VA SAYS STUDY COULD FIND VETERANS WITH HIGH-RISK OF SUICIDE

FROM:  U.S. DEPARTMENT OF VETERANS AFFAIRS
Study may help Department of Veterans Affairs find patients with high-risk of suicide
June 11, 2015, 04:04:00 PM
Study May Help Department of Veterans Affairs Find Patients With High-Risk of Suicide

Clinicians are challenged every day to make difficult decisions regarding patients’ suicide risk. Using Veterans Health Administration (VHA) health system electronic medical record data, Veterans Affairs (VA) and National Institute of Mental Health (NIMH) scientists were able to identify very small groups of individuals within the VHA’s patient population with very high, predicted suicide risk -- most of whom had not been identified for suicide risk by clinicians. Such methods can help the VHA to target suicide prevention efforts for patients at high risk, and may have more wide-ranging benefits.

John McCarthy, Ph.D., M.P.H, director of the Serious Mental Illness Treatment Resource and Evaluation Center in the VA Office of Mental Health Operations, Robert Bossarte, Ph.D., director of epidemiology in the VA Office of Public Health, Ira Katz, M.D., senior consultant for mental health program analysis in the VA Office of Mental Health Operations, and colleagues report their findings today in the online issue of American Journal of Public Health. This paper is the result of a collaboration between the VA and NIMH, which is part of the National Institutes of Health.

Dr. McCarthy and colleagues developed their suicide-risk algorithm by studying the VHA patient population from fiscal years 2009-2011. Data on manner of death came from the National Death Index, and predictors of suicide and other types of death came from VHA clinical records. Dividing randomly the patient population in half, the team used data from one half to develop the predictive model, and then tested the model using data from the other half. Each of the two study samples included 3,180 suicide cases and 1,056,004 control patients. Researchers compared predicted suicide risk to actual mortality to assess the performance of the predictive model.

“As the largest health care provider in the U.S., VA has the responsibility to continuously examine how our extensive suicide prevention efforts are working, and to identify critical opportunities for improvement in service to our nation’s Veterans,” said Dr. Caitlin Thompson, Deputy Director for Suicide Prevention for VA. “This collaborative effort with NIMH provides us with unprecedented information that will allow us to design and implement innovative strategies on how to assess and care for those Veterans who may be at high risk for suicide. This model will advance the care provided to Veterans through VA’s suicide prevention programs to allow us to better tailor our suicide prevention efforts so that we can ensure that ALL Veterans remain safe.”

The VHA care system identifies patients as being at high-risk of suicide based on information assessed during clinical encounters. Researchers found that their predictive model was more sensitive than this clinical flagging, in the sense that, even in groups with the highest predicted suicide risk based on the model, less than one-third of patients had been identified clinically.

“This is valuable, because it gives the VA more extensive information about suicide risk,” said Michael Schoenbaum, Ph.D., senior advisor for mental health service, epidemiology and economics at NIMH and one of the co-authors of the report.  “If the VA can identify small groups of people with a particularly high-risk of suicide, then they can target enhanced prevention and treatment services to these highest-risk individuals,”

“It’s particularly encouraging that these analyses use the types of data available to any large health care system,” said NIMH Director Thomas Insel, M.D. “ These methods could help us prevent civilian as well as veteran suicides.”

In addition to identifying suicide risk, the team looked at deaths among people identified as highest risk for suicide in 2010. The team found that this group had both very high suicide and non-suicide death rates over the next 12 months.

“This finding reinforces the idea that using this process to target suicide risk interventions may have wide benefits across an extended span of time,” concluded Dr. Schoenbaum.

Reference:
McCarthy J.F., et al., Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs. American Journal of Public Health (in press)
About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.
About the Department of Veterans Affairs: The VA is the second largest Federal department with close to 300,000 employees. The Department's mission is to serve America's veterans and their families with dignity and compassion and to be their principal advocate in ensuring that they receive the care, support and recognition earned in service to this Nation.

FDA APPROVES FIRST GENERIC VERSIONS OF DRUG APPROVED TO TREAT SCHIZOPHRENIA, BIPOLAR DISORDER

FROM:  U.S. FOOD AND DRUG ADMINISTRATION

The Division of Drug Information (DDI) is CDER's focal point for public inquiries. We serve the public by providing information on human drug products and drug product regulation by FDA.

The U.S. Food and Drug Administration today approved the first generic versions of Abilify (aripiprazole). Generic aripiprazole is an atypical antipsychotic drug approved to treat schizophrenia and bipolar disorder.

Alembic Pharmaceuticals Ltd., Hetero Labs Ltd., Teva Pharmaceuticals and Torrent Pharmaceuticals Ltd. have received FDA approval to market generic aripiprazole in multiple strengths and dosage forms.

Schizophrenia is a chronic, severe and disabling brain disorder. About one percent of Americans have this illness. Typically, symptoms are first seen in adults younger than 30 years of age. Symptoms of schizophrenia include hearing voices, believing other people are reading their minds or controlling thoughts and being suspicious or withdrawn.

Bipolar disorder, also known as manic-depressive illness, is another brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks. The symptoms of bipolar disorder include alternating periods of depression and high or irritable mood, increased activity and restlessness, racing thoughts, talking fast, impulsive behavior and a decreased need for sleep.

All atypical antipsychotics contain a Boxed Warning alerting health care professionals about an increased risk of death associated with the off-label use of these drugs to treat behavioral problems in older people with dementia-related psychosis. No drug in this class is approved to treat patients with dementia-related psychosis.

$99 MILLION IN GRANTS ANNOUNCED TO IMPROVE MENTAL HEALTH SERVICES FOR YOUNG PEOPLE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVIES 

September 22, 2014

Contact: SAMHSA Press Office

240-276-2130

HHS announces $99 million in new grants to improve mental health services for young people

Health and Human Services Secretary Sylvia M. Burwell announced today $99 million to train new mental health providers, help teachers and others recognize mental health issues in youth and connect them to help, and increase access to mental health services for young people. These funds were included in the President and Vice President’s Now Is the Time plan to reduce gun violence by keeping guns out of dangerous hands, increasing access to mental health services, and making schools safer.

“The Administration is committed to increasing access to mental health services to protect the health of children and communities,” said Secretary Burwell. “Today, I am pleased to announce another step the Department is taking to help ensure that our young people have access to the mental health services they need to reach their full potential.”

The Obama Administration has taken a number of steps to reduce the barriers that too often prevent people from getting the help they need for mental health and other behavioral health problems. The historic expansion of insurance coverage for mental health and substance abuse services made possible by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act will help make mental health services more affordable and accessible for tens of millions of Americans.

Today, the Department of Health and Human Services is announcing the following awards:

More than $34 million to train just over 4000 new mental health providers, including:

$30.3 million to expand the mental health workforce through 100 new grants to training programs to train new mental health and substance abuse health professionals who treat children, adolescents, and young adults with, or at risk for, a mental health or substance use disorder.

$2.7 million for 5 new grants to support youth Minority Fellowship Programs to increase access to mental health services for youth and young adults in America.
$1.6 million for 2 new grants to support addiction counselor Minority Fellowship Programs to increase access to substance abuse treatment services for youth in America.

More than $48 million to support teachers, schools and communities in recognizing and responding to mental health issues among youth, creating safe and secure schools and promoting the mental health of students in communities across the country through 120 new Project AWARE (Advancing Wellness and Resilience in Education) grants to state and local educational agencies.

$16.7 million to support 17 new Healthy Transitions grants, to improve access to treatment and support services for youth and young adults ages 16 to 25 that either have, or are at high risk of developing, a serious mental health condition.
To see the lists of award winners, visit

www.hrsa.gov/about/news/2014tables/behavioralworkforce/

http://beta.samhsa.gov/sites/default/files/fy14-grant-awards-nitt.pdf

REGULATIONS PROPOSED TO CLARIFY MENTAL ILLNESS PROHIBITION FROM PURCHASING FIREARMS

FROM:  JUSTICE DEPARTMENT 
Friday, January 3, 2014
Department of Justice Takes Steps to Strengthen Federal Background Check System for Firearms Transfers
Proposed Regulation Would Clarify Who Is Prohibited from Possessing Firearms for Mental Health Reasons

The Department of Justice today announced it is proposing a regulation that will clarify who, due to mental health reasons, is prohibited under federal law from receiving, possessing, shipping or transporting firearms.  In addition to providing general guidance on the federal law, this clarification will help states determine what information may be appropriately shared with the federal background check system for firearms transfers – the National Instant Criminal Background Check System (NICS) – in order to keep guns out of the hands of individuals who may be a danger to themselves or others.

The revised definition clarifies that the statutory terms “adjudicated as a mental defective” and “committed to a mental institution” include persons who are found incompetent to stand trial or not guilty by reason of mental disease or defect; persons lacking mental responsibility or deemed insane; and persons found guilty but mentally ill, regardless of whether these determinations are made by a state, local, federal or military court.  The proposed regulation also clarifies that the statutory term includes a person committed to involuntary inpatient or outpatient treatment.

“We are taking an important, commonsense step to clarify the federal firearms regulations, which will strengthen our ability to keep dangerous weapons out of the wrong hands,” said Attorney General Eric Holder.  “This step will provide clear guidance on who is prohibited from possessing firearms under federal law for reasons related to mental health, enabling America’s brave law enforcement and public safety officials to better protect the American people and ensure the safety of our homes and communities.  And it is emblematic of the Justice Department’s broader commitment to use every tool and resource at its disposal to combat gun violence and prevent future tragedies while respecting the Constitutional rights to which all Americans are entitled.”

The NICS background check system is a critical tool in keeping guns out of the hands of those who cannot legally have one.  To date, NICS has prevented more than 2 million guns from falling into the wrong hands. In order for background checks to continue to be effective, the system must have access to relevant, correct and complete information.

Clarifying the existing Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) regulation is just one of many common-sense steps the department has taken to keep guns out of the wrong hands. The department is working diligently to reduce gun violence and is committed to using every tool at its disposal, including implementing effective prevention, enforcement and re-entry strategies.  In addition, the department is working with other federal departments and agencies to ensure relevant information is shared with the NICS and has also provided monetary support to states to improve their abilities to share this information.

GOVERNMENT ISSUES MENTAL HEALTH AND SUBSTANCE ABUSE DISORDER PARITY RULE

FROM:  U.S. LABOR DEPARTMENT

Administration issues final mental health and substance use disorder parity rule
Final rules break down financial barriers and provide consumer protections

WASHINGTON — The Departments of Labor, Health and Human Services and the Treasury today jointly issued a final rule increasing parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans.

The final rule issued today implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and ensures that health plan features like copays, deductibles and visits limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits.

Today's action also includes specific additional consumer protections, such as:
Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings; Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law; Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy; and Eliminating an exception to the existing parity rule that was determined to be confusing, unnecessary and open to abuse.

By issuing this rule, the administration has now completed or made significant progress on all 23 executive actions included in the President and Vice President's plan to reduce gun violence. An updated report summarizing the status of all 23 executive actions is available here:http://www.whitehouse.gov/sites/default/files/docs/november_exec_actions_progress_report_final.pdf.

In January, as part of the President and Vice President's plan to reduce gun violence, the administration committed to finalize this rule as part of a larger effort to increase access to affordable mental health services and reduce the misinformation associated with mental illness. As the President and Vice President have made clear, mental illness should no longer be treated by our society — or covered by insurance companies — differently from other illnesses.
The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act and requires coverage of mental health and substance use disorder services as one of ten essential health benefits categories. Under the essential health benefits rule, individual and small group health plans are required to comply with these parity regulations.

"New efforts are underway to expand coverage to the millions of Americans who have lacked access to affordable treatment for mental and substance use disorders," said Labor Secretary Thomas E. Perez. "These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices and increase health plan transparency. Ultimately, they'll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it."

"This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans," said Health and Human Services Secretary Kathleen Sebelius. "Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible."

"Americans deserve access to coverage for mental health and substance use disorders that is on par with medical and surgical care," said Treasury Secretary Jacob J. Lew. "These rules mark an important step in ending the disparities that exist in insurance plans, and will provide families nationwide with critical coverage and protections that fulfill their health needs."

The final Mental Health Parity and Addiction Equity Act rule was developed based on the departments' review of more than 5,400 public comments on the interim final rules issued in 2010.

The final rules may be viewed at https://www.federalregister.gov.