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November 17, 2016

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor

NPs and PAs are Now Allowed to Prescribe Buprenorphine

On Tuesday, November 15th, the Department for Health and Human Services (HHS) announced additional steps to expand access to medication-assisted treatment (MAT) for opioid use disorders .
Starting February 2017, Nurse Practitioners and Physician Assistants will be able to prescribe buprenorphine, a medication typically used to treat opioid use disorders. Once training requirements are met, Nurse Practitioners and Physician Assistants can apply for a waiver to treat up to 30 patients.
These actions build on one of the three main priorities of HHS Secretary Burwell's initiative to combat the opioid epidemic: increasing access to MAT for opioid use disorder and reflects public input on the issue.

Updates on training information and the waiver application will be available at
New Mobile App will Provide Instant, Vital Information on Medication-Assisted Treatment for Opioid Use Disorder

SAMHSA recently launched a free smartphone app designed to provide essential resources and information to doctors interested in utilizing Medication-Assisted Treatment (MAT) to treat patients with a prescription opioid abuse disorder. The MATx app  is one of the latest measures taken by the SAMHSA to spread awareness about MAT to primary care physicians and other health care providers.

MATx empowers health care practitioners to provide effective, evidence-based care for opioid use disorders.  MATx features include:
  • Information on treatment approaches and medications approved by the U.S. Food and Drug Administration for use in the treatment of opioid use disorders
  • A buprenorphine prescribing guide, which includes information on the Drug Addiction Treatment Act of 2000 waiver process and patient limits
  • Clinical support tools, such as treatment guidelines, ICD-10 coding, and recommendations for working with special populations
  • Access to critical helplines and SAMHSA's treatment locators.
More information about the free app and how to download it to a mobile device is available here.
Study: Spending Money on Mental Health Care Saves Jail Expenditures 

Every dollar a state spends on mental health cuts about 25 cents from jail expenditures, according to  a new study  from Oregon State University.

The study, published in the journal "Social Science & Medicine," looked at 44 states and Washington, D.C., over a period of nine years.

Professor Jangho Yoon with the College of Public Health and Human Sciences, says 35 of the states could have reduced their jail populations by spending more money on inpatient mental health care.

"We find that $1 increase in inpatient mental health expenditures would lead to a 25-cent decrease in jail costs overall," Yoon said.

The idea is that the more help you give someone struggling with mental illness, the less likely they are to run afoul of the law and go to jail.

The U.S. Department of Justice estimates that  more than half of inmates have a mental health problem.

The average cost for housing a jail inmate is $60 a day.

Rural Veterans May Not Be Receiving the Mental Health Treatment They Need

Living in a rural area, for all its benefits, can come with some specific challenges.  An important one can be access to services such as health care.  This can be especially true for specialty services like behavioral health care.  Serving those with unique health care needs requires new approaches when large specialty health care providers are far from home.  For rural veterans, this means improving access to quality care.

There are approximately 22 million veterans nationwide, with 5.3 million (24 percent) of those veterans living in rural areas. According to the U.S. Department of Veterans Affairs (VA), veterans in rural settings have a lower quality-of-life and are ill more often when compared to urban veterans.  The overall health needs of rural veterans are reportedly greater than those of urban veterans, and they receive mental health services less often than warranted.

According to the 2012-2014  National Survey on Drug Use and Health (NSDUH)
veterans  in rural areas were 70 percent less likely to receive any mental health treatment compared to their urban counterparts.  Read more here.



CTAC is offering a 6-part webinar series on the broad principles and core competencies of documentation for direct service providers and supervisors. 

November 30, 12 - 1 pm




Children & Families Committee
November 22:  11:30 am - 1 pm
GTM Only

Office Closed - Thanksgiving
November 24, 25


RPC Advisory Committee 
December 1:  8 am
GTM Only

Mental Hygiene Planning Committee
December 1:  11 am - 2 pm
In-Person Meeting

Officers & Chairs - Call In
December 7:  8 am

RPC Advisory Committee 
December 8:  8 am
GTM Only

Children & Families Committee
December 13:  11:30 am - 1 pm
GTM Only

RPC Advisory Committee 
December 15:  8 am
GTM Only  

Directors/Executive Committee
December 20:  9:30 - 11:30 am
GTM Only

Office Closed - Christmas
December 26

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
U.S. Surgeon General Murthy Ramps Up Addiction Battle 

The U.S surgeon general has released Facing Addiction in America the first comprehensive report on addiction in America, and he wants it to have as much public health punch as the groundbreaking report on the dangers of tobacco 50 years ago.

In an interview with POLITICO on the eve of its release, Surgeon General Vivek Murthy said that he's determined to make the  report
an action item in communities across the country, and not just put it on the shelf.

"We can't afford not to address it," he said. "We can't afford to stay on the path we're on."

More than 20 million people in America have substance abuse problems; 78 die every day from opioids alone.

The report, released this morning, is about substance abuse broadly - both alcohol and drugs, legal and illegal. But it's the opioid epidemic that has grabbed public attention. And opioids have gradually emerged as one of Murthy's top priorities, particularly as he's traveled the country listening to family's stories.

In Washington and the states, Republicans and Democrats alike have endorsed a more robust response, and Congress passed bipartisan legislation - although it's not yet funded. But the report, " Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs and Health," arrives amid heightened uncertainty about policy and access to treatment.  Read more here .
National Council Releases Toolkit for the Surgeon General's Report on Addiction 

Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health was released today.

Surgeon General Vivek Murthy made the goal for the report clear: ignite meaningful conversation to 'turn the tide' on our nation's addiction crisis.

The conversation will only be meaningful if key players in solving the addictions crisis take part in the conversation. This toolkit can help you engage media, craft compelling stories and inform the community about addiction.

Click here to access the toolkit.
In Opioid Epidemic, Prejudice Persists Against Methadone

When Rebecca Schmaltz found out she was pregnant with her second child, she tried to quit heroin cold turkey. She stopped injecting for a day or two, became sick with withdrawal symptoms, and relapsed. She kept trying, though, to kick the habit on her own.

Finally in her fourth month of pregnancy she passed out from severe withdrawal symptoms and ended up in a hospital. When she woke up, she learned a doctor had given her methadone to eliminate her symptoms, which can be life-threatening to the fetus.

Her doctor told her she would have to stay on daily doses of methadone for the rest of her pregnancy or risk more hospitalizations and possibly lose her baby. But methadone wasn't available in her hometown of Minot, North Dakota. In fact, the nearest clinic was nearly 450 miles away in Billings, Montana.
Schmaltz's predicament is not unusual.

Despite the nation's decadelong surge in opioid addiction, large swaths of the U.S. still lack specialized opioid treatment centers that can dispense methadone, one of three medications available to treat addiction to heroin and prescription pain pills.

The other two medications, buprenorphine (approved by the Food and Drug Administration in 2002) and Vivitrol (approved in 2010), can be prescribed by doctors. But for some patients, particularly those who have built up a high tolerance for opioids through prolonged use or high doses, methadone can be the only addiction medication that works.  Read more here.
Community Paramedics Work To Link Patients With Mental Health Care

For Kelly Kjelstrom, plugging the gaps in mental health care can mean something as simple as a late-night taco and a friendly chat.

Kjelstrom, 45, is a community paramedic in Modesto, California. Part of his job is to help psychiatric patients in need of care avoid winding up in the emergency room, where they can get "boarded" for days, until they are released or a bed frees up at an inpatient facility.

Here's how the concept of community paramedics works. When the local 911 system comes upon a patient with a potential mental health crisis, these specially trained paramedics are dispatched to the scene. They've learned to identify problems, intervene and de-escalate the situation.

After a physical assessment, paramedics like Kjelstrom talk to the patient - to figure out what, precisely, the issue is, asking also about issues like a patient's mental health history, drug use and insurance status. They use that information, along with details about resources available, to figure out the next steps for the patient - maybe it is a hospital or a psych facility, or maybe it is outpatient care.

Increasingly, these paramedics also become involved in follow-up. Kjelstrom estimates that, on visits, he spends twice as long with patients as he used to. He builds relationships with them. While out on duty, if he runs across a familiar face, he stops and checks in. Like over a night-time snack. 
Read more here .
New Pain Findings May Help Explain Severity of Opioid Withdrawal

Pain is not simply a matter of nerves, but one that significantly involves our glial cells, the most common type of cell in the human brain and spinal cord, according to a new study by researchers at the Division of Neurophysiology at MedUni Vienna's Center for Brain Research.

Glial cells surround neurons and play an important supporting role. When glial cells are activated - by pain processes, for example - they are able to release messenger substances, such as inflammatory cytokines. This results in a strong pain-amplifying effect.

The findings may help explain why opioid withdrawal produces such severe pain throughout the entire body, a phenomenon that has been unclear until now.

Other factors that can lead to activation of glial cells include neuroinflammatory diseases of the brain, environmental factors, and even a person's own lifestyle choices, such as exercise and diet. Examples from the current literature  are  depression anxiety
disorders and chronic stress, multiple sclerosis or Alzheimer's and diabetes, as well as lack of exercise and poor diet.

"The activation of glial cells results in a pain-amplifying effect, as well as spreading the pain to previously unaffected parts of the body. For the very first time, our study provides a biological explanation for this and for other hitherto unexplained pain phenomena in medicine," said Jürgen Sandkühler, M.D., Ph.D., head of the Division of Neurophysiology at MedUni Vienna's Center for Brain Research.

Over-activation of glial cells in the spinal cord can be triggered by strong pain stimuli from a wound or surgical intervention - or even by opiates.  Read more here.
Open Minds White Paper:  
Gaps In Successful EHR Implementations: The Challenges & Successes Of Providers In The Marketplace

While there is consensus among behavioral health providers that implementation of an electronic health record (EHR) system brings value, there are multiple challenges to assuring that an EHR implementation will be successful and will result in the operational and strategic impacts expected.

During a recent national survey of behavioral health providers, it was found that a majority of behavioral health organizations have already implemented an EHR system, but the level of success varies from one organization to another. Organizations reported considerable variance in EHR implementation timelines, with the majority reporting 6-12 months to fully implement and over 10% reporting implementations of 2 years or longer. The study also looked at factors influencing delays, which provided some interesting insights into the challenges that can occur during implementation.

So how do we define a successful EHR implementation, and how do we ensure we make it happen? The good news is, when organizations select the right EHR vendor partner and take the necessary steps for successful implementation, challenges can be avoided and organizations can gain all the advantages of a complete EHR system.

Click here to learn the seven steps industry experts have identified that lead to successful and effective EHR implementation.
The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.