Category Archives: Mental Health

Preventing Suicide Within Your Workforce: Five Steps to Take

Source: Maureen Minehan, Employment Alert, Vol. 37 no. 3. February 5, 2020
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The suicide statistics in the United States are alarming. According to the U.S. Centers for Disease Control (CDC), 45,000 lives have been lost to suicide since 2016. In the past two decades, suicide rates have risen by 30% or more in 23 states, with North Dakota (58%), Vermont (49%), New Hampshire (48%) and Utah (47%), experiencing the highest increases. The CDC says employers have a role to play in reducing suicide rates by promoting employee health and well-being, supporting employees at risk, and putting plans in place to respond to people showing warning signs. ….

Solidarity and disparity: Declining labor union density and changing racial and educational mortality inequities in the United States

Source: Jerzy Eisenberg‐Guyot, Stephen J. Mooney, Amy Hagopian, Wendy E. Barrington, Anjum Hajat, American Journal of Industrial Medicine, Early View, December 17, 2019
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From the abstract:
Background:
Recently, United States life expectancy has stagnated or declined for the poor and working class and risen for the middle and upper classes. Declining labor‐union density—the percent of workers who are unionized—has precipitated burgeoning income inequity. We examined whether it has also exacerbated racial and educational mortality inequities.

Methods:
From CDC, we obtained state‐level all‐cause and overdose/suicide mortality overall and by gender, gender‐race, and gender‐education from 1986–2016. State‐level union density and demographic and economic confounders came from the Current Population Survey. State‐level policy confounders included the minimum wage, the generosity of Aid to Families with Dependent Children or Temporary Assistance for Needy Families, and the generosity of unemployment insurance. To model the exposure‐outcome relationship, we used marginal structural modeling. Using state‐level inverse probability of treatment‐weighted Poisson models, we estimated 3‐year moving average union density’s effects on the following year’s mortality rates. Then, we tested for gender, gender‐race, and gender‐education effect‐modification. Finally, we estimated how racial and educational all‐cause mortality inequities would change if union density increased to 1985 or 1988 levels, respectively.

Results:
Overall, a 10% increase in union density was associated with a 17% relative decrease in overdose/suicide mortality (95% confidence interval [CI]: 0.70, 0.98), or 5.7 lives saved per 100 000 person‐years (95% CI: −10.7, −0.7). Union density’s absolute (lives‐saved) effects on overdose/suicide mortality were stronger for men than women, but its relative effects were similar across genders. Union density had little effect on all‐cause mortality overall or across subgroups, and modeling suggested union‐density increases would not affect mortality inequities.

Conclusions:
Declining union density (as operationalized in this study) may not explain all‐cause mortality inequities, although increases in union density may reduce overdose/suicide mortality.

Behavioral Health Provider Participation in Medicaid Value-Based Payment Models: An Environmental Scan and Policy Considerations

Source: Melissa Bailey, Rachael Matulis, Kelsey Brykman, Center for Health Care Strategies, September 2019

From the abstract:
Health care payers are increasingly shifting from fee-for-service payment systems that reward volume to adopt value-based payment (VBP) models that promote high-quality, cost-effective care. While increased access to and coordination of behavioral health services is a policy priority for federal and state policymakers, the extent that the behavioral health system is engaged in VBP is less well understood than its physical health counterpart. In partnership with the National Council for Behavioral Health, the Center for Health Care Strategies (CHCS) conducted interviews with representatives from behavioral health associations, community-based behavioral health providers, state agencies, Medicaid managed care organizations (MCOs), and other subject matter experts to understand the successes and challenges associated with implementing VBP in Medicaid behavioral health care.

Informed by these interviews and a review of state program guidelines, quality measures, and MCO contracts, this report provides: (1) an overview of the behavioral health system’s engagement in VBP in the U.S., with a focus on 11 states; (2) lessons on implementing VBP from the perspective of behavioral health providers; and (3) policy recommendations for how state and federal policymakers, MCOs, and other stakeholders can support the adoption of VBP within behavioral health care. It also identifies nine key themes that support successful behavioral health VBP design and implementation to inform efforts in states across the country.

After The Fall: Safeguarding Employees’ Mental Health After Workplace Injuries

Source: Maureen Minehan, Employment Alert, Volume 36, Issue 18, September 4, 2019
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An employee trips and falls at work and sustains a significant knee injury. She needs surgery and misses months of work while recovering. You know she’s receiving good care for her physical injuries, but do you need to also be concerned about her mental health?

Related:
Suicide and drug‐related mortality following occupational injury
Source: Katie M. Applebaum, Abay Asfaw, Paul K. O’Leary, Andrew Busey, Yorghos Tripodis, Leslie I. Boden, American Journal of Industrial Medicine, Volume 62 Issue 9, September 2019
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From the abstract:
Background:
Drug overdoses and suicides have been rising since 2000 and are major contributors to a 3‐year decline in US life expectancy. Studies suggest that injured workers have elevated rates of depression and opioid use, but no studies have measured excess mortality related to these risks.

Materials and methods:
We linked New Mexico workers’ compensation data for 100 806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data. We then estimated the association between receiving lost‐time workers’ compensation benefits and mortality hazard ratios (HRs) and 95% confidence intervals (CIs) based on Fine and Gray cause‐specific subdistribution hazards for common causes of death and for drug‐related, suicide, and alcohol‐related mortality.

Results:
There was almost a 3‐fold increase in combined drug‐related and suicide mortality hazard among women (HR = 2.63, 95% CI = 1.91‐3.64) and a substantial increase among men (HR = 1.42, 95% CI = 1.13‐1.79). Circulatory disease mortality hazard was elevated for men (HR = 1.25, 95% CI = 1.05‐1.50).

Conclusion:
Workplace injuries severe enough to require more than a week off work may impair workers’ long‐term health and well‐being. Drug‐related deaths and suicides may be important contributors to the long‐term excess mortality of injured workers. Improved workplace conditions, improved pain treatment, better treatment of substance use disorders, and treatment of postinjury depression may substantially reduce mortality consequent to workplace injuries.

Associations between daily‐on‐the job hassles with perceived mental exertion and depression symptoms in taxi drivers

Source: Barbara J. Burgel, Rami A. Elshatarat, American Journal of Industrial Medicine, Early View, July 22, 2019
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From the abstract:

Introduction:
Taxi drivers experience frequent hassles that may contribute to mental exertion and depression symptoms.

Aim:
Mental exertion and depression symptoms in taxi drivers are explored in association with hassles, effort‐reward imbalance, job strain, and iso‐strain.

Methods:
Personal interviews were conducted with 130 drivers in San Francisco.

Results:
Mental exertion averaged 4.5 (±2.68) and physical exertion averaged 3.71 (±2.1) on 0 to 10 Borg scales. Based on the Center for Epidemiological Studies‐Depression scale, 38% had depression symptoms. Mental exertion and depression symptoms correlated with job strain, iso‐strain and effort‐reward imbalance in anticipated directions, lending construct validity to the Borg mental exertion scale. Physical exertion, night shift, stressful personal events, and being uninsured for healthcare predicted mental exertion. Lack of respect by dispatchers and stressful personal events predicted depression symptoms.

Conclusion:
Selected hassles may be remedied by communication trainings, emphasizing mutual respect. Recognition and treatment of depression in taxi drivers are important.

Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015

Source: Devan Hawkins, Cora Roelofs, James Laing, Letitia Davis, American Journal of Industrial Medicine, Early View, July 26, 2019
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From the abstract:

Background:
Thousands of people in the United States continue to die from opioid overdoses every year. Work‐related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid‐related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work‐related factors that might contribute to these differences.

Methods:
We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work‐related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD.

Results:
Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD.

Conclusions:
These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.

Rising Mortality Rates Among Working-Age Americans

Source: Emily Fazio, Regional Financial Review, Vol. 29 no. 9, May 2019
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Mortality in the U.S. is rising. As a result, life expectancy at birth has fallen every year since its peak in 2014. This paper discusses the rise in mortality and the influence of increased rates of suicide and fatal drug overdoses. It also looks at geographic differences in mortality. Third, this paper considers the impact of economic conditions on changes in mortality, suicide rates, and fatal drug overdoses.

California’s Behavioral Health Services Workforce Is Inadequate for Older Adults

Source: Janet C. Frank, Kathryn G. Kietzman, and Alina Palimaru, UCLA Center for Health Policy Research, Health Policy Brief, January 2019

The Workforce Education and Training component of California’s Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. The brief offers recommendations to the following specific audiences for improving workforce preparation and distribution: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers…..

The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act

Source: Johanna Catherine Maclean, Brendan Saloner, Journal of Policy Analysis and Management, Volume 38, Issue 2, Spring 2019
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From the abstract:
We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid‐reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event‐study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post‐expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.