On MLK Jr. Day, a self-care reminder

Monday, January 16, 2023

By Don Sapatkin

“What I have been doing is giving, giving, giving, and not stopping to retreat and meditate like I should – to come back. If the situation is not changed, I will be a physical and psychological wreck. I have to reorganize my personality and reorient my life. I have been too long in the crowd, too long in the forest.”

Words worth considering, as we remember Dr. King’s legacy and think about how to care for ourselves, as we also try to look out for others.

That’s pretty much the theme of a new University of Maryland class called “U Sad?” In other stories, the mental health crisis is placing a burden on state Medicaid programs, although a new law may help. Depression often looks and feels a bit different to Black women, leading to missed diagnoses. And a single brain network may be involved in several psychiatric conditions linked to different regions of the brain. Plus: a MindSite News exclusive investigation into the unregulated Wild West that is the training and certification industry for grief counseling.

How I Passed a Test to Be a Grief Therapist Without Really Trying

by Astrid Landon

 ‘U SAD?’ One-credit course helps Maryland college students cope with stress, anxiety, depression

A one-credit course that aims to help undergraduates at the University of Maryland manage stress and mental health challenges and will start near the end of January is filling up quickly, Inside Higher Ed reported.

Morgan developed the in-person course, which will rely on videos and articles about anxiety, interpersonal communication and suicide prevention – along with student discussions and activities with a partner. While students will likely discuss their own mental health, Morgan said, they will develop ground rules and boundaries with their teachers on the first day – no “trauma-dumping,” for example, a reference to oversharing distressing experiences that might dominate the discussion. Faculty are encouraged to identify struggling students and invite them to enroll.

The course, which will meet weekly for 14 weeks, isn’t group therapy but can be a part of students’ larger mental health journey, Morgan said. Colleges and universities have increasingly offered therapy in recent years, although a 2019-20 survey of college counseling center directors found that nearly 46% limited the number of one-on-one counseling sessions (U-MD allows eight a year.) And while many campus mental health centers refer students to outside counseling, a substantial percentage told Inside Higher Ed last year that the referral process was difficult.

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Can Medicaid address growing mental health needs?

The nation’s increasing mental health crisis places a growing and disproportionate burden on Medicaid programs, according to a report by Fierce Healthcare on a Kaiser Family Foundation survey of Medicaid officials in 44 states.

Nearly 40% of Medicaid enrollees lived with a mental health or substance abuse problem in 2020, the KFF analysis noted. Mental health services cost Medicaid more than they do for any other payor partly because of enrollees higher rates of chronic diseases, which exacerbate behavioral health issues. Yet low reimbursement rates are a major problem, especially for psychiatrists: Only 36% accept new Medicaid patients, largely due to the lower pay and higher hassles of dealing with managed care organizations.

“State strategies to address the behavioral health workforce shortage fall into four key areas: increasing rates, reducing burden, extending workforce, and incentivizing participation,” the KFF analysis noted. Oregon, for example, directed its Medicaid coordinated care organizations to increase 2023 pay rates by 30% for behavioral health providers who receive at least half their revenue from Medicaid, and 15% for providers with less Medicaid revenue. New Jersey now allows licensed clinical social workers to bill Medicaid independently for mental health services. And 31 states said they are adding peer and family support specialists as providers whose services can be paid for by Medicaid.   

Looking ahead, the sprawling omnibus bill that Congress passed just before Christmas to keep the government running authorizes funding for at least 100 new psychiatric residency positions and will substantially increase the number of providers authorized to prescribe buprenorphine to treat opioid use disorder by eliminating an administrative burden known as the “X waiver” requirement. The bill also provides grants for peer support providers and requires insurers with Medicaid managed care contracts to update their notoriously inaccurate provider directories, which often list mental health providers who actually aren’t available to see patients.

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For Black women, some symptoms of depression look (and feel) different

Depression often goes unrecognized in historically marginalized groups – especially Black women – because of wide variations in how symptoms are discussed and presented. The standard criteria used to diagnose depression was based largely on studies that mostly included white men, HuffPost reported. A new study seeks to identify some of the nuances.

The new study, published in Nursing Research, found that Black women are more likely to report self-criticism, self-blame, trouble sleeping, an inability to experience pleasure and irritability than the more widely recognized symptoms of depression like feeling sad or hopeless. “It’s not emotionally safe to simply be sad or hopeless, which are some of the hallmark symptoms of depression,” Toronto-based psychotherapist Meghan Watson, the founder and clinical director of Bloom Psychology and Wellness, told HuffPost. She said the stereotypes of “strong and resilient” Black woman may also keep them from leaning into sadness or anything that could be seen as “weak.”

“Based on our findings, it’s possible that health care providers may miss depression symptoms in Black women, resulting in underdiagnosis and undertreatment,” psychiatric nurse practitioner Nicole Perez, lead author of the study and a postdoctoral associate at New York University’s Rory Meyers College of Nursing, said in an NYU press release.

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In other news…

Six distinct psychiatric disorders may involve a single neural network across several regions of the brain, New Scientist reported: depression, anxiety, schizophrenia, bipolar disorder, addiction, and obsessive-compulsive disorder.

The “transdiagnostic network, described in Nature Human Behavior, was mapped using a meta-analysis of neuroimaging studies. “This convergent brain network for psychiatric illness may partially explain high rates of psychiatric comorbidity and could highlight neuromodulation targets for patients with more than one psychiatric disorder,” the authors wrote.

Patients more likely to stay in care when getting opioid addiction med’s from pharmacists. A new study published in the New England Journal of Medicine found that pharmacists – not just  doctors  in clinics or private practice – can safely and effectively start patients with opioid use disorder on the lifesaving medication buprenorphine. In the study, 100 patients were initially started on buprenorphine by a specially trained pharmacist. The patients were then randomized to get continued care and prescribing from the pharmacist or from a doctor – and almost 90% of those getting care from a pharmacist continued for a month, compared to less than 20% getting doctor-based care. “Dramatically increasing capacity to provide good, lifesaving treatment for people with opioid use disorder through pharmacies is an approach that could be ramped up today,” said Traci Green, lead study author and co-director of Rhode Island Hospital’s Center of Biomedical Research Excellence on Opioids and Overdose. “It’s a game-changer.”

VA expanding access to non-VA facilities for suicidal veterans. The Department of Veterans Affairs will cover 30 days of inpatient care and 90 days of outpatient care in non-VA facilities starting this week, NBC News reported. After years of steady increases, suicide among veterans declined in 2020 for the second year in a row, reaching the lowest point since 2006, according to a Department of Veterans Affairs press release that includes details of the interim final rule.

A “transcultural mental health line” serving Australia’s diverse communities launched last week, staffed by mental health professionals fluent in 30 languages (200 are spoken countrywide), the state of New South Wales reported.

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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.

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