MLK Jr. and Mental Health

Monday, January 15, 2024

By Don Sapatkin

In fact, King struggled with depression in his youth and as an adult but never discussed it with anyone except his closest friends and family because of the stigma and his fear that it could be used against him and the movement. A Columbia University psychologist wrote about some of the lessons from Dr. King’s life that we still need to learn today.

Also in today’s Daily: What you probably didn’t know about finding residential addiction treatment for adolescents. New weight-loss drugs don’t appear to be linked to suicidal thinking, a preliminary review by the FDA finds. Teletherapy sweeps college campuses nationwide. And the counter-intuitive case for illicit buprenorphine.

---

What Martin Luther King Jr. knew but never said

There is one thing Martin Luther King Jr. never touched in his great orations even though he knew a lot about the subject privately. That is mental illness.

In many respects, Pike notes, King’s depression is not surprising, considering the pressure he was under as a leader, the attacks and repeated death threats he faced, the blackmail against him from J. Edgar Hoover’s FBI. “Severe and enduring stress are clear risk factors for depression – a condition that afflicts nearly one in five people over the course of their lives,” Pike writes. Racism, discrimination and marginalization also increase the risk for mental health issues, she notes, and Black people are more likely to report serious psychological distress but less likely to seek treatment.

Pike also points out a common fallacy: that successful people are immune to mental illness and that people with mental illness cannot be successful. In fact, mental health challenges like depression and anxiety often live side by side with love, meaning, and success, she writes, and “MLK’s legacy is a case in point.” You can read Pike’s column in full on the MindSite News website.

---

As teen overdose deaths soar, access to treatment is daunting

I calculated that from 2018 to 2022 overdose fatality rates for adults 18 and older rose 58% – but for those 17 and under, they grew an astonishing 280%.

That bit of context makes findings from a new study published in Health Affairs all the more distressing. The researchers wanted a real-world picture of that challenge, so they relied not on databases but on their own phone calls to residential treatment facilities. They posed as aunts and uncles of 16-year-olds who’d just survived a fentanyl overdose and tried to get their nieces or nephews into treatment.

Using a government treatment locator tool and Google ads, the research team called 327 facilities nationwide that were listed as serving patients under 18 and found that only half of them actually did serve teenagers. Of those 160 locations, just over half had a bed immediately available, while about 40% offered only a waitlist, with an average wait of 28 days – a real problem when your kid is in crisis. Ten states plus Washington D.C. had no facilities that served adolescents.

Almost 60% of these facilities were nonprofit, and 83% of those accepted Medicaid. Among the for-profit programs, on the other hand, fewer than 20% took Medicaid. Most programs said they’d accept cash – with the for-profits charging an average of $1211 a day and the nonprofits charging $395. Such costs add up in a hurry. For a two-month stay – the median duration for adolescent residential treatment, according to other research – that makes the cost of paying out of pocket around $24,000 at a nonprofit and $74,000 at a for-profit.

But that’s not all. Nearly half of the facilities required major up-front payments – an average $29,000 at the nonprofits and $35,000 at the for-profits. When the secret shoppers said they didn’t have that kind of money, the facilities often suggested options: Take out a loan, get a second mortgage, put it all on credit cards. And what do you get for all this money? Another study just a few months ago found that only a quarter of the residential facilities that serve adolescents offered buprenorphine, the gold standard for treating opioid dependence in teens.

The research team came to this conclusion: “Access to adolescent residential addiction treatment centers in the United States is limited and costly.” I’d put it more succinctly: “Good luck.”

---

The campus counselor is in – on your digital device

In recent years, a perfect storm has swept across college campuses. Growing numbers of students are distressed or in mental health crisis, and schools can’t meet the demand. At the same time, a new digital mental health sector has emerged, eager to serve young people comfortable with new technologies. The process has transformed the world of campus counseling – and created a booming business for teletherapy providers, The Chronicle of Higher Education reported.

Hundreds of colleges are now contracting with these companies to assist their in-house counselors. New Jersey, for example, recently purchased teletherapy access for every college student in the state. Texas-based TimelyCare claims 3,000% growth over the past three years, and says it serves more than 350 colleges.

Many students say they like the option of doing therapy anytime from anywhere, and the 24/7 availability is especially helpful in a crisis. The companies say they work with colleges to get on-the-ground support to students in danger as quickly as possible. The scale at which the biggest companies operate also means that students should be able to find therapists from different racial, religious, and gender backgrounds – a feature often lacking at small colleges with few counselors. But skeptics have questions. They say it can be difficult for colleges to exercise oversight and quality control over third-party vendors and argue that virtual care from far-away therapists can’t replace the institutional, cultural, and local connections that college counselors have with students.

---

In other news…

Blockbuster weight-loss drugs Ozempic and Wegovy don’t appear to be linked to suicidal thoughts and actions, according to a preliminary review posted by the FDA. As we reported in September, the European Medicines Agency had begun examining 150 reports of self-harm and suicidal thoughts in people using the drugs. The medications have become wildly popular for weight loss, leading to a deluge of reports about possible side-effects coming into an FDA database. The FDA said its evaluation of the data is ongoing but so far had not found any such link, the Washington Post reported.

Opioid prescribing by surgeons declined by more than a third from 2016 to 2022, according to a study of more than 140 million prescriptions dispensed by U.S. retail pharmacies over the seven-year period. But that’s still more than patients need, the authors wrote in a JAMA Network Open research letter, noting that the average opioid prescription in December 2022 was written for 44 pills – more than what standard guidelines recommend for any of the 30 surgical procedures covered. “Going forward,” they concluded, “surgical opioid prescribing guidelines based on patient-reported opioid consumption could align prescribing with patient need.”

The counter-intuitive case of illicit buprenorphine: More than a year ago, Congress eased burdensome rules in an effort to increase prescribing of buprenorphine, a medication shown to be highly effective for treating opioid addiction. But the rule changes don’t appear to be working. “It seems that providers simply don’t want to prescribe it more,” public health epidemiologist Joëlla W. Adams wrote in an opinion piece for Stat. Adams notes that some critics have argued that more prescribing could lead to more buprenorphine – itself an opioid – getting diverted for illicit use. That’s probably true, Adams says, but much of the illicit use on the street turns out to people treating their own addiction. When Adams conducted a modeling study a few months ago she found that increased diversion of buprenorphine to the streets was linked to a drop in overdoses.

Politico isn’t known for its mental health coverage. But its health-policy newsletters pay a lot of attention to behavioral health issues. Here are three from last week’s Politico Future Pulse newsletters:

Cutting back on use of stimulants like cocaine or meth by as little as one day a month – a form of harm reduction – was linked to lower levels of drug craving and depression, a noteworthy finding since there are no licensed treatments for stimulant addiction. Artificial Intelligence can do a decent job of converting miscellaneous doctor’s notes into corresponding social determinants of health worth addressing – an AI use that the Luddite in me would have no qualms about. YouTube is making an effort to be part of a misinformation solution by offering a pinned shelf of information from reputable sources when users search the site for terms that may indicate a health crisis. (I tried “opioid overdose” and “suicide”: The first was spot-on, the second not so much, although it did present the 988 Suicide Crisis and Lifeline at the top.)

---

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

---