But first: My favorite headline of the week, in JAMA Psychiatry: “Cross-Species Framework for Emotional Well-Being and Brain Aging” (The article is as impenetrable as its headline, but be my guest.) 

News flash: Trump may rescind new Biden rules for enforcing federal parity law

The Trump administration, through a legal filing submitted Friday to the federal district court in Washington, D.C., has indicated that it may rescind or modify final rules approved last year by the Biden administration for enforcing the Mental Health Parity and Addiction Equity Act. In the meantime, it will not enforce the new regulations, according to a post by KFF Health News reporter Aneri Pattani.

The Biden rules were strongly supported by mental health advocates as a way to compel health insurers to remove barriers that prevent people needing mental health services from getting them approved or covered by insurers. Days after President Donald Trump’s inauguration, a trade association representing about 100 large employers sued the federal government, claiming that the regulations were an overreach, would increase costs, and risked reducing the quality of care.

For more background on these developments, see Pattani’s story for KFF Health News on Friday and this piece by MindSite News contributor Melanie Haiken in December.

The Kennedy Forum will host a town hall on Thursday, May 15 at 1 p.m. Eastern time to discuss the latest developments. MindSite News Founding Editor Rob Waters will moderate. You can register to attend the webinar by clicking on this link.

And, while we’re talking about parity, be sure to read each part of our new series, Deadly Denials, which investigates the hurdles erected by health insurers that keep people with eating disorders from getting the care they need.  Part 2, published this morning, can be found here; Part 1 is here.

Good news and bad on Trump mental health cuts

House Speaker Mike Johnson retreated from perhaps the most controversial of the GOP proposals to cut Medicaid, The Fiscal Times reported, and is considering backing off from another. His decision comes after pressure from moderate Republicans, whose constituents – like people all over the country – rely on Medicaid. The abandoned plan would have lowered the 90% federal share of funding for people in the 41 states that took part in the Medicaid expansion established by the Affordable Care Act. Reducing the federal contribution would force states to pay more or cause them to drop out of expanded Medicaid.

Pulling back from that plan creates another problem for Republicans in Congress. Their 10-year budget plan calls for cutting $880 billion in spending – largely from Medicaid, which covers a huge share of all spending on mental health and substance use treatment. Reducing the federal match would raise $710 billion, according to the Congressional Budget Office so stepping back from this cut makes it much harder to achieve $880 billion in cuts. Johnson also downplayed, but did not rule out, imposing spending limits on state Medicaid plans, which would save an estimated $682 billion.

With these two ideas now apparently off the table, the biggest remaining option is limiting the way states use a tax loophole to increase federal spending on Medicaid. That would save $668 billion, mostly by reducing Medicaid spending in poorer, Southern – i.e. red – states, the New York Times reported. Without major cuts to Medicaid – which, along with politically-untouchable Social Security and Medicare, makes up about 40% of the federal budget – House Republicans’ goal of $2 trillion in cuts looks virtually impossible to achieve. The savings are earmarked for extending the 2017 tax cuts and introducing new ones.

In other Trump administration news: 

Major Medicaid cuts could force psychiatric units at small and rural hospitals to close, NPR reports. The program insures an unusually large share of mental health inpatients, most of whom are admitted through the emergency room. Hospitals say spending cuts could accelerate a decades-long trend of psych unit closures. Cuts to Medicaid would also undermine progress on lowering opioid overdose deaths, according to a piece in Health Affairs Forefront. The article highlights the huge potential impact of cuts – 3.9 million adult Medicaid enrollees had substance use disorder diagnoses in 2021, compared with 5.2 million with high blood pressure, 1.9 million with asthma and just 600,000 with heart disease. (My colleague Josh McGhee wrote last month about the cuts’ potential threat to coverage for those coming out of incarceration, when the risk of fatal overdoses is particularly high.) 

The National Institute for Mental Health had the most grants terminated of any center in the National Institutes of Health, according to research published in JAMA. NIMH’s 128 terminations was 60% higher than the next worst-hit center, the National Institute on Minority Health and Health Disparities, which lost 77 grants. The value of the latter ($223.6 million) was higher than NIMH’s ($172.8 million), although larger entities like the National Cancer Institute lost more in terms of dollars. A total of 694 NIH grants worth $1.8 billion were terminated.

More police officers die by suicide than on duty. Why?

According to the FBI, 57 police officers are killed each year by suspects, on average. That threat looms relatively large in the public imagination compared to the 184 public-safety officers – half of them local police – that typically die by suicide each year. Law-enforcement officers are 54% more likely to die by suicide than the average American worker, according to one estimate, but there is no central repository for data on police suicides; each of these figures comes from a different source.

The New York Times Magazine, in a deeply reported story about a Des Moines cop’s suicide and the impact it had on his partner and best friend, examines the reasons behind the numbers – and why they garner so little attention.

What I found particularly hard to fathom was the cold response from leadership. No brass showed up at the scene after Sgt. Joe Morgan, a 23-year veteran, took his own life outside his home – something they always do when a police officer is killed in the line of duty. He was accorded none of the honors typically bestowed on officers who die of cancer – an officer staying with the body before burial so their fallen comrade is never alone, commanders wearing dress uniforms to funerals as a sign of respect. Families of officers who die in the line of duty could receive, by one calculation, $1 million in cash and benefits. But after a suicide, surving spouses may find their health insurance canceled.

It’s not hard to understand why police might be prone to suicide. They’re mostly male, a demographic with higher suicide rates, and the culture stigmatizes the need for support as weakness, discouraging troubled officers from seeking help. Alcohol – a socially acceptable coping method – can compound mental health problems, as can the fatigue of shift work. Cops have ready access to firearms. Highly publicized police killings and misconduct have turned many people against them. Day-to-day, they’re more likely to respond to a suicide call than to shoot it out with a bad guy, and that chronic stress can lead to PTSD and depression. 

Compare what happened to two of the officers who sustained injuries during the Jan. 6 attacks on the Capitol and died in the days that followed. One succumbed to physical complications (two strokes), and lay in honor in the Capitol Rotunda, praised for “profound inner strength.” The other, who may have suffered a traumatic brain injury on Jan. 6, shot himself days later, and wasn’t similarly honored. Recent legislation allows for some suicides to be considered “line of duty” deaths, creating a route to support families and recognize the fallen, theoretically allowing some officers who died by suicide  to be added to a Washington D.C. memorial that records the names of fallen officers going back to 1786.

National Police Week began in Washington on Sunday, and its most important event is a candlelight vigil honoring fallen officers including those who died from  heart attacks, strokes and Covid-19 – but not suicide. Bill Alexander, who heads the organization that mainstains the memorial wall, says not all police suicides are related to police work and that he and his colleagues want to maintain the integrity of the country’s most important police monument. “The board felt a strong moral duty to protect what they view, and what I view, as a very sacred space,” he said.

Kaiser Permanente settles six-month strike with mental health workers

Unionized mental health workers in Southern California voted overwhelmingly to accept a new four-year contract, ending a half-year strike. Kaiser Permanente had been under pressure for some time from legislators and the governor to settle, Healthcare Dive reports, amid reports of increased waits for therapy appointments. 

In between the announcement of the agreement and the 1,799 to 24 vote to ratify it, the California Assembly health committee held an oversight hearing about the sprawling nonprofit provider’s behavioral health services. Union representatives, lawmakers and patients all spoke about shortcomings in Kaiser’s care, according to CalMatters. Kaiser did not attend, contending in a two-page letter that “it would not have been a productive or balanced discussion.” 

Union members were mostly happy with the new contract, which covers approximately 2,400 Southern California-based mental health workers and is retroactive to September 2024, expiring in 2028. It gives full-time therapists five guaranteed hours per week to handle patient care tasks outside of appointments – seven hours had been a key demand – as well as a 20% raise over four years and a more secure pension plan, though one still less lucrative than Kaiser’s plan for medical employees. 

A union news release noted that the terms are “substantially better” than what Kaiser offered before the strike but still leave Kaiser mental health therapists making up to 50 percent less than, for example, physical therapists. A Kaiser spokesperson expressed frustration about continuing union criticism post-agreement – the latest in a long series of testy exchanges since workers walked out in October.

In other news…

• The emotional toll of hearing loss may raise the risk of heart failure, according to JAMA Medical News in Brief. It reported on a paywalled study in the journal Heart, which assessed hearing ability and mental health measures in 164,000 participants who didn’t have heart failure at the onset. After nearly 12 years of follow-up, the risk of heart failure rose 15% in people with slight hearing problems and 26% to 28% in those with poor hearing. Psychological distress, social isolation and neuroticism were identified as potential factors driving the heightened risk of heart failure, the study authors wrote.
• In Minnesota, 7.9% of teenage students are frequent gamblers and 0.7% are problem gamblers, according to a 2022 survey of 83,545 youth. The analysis, in JAMA Pediatrics, defined “frequent gambling” as once a week or more and “problem gambling” as people who gambled in the past year and ranked high on a youth-gambling measure. And that’s in a state where sports gambling is not yet legal but is growing fast. Most of the 6,603 frequent gamblers were male (62%) and most bet informally (89%) or formally (59%) on sports and games, bought lottery tickets (26%), or engaged in online (25%) and casino (12%) gambling. Among the 550 problem gamblers, 76% were male and they tended to engage in multiple forms of gambling.