Benjamin F. Miller, PsyD, Chief Strategy Officer, Well Being Trust
John Auerbach, President and CEO, Trust for America’s Health February 23, 2018 Trends in Alcohol, Drug and Suicide Deaths New National Findings Death still increasing - 11% between 2015 and 2016 (our most recent data) 142,000 died from the 3 causes Opioid deaths increasing most rapidly One death every 4 minutes Deaths could top 2 M in next decade New National Findings - Opioids Deaths doubled from fentanyl, carfentanil & other synthetic opioids - surpassing prescription and heroin deaths Opioid Death rates among Blacks rose 58%; Latinos up 35% (Whites still higher though) Death rates increased 33% among 18-34 year olds (26% among 35 -54 year olds) Geography and "Deaths of Despair" in 2016
States with highest "despair"
death rates: West Virginia, New Mexico and Alaska States with fast growing rates: DC, PA, DE, MD, NJ, MO, WV, VA, NY, MA, Ohio, Ill. A Path Forward: State & Local Public Health Perspective
Evidence growing but uneven
No single approach is sufficient: Changing characteristics (e.g. synthetics vs. prescription; populations affected) Complexity of factors - economic and educational Underlying social and emotional risks Danger: Treating only symptoms not underlying cause A Path Forward: State & Local Public Health Perspective Opioid/alcohol addiction & suicide are public health issues Multi-sectoral approaches needed Key collaboration with public safety & health care Other sectors, too: education (children/adults), business, recreation, faith Public Health can serve as Chief Health Strategist A Path Forward: a National Resilience Strategy
Prioritize Prevention, Reduce
Risk Factors and Promote Resilience in Children, Families and Communities by limiting trauma and adverse experiences, which have the biggest long-term impact on later substance misuse, and promoting better mental health. A Path Forward: a National Resilience Strategy Reboot Substance Misuse Prevention and Mental Health in Schools by scaling up evidence-based life- and coping-skills programs and inclusive school environments and increasing the availability of mental health and other services. Focus on Children
Two-thirds of Americans report
having experienced an adverse childhood experience (ACE) while growing up — across all socio- economic levels. Nearly 40 percent experienced two or more ACEs, and 22 percent experience three or more ACEs. National Resilience Strategy: Programs in Action Nurse-Family Partnership (NFP): works with at-risk young, low- income, first-time pregnant women; has trusted relationship with public health nurse, meets with mother from pregnancy until baby turns two. NFP has enrolled mothers early in their pregnancies and helped public health nurses continuously conduct home visits over a two-and-a-half year period. Provides a net benefit to society of $34,148 (in 2003 dollars) per higher- risk family served, totaling a return of $5.70 for every dollar invested. The ROI of a National Resilience Strategy Learning from history Un-burying the lead: Public health tools are the key to beating the opioid epidemic. Utilize Medicaid to reimburse supportive housing programs that co- locate employment, education, and health services. Promote and finance two-generation, family-centered treatment and support for children under foster and kinship care. Involve community leaders in designing preventive systems for younger children to promote healthy behaviors, social skills, community opportunities, and pro-social involvement. A Path Forward: Health Systems Perspective Develop financial incentivizes for health systems to promote non-opioid pain treatment options for non-cancer patients. Integrate mental health into primary care throughout the health system. Integrate suicide prevention into primary and behavioral health care (e.g. Zero Suicide). A Path Forward: Health Systems Perspective Integrated sites: 39 percent received some type of substance use treatment in integrated sites
Non-integrated: 16.8 percent
received substance use treatment in non-integrated sites A Path Forward: a National Resilience Strategy Improve Pain Management and Treatment by helping people heal physically, mentally and emotionally. Approaches must acknowledge that there are different types of pain and experts from mental health, medical care and other disciplines must develop team-based solutions that focus on proactively addressing pain before it gets worse. A Path Forward: a National Resilience Strategy
Stem the Opioid Crisis with a full-scale approach – including
promoting responsible opioid prescribing practices (such as provider education and best practices for Prescription Drug Monitoring Programs); public education about misuse and safe disposal of unused drugs; "hotspot" intervention strategies; anti-trafficking to stop the flow of heroin, fentanyl and other illicit drugs; and expanding the use and availability of rescue drugs, sterile syringes and diversion programs. A Path Forward: a National Resilience Strategy Address the Impact of the Opioid Epidemic on Children – and the Need for a Multi-Generational Response that includes substance use disorder treatment for parents and wrap-around services for children and families, including grandparents and other relatives who help care for children, and expand support for the foster care system. A Path Forward: a National Resilience Strategy
Lower Excessive Alcohol Use through evidence-based policies,
such as by increasing pricing, limiting hours and density of alcohol sales, enforcing underage drinking laws and holding sellers and hosts liable for serving minors. A Path Forward: a National Resilience Strategy Prevent Suicides by expanding crisis intervention services; anti-bullying and social-emotional learning in schools; and support systems for Veterans; and better integrating mental health into primary care. A Path Forward: a National Resilience Strategy Expand and Modernize Mental Health and Substance Use Disorder Treatment Services – Toward a Goal of Focusing on the "Whole Health" of Individuals by prioritizing innovative integrated delivery models for rural and underserved urban areas and expanding the provider workforce, including those who can deliver medication-assisted treatment. Suicide Deaths and Primary Care Visits National Resilience Strategy: Programs in Action
Bexar County Jail Diversion Program aligned its criminal justice
system, hospital, mental health services and community partners to transform the mental health system into one focused on diverting people with serious mental illness away from jail and toward treatment. This effort successfully diverted over 100,000 adults from jails and emergency departments and resulted in a cost savings of nearly $100 million over an eight-year period. National Resilience Strategy: Programs in Action
The Zero Suicide Initiative requires primary care doctors to screen
every patient during every visit with two questions: How often have you felt down in the past two weeks? How often have you felt little pleasure in doing things? High scores lead to further questions about sleep disturbances, changes in appetite and/or thoughts of hurting oneself. The model led to an 80 percent reduction in suicide. National Resilience Strategy: Programs in Action Our report highlights more than 60 research-based policies, practices and programs.