TALK (8255) Spanish Language: For hearing impaired: TTY (4889) NATIONAL CRISIS TEXT LINE

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1 Suicide: A Rising Public Health Concern in Florida NATIONAL SUICIDE PREVENTION RESOURCES NATIONAL SUICIDE PREVENTION LIFELINE Available 24 hours per day, 7 days per week TALK (8255) Spanish Language: For hearing impaired: TTY (4889) NATIONAL CRISIS TEXT LINE Available 24 hours per day, 7 days per week STATISTICS ON SUICIDE-RELATED DEATHS IN FLORIDA Suicide is a leading preventable cause of death. Yet, the number of suicide-related deaths has continued to increase every year in Florida since In 2017, the age-adjusted suicide death rate was 14.1 per 100,000 people, one of the highest death rates in almost twenty years. As the rates of suicide continue to rise in Florida and across the nation, suicide prevention has become an important area of focus. Suicidal thoughts and behaviors can affect any individual regardless of age, gender, or ethnicity, although men, people over age 45, and certain ethnicities such as Native Americans are at higher risk for suicide. In addition, the circumstances that lead individuals to commit suicide are complex there is no single identified cause leading to suicidal thoughts or actions. Some risk factors are known; for example, aside from mental illness, risk factors for suicidal thoughts or actions include previous suicide attempts, substance use, family history, poor job security, history of abuse, and serious medical illnesses. Preventing suicide not only identifying individuals who are at risk for suicide, but also improving access to medical and behavioral health services, increasing coordination between healthcare providers, ensuring smooth care transitions, and providing close follow-up, especially during and after times of crisis. In this newsletter, the Program highlights some of the statistics related to suicide and provides resources to facilitate suicide prevention efforts in Florida. Reference: Suicide is the 10th leading cause of death in Florida By age group, in Florida, suicide deaths account for the: 3rd leading cause of death for ages nd leading cause of death for ages th leading cause of death for ages th leading cause of death for ages th leading cause of death for ages th leading cause of death for ages 65+ The total deaths to suicide reflect a total of 51,424 years of potential life lost (YPLL) before age 65. Reference: American Foundation for Suicide Prevention. Suicide facts and figures: Florida Available from: state-fact-sheets/.

2 SUICIDE RATES RISING ACROSS THE UNITED STATES Centers for Disease Control and Prevention Report Key Points Suicide is the 10th leading cause of death across the United States Suicide is one of three leading causes of death (other than Alzheimer s disease and drug overdose) that are on the rise Nearly 45,000 Americans ages 10 and older died by suicide in 2016 Since 1999, suicide rates increased more than 30% in twenty-five states across the U.S. Florida was one of twenty-five states to experience an increase in suicide-related deaths More than half of individuals who died by suicide did not have a diagnosed mental health condition Suicide prevention requires a comprehensive approach that addresses the range of factors contributing to suicide Everyone can learn the signs of suicide, how to respond, and where to access help. For more information on how to help someone in crisis, visit For additional information on CDC recommendations, visit References: 1. Centers for Disease Control and Prevention. Suicide rates rising across the US. 7 June Available from: releases/2018/p0607-suicide-prevention.html 2. Centers for Disease Control and Prevention. Preventing suicide. 9 Aug Available from: preventingsuicide/index.html 3. Centers for Disease Control and Prevention. Preventing suicide: a technical package of policy, programs, and practices Available from: 4. National Suicide Prevention Lifeline. #BeThe1To. Available from: SUICIDE PREVENTION: FLORIDA RESOURCES The Statewide Office of Suicide Prevention: The Statewide Office for Suicide Prevention focuses on initiatives to prevent suicide and promote wellness and recovery Florida Suicide Prevention and Resource Directory: Suicide-Prevention-Resource%20Directory pdf. Provides a comprehensive list of mental health crisis centers, organizations, and support groups available across Florida. The directory divides the state of Florida into six separate regions: Northwest, Northeast, Central, Suncoast (i.e., Southwest Florida), Southeast, and Southern. Selected resources are listed below. For additional information on crisis centers and support groups, visit pdf. For updated information on services offered, contact each organization directly. page 2

3 SUICIDE PREVENTION: FLORIDA RESOURCES (CONTINUED) Northwest Life Management Center of Northwest Florida (Panama City, FL): Bridgeway Center, Inc. (Ft. Walton Beach, FL): The Apalachee Center (Tallahassee, FL): Northeast Flagler Hospital (St. Augustine, FL): Mental Health Resource Center (Jacksonville, FL): Central Alachua County Crisis Center (Gainesville, FL): CrisisCenter/Pages/CrisisCenter.aspx The Centers (Ocala, FL): Aspire Health Partners (Orlando, FL): Southwest (Suncoast) Crisis Center of Tampa Bay (Tampa, FL): Charlotte Behavioral Health Care (Punta Gorda, FL): David Lawrence Center (Naples, FL): Southeast Jerome Golden Center (West Palm Beach, FL): Henderson Behavioral Health (Ft. Lauderdale, FL): Southern Citrus Health Network (Hialeah, FL): Guidance/Care Center, Inc. (Florida Keys): SUICIDE PREVENTION: NATIONAL RESOURCES National Suicide Prevention Lifeline Consists of a network of 150 local and state-funded crisis centers Provides free and confidential emotional support to people in emotional distress or crisis. Services are available 24 hours per day, 7 days per week. Calls are routed to the closest crisis center based on area code. Available in all areas of the United States. Available in over 150 languages through the tele-interpreters service to participating crisis centers. Also available for individuals who are hearing impaired. For more information, visit National Suicide Prevention Lifeline: Lifeline Chat Lifeline Chat service is offered through the National Suicide Prevention Lifeline website at Connects individuals with counselors across the United States to provide emotional support. Available 24 hours per day, 7 days per week. Communications are securely encrypted. For more information, visit National Crisis Text Line Offers access to free support 24 hours per day, 7 days per week to anyone in any type of emotional crisis Chats to trained volunteer crisis counselors are initiated by texting HOME to from anywhere in the United States at any time. The crisis counselor is not a medical professional. They provide support but do not provide medical advice. The first two responses to the National Crisis Text Line are automated, indicating that the individual is being connected with a crisis counselor. Once connected, the crisis counselor will introduce themselves, reflect on what is said, and invite the individual to share more information. For more information, visit page 3

4 Florida Medicaid Drug Therapy Management Program Legislative updates House Bill 21, the Controlled Substances Bill and upcoming changes for prescribers and dispensers will take effect July 1, House bill 21 new webpage Control/ Goes into effect July 1, 2018 Requires the prescriber or dispenser (or designee of a prescriber or dispenser) to consult the database to review the patient s controlled substance dispensing history before prescribing or dispensing any controlled substance for patients who are 16 years or older. For example, before prescribing stimulants for ADHD to adolescents 16 years or older, E-FORCSE must be consulted. Since stimulants are controlled substances the following apply: Consultation of E-FORCSE should be noted in the chart. Failure to consult E-FORCSE and document doing so can result in disciplinary action. If E-FORCSE cannot be accessed by the prescriber or dispenser, the reason why the database was not consulted must be documented and no more than a three-day supply of medication can be prescribed or dispensed. Requires each person registered with the DEA and authorized to prescribe controlled substances to take a board-approved two-hour continuing education course on prescribing controlled substances designated for the AMA PRA Category 1 credit or AOA Category 1-A credit by January 31, 2019 and then prior to each subsequent license renewal. Prescription of a Schedule II opioid for acute pain generally may not exceed a three-day supply A seven-day supply of a Schedule II opioid can only be prescribed if: More than a three-day supply is needed based on professional judgment of the prescriber The prescriber indicates acute pain exception on the prescription Documents in the medical records the acute medical condition and lack of alternative treatment options If a Schedule II controlled substance for the treatment of pain is prescribed for a traumatic injury with a severity score of 9 or greater, the practitioner must concurrently prescribe an emergency opioid antagonist (note that the legislation states Schedule II controlled substance and not opioid drug listed as a Schedule II controlled substance ) for this requirement. Selected Program Highlights Program Collaborations The Program continues to collaborate with MMA plans and the Agency on a range of topics such as medication prescribing, medication adherence, and outcomes (ED visits, inpatient hospitalizations, rehospitalizations) among adult and child Florida Medicaid recipients with serious mental illness and serious emotional disturbances. This year, the Program will also collaborate with Children s Medical Services (CMS) on a pilot project to improve access to behavioral health services rural areas through telepsychiatry. Pediatric Telepsychiatry Services Throughout Florida Use of technology is an innovative way to address the shortage of behavioral health providers in rural settings and improve disparities in care based on geographic location. In collaboration with Children s Medical Services and All Children s Hospital in St. Petersburg, FL, the Program will setup telepsychiatry services at three rural pediatric practice sites throughout Florida and track outcomes of Medicaid recipients who receive behavioral health services through the telepsychiatry service. The goal of this project is to improve access to behavioral health care, minimize disparities in care, and improve recipient outcomes in rural areas through the use of technology.

5 Florida Medicaid Drug Therapy Management Program Selected Program Highlights (continued) Webinars Upcoming Webinar: Telepsychiatry for Children with Mild Developmental Disabilities Treated in Primary Care June 29, 2018, 12:30-1:45 p.m. Speakers: Daniel Castellanos, M.D.; Anna M. Baznik, M.A.; Robert S. Benson, M.D. Visit the Program s website to view recent webinars: Telepsychiatry as a Delivery Model for Integrated Care in the Pediatric Setting Daniel Castellanos, MD; Anna Baznik, MA; Robert Benson, MD; Haravu Lokesh, MD, MBA The Role of Telepsychiatry in Primary Care Justyna Wojas, M.D. Psychological Trauma in the Pediatric Population: Diagnosis and Treatment Eugenio M. Rothe, M.D. Evaluation and Management of Cardiovascular Disease Risk Factors Sarah E. Stumbar, M.D. The Role of Long-Acting Antipsychotics in the Management of Schizophrenia Cristoph Correll, M.D. Webinar recordings available at medicaidmentalhealth.org Guidelines The Program collaborates with clinicians, pharmacists, and local and national experts to update the Florida Best Practice guidelines based on the latest evidence and clinical consensus. Available Guidelines: Florida Best Practice Psychotherapeutic Medication Guidelines for Adults Florida Best Practice Psychotherapeutic Medication Guidelines for Children and Adolescents Autism Spectrum Disorder and Intellectual Developmental Disorder Best Practice Recommendations Florida Best Practice Recommendations for Women of Reproductive Age Monitoring Physical Health and Side-Effects of Psychotherapeutic Medications For print copies of the guidelines, contact Sabrina Singh, MPH at sabrinasingh@usf.edu Guidelines can also be downloaded electronically from the Program website at medicaidmentalhealth.org. page 5

6 Florida Medicaid Drug Therapy Management Program Selected Program Highlights (continued) Data Analyses The Program performs several in-depth data analyses designed to inform about the status of recipients with serious mental health conditions. The Program produces updated reports based on these findings to inform the Agency of the current status these Medicaid recipients and provide recommendations to inform policy decisions. Program reports include: Complex Care Indicators (CCIs) in Adults and Children Analyses of Long-Acting Injectable (LAI) Antipsychotic Use in Adults and Children Psychotherapeutic Medication Prescribing to Children and Adolescents Comparison of Antipsychotic Prescribing in Children in Florida versus Five States Comparison of Medication Adherence and Differences in Outcomes Among Single versus Multiple Pharmacy Users In calendar year (CY) 2017: The total number of unique recipients with prior authorization (PA) requests for psychotherapeutic medications increased by 9% from 563 recipients in 2016 to 613 recipients in recipients under age 6 at the time of the first antipsychotic PA in 2008 were prescribed continuous antipsychotic medications every year through The most common behavioral health diagnoses for which psychotherapeutic medications were prescribed to children and adolescents were disruptive behavior disorders. Antipsychotic polypharmacy (two or more APs) declined nearly 6%. The top co-morbid physical health diagnoses for children and adolescents prescribed antipsychotics, antidepressants, and/or stimulants/atomoxetine were sleep disorders, cardiac problems/hypertension, and obesity. Pediatricians, adult psychiatrists, child/adolescent psychiatrists, and advanced practice registered nurses (APRNs), respectively, prescribed the most antipsychotics, antidepressants, or stimulants/ atomoxetine. The shortage of psychiatrists in Florida is most acute in the subspecialty of child/adolescent psychiatry. Opioid Use Among Adults with SMI The Program continues to track adults with SMI who utilize opioid medications and outcomes such as ED visits, inpatient hospitalizations, and re-hospitalizations among these recipients. In CY2017, opioid use was an important factor for frequent ER and inpatient utilization among adults with SMI. Registry Through the Registry, the Program tracks prescribing practices and health outcomes of children and adolescents who receive psychotherapeutic medications. For more information about the Florida Medicaid Drug Therapy Management Program for Behavioral Health, visit our website at medicaidmentalhealth.org Newsletter compiled by Vanita Sahasranaman, MD (vanitas@usf.edu) For inquiries, please contact Sabrina Singh, MPH at sabrinasingh@usf.edu page 6

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