FCC advances plans for 988, a national suicide-prevention hotline

By Taylor Telford, The Washington Post, December 13

The Federal Communications Commission is moving forward with plans to make 988 the nation’s suicide prevention hotline in the face of a mental health pandemic that claims more than 130 Americans each day.

The agency says three digits will be simpler to remember in times of crisis, as 988 echoes the national 911 emergency hotline. “We believe that this three-digit number dedicated for this purpose will help ease access to crisis services, it will reduce the stigma surrounding suicide and mental health conditions, and ultimately it will save lives,” FCC Chairman Ajit Pai said Thursday during the commission’s open December meeting.

The proposal is now open for public comment before the agency begins the rulemaking process. Currently, the proposal calls for carriers to implement 988 within 18 months. The decision comes as the United States grapples with a spike in suicides, even as rates are on the decline in other parts of the world. The suicide rate hasn’t been this high since World War II, according to the National Center for Health Statistics.

From 1999 to 2017, the U.S. suicide rate rose 33 percent, and the jump has sharpened since 2006. It is the fourth leading cause of death for people ages 35 to 54, according to the American Psychological Association, and the 10th leading cause of death overall. In 2018, the national suicide rate was 13.9 per 100,000 people, according to the United Health Foundation. And 2019 is on track to surpass it.

The trend line is even more dire among certain populations: Among Native Americans, rates have skyrocketed 139 percent for women and 71 percent for men since 1999, the federal Centers for Disease Control and Prevention reported in June. Experts think this is tied to Native Americans’ higher rates of poverty, substance abuse, unemployment and post-traumatic stress disorder, as well as geographical challenges that keep them sequestered from mental health resources.

Other at-risk groups include veterans and LGBTQ youth, who experience far higher suicide rates than the rest of the population, commissioners noted at Thursday’s meeting. More than 20 veterans commit suicide each day, and more than 500,000 LGBTQ youth attempt to kill themselves annually. In 2018, more first responders died by suicide than in the line of duty.

“Those facts are not easy to hear,” Commissioner Jessica Rosenworcel said Thursday. “Because for those of us who have lost family or friends they loved — myself included — they are cruel reminders of birthdays missed, holidays gone and words of encouragement that were never received.”

Suicides also have swelled in farming communities, which have been rocked by disastrous weather that is ruining crops, a protracted trade war that’s erasing profits, and towering farm bankruptcies and loan delinquencies. One 2017 study found that farm owners and workers were three to five times as likely to kill themselves on the job compared with other occupations.

The data speaks to the correlation between declining economic and social well-being and high suicide rates among America’s white working class. Research from Princeton University economists Anne Case and Angus Deaton found that overall deaths from suicide, drugs and alcohol, or “deaths of despair,” have risen steeply since 2000, especially for middle-aged white Americans without college or high school educations. The rise in these deaths has contributed to a drop-off in American life expectancy, which has fallen each of the past three years.

“Feelings of isolation and crisis — those are not experiences that happen to ‘them’ or ‘others.’ What we’re talking about is what our parents feel, our kids feel, what we feel,” Commissioner Brendan Carr said at the meeting. “Anything we can do to break down barriers, to make it easier for conversations about mental health and counseling to feel within reach, is something we should do.”

The push for a 988 line began in August 2018, when Congress and President Trump signed the National Suicide Hotline Improvement Act, which ordered a study of the efficacy of a three-digit hotline and a review of the existing National Suicide Prevention Lifeline (1-800-273-TALK). According to the FCC’s report, the lifeline responded to more than 2.2 million calls in 2018, with an average of 183,790 calls per month. The lifeline’s crisis chat function responded to more than 102,500 chats in the same period.

The FCC’s report found that it would be easier to put a new, three-digit number in place than to mount a campaign to repurpose an existing N11 code (such as 211 or 911). The new three-digit hotline will cost about $570 million the first year, the FCC estimated in its report to Congress, and about $175 million the second year, but the agency believes that the benefit would quickly outweigh the initial costs: Suicides and suicide attempts cost the nation nearly $70 billion annually in lifetime medical and work-loss costs alone, according to the CDC.

Certified Community Behavioral Health Clinics Set to Expand to More States

From the National Council for Behavioral Health

Leaders of the US Senate Finance Committee reached an agreement in early December on a 2-year extension that more than doubles the current number of Certified Community Behavioral Health Clinic Medicaid programs by adding 11 additional states. This agreement was announced by Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR), the two lead negotiators on a year-end package of health care bills.

While this is an exciting development, there is still work ahead before this legislative package becomes law. The package must still be voted on by both the House and Senate before going to President Trump for his signature.

The National Council thanks its dedicated advocates for their work in building nationwide support for CCBHCs. Your voices have been heard!

Please see below for a statement on today’s announcement from National Council President and CEO Chuck Ingoglia.

“We applaud the members of Congress who worked so hard on this agreement to fund and expand our nation’s Certified Community Behavioral Health Clinics. Extending and expanding this successful program is vitally important to people who rely on the mental health and addiction services provided by CCBHCs. It’s crucial that the delivery of care not suffer from disruption, and this agreement would ensure programs and services continue uninterrupted.

“Just as importantly, expanding the program means more people in more states will benefit from access to high quality care provided by CCBHCs. In a nation reeling from an opioid and suicide crisis, that is welcome news. While the mental health and addiction crisis continue to devastate the lives of people across the country, CCBHCs represent our nation’s best response. Expansion of the program is both a fiscally responsible decision and a compassionate response from lawmakers who understand the impact CCBHCs provide in communities across the country. Expansion represents a profound opportunity to help people and heal communities.

“We understand there are many hurdles to overcome before this agreement to provide funding and expand the CCBHC program becomes a reality, but we want to applaud the leadership of those responsible for championing the CCBHC program – Chairman Charles Grassley (R-Iowa), Ranking Member Ron Wyden (D-Ore.), Senator Debbie Stabenow (D-Mich.), Senator Roy Blunt (R-Mo.), Representatives Doris Matsui (D-Calif.), Markwayne Mullin (R-Okla.), Greg Walden (R-Ore.) and Frank Pallone (D-N.J.).

“We also want to thank our partners in the field who joined forces with us in this shared mission. The National Alliance on Mental Illness, Mental Health America, National Association of State Mental Health Program Directors, the National Association for Behavioral Healthcare and many others have served as leaders in championing this vital program.”

Ravaged by Opioid Deaths and HIV, Broward Approves Needle Exchange. Miami is the Model

In the text of the ordinance authorizing a needle exchange in Broward County, commissioners ticked off a list of alarming public health statistics: 1,642 opioid overdoses in 2017, more than 21,000 people living with HIV, 387 heroin- and fentanyl-related deaths in 2018.

Needle exchanges are designed to prevent the spread of infectious diseases among drug users by providing clean syringes and help reverse opioid overdoses by distributing naloxone directly to people who use drugs, as well as offering them access to other services like testing for hepatitis.

After a three-year test run, Miami’s exchange, the first in the state of Florida and run by the University of Miami’s Miller School of Medicine’s harm reduction research group, has become the gold standard.

“We have an epidemic in our community,” said Broward Commissioner Nan Rich, who spearheaded the legislation that passed with unanimous consent Tuesday. “This is a best practice now, as far as I can see from other experiences in other places.”

UM created the exchange under the leadership of Hansel Tookes, who had advocated for the program for years before getting the Florida Legislature on board with a pilot run by his research group in 2016. Earlier this year, state lawmakers authorized Florida counties to go ahead with more needle exchanges.

On Tuesday, the same day that Broward authorized a needle exchange of its own, Miami-Dade commissioners made that pilot program permanent, passing the ordinance unanimously with little discussion and all the commissioners joining in as co-sponsors.

“It’s huge,” said state Rep. Shevrin Jones, a Broward Democrat who co-sponsored the bill that became this year’s needle exchange law. “You’ve got the two largest counties in the state of Florida who have passed life-saving pieces of legislation.”

Last month, Tookes put the life-saving component of exchanges into context, highlighting new data showing a steep drop in opioid-related deaths in Miami-Dade County: down by nearly 100 to 213 in 2018, compared to 305 in 2017 and 321 in 2016, the years that the exchange came into operation.

Not only are the exchanges designed to combat the opioid crisis, but they could also be a boon to HIV prevention. South Florida has some of the highest rates of new HIV diagnoses in the country.

Heather Davidson, director of policy for the United Way of Broward County, said needle exchanges lead to reductions in HIV transmissions and hospital costs for indigent people who need care.

“Syringe change programs have been shown to create a bridge where someone can be in crisis from intravenous drug use, and they need to be able to access a clean syringe,” Davidson said. “That ends up being a bridge to have a warm handoff into treatment, and that may take some time.”

William Green, who is overseeing the logistics of the needle exchange for Broward County’s human services department, said the clinic will be modeled closely after Miami’s: It will distribute clean syringes and naloxone, also known under the brand name Narcan, which is administered via a nasal spray and can almost immediately reverse an overdose. The clinic will also test for Hepatitis A and B, Green said.

Green said the county is in the process of convening potential funders, as the law passed by the Florida Legislature prohibits state or county funds from being used to operate the exchanges.

Rich, the Broward commissioner, said it will likely be funded by grants and donations.

“We’re pretty good at that in Broward,” she said. “That will not be an issue.”

Tookes, the UM doctor who served as the architect for Florida’s needle exchanges, said the news out of Broward and Miami-Dade was welcome this week, “but it’s not over until we reach all of the affected communities in the state.”

“They have to act,” Tookes said of the other counties. “I don’t know how they can see the overdose numbers and the HIV numbers and even hesitate. It’s their move.”

Statewide Task Force on Opioid Abuse Meeting

Task Force Chair Attorney General Ashley Moody

The second meeting of the statewide task force on opioid abuse met on Thursday, November 21 at St. Leo University. The task force is chaired by Attorney General Ashley Moody. Council members include DACCO CEO Mary Lynn Ulrey and FBHA President Melanie Brown-Woofter.

The overarching purpose of the taskforce, as defined by executive order, is to research and assess the nature of opioid drug abuse in Florida and develop a statewide strategy to identify best practices to combat the opioid epidemic through education, treatment, prevention, recovery and law enforcement.

Read the Minutes from the first meeting on October 11, 2019.

The second meeting of the task force listened to reports on topics that included: Efficacy of MAT for Opioid Use Disorder, Narcan Administration by County, and ER to Warm-Handoff – What Happens after an Overdose?

Dr. Aaron Wohl, Medical Director, Lee Health System

To listen to the full second meeting of the Opioid Task Force you may click this link that takes you to The Florida Channel and locate Statewide Task Force on Opioid Abuse from 11/21.

New Medicaid Housing Assistance Pilot Program to Support Individuals with Serious Mental Illness and Substance Use Disorders

Read or Download Press Release Here

Melanie Brown-Woofter, President FBHA; AHCA Secretary Mary Mayhew

The Florida Behavioral Health Association (FBHA) was pleased to recently stand with Agency for Health Care Administration Secretary (AHCA) Mary Mayhew as she announced the new Medicaid Housing Assistance Pilot Program. This new program received federal approval earlier this year and will begin operations in December. The pilot program will launch in Medicaid Regions 5 and 7 in the counties of Pinellas, Pasco, Seminole, Orange, Osceola, and Brevard.

“Our community mental health and substance use disorder providers in the area are looking forward to working with AHCA and the participating health plans to provide housing assistance services to individuals with serious mental illness (SMI),” said FBHA President and CEO Melanie Brown-Woofter. “Individuals with SMI often find themselves homeless and without adequate resources to find even a temporary residence. This new housing assistance program will allow people enrolled in the program to have a  better opportunity to find a place to call home.”

At Lectern: Karen Koch, Florida Supportive Housing Coalition speaking at AHCA Housing Assistance Pilot Program Press Conference 11/21/19

One of the goals of the program is to help people find permanent housing. AHCA will measure the percentage of participants who achieve long-term housing as one of the performance metrics. Additional performance metrics include tracking the reduction of the days of homelessness, the number of enrolled people receiving medication-assisted treatment, and the reduction in the number of emergency room visits and inpatient hospital stays among participants.

AHCA Secretary Mayhew said, “In partnership with community providers, our Agency, through selected managed care plans, will address a major social determinant of health for individuals with mental illness or substance use disorder by focusing on efforts to support stable housing to improve their health outcomes and reduce preventable hospitalizations.”

Boley Centers is a community treatment provider with services in multiple locations including Pinellas County. Boley Centers currently offers several housing services and they are thrilled to have additional housing support assistance and funding through the Medicaid pilot program.

“This will assist us in helping people throughout Pinellas County,” said Boley Center CEO Gary MacMath. “We provide different types of housing based on individual needs. This is a great lifeline for people recovering from mental illnesses or who have re-occurring substance abuse problems.”

Aspire Health Partners in Orlando, Florida has behavioral health services across Medicaid Region 7. They assist all age groups from children and adolescents to adults and seniors.

“We are delighted that this program will enhance resources so that individuals can access much needed resources to address their mental illness and substance use disorder needs,” said Aspire Health Partners CEO Babette Hankey. “Focusing on removing barriers, particularly housing, will enable individuals to focus on their treatment needs, leading to more successful outcomes.”

The health plans participating in the Medicaid Housing Assistance Pilot Program include Aetna, Simply Healthcare, Staywell, and Magellan Complete Care.

Governor’s Budget Proposals Include $54 Million to Opioid Crisis and $17 Million in New MH and SA Funding

Governor Ron DeSantis

Governor Ron DeSantis is recommending $54.8 million be used to fight the opioid epidemic in Florida. Part of that funding, a little over $12 million, will come from federal dollars in the form of the State Opioid Response Grant already targeted for evidence-based prevention, medication-assisted treatment, and recovery.

The Governor is also recommending an increase of over $17 million in new funding for behavioral health. A portion of the new dollars are allocated for the expansion of Community Action Teams (CATs) and the creation of nine new CATs in the following locations: Alachua, Citrus/Hernando, Polk/Highlands/Hardee, Orange, Walton, Brevard, Pasco, and Marion.

The Governor’s total budget recommendations are $91.4 billion. One of the most notable additions is an increase to teachers’ salaries with a cost of about $600 million.

View the full Bolder, Brighter, Better Future Budget here.

US Representatives Highlight Florida Program in Fight Against Opioids to HHS

By U.S. Congressman John Rutherford, from Rutherford Roundup 11/8

Read Full Letter and Signatures Here

I recently led a letter with my colleague Rep. Charlie Crist to Health and Human Services (HHS) highlighting Florida’s leadership in combatting the opioid crisis. Our state-run wraparound programs provide education and funding for treatment services that have lowered opioid overdoses, relapses, and deaths. Because of this success, we are asking HHS to use our state’s innovative model as an example for fighting the opioid crisis throughout the U.S.