both so much for sharing your insights with us today.

I think that our members at the AHA really going to learn a lot from this conversation, and we really appreciate that you took the time to share with us.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

Psychiatric Medical Care’s chief executive officer, J.R. Greene shared his thoughts about how mental health treatment can be more accessible as the need for behavioral healthcare continues to rise. Below is an excerpt from the article “Changing Behaviors” which was published by Healthcare Executive.

Click here to view a printable PDF of the entire article.

Excerpt of “Changing Behaviors” Featuring J.R. Greene

J.R. Greene, FACHE, CEO, Psychiatric Medical Care, Nashville, Tenn., points to the paucity and ambiguity of funding sources. Founded in 1992 by Greene’s father, James A. Greene, MD, the mental health management organization partners with more than 250 facilities in 34 states—historically focused on rural areas but recently moving into urban markets as well—to provide outpatient, inpatient, telehealth and pediatric psychiatry services.

“The funding has not universally been at a rate that would motivate many practitioners to become behavioral health experts compared to other specialties,” he says. And payers don’t have the same hard data about the costs of behavioral health treatment as they would, say, for a hip replacement. “We don’t know the exact costs associated with treating various mental disorders,” he adds. “As an example, we can’t tell someone with adult bipolar illness that they will need a certain type of treatment for a very strict amount of time, at a set industry cost. [That] ambiguity of behavioral health treatment disrupts the funding mechanisms. Insurance providers want to see consistent data to know their realistic estimated cost by treatment. Behavioral doesn’t have this near perfect sophisticated capability—yet.”

Greene recommends continued investment in patient data and outcomes, along with the right expertise, which involves not just recruitment but also retention of behavioral health providers—along with adequate training to bring it about. Virtual care should be encouraged whenever possible to ensure wider access, with the caveat that acute needs will still need to be handled in person, he says. “Leaders across all of healthcare need to become more comfortable with a virtual or hybrid level of mental healthcare,” he adds. 

Other steps to improving access include advocating for more complete insurance coverage and working to reduce the stigma around mental healthcare, Greene says. One local success he’s seen involves a youth soccer team that has previously seemed hesitant to adopt Psychiatric Medical Care as its sponsor accepting the sponsorship this year, even placing the medical company’s logo on the players’ jerseys.

Any internal effort begins with—but should not be limited to—an employee assistance plan, Greene says. About 36% of Psychiatric Medical Care employees leveraged that benefit in 2022, with many of them using the teletherapy option, he says. Greene agrees that reducing the stigma around behavioral health is a key ingredient internally, as well.

Bridging these gaps is essential for people to get coordinated care, which requires not only human communication but also electronic interoperability to ensure a seamless flow of data, Greene says. “It’s building the relationships—and sharing the information and outcomes,” he says. “We’ve been able to do a lot of this because we work with FQHCs, community mental health centers, academic centers and hospitals themselves.” Information about outcomes can help build the data and algorithms that insurers want, he adds.

“The outcomes we’ve gathered vary based on the patient population, but we work with our partners to share access to key data points that drive care, reduce recidivism and improve outcomes,” Greene says. “A few key data points we collect and share include polypharmacy usage, ED visits for mental health crises, reduction in ED visits over time with mental healthcare access, patient outcomes from evidence-based testing and continuing care instructions between care teams.”

Emotions after a shooting can be difficult to process.

Many of us find it difficult to process acts of community violence, especially a school shooting. We question the perpetrator’s motives. We wonder how law enforcement handled the situation. We ask “Why here? Why now?” We think about how safe we really are.

It’s normal to experience strong feelings of fear, dread, sorrow and even guilt after an act of community violence. Even people who were not directly impacted by a shooting can develop symptoms of emotional distress. You may feel shock, anger, grief and disillusionment. You might have trouble concentrating, eating or sleeping. This reaction is common and in most cases will pass. Most of us rely on family and friends as a support network. We talk about the tragedy that took place, try to comfort each other and reach a sense of understanding that things will soon get back to normal.

Some people find it harder to cope with acts of community violence than others. Their distress may impact their ability to function normally. Children may struggle with these events. Whether they witnessed a shooting, saw it on social media or heard about it from friends, they often feel scared, unsafe and confused about what happened.

Use the resources below to find a mental health provider, get tips for managing distress after a shooting and learn how to talk to children about community violence.

Resources to Help Cope with Community Violence, Including Mass Shootings

Mental Health Services:

• Mental Health Treatment Facility Locator
  800-789-2647
  Website: http://findtreatment.gov
• Website: http://www.mentalhealth.gov
• Suicide and Crisis Lifeline
  988
  Website: 988lifeline.org
• SAMHSA Disaster Distress Helpline
  800-985-5990
  Website: www.samhsa.gov/find-help/disaster-distress-helpline
• (Iowa Residents) Embrace Health, Teletherapy
  515-612-9583
  https://www.embracehealth.com/https://www.embracehealth.com/

Guides and Tips:

• Managing Distress After a Shooting, by the American Psychological Association
  https://www.apa.org/topics/gun-violence-crime/mass-shooting
• Helping Youth Cope After a Mass Shooting, by Youth.Gov
  https://youth.gov/feature-article/resources-help-youth-cope-after-mass-shooting
• How to Talk to a Child About Acts of Violence, by Embrace U
  https://www.embraceu.com/how-to-talk-to-a-child-about-acts-of-violence/
• Talking to Children about Violence, by the National Association of School Psychologists
  https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-safety-and-crisis/school-violence-resources/talking-to-children-about-violence-tips-for-families-and-educators
• How to Talk to Kids about School Shootings, by Yale Medicine
  https://www.yalemedicine.org/news/school-shootings-talk-with-kids

Taking Care of Yourself

You may wonder how to go on with your daily life after the school shooting. Here are some tips to help you cope during this challenging time and strengthen your resilience.

Talk about it
Speaking with others who have shared an experience can help you feel connected. Seek support from friends and family. Consider talking with a therapist or mental health expert for guidance.

Strive for balance
It’s easy to become overwhelmed. Remind yourself of people and events which are meaningful and comforting. Striving for balance empowers you with a healthier perspective.

Turn it off and take a break
We want to stay informed, but limit the amount of news you take in. Images can reawaken your feelings of distress. Do something you enjoy. It’s ok to distract yourself.

Honor your feelings
It’s common to experience a range of emotions after a tragedy. It’s ok to feel sad, scared, exhausted or off balance. Acknowledge how you are feeling.

Signs and Symptoms of Emotional Trauma

Physical Signs

• Headaches
• Sleeping too much or too little
• Stomachaches
• Racing heart
• Easily startled
• Overly tired or exhausted

Emotional & Mental Signs

• Overwhelming fear
• Helplessness, hopelessness
• Guilt
• Shock
• Irritability
• Panic and anxiety
• Disbelief
• Intrusive thoughts

Impacts of Tragedy and Trauma

Witnessing a mass shooting or a tragic event can lead to trauma due to the profound psychological and emotional impact of such experiences. Trauma is a complex psychological response to an event that is shocking, distressing, or harmful. Such trauma can affect cognitive functions such as concentration, memory, and decision-making. Individuals may find it difficult to focus on tasks, experience memory lapses, or struggle with making simple decisions.

Trauma often leads to intense and overwhelming emotions. Individuals may experience heightened anxiety, depression, anger, or a sense of emotional numbness. Managing and regulating these emotions becomes challenging, impacting day-to-day emotional well-being. Witnessing a mass shooting can strain relationships and social interactions. Traumatized individuals may withdraw from others, have difficulty trusting people, or struggle to relate to those who have not experienced similar experiences.

Trauma can affect a person’s ability to perform at work or maintain employment. Difficulties concentrating, increased irritability, and emotional distress may lead to decreased productivity and job satisfaction. Some individuals may develop avoidance behaviors as a coping mechanism. They may avoid places, activities, or people associated with the traumatic event, leading to limitations in their daily life and potential isolation. Trauma often contributes to sleep disturbances such as nightmares, insomnia, or night sweats. Poor sleep quality can exacerbate existing challenges and contribute to overall fatigue and difficulty functioning during the day. If you or someone you know needs help processing an act of community violence, understanding and controlling emotions, or regaining a sense of normalcy consider seeking the help of a mental health professional.

How to Talk to Children About School Shootings

• Stay calm.
• Be their source of information.
• Let them lead the conversation.
• Give them space to heal.
• Feel with them. Don’t process with them.
• Answer questions honestly but age-appropriately.
• They don’t need all the answers.
• Talk about what they can control.
• Ask what would help them feel safe at school.
• Remind them of the truth you know.

The following story was written by a woman who lost her husband and fell into depression and grief. She joined Senior Life Solutions, a group therapy program that helps older adults experiencing mental health challenges like depression, anxiety and grief.
(Warning: This story deals with thoughts of suicide. If that’s a trigger for you do not read. If you’re at risk for suicide consider calling 988 to reach the Suicide and Crisis Lifeline, or talking to a mental health professional. )

Healed From Heartbreak

After 51 years, eight months and 11 days of marriage, I lost the love of my life. I was okay for a few weeks, keeping busy and paying bills. All too soon those tasks were finished and the lonesomeness and deafening silence set in around me. The children called or came by, and as much as I love them, they could not fill the void of my loss.

It was hard to make decisions. I quit going to church and hid in the house unless I absolutely forced myself to go to the store. I use to cook, but T.V. dinners were now my norm. My daughters decided I should go for counseling, reminding met they had lost their dad and didn’t want to lose me too. Reluctantly I want to a hospice group therapy. If my attitude had been better it might have helped. I quit after one session. Next, I tried one-on-one therapy. The therapist was 20 years younger than my youngest child. I decided after four sessions she didn’t have a clue about what true love was and the loss I suffered. I quite that one too with never a look back. I decided I would be fine. Wrong!

I had an appointment with a V.A. service officer to fill out some paperwork. She asked me how I was doing, and I broke down and cried, spilling my anger and hurt out for the first time. When I calmed down she handed me a pamphlet on Senior Life Solutions, a new program starting close to where I lived. I called and made an appointment for the next day. After filling out the paperwork, I spoke with one of the therapists. After that I saw the psychiatrist and was accepted to the program. Then I found out they expected me to come three times a week.
As I drove way I thought, “I can’t leave the house that often. I don’t want to dress up. I like my pjs and sweat suits. If they want to help they can work on my time frame, that would be once a week, if I feel like it.”

Can you see the anger I added to my sorrow?
Over the months after my husband’s death I had gotten good at talking myself out of getting help. Now I was hanging on to the bottom of the rope. I called the Senior Life Solutions program and informed them I wouldn’t be coming to the program because I wouldn’t come three times a week. I wouldn’t even listen, telling them, as I was crying, to remove me from the list. I didn’t know she would talk to someone about me.

Meanwhile, I believed there was not help for me and decided my life was useless. I got a pad of paper and went to set in my easy chair. I wrote a goodbye letter to my children and loaded my pistol. The phone rang. Thinking it was one of the kids I put the gun down. When I answered the phone the introduced himself as John from Senior Life Solutions. He asked if I had a few minutes to talk. As my only plan that day was killing myself, I thought, “What does it matter?” I agreed to talk. I asked some questions and liked his answers. Mainly it was okay if I only came two times a week. This was a compromise for both of us. That call saved my life. I started the program that week.

What have I learned about grief?
First, I had been playing the “blame game.” Why didn’t I get someone to do the shopping instead of leaving my husband’s side during his last days? I felt guilty if I even hung the wash on the close line in case he needed me. For months I cried, thinking I should have done more for him. I was in the medical field and he was my last patient. The doctor told me he wouldn’t have lasted as long if I hadn’t cred for him. It made no difference to me at the time.
Second, your thoughts can rule your life if you allow them to.
Third, don’t should on myself. I should have this. I should have that. I filled in the blanks with hundreds of things I should have done.
Fourth, I’m not a Q-tip. That means quit taking it personally.
Fifth, I did the best I could at the time. It was hard for me to accept this and it took time.
Sixth, sometimes I have to fake it till I make it.
Seventh, my favorite, I don’t have to be perfect to be a good person. Mistakes just happen.
Last, the handout “What causes grief” helped me. Because of the Senior Life Solutions program I have achieved the self-esteem I needed to face life and live again. I get dressed everyday and don’t hide in the house. I’ve joined a gym and the senior center. I write in my journal, long letters to my husband. When I get ready for bed at night, I kiss his picture and say the words we said when we kissed, “I’ll love you forever and a day. Goodnight sweetheart.”

My husband was cremated and that was also my choice. My daughters and my oldest son know when that time comes my ashes will be mixed with their dad’s. We will be scattered on our home place together again to fill our last destiny.

About Senior Life Solutions

Senior Life Solutions partners with critical access hospitals to provide outpatient therapy programs to older adults who are experiencing depression, anxiety or other mental health challenges, often associated with aging. Participants typically come to the hospital three times a week for health assessments, group therapy and medication management. Contact us to find out more about partnering with Senior Life Solutions.

The Internal Revenue Service, Employee Benefits Security Administration and the Health and Human Services Department have proposed amendments with the aim of bolstering enforcement of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). The agencies want to enhance patients’ access to mental health and substance use disorder (MH/SUD) care and close existing loopholes that insurance companies often exploit to deny such care.

How the Mental Health Parity and Addiction Equity Act Could Change

The proposed changes in the rule released by the Departments of Labor and Health and Human Services could have a significant impact on individuals seeking mental health and substance use disorder (MH/SUD) care. Here’s how these changes could affect a person:

1. Improved Access to Care: The proposed rule aims to ensure that individuals have better access to mental health and substance use disorder treatment. By clarifying and strengthening the requirements for parity between mental health benefits and medical/surgical benefits, it becomes more likely that people will receive the care they need.
2. Broader Coverage: The rule mandates that if a health plan provides treatment for a specific MH/SUD condition in one benefit classification (e.g., outpatient, in-network), it must provide treatment in all other benefit classifications. This means that individuals may have a broader range of treatment options and choices within their health plans.
3. Clearer Protections: The rule explicitly recognizes eating disorders and autism spectrum disorder as mental health conditions protected under the parity law. This means individuals with these conditions are more likely to receive insurance coverage for their treatment, potentially reducing the financial burden on them and their families.
4. Data-Driven Improvements: The requirement for plans and issuers to collect and evaluate data on the impact of nonquantitative treatment limitations (NQTLs) can lead to data-driven improvements in care access. If disparities in access are identified, plans will need to take “reasonable action” to address them. This could result in more equitable access to MH/SUD care for individuals.
5. Certainty in Coverage: With the proposed rule, individuals can have more confidence that their health plans will provide meaningful and equitable MH/SUD benefits. This certainty can alleviate concerns about denied claims or limited coverage for mental health and substance use disorder treatment.
6. Addressing Provider Shortages: The proposed rule includes an enforcement safe harbor for plans/issuers facing access disparities due to provider shortages. This may encourage health plans to work towards expanding their provider networks, ultimately improving access for individuals in areas with limited provider options.
7. Impact on Serious Mental Illness: The American Psychiatric Association has urged that meaningful benefits for serious mental illness include access to coordinated care, supported education, and supported employment. If the proposed rule leads to more comprehensive coverage, individuals with serious mental illness may receive the support they need to lead more fulfilling lives.

Key Provisions of the Proposed Rule

• Clarifying that the MHPAEA’s purpose is to ensure that plan participants can access MH/SUD benefits on par with their medical/surgical benefits.
• Mandating that plans/issuers provide meaningful MH/SUD benefits across various benefit classifications.
• Recognizing eating disorders and autism spectrum disorder as mental health conditions protected under MHPAEA.
• Requiring plans/issuers to collect and assess outcome data to address material differences in accessing MH/SUD benefits compared to medical/surgical benefits.
• Demanding plans to demonstrate corrective action if their analyses reveal noncompliance with the parity law.
• Offering an exception for nonquantitative treatment limitations (NQTLs) when professional medical or clinical standards are applied impartially or to prevent fraud, waste, and abuse.
• Proposing an enforcement safe harbor for plans/issuers facing access disparities due to provider shortages, contingent upon reasonable efforts to expand their MH/SUD provider networks.
• Requiring NQTL comparative analyses to be certified by named fiduciaries who have reviewed the analysis.

The American Psychiatric Association expressed support for these measures but raised concerns regarding exceptions to non-quantitative treatment limitations (NQTLs) requirements and the consequences of non-compliance. The association also urged that meaningful benefits for serious mental illness include access to coordinated care, supported education, and supported employment.

Furthermore, the proposed rule seeks to amend regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and establish new regulations for NQTLs comparative analyses under the Consolidated Appropriations Act, 2021.

These changes aim to prevent plans and issuers from imposing greater limits on MH/SUD benefits compared to medical/surgical benefits, emphasizing data collection and assessment. The rule also sets content requirements for NQTL comparative analyses and details how plans and issuers must share these analyses with relevant departments and authorities.

Additionally, the departments are soliciting input on ways to enhance mental health and substance use disorder coverage through other federal provisions. Finally, HHS proposes amendments to implement the sunset provision for self-funded, non-federal governmental plan elections to opt out of MHPAEA compliance, as adopted in the Consolidated Appropriations Act, 2023. The proposed rule is expected to take effect on January 1, 2025, for group health plans and on January 1, 2026, for individual health plans.

Do you know which profession has the highest death-by-suicide rate in the United States? The answer might surprise you – farmers. Agricultural workers die by suicide at a rate three and a half times higher than the general population, according to the National Rural Health Association. Between 2000 and 2002, suicide rates increased 46% in non-metro areas compared to a 27% increase in metro areas, according to the Centers for Disease Control and Prevention.

Financial stress, limited access to mental health services, and a reluctance to seek help could be associated with the elevated risk of suicide among farmers, mental health experts say. Iowa farmer and psychologist Mike R. Rosmann, spent decades trying to better understand and address suicide risk in this population.

“Farming has always been a stressful occupation because many of the factors that affect agricultural production are largely beyond the control of the producers,” Rosmann wrote in the journal Behavioral Healthcare. “The emotional well-being of family farmers and ranchers is intimately intertwined with these changes.”

Mental Health Services and Farmers

Access to confidential crisis services and culturally competent mental health care is key to preventing suicide in agricultural populations, Rosmann explained. Josie Rudolphi, a professor of agricultural and biological engineering at the University of Illinois and co-director of the North Central Farm and Ranch Stress Assistance Center, explained that most farmers are independent producers who operate on very thin margins and mental health care is often considered a luxury or an unnecessary expense. Rudolphi said the geographical distribution of farmers is another challenge. They are scattered across the counties and states and not in one centralized workplace like a healthcare facility or university campus that would make mental health education and outreach easier. And their schedules are incredibly varied.

“We still see stigmatization around mental health in these communities, but I think that’s starting to change,” Rudolphi told the University of Illinois News Bureau in 2022. “Stigma seems to be more pervasive among certain demographics. For example, it appears as though it’s more challenging for older generations to talk about mental health issues. And in small communities, people are very conscious of other people knowing what their vehicles look like and not wanting people to recognize their car or truck parked outside a mental health clinic.”

Psychiatric Medical Care treats many current and retired agricultural workers in our different care environments. It is important to not only understand their increased risk, but to also understand interventions that can assist with lowering their risk for suicide.

Stress and Depression Checklist for Farmers

Professors at Colorado State University and the University of Wisconsin created a checklist and guide to help identify stress and depression in farm and ranch families. These signs can be observed by anyone, including friends, extended family members, neighbors, milk haulers, veterinarians, clergy, school personnel, or health and human service workers. 
Signs of stress and depression include:

•Change in routines
The rancher or ranch family stops attending church, drops out of 4-H, Home makers or other groups, or no longer stops in at the local coffee shop or feed mill.   
•Care of livestock declines 
Cattle may not be cared for in the usual way; they may lose condition, appear gaunt or show signs of neglect or physical abuse.

•Increase in illness
Farmers or farm family members may experience more upper respiratory illnesses (colds, flu) or other chronic conditions (aches, pains, persistent cough).         
•Increase in farm or ranch accidents
The risk of farm accidents increases due to fatigue or loss of ability to concentrate; children may be at risk if there isn’t adequate childcare.
•Appearance of farmstead declines
The farm family no longer takes pride in the way farm buildings and grounds appear, or no longer has the time to do maintenance work.        
•Children show signs of stress
Farm and ranch children may act out, decline in academic performance or be increasingly absent from school; they may also show signs of physical abuse or neglect.

Signs of Suicidal Intent

• Anxiety or depression:  Severe, intense feelings of anxiety or depression.
• Withdrawal or isolation:  Withdrawn, alone, lack of friends and supports.
• Feeling Helpless and hopeless:  Sense of complete powerlessness, a hopeless feeling.
• Alcohol abuse:  There is often a link between alcoholism and suicide.
• Previous suicidal attempts:  May have been previous attempts of low to high lethality.
• Suicidal plan:  Frequent or constant thoughts with a specific plan in mind.
• Cries for help:  Making a will, giving possessions away, making statements such as “I’m calling it quits,” or “Maybe my family would be better off without me.”

If you suspect someone is at risk of suicide there are a number of resources available to help. You may start by calling 988, the Suicide and Crisis Lifeline.

A study by the University of Illinois found that 45% of all farmer and rancher suicides in the last 15 years were committed by people aged 65 and older. Our Senior Life Solutions program in Kingsman, KS started using an idea created by the Suspenders for Hope Foundation. Working with a local hospital, they create Suspenders for Hope kits. According to Suspenders for Hope, in the days following a hospitalization or visit to a crisis center for a mental health crisis or suicide attempt, individuals often face stigma and shame and are at higher risk of attempting.

Their aim is to provide Suspenders4Hope kits to patients leaving emergency mental health and detox services equipping them with essential resources to help bridge the lethal gap between crisis services and connecting with outpatient treatment. The kits are designed to increase coping and destigmatize help-seeking. Suspenders4Hope kits include items that instill hope, develop emotion management skills, provide information about crisis resources, peer support, and patient education, and reinforce reasons for living.

The kit is intended to increase protective factors identified through research (mental healthcare, DBT skills, connectedness, life skills, harm reduction, peer support, self-esteem and sense of purpose, and personal beliefs that discourage substance use and suicide).

Learn more about our Senior Life Solutions program and how it helps older adults in rural communities who are experiencing depression, stress and anxiety.

A new survey funded by the Mental Health Treatment and Research Institute LLC, a tax-exempt subsidiary of The Bowman Family Foundation, sheds more light on the deepening mental health and substance use crisis. Authors of a report which presents the survey’s findings call for urgent action to ensure equitable access to timely and clinically effective care and adequate reimbursement by insurers. The authors state that despite significant strides in recognizing mental health as a vital aspect of overall well-being, in-network health insurance coverage for mental health and substance use treatment remains inadequate, lagging behind coverage for physical health treatment. To shed light on this critical issue, NORC, a non-partisan research institute at the University of Chicago, conducted the patient-experience survey, providing valuable insights into the challenges faced by patients seeking mental health and substance use care.

Urgent Need for Mental Health Services

The survey highlights the pressing need for accessible mental health and substance use care. Patients across the nation are struggling to receive the treatment they require, facing barriers in finding in-network providers who accept new patients. The survey delves into the frequency with which mental health or substance use care is needed but not received, bringing attention to the potential consequences of unmet mental health needs.

As patients encounter difficulties with in-network providers, they often resort to seeking care from out-of-network sources. The survey explores the reasons behind this trend and analyzes the disparities between seeking mental health or substance use care versus physical health care. Understanding these patterns is crucial in devising strategies to enhance access to in-network care for all.

Patients often rely on primary care providers and other physical health providers for mental health or substance use care. However, the survey uncovers concerns regarding the adequacy of care provided by PCPs and physical health professionals for mental health conditions. Addressing these concerns could lead to more integrated and comprehensive care models.

The survey also examines the prevalence of service denials and disparities faced by patients seeking mental health and substance use care. These challenges not only hinder access to treatment but can also exacerbate existing mental health conditions, highlighting the urgent need for policy changes and awareness.

Key Findings

The survey reveals a significant disparity between mental health care and physical health care, emphasizing the urgent need for equitable and timely treatment options.

Limited Access to Mental Health and Substance Use Care: The survey found that 57% of patients seeking mental health or substance use care did not receive any care in at least one case, in contrast to 32% of patients seeking physical health care. The figures were even more alarming for adolescents, with 69% experiencing limited access to mental health and substance use care, compared to only 17% for physical health care. These statistics indicate a critical need to improve access to mental health services for patients of all ages.

Difficulties in Finding In-Network Providers: For those who use health insurance and seek care from in-network mental health or substance use providers, 40% had to contact four or more in-network providers before securing an appointment with a new in-network provider. In comparison, only 14% faced similar challenges when seeking physical health care. This highlights the challenges patients encounter when trying to find appropriate and available mental health care providers within their insurance network.

High Reliance on Out-of-Network Providers: A significant percentage of patients, particularly those in employer-sponsored health plans, sought care from out-of-network mental health or substance use providers. As high as 39% of patients used out-of-network providers for outpatient care, compared to just 15% for physical health care. The financial burden of higher co-pays and deductibles faced by patients using out-of-network providers underscores the urgency to improve in-network coverage for mental health and substance use care.

The Need for Specialized Care: An overwhelming majority of patients who received mental health or substance use care from physical health providers (87% of all ages and 98% of adolescents) felt that they needed additional help from a mental health or substance use specialist. This highlights the importance of integrated care and the crucial role of specialized professionals in addressing mental health and substance use issues effectively.

Collaboration is Key to Improving Behavioral Healthcare

The NORC patient-experience survey sheds much-needed light on the profound disparities in accessing mental health and substance use care in the United States. The findings underscore the pressing need for policymakers, insurers, and healthcare providers to collaborate and implement equitable solutions. By improving in-network insurance coverage, enhancing provider networks, and addressing service denials, we can take a significant step forward in ensuring that mental health and substance use care are on par with physical health treatment. Together, let us strive for a future where all individuals have access to timely and effective care, leading to improved mental well-being and healthier communities.