NR554: Nurse Leader and Healthcare Policy

NR554: Nurse Leader and Healthcare Policy DATE Discuss how social visibility and financial cost impact healthcare policy Social Visibility of Health Issue Mental health disorders have gained a lot of visibility in the news with the recent mass shooting. Mass shootings create outpourings of public horror and outrage. With each tragedy, we hear arguments about gun violence and mental health. On December 14, 2012, 26 people were shot and killed at the Sandy Hook Elementary School in Newtown, Connecticut. Investigators reported the assailant, a 20-year-old male, had a history of psychiatric disorders like anxiety and obsessive-compulsive disorder that was untreated (Cowan, 2014). It was also reported the killer was suffering from undiagnosed anorexia that may have affected his mental state. Following this shooting, President Barack Obama signed an executive order on gun control December 2016. The executive order restricted gun ownership for Social Security beneficiaries with psychiatric disabilities, who used a “representative payee” to deal with their finances (The White House, 2016). The assumption behind the regulation was that if someone was too mentally ill to handle their disability payments, then they shouldn’t be eligible to buy guns. However, on February 28, 2017, President Trump signed a bill passed by Congress, House Joint Resolution 40, that rescinded the order stating, “it could endanger the Second Amendment rights of law-abiding citizens” (GovTrack, n.d.). That same year in October a gunman in Las Vegas, Nevada unleashed a shower of bullets on an outdoor country music festival, killing at least 59 people and injuring 527 (At least 59 dead, 527 injured in a mass shooting on Las Vegas Strip, 2017). This was the deadliest mass shooting in U.S. history. The 64-year-old male was believed to be suffering from the untreated bipolar disorder. It was also reported the gunman was taking Diazepam for anxiety. The following month of November, 26 people were killed at First Baptist Church in rural Sutherland Springs, Texas. The killer was a 26-year-old male with a history of mental illness. The most recent mass shooting occurred February 14, 2018, where a 19-year-old male armed with a semi-automatic rifle entered Marjory Stoneman Douglas high school in Parkland, Florida killing 17 people. It is reported the gunman suffers from depression, autism, and attention deficit hyperactivity disorder. One of the problems of turning the link between mental illness and mass shootings into effective public policy is that mass shootings are rare events. However, with so much media attention, people are demanding more financial resources for access to mental health services. The first step was taken by Florida Governor Rick Scott who announced that he will propose over $19 million in his recommended budget for mental health and substance abuse needs in Florida (Florida Department of Children and Families, n.d.). The funding will support the efforts outlined in an executive order that Governor Scott issued earlier March to better coordinate mental health care services across Florida. The funding will support Community Behavioral Services, thus strengthening counties to work with local entities, law enforcement, and non-profit organizations to better serve individuals with behavioral health needs (Florida Department of Children and Families, n.d.). The funding also supports Community Action Treatment (CAT) teams by adding five CAT teams to surrounding areas that do not have them. CAT teams provide comprehensive treatment to youth with significant behavioral and mental health needs so care can be received in communities (Florida Department of Children and Families, n.d.). Lastly, the funding will expand Family Intensive Treatment (FIT) teams to six additional counties that have high numbers of verified abuse and neglect reports related to substance abuse (Florida Department of Children and Families, n.d.). This is an example of how state funding is spent efficiently to deliver evidence-based treatments to the seriously ill in order to reduce violence, suicide, victimization, homelessness, hospitalization, incarceration and needless tragedies and save money by reducing the use of hospitals and jails. References At least 59 dead, 527 injured in mass shooting on Las Vegas Strip. (2017, October 1). Las Vegas Sun. Retrieved from Cowan, A.L. (2014, November 21). Adam Lanza’s mental problems ‘completely untreated’ before Newton shootings, report says. The New York Times. Retrieved from Florida Department of Children and Families. (n.d.). Gov. Scott: We will propose over $19 million to help Floridians affected by mental illness and substance abuse. Retrieved from GovTrack. (n.d.) H.J.Res. 40: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Social Security Administration relating to Implementation of the NICS Improvement Amendments Act of 2007. Retrieved from The White House. (2016, January 4). Fact Sheet: New executive actions to reduce gun violence and make our communities safer. Retrieved from Professor Response to Post: Carole, I am glad the Florida governor is dedicating state funding for this work. I hope that he also enrolls all intersectoral agencies in this very important work. Please check out upstream strategies for the promotion of mental health in communities and share your thoughts about it. Thanks, Dr. Fildes Response to Professor: Dr. Fildes, Suicide prevention efforts have largely focused on strategies to identify and get help for those who are at-risk for suicide, but suicide prevention can also occur prior to the onset of risk to prevent the development of risk. Such “upstream” suicide prevention approaches may be able to protect individuals against suicide. In my community, the Portage County Community Health Partners conducted community health assessments (CHA) for the purpose of measuring and addressing health status. The Portage County Community Health Improvement Planning Partners were asked to identify positive and negative forces which could impact community health improvement and overall health of the Portage County community over the next three to five years. One priority health issue addressed for Portage county includes increasing mental health services to citizens in the community. Action steps taken to address mental health support for youth in the community include expanding evidence-based suicide prevention and bullying programs targeting youth and families, establishing a youth-focused community center at the former Mantua Center School, and providing mental health first aid training (Portage County Community Health Improvement Planning Partners, 2016). School-based upstream approaches include the Incredible Years programs for parents and teachers to reduce challenging behaviors in children and increase their social and self-control skills (Portage County Community Health Improvement Planning Partners, 2016). The Incredible years program parents and teachers learn a range of strategies to help children better regulate their emotions and improve their social skills so that they can develop social skills that will assist them in socializing with peers and adults and perform better academically. Life Skills Training is a school-based program that aims to prevent alcohol, tobacco, and marijuana use and violence by targeting the major social and psychological factors that promote the initiation of substance use and other risky behaviors (Portage County Community Health Improvement Planning Partners, 2016). LST addresses multiple risk and protective factors and teaches personal and social skills that build resilience and help youth navigate developmental tasks, including the skills necessary to understand and resist pro-drug influences. Red Flags is a framework for school-based mental health education that promotes sound mental health as an essential component of overall health. The Ohio Department of Mental Health recognized the importance of Red Flags for universal prevention and early intervention for all Ohio middle schools (Portage County Community Health Improvement Planning Partners, 2016). To improve the mental health of Portage County youth, we need a public health strategy that includes promotion, prevention, treatment, and monitoring. Stakeholders in the community must evaluate existing early childhood development programs for mental health outcomes and support new research on effective ways to promote healthy development. They must evaluate existing prevention programs, establish and evaluate new prevention programs based on current research evidence, and support new research on underlying processes and the prevention of children’s mental disorders. Reference Portage County Community Health Improvement Planning Partners. (2016). Portage County Community Health Improvement Plan . Retrieved from Response to Student Post: The social visibility and financial costs of healthcare that I feel are currently best to review at this time is the opioid crisis in the United States. The issue of addiction and overdose-related to the use and abuse of opioids has gained great momentum due to the public visibility (Blendon & Benson, 2018). This visibility then moves to the focus and corrective measures in trying to control the problem which can then present a financial cost. The opioid problem places a significant financial burden on healthcare by not addressing the problem, with addicts showing up in ER’s across the nation who may not have health insurance (Meeker & Doctor, 2017). Lynne and Penny, Substance misuse is one of the critical public health problems of our time with consequences that are deadlier than ever. According to the CDC in 2016, nearly 64,000 people died of drug overdoses in the U.S. with synthetic opioids (such as fentanyl), heroin, and common opioid painkillers (like Percocet and OxyContin) topping other causes of overdose (Centers for Disease Control and Prevention, 2016). According to the surgeon general’s 2016 report on addiction, only 10 percent of people suffering from a drug use disorder get specialty treatment (U.S. Department of Health & Human Services, 2016). The report attributed the low rate to shortages in the supply of care, with some areas of the country lacking affordable options for treatment which can lead to waiting periods of weeks or even months just to get help. Most people with substance use disorders do not seek treatment on their own, many because they do not believe they need it or they are not ready for it, and others because they are not aware that treatment exists or how to access it. However, individuals with substance use disorders often do access the health care system for other reasons, including acute health problems like illness, injury, or overdose, as well as chronic health conditions. Early screening for substance misuse and substance use disorders in diverse health care settings is the first step to identifying substance use problems and engaging patients in the appropriate level of care. According to the Substance Abuse and Mental Health Administration, “the Screening, Brief Intervention, and Referral to Treatment (SBIRT) program can reduce illicit drug use among patients seeking medical care in a wide variety of healthcare settings such as hospitals, physician offices, and community clinics” (2008). SBIRT can be used in a wide variety of health care settings including primary care centers, hospital emergency rooms, trauma centers, and other community settings, and provides options for addressing the particular substance abuse problems of patients. Early identification through screenings within primary and other healthcare settings can lead to early intervention. Screening and brief intervention in primary care settings can promote significant reductions in alcohol and substance use. Additionally, other physical health, emotional, and interpersonal problems associated with substance abuse can also be addressed once identified. Reference Centers for Disease Control and Prevention. (2016). Drug overdose deaths in the United States, 1999–2016. Retrieved from Substance Abuse and Mental Health Administration. (2008). Major report finds screening and early intervention program used in diverse health care settings dramatically reduces illicit drug use among patients. Retrieved from U.S. Department of Health & Human Services. (2016). Facing addiction in America. The Surgeon General’s report on alcohol, drugs, and health. Retrieved from NR554: Nurse Leader and Healthcare Policy DATE Discuss how social visibility and financial cost impact healthcare policy Social Visibility of Health Issue Mental health disorders have gained a lot of visibility in the news with the recent mass shooting. Mass shootings create outpourings of public horror and outrage. With each tragedy, we hear arguments about gun violence and mental health. On December 14, 2012, 26 people were shot and killed at the Sandy Hook Elementary School in Newtown, Connecticut. Investigators reported the assailant, a 20-year-old male, had a history of psychiatric disorders like anxiety and obsessive-compulsive disorder that was untreated (Cowan, 2014). It was also reported the killer was suffering from undiagnosed anorexia that may have affected his mental state. Following this shooting, President Barack Obama signed an executive order on gun control December 2016. The executive order restricted gun ownership for Social Security beneficiaries with psychiatric disabilities, who used a “representative payee” to deal with their finances (The White House, 2016). The assumption behind the regulation was that if someone was too mentally ill to handle their disability payments, then they shouldn’t be eligible to buy guns. However, on February 28, 2017, President Trump signed a bill passed by Congress, House Joint Resolution 40, that rescinded the order stating, “it could endanger the Second Amendment rights of law-abiding citizens” (GovTrack, n.d.). That same year in October a gunman in Las Vegas, Nevada unleashed a shower of bullets on an outdoor country music festival, killing at least 59 people and injuring 527 (At least 59 dead, 527 injured in a mass shooting on Las Vegas Strip, 2017). This was the deadliest mass shooting in U.S. history. The 64-year-old male was believed to be suffering from the untreated bipolar disorder. It was also reported the gunman was taking Diazepam for anxiety. The following month of November, 26 people were killed at First Baptist Church in rural Sutherland Springs, Texas. The killer was a 26-year-old male with a history of mental illness. The most recent mass shooting occurred February 14, 2018, where a 19-year-old male armed with a semi-automatic rifle entered Marjory Stoneman Douglas high school in Parkland, Florida killing 17 people. It is reported the gunman suffers from depression, autism, and attention deficit hyperactivity disorder. One of the problems of turning the link between mental illness and mass shootings into effective public policy is that mass shootings are rare events. However, with so much media attention, people are demanding more financial resources for access to mental health services. The first step was taken by Florida Governor Rick Scott who announced that he will propose over $19 million in his recommended budget for mental health and substance abuse needs in Florida (Florida Department of Children and Families, n.d.). The funding will support the efforts outlined in an executive order that Governor Scott issued earlier March to better coordinate mental health care services across Florida. The funding will support Community Behavioral Services, thus strengthening counties to work with local entities, law enforcement, and non-profit organizations to better serve individuals with behavioral health needs (Florida Department of Children and Families, n.d.). The funding also supports Community Action Treatment (CAT) teams by adding five CAT teams to surrounding areas that do not have them. CAT teams provide comprehensive treatment to youth with significant behavioral and mental health needs so care can be received in communities (Florida Department of Children and Families, n.d.). Lastly, the funding will expand Family Intensive Treatment (FIT) teams to six additional counties that have high numbers of verified abuse and neglect reports related to substance abuse (Florida Department of Children and Families, n.d.). This is an example of how state funding is spent efficiently to deliver evidence-based treatments to the seriously ill in order to reduce violence, suicide, victimization, homelessness, hospitalization, incarceration and needless tragedies and save money by reducing the use of hospitals and jails. References At least 59 dead, 527 injured in mass shooting on Las Vegas Strip. (2017, October 1). Las Vegas Sun. Retrieved from Cowan, A.L. (2014, November 21). Adam Lanza’s mental problems ‘completely untreated’ before Newton shootings, report says. The New York Times. Retrieved from Florida Department of Children and Families. (n.d.). Gov. Scott: We will propose over $19 million to help Floridians affected by mental illness and substance abuse. Retrieved from GovTrack. (n.d.) H.J.Res. 40: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Social Security Administration relating to Implementation of the NICS Improvement Amendments Act of 2007. Retrieved from The White House. (2016, January 4). Fact Sheet: New executive actions to reduce gun violence and make our communities safer. Retrieved from Professor Response to Post: Carole, I am glad the Florida governor is dedicating state funding for this work. I hope that he also enrolls all intersectoral agencies in this very important work. Please check out upstream strategies for the promotion of mental health in communities and share your thoughts about it. Thanks, Dr. Fildes Response to Professor: Dr. Fildes, Suicide prevention efforts have largely focused on strategies to identify and get help for those who are at-risk for suicide, but suicide prevention can also occur prior to the onset of risk to prevent the development of risk. Such “upstream” suicide prevention approaches may be able to protect individuals against suicide. In my community, the Portage County Community Health Partners conducted community health assessments (CHA) for the purpose of measuring and addressing health status. The Portage County Community Health Improvement Planning Partners were asked to identify positive and negative forces which could impact community health improvement and overall health of the Portage County community over the next three to five years. One priority health issue addressed for Portage county includes increasing mental health services to citizens in the community. Action steps taken to address mental health support for youth in the community include expanding evidence-based suicide prevention and bullying programs targeting youth and families, establishing a youth-focused community center at the former Mantua Center School, and providing mental health first aid training (Portage County Community Health Improvement Planning Partners, 2016). School-based upstream approaches include the Incredible Years programs for parents and teachers to reduce challenging behaviors in children and increase their social and self-control skills (Portage County Community Health Improvement Planning Partners, 2016). The Incredible years program parents and teachers learn a range of strategies to help children better regulate their emotions and improve their social skills so that they can develop social skills that will assist them in socializing with peers and adults and perform better academically. Life Skills Training is a school-based program that aims to prevent alcohol, tobacco, and marijuana use and violence by targeting the major social and psychological factors that promote the initiation of substance use and other risky behaviors (Portage County Community Health Improvement Planning Partners, 2016). LST addresses multiple risk and protective factors and teaches personal and social skills that build resilience and help youth navigate developmental tasks, including the skills necessary to understand and resist pro-drug influences. Red Flags is a framework for school-based mental health education that promotes sound mental health as an essential component of overall health. The Ohio Department of Mental Health recognized the importance of Red Flags for universal prevention and early intervention for all Ohio middle schools (Portage County Community Health Improvement Planning Partners, 2016). To improve the mental health of Portage County youth, we need a public health strategy that includes promotion, prevention, treatment, and monitoring. Stakeholders in the community must evaluate existing early childhood development programs for mental health outcomes and support new research on effective ways to promote healthy development. They must evaluate existing prevention programs, establish and evaluate new prevention programs based on current research evidence, and support new research on underlying processes and the prevention of children’s mental disorders. Reference Portage County Community Health Improvement Planning Partners. (2016). Portage County Community Health Improvement Plan . Retrieved from Response to Student Post: The social visibility and financial costs of healthcare that I feel are currently best to review at this time is the opioid crisis in the United States. The issue of addiction and overdose-related to the use and abuse of opioids has gained great momentum due to the public visibility (Blendon & Benson, 2018). This visibility then moves to the focus and corrective measures in trying to control the problem which can then present a financial cost. The opioid problem places a significant financial burden on healthcare by not addressing the problem, with addicts showing up in ER’s across the nation who may not have health insurance (Meeker & Doctor, 2017). Lynne and Penny, Substance misuse is one of the critical public health problems of our time with consequences that are deadlier than ever. According to the CDC in 2016, nearly 64,000 people died of drug overdoses in the U.S. with synthetic opioids (such as fentanyl), heroin, and common opioid painkillers (like Percocet and OxyContin) topping other causes of overdose (Centers for Disease Control and Prevention, 2016). According to the surgeon general’s 2016 report on addiction, only 10 percent of people suffering from a drug use disorder get specialty treatment (U.S. Department of Health & Human Services, 2016). The report attributed the low rate to shortages in the supply of care, with some areas of the country lacking affordable options for treatment which can lead to waiting periods of weeks or even months just to get help. Most people with substance use disorders do not seek treatment on their own, many because they do not believe they need it or they are not ready for it, and others because they are not aware that treatment exists or how to access it. However, individuals with substance use disorders often do access the health care system for other reasons, including acute health problems like illness, injury, or overdose, as well as chronic health conditions. Early screening for substance misuse and substance use disorders in diverse health care settings is the first step to identifying substance use problems and engaging patients in the appropriate level of care. According to the Substance Abuse and Mental Health Administration, “the Screening, Brief Intervention, and Referral to Treatment (SBIRT) program can reduce illicit drug use among patients seeking medical care in a wide variety of healthcare settings such as hospitals, physician offices, and community clinics” (2008). SBIRT can be used in a wide variety of health care settings including primary care centers, hospital emergency rooms, trauma centers, and other community settings, and provides options for addressing the particular substance abuse problems of patients. Early identification through screenings within primary and other healthcare settings can lead to early intervention. Screening and brief intervention in primary care settings can promote significant reductions in alcohol and substance use. Additionally, other physical health, emotional, and interpersonal problems associated with substance abuse can also be addressed once identified. Reference Centers for Disease Control and Prevention. (2016). Drug overdose deaths in the United States, 1999–2016. Retrieved from Substance Abuse and Mental Health Administration. (2008). Major report finds screening and early intervention program used in diverse health care settings dramatically reduces illicit drug use among patients. Retrieved from U.S. Department of Health & Human Services. (2016). Facing addiction in America. The Surgeon General’s report on alcohol, drugs, and health. Retrieved from