TSPN Call to Action ECONOMIC STIMULUS PACKAGE PROMISES MEDICAID AND MENTAL HEALTH WINDFALL

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1 VOLUME 5, ISSUE 3 MARCH 2009 TSPN Call to Action T E N N E S S E E S U I C I D E P R E V E N T I O N N E T W O R K ECONOMIC STIMULUS PACKAGE PROMISES MEDICAID AND MENTAL HEALTH WINDFALL The economic stimulus package approved by President Barack Obama earlier last month includes roughly $130 billion dollars in medical and mental health funding, the bulk of it involving Medicaid relief to state governments. INSIDE THIS ISSUE: TSPN Advisory Council Meeting Suicide Prevention Conference U.S. Army Suicide Outbreak SCHIP Extension Signed OJJDP Study Exposé 4 Suicide in Long-Term Care Facilities TSPN Regional Calendar Advisory Council Contact Information PO BOX NASHVILLE, TN PHONE: (615) FAX: (615) TSPN@TSPN.ORG The inclusion of Medicaid relief comes as welcome news to the Tennessee Department of Mental Health and Developmental Disabilities (TDMHDD), which was recently forced to pick up two classes of TennCare clients on top of statewide budget cuts. TDMHDD Commissioner Virginia Trotter Betts, MSN, RN, JD, FAAN, spoke about these cuts during the February 11 Advisory Council meeting (see page 2). She expressed hopes that some of the stimulus package funding could be used to offset the cuts effects on the perpetually undersourced agency. The package, formally called the American Recovery and Reinvestment Act (ARRA) (HR 1), was signed into law on February 17. The bill passed the House on January 28 by a vote of with no Republicans voting in favor. The Senate approved its version February 10, voting with neither of Tennessee s senators in favor of the bill. Perhaps the most important aspect of ARRA from a health standpoint is the $87 billion in additional federal Medicaid matching funds, to be disbursed over a 27-month period. According to a February 13 press release on the National Alliance for Mental Illness (NAMI) website, 35% of the funds are earmarked for direct disbursement to states depending on the increase in their respective unemployment rates since the recession began. The other 65% covers an overall increase in state Medicaid match rates, in essence raising all match rates by approximately 6%. The Medicaid language also features a maintenance of effort stipulation that prevents states receiving funding from any further changes to Medicaid eligibility guidelines for the next two years. Locally, this means no further cuts or disenrollments from TennCare during the period in question. As explained in the NAMI statement, This is by far the most important piece of the economic stimulus legislation for people living with mental illness. These funds will begin flowing to states within the next few months and will be critical in helping states avoid further deep cuts to mental health services this year and next year. On top of the additional Medicaid funding, ARRA mandates a three-month extension of the ongoing legislative moratoria on several regulations of the program. Mental health advocates are concerned that removing these regulations will cut off access to rehabilitation services, case management, and school-bases services to Medicaid participants. Other provisions of ARRA critical to the mental health field: $19 billion for the Health Information Technology (HIT) program and the development of electronic medical records, with provisions allowing community mental health centers to compete for Health and Human Services grants while receiving Medicare and Medicaid incentive payments. $8.5 billion in additional funds for biomedical research at the National Institutes of Health (NIH) and the National Institute of Mental Health (NIMH). This funding supports research proposals submitted last year which went unfunded despite their scientific merit. Research facilities at NIH itself will also be upgraded. An extra one-time payment of $250 for all SSI beneficiaries and veterans receiving disability compensation. In related news, Obama signed an extension of the State Children's Health Insurance Program (SCHIP) into law on February 4 (see page 3 for details).

2 TSPN CALL TO ACTION TDMHDD COMMISSIONER ADDRESSES TSPN ADVISORY COUNCIL The TSPN Advisory Council met on February 11, its first meeting since the awards dinner and symposium in September of last year. Virginia Trotter Betts, MSN, JD, RN, FAAN, Commissioner of the Tennessee Department of Mental Health and Developmental Disabilities (TDMHDD), was the Council s keynote speaker for this meeting. Members convened in the Community Room of the Metro Nashville Police Department s Hermitage Precinct. There, Betts described the potential impact of statewide budget cuts on TDMHDD. Recently the department was forced to pick up clients with Severe and Persistent Mental Illness (SPMI) dropped by TennCare, but without any additional funding. While all departments are subject to a 15 % budget cut for fiscal year 2010, the cuts combined with the TennCare absorption amounts to a 22% cut for TDMHDD. In the meantime, Betts remains optimistic, continuing to push for the establishment of community crisis stabilization units (CSUs) as an alternative to inpatient hospitalization at state hospitals. Other business involved edits to two TSPN publications currently in development: a brochure on substance use and suicide as well as a revision of the existing brochure on veteran mental health. Members considered guidelines regarding emeritus status for distinguished prior members of the Advisory Council, discussed the Network s Photo of Commissioner Betts courtesy of the TDMHDD website ( development of an older adult suicide prevention plan, and discussed a white paper on mental health and substance abuse services cuts in Tennessee. The next Advisory Council meeting will convene during the annual retreat at Montgomery Bell State Park on June 3-4. The meeting is open to the public; parties interested in attending should contact the TSPN central office at (615) or tspn@tspn.org. LEWISBURG TO HOST SUICIDE PREVENTION CONFERENCE TSPN s South Central Region will stage a suicide prevention conference on Friday, March 27, in Lewisburg. The conference will feature a series of panel discussions and presentations, as well as the screening of a landmark documentary on suicide loss. Judy Collins (left) guides viewers of Fierce Goodbye through the stories and interviews. Dr. Kay Jamison of Johns Hopkins University, a leading authority on mood disorders and author of the best-seller An Unquiet Mind, is one of several mental health experts interviewed. (Photos courtesy of the Fierce Goodbye website.) How to Save a Life: A Community Response to the Issue will take place at First Presbyterian Church, located at 122 Second North Street, and will run from 8 AM to 3 PM. Major presenters include Kari Reeves, CNS-BC, MSN, APRN, of Centerstone and nationally regarded lecturer Bill McDonald, M.Div. Reeves will discuss the interplay between psychotropic medications and suicidal impulses. McDonald will speak about the consequences of and recovery from losing a loved one to suicide. The conference will also feature a panel discussion featuring survivors of suicide and a presentation on the demographics of suicide in Tennessee. Participants will also view the documentary Fierce Goodbye: Living in the Shadow of Suicide. Hosted by singer Judy Collins, the program explores suicide from the survivor s perspective. In addition to stories of loss and healing from families who have lost loved ones to suicide, Fierce Goodbye also offers commentary from mental health experts, Biblical scholars, and theologians with an emphasis on the role of religious faith in the recovery process. The program has aired on ABC, NBC, and the Hallmark Channel; more information is available at the documentary website ( A continental breakfast and luncheon will be provided during the conference. A certificate of attendance for 4.5 contact hours will be awarded to all participants. Registration for the event costs $15 ($10 for students with ID). A PDF registration form is available through the Conferences and Trainings section on the TSPN website ( interested parties may also contact Pam Arnell at (931) Space is limited to the first 90 registrants; the registration deadline is 3 PM CST on Friday, March 20. PAGE 2

3 VOLUME 5, ISSUE 3 JANUARY S ARMY SUICIDE OUTBREAK RAISES ALARMS 24 confirmed and suspected suicides were reported among U.S. Army personnel in January, a number which surpassed Afghanistan and Iraq combat deaths for that month and suggests a possible explosion in the already record-high Army suicide rate. The revelation follows news of an all-time high annual number of suicide deaths among this branch of the military in According to the Associated Press (AP), top Army officials briefed members of Congress on the January deaths on February 5. Such meetings, as well as the monthly report, are relatively uncommon, but were authorized in recognition of increased interest in mental health care for current and former service personnel. In late January, it was announced that 128 Army suicides were confirmed in 2008, with 15 under investigation (as reported in the January TSPN Call to Action). The figures represented the fourth straight annual increase, and the suicide rate for this branch surpassed that of the population at large. AP research shows that only twenty suicide deaths were reported during the months of January 2006, January 2007, and January 2008 combined. In the past year, the Army has announced several projects designed to stem current trends. Starting this month, the Army will conduct crisis intervention training sessions as part of a larger suicide prevention program. The Army is also collaborating with the National Institute of Mental Health (NIMH) on a five-year study on factors affecting soldiers mental health. Additionally, anti-stigma and prevention campaigns have been launched on the front lines and for families of service personnel. "Why do the numbers keep going up? We cannot tell you," Army Secretary Pete Geren stated during a Pentagon press conference reported by the AP on February 5. "We can tell you that across the Army we're committed to doing everything we can to address the problem." PRESIDENT AUTHORIZES SCHIP EXTENSION President Barack Obama has signed an extension of the State Children's Health Insurance Program (SCHIP), authorizing the provision of health coverage, including mental health care, to 4 million uninsured children. The extension s approval, following two vetoes by former President George W. Bush, is considered a major victory for the mental health field. Obama signed the bill mandating the extension on February 4, the same day it passed the House by a vote of While 40 Republican representatives voted for the bill, Tennessee s House delegation was split down party lines, with its five Democrats in favor and its four Republicans against. The Senate version passed on January 29; Senators Alexander and Corker were two of nine Republican senators who broke party ranks to approve the bill. The extension will cost $32.8 billion and will be funded by an increase in the cigarette tax, from 39 cents a pack to $1.01. With the extension, the SCHIP program will provide insurance for a total of 11 million children and teens through The extension s approval, following two vetoes is considered a major victory for the mental health field. Passage of the SCHIP extension was one of Obama s primary objectives for his first 100 days in office. However, Republican opponents raised the same arguments cited during previous debates on the bill. They argued that the extension would encourage middle-class families with private insurance to switch needlessly to SCHIP coverage. They also objected to the cigarette tax increase s presumed effect on low-income persons and the extension of SCHIP and Medicaid to the children of recent immigrants. But opponents countered that the dire state of the economy trumped these concerns. The Associated Press reports that during the House debate on the bill, Rep. Frank Pallone (D-New Jersey) reported that roughly 4 million people have lost employer-sponsored insurance in the past year. "Do (people) keep their families' health insurance or do they put food on the table at night? Pallone was quoted as saying in an MSNBC.com report on the vote. During this economic recession, these kinds of decisions are unfortunately becoming more common." PAGE 3

4 TSPN CALL TO ACTION JUVENILE JUSTICE SUICIDE STUDY WITHHELD FOR FIVE YEARS An exposé by a national professional journal reveals that a major federal report on suicides in juvenile facilities was withheld from the public for five years despite potentially explosive findings. According to an article published on the website of Youth Today, the U.S. Office of Juvenile Justice and Delinquency Prevention (OJJDP) ordained the compilation of Characteristics of Juvenile Suicide in Confinement. Lead author Lindsay Hayes, a project director for the National Center on Institutions and Alternatives (NCIA), claims the report was finished in 2004 with an unofficial version posted on the OJJDP website. But Hayes claims that despite promises by then -OJJDP Administrator J. Robert Flores to fast-track publication of the report, it was never published. In the summer of 2008, after Hayes sent Flores a letter complaining about the delay, the OJJDP approved the study but then withdrew its approval in December. The study was ultimately published on February 9, after Flores had left OJJDP. "I have a sense that Flores' hands were all over (the delayed release)," Hayes tells Youth Today in an online article dated the same day. The online publication Suicide Prevention News and Comment, which ran a summary of the Youth Today piece on February 16, reports that in 2008 Flores was questioned by the House Oversight and Government Reform Committee regarding a lack of transparency in the OJJDP s grant-making process. He was also investigated for misuse of government funding, and staffers have accused Flores of diverting OJJDP grant funds to programs that had religious, social or political connections to the Bush administration. St. Paul Pioneer Press Ruben Rosario cited these and other allegations in February 15 column on the report s delay, which he called a public disservice. Characteristics of Juvenile Suicide in Confinement is available through the Suicide Prevention News and Comment website; available URL: Selected findings from the OJJDP report: Over one-third of the 110 suicide deaths in juvenile justice facilities between 1995 and 1999 were not reported to the supervising or licensing state agency, or any child advocacy agency. Nearly one-sixth of these deaths were only learned about through newspaper articles and conversation, in spite of surveys sent to almost 4,000 public and private juvenile facilities. More than two-thirds of private facilities did not respond to the aforementioned survey. More than 70 percent of the victims were between the ages of 15 and 17. More than half of juveniles who died by suicide in detention did so in the first six days. Only 35 percent of the victims had received a mental health assessment at the time of their death. Only 17 percent of the victims were on suicide watch at the time of their deaths. Summary courtesy of the Suicide Prevention News and Comment summary. STUDY REVIEWS SUICIDE AMONG OLDER ADULTS IN LONG-TERM CARE Suicide risk among older adults in long-term care (LTC) facilities has remained constant over the last 15 years despite a general decline among the elderly at large, according to a paper recently published in the Journal of the American Geriatric Society. Researchers from four universities and the New York Academy of Medicine collaborated on what may be the most intensive review of suicide in nursing homes and assisted living facilities ever published. They reviewed fifteen years of suicide deaths among New York City residents aged 60 and over (1,771 total) for demographics, cause of death, location of death, and toxicology results. While actual suicide numbers fluctuated from year to year, fitting the numbers to a linear regression line showed a definite downward trend among older adults living outside LTC settings over the period studied. Meanwhile, trends remained stable, even suggestive of a slight increase, among LTC suicides during this timeframe. The authors note that LTC residents often suffer from depression and/or dementia, two known risk factors for elder suicide, and often have low social support (i.e., fewer friends and family). They also observe the apparent contradiction of conventional wisdom that the surveillance and access to trained health care professionals afforded by LTCs should reduce suicide risk. The study also finds that suicide victims in LTC facilities tend to be older than victims still living in the community (average age of 76.2 versus 72.9). Within both groups, most victims were non-hispanic white and male. LTC suicide victims were far less likely to use firearms, since most facilities do not allow them. Deaths were more likely to involve falls (51.1% versus 29.1% for non-ltc victims), a point consistent with other studies on suicide in LTC environments. (Such studies also suggest hanging is a more common method, and while there were more deaths of this nature among the LTC victims in this study, the difference was not considered statistically significant.) The citation for this study is as follows: Mezuk, B., et al. (2008) Suicide in older adults in long-term care: 1990 to Journal of the American Geriatric Society 56: PAGE 4

5 VOLUME 5, ISSUE 3 TSPN REGIONAL CALENDAR No December meetings are scheduled unless otherwise marked. Dates in amethyst indicate alternate meeting dates intended to accommodate state holidays or other previously scheduled events. East Tennessee Region monthly, 4th Tuesday, 3:30 PM Whittle Springs Middle School, 2700 White Oak Lane, Knoxville, March 24, April 28, May 26, June 23, July 28, August 25, September 22, October 27, and November 24 Memphis/Shelby County Area bi-monthly, 3rd Wednesday, 4 PM Family Services of the Mid-South, 2430 Poplar Avenue, Memphis, March 11, May 13, July 8, and November 18 Mid-Cumberland Region monthly, 2nd Thursday, 10:30 AM Tennessee Voices for Children, 701 Bradford Avenue, Nashville, March 12, April 9, May 14, June 11, July 9, August 13, September 10, October 8, November 12, and December 10 Northeast Region monthly, 4th Tuesday, 10:30 AM Boone s Creek Christian Church, 305 Boone s Creek Road, Gray, March 24, April 28, May 26, June 23, July 28, August 25, September 22, October 27, and November 24 Rural West Every 3rd Wednesday, 10:30 AM Behavioral Health Initiatives, 36C Sandstone Circle, Jackson, March 18, April 15, May 20, June 17, July 15, August 19, September 16, October 21, November 18, and December 16 South Central Every 1st Tuesday, 10:30 AM Centerstone, Inc., 604 South Wall Street, Shelbyville, March 3, April 7, May 5, June 2, July 7, August 4, September 1, October 6, November 10, and December 1 Southeast Region Every 2nd Tuesday, 9:30 AM Bradford Health Associates, 6160 Shallowford Road, Suite 103, Chattanooga, March 10, April 14, May 12, June 9, July 14, August 11, September 8, October 13, November 10, and December 8 Upper Cumberland Region Every 4th Thursday, 10 AM Volunteer Behavioral Health Care Systems, 1200 Willow Avenue, Cookeville, March 26, April 23, May 28, June 25, July 23, August 27, September 24, October 22, November 19, and December 17 Intra-State Department Meetings Tennessee Department of Mental Health and Developmental Disabilities, Third Floor Conference Room, Cordell Hull Building, 425 Fifth Avenue North, Nashville, (2:30 PM) April 21, July 21, and October 20 Advisory Council June 3-4 (Montgomery Bell State Park, 1020 Jackson Hill Road, Burns) September 9 (to be announced) Blount County Mental Health Awareness and Suicide Prevention Alliance Every 1st Friday, 12 PM Blount County Health Department, 301 McGhee Street, Maryville, March 6, April 3, May 1, June 5, July 10, August 7, September 11, October 2, November 6, and December 4 Giles County Suicide Prevention Task Force bi-monthly, 3rd Monday, 1:30 PM Giles County Career Center, 125 South Cedar Lane, Pulaski, March 16, May 18, July 20, September 21, November 16 Hickman County Suicide Prevention Task Force Every 4th Friday, 1:30 PM Hickman Community Hospital, Senior Care Building, 135 East Swan Street, Centerville, March 27, April 24, May 22, June 26, July 24, August 28, September 25, October 23, and November 20 PAGE 5

6 ADVISORY COUNCIL CONTACT INFORMATION If you are interested in getting involved with TSPN on a local level or have other questions, contact the chairperson of your region as indicated by the map provided below: East Tennessee region Anne Young, MS, CAS (865) sayoung3@comcast.net Memphis and Shelby County Michael LaBonte (901) mlabonte@family-services.org Mid-Cumberland region Misty Yarbrough, BBA, BSW (615) myarbrough@mhamt.org Northeast region Harold Leonard, MA, LPC-MHSP (423) leonardhb@msha.com Rural West region Carol Burroughs, MSCPS (731) burroughsc@k12tn.net South Central region Pam Arnell (931) work angel1@surfmore.net Southeast region Tim Tatum, MA (423) tim_tatum@chs.net Upper Cumberland region Linda Moran (931) lmoran@vbhcs.org Advisory Council Chair Sam Bernard (423) sambernard@comcast.net Executive Director Scott Ridgway, MS (615) sridgway@tspn.org Lake Lauderdale Obion Henry Weakley Dyer Gibson Carroll Crockett Haywood Madison Tipton Chester Henderson Benton Decatur Stewart Houston Humphreys Perry Montgomery Dickson Hickman Lewis Cheatham Maury Robertson Davidson Williamson Marshall Macon Sumner Clay Pickett Scott Claiborne Hancock Fentress Campbell Hawkins Trousdale Jackson Overton Union Smith Wilson Rutherford Bedford Cannon Putnam Morgan De Kalb Cumberland White Roane Warren Coffee Grundy Van Buren Sequatchie Bledsoe Rhea Meigs McMinn Knox Loudon Blount Monroe Anderson Grainger Hamblen Jefferson Cocke Sevier Greene Washington Unicoi Sullivan Carter Johnson Shelby Fayette Hardeman McNairy Hardin Wayne Lawrence Giles Lincoln Moore Franklin Marion Hamilton Bradley Polk