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July 2, 2021

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Why In-Home Crisis Stabilization for Kids Is Integral to the Mental Health Crisis System


As states prepare for 988—the three-digit number for behavioral health emergencies that must be live by July 16, 2022—Andrea Rifkind, LCSW-C, hopes they’ll expand their crisis continuum to include in-home stabilization for young people. “It allows us to meet children where they are,” she says. Rifkind is the program director of Sheppard Pratt Health System’s Care and Connection for Families in Montgomery County, Maryland.
Read the June 29 #CrisisTalk.

How a 911-EMS Crisis Intervention Diverts People in Mental Health Crisis


Grady EMS in Atlanta, GA, diverts 911-EMS callers experiencing mental health challenges. The team looks for alternative solutions for people when the ED isn’t the best fit, says Erin K. Vickery, EMS director of operations at the Fulton Division of Grady Health System. That might mean a warm handoff to GCAL or an in-person response. The latter is where Upstream Mobile Crisis Intervention comes in—each mobile team is made up of a Grady EMS paramedic and a BHL LCSW. Read the June 22 #CrisisTalk.

Dr. Miriam Delphin-Rittmon Confirmed as SAMHSA Assistant Secretary


NASMHPD congratulates Dr. Miriam Delphin-Rittmon, who was confirmed as the Assistant Secretary for Mental Health and Substance Use, Department of Health and Human Services (SAMHSA) on June 25, 2021. We wish her the best of luck and look forward to her leadership!

State Spotlight: Northern Mariana Islands Go Above and Beyond for Mental Health Awareness Month

For this May's Mental Health Awareness month (MHAM), the Commonwealth of the Northern Mariana Islands (CNMI) organized a variety of activities and PSAs. The overall focus and message of MHAM was promoting whole health, wellness, and managing stress in day-to-day life. Activities included: their DEAR (Drop Everything And Reset) Campaign, focused on stress management, which included an 8-minute instructional video; a series of PSAs in partnership with key stakeholders, local sports stars, local artists, and celebrities; an active partnership with their public schools, involving students in PSAs and integrating mental health tips and activities throughout their school Spirit Week, beginning with Mindful Monday; and other outreach and activities for populations of focus such as older adults, the LGBTQ+ community, youth, and individuals with disabilities.

The Commonwealth Healthcare Corporation (CHCC) Community Guidance Center (CGC), in collaboration with Northern Marianas Athletics (NMA) and various community partners, hosted the Marianas Relay on May 29 to close out MHAM. The event promoted mental health and wellness through physical health and nutrition by encouraging community members to take proactive steps to improving their overall health and well-being. A total of 37 teams and over 100 participants laced up on the track to “pass the baton” in support of mental wellness in CNMI, with participants spanning ages 4 to 60. Free blood pressure and glucose screenings were provided from the Northern Marianas College Nursing Club and information was distributed from the CGC and the Non-Communicable Disease Bureau (NCDB). Team incentives, raffle prizes, and refreshments were made available through generous donations from various partners and businesses.

Other outreach and awareness activities during MHAM included a proclamation-signing video with the Governor and Lieutenant Governor, which was broadcasted on social media, a 5K or 1 mile virtual run, multiple mental health campaign videos featuring  community groups sharing how they take care of their mental health, a Mental Health First Aid Training for adults, physical health and wellness content shared via social media, a Vibe in Color obstacle course, a basketball tournament, Zumba, and a coffee and paint activity for parents. Overall, over 8,600 individuals participated in MHAM activities on Saipan, Tinian, and Rota, and the social media campaign drew over 10,100 viewers.

Leading Mental Health Organizations Strongly Support New Bipartisan Peer Support Legislation Introduced in the Senate
NASMHPD and valued partners have voiced strong support for new bipartisan legislation introduced in the Senate to provide Medicare coverage of peer support services for individuals with mental health or substance use disorders who are being treated in primary care and receiving integrated behavioral health services. View the statement on Mental Health America's website for more information. View the companion bills: Senate Bill 2144 and House Bill 2767.

New NASMHPD Resource: Transformation Transfer Initiative 2021 Resource Guide

NASMHPD developed a Resource Guide to support the work of the 2021 SAMHSA Transformation Transfer Initiative (TTI) awardees. The Guide, separated into three Folios based on the 2021 topics - Bed Registries and Behavioral Health Crisis Services, Diversion from Jail, and Improving Mental Health Services within Jails - includes guidance, best practices and noteworthy examples in areas that states and territories have had challenges or seen opportunities. Each Folio includes a variety of topics that affect every TTI project—including trauma informed resources, addressing health disparities and inequities, peer support, faith-based resources, rural behavioral health resources, 988 readiness—and then delves into more specific resources based on the folio subject.

Bed Registries and Behavioral Health Crisis Services folio has a section dedicated specifically to states and territories implementing Service Registries, working to create or enhance service registries in their states. This Folio includes the experiences of 23 previous TTI Registry participants and is intended to guide states as they build coalitions, organize services, and ultimately launch registries.

Diversion from Jail folio includes resources for prevention, intervention, diversion and services in jails and post detention and provides information on these topics and models such as Crisis Now and LEAD that have helped many states.

Improving Mental Health Services within Jails folio includes the resources from the Diversion from Jail folio and is intended for states who are working to implement programs within jails or programs for individuals who are re-entering into the community. It includes published papers on medication programs in jails and states re-entry programs that have found success

CMS Announces Director of Center for Medicaid and CHIP Services
On June 28th, the Centers for Medicare and Medicaid Services announced Daniel Tsai as Deputy Administrator and Director of Center for Medicaid and CHIP Services (CMCS). With a record 80 million people receiving health coverage through Medicaid and the Children’s Health Insurance Program (CHIP), Tsai will lead the Center’s efforts in addressing disparities in health equity and serving the needs of children, pregnant people, parents, seniors, and individuals with disabilities who rely on these essential programs. Daniel Tsai will start on July 6.
 
Tsai comes from the Commonwealth of Massachusetts where he served as the Assistant Secretary for MassHealth and Medicaid Director. His tenure has focused on building a robust and sustainable Medicaid program that ensures equitable coverage and reshapes how health care is delivered for two million individuals and families in the state. Read the full press release. 

Division Spotlight: NASHP Presentation on their National Care Coordination Standards for Children and Youth with Special Health Care Needs


The NASHP Presented to the NASMHPD Children, Youth, and Families Division and the NASMHPD Finance and Policy Division on June 28, 2021.

In October 2020, the National Academy for State Health Policy (NASHP) published the National Care Coordination Standards for Children and Youth with Special Health Care Needs (CYSHCN). The National Care Coordination Standards describe the core elements of high-quality, family-centered, care coordination for CYSHCN.  On June 28, NASHP presented to the NASMHPD Children, Youth and Families and Finance and Policy Divisions on the National Care Coordination Standards and their relevance for state mental health programs and the children that they serve. The presentation included a brief review of the National Care Coordination Standards for CYSHCN, followed by a discussion of strategies that state mental health programs deem as critical to supporting high-quality care coordination systems. View the recording below.

SAMHSA Distributes Garrett Lee Smith Campus Suicide Prevention Grants
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released awards totaling $3.3 million to 33 colleges through its Garrett Lee Smith (GLS) Campus Suicide Prevention grant program. The Biden administration, bolstering the effort through American Rescue Plan Act of 2021 (ARP) funding, is enabling SAMHSA to expand the program reach by eight colleges. The funding comes at a time when pandemic-related stressors have increased mental health disorders among younger Americans.

The GLS program, operated out of SAMHSA’s Center for Mental Health Services, promotes colleges’ development of comprehensive approaches to enhance mental health services for their students – including those who are at risk of suicide, depression, serious mental illness, serious emotional disturbances, and/or substance use disorders (SUDs). Other goals are to prevent mental disorders and SUDs, promote help-seeking behavior, reduce negative public attitudes and improve the identification and treatment of at-risk college students so they can successfully complete their studies. Read the announcement. 

ER Visits by Adolescent Females for Suspected Suicide Attempt Spiked February to March 2021
Emergency room (ER) visits for possible suicide attempt rose 50.6 percent for adolescent females aged 12 to 17 in early months of 2021 compared to the corresponding period in 2019, according to a new report released by the Centers for Disease Control and Prevention (CDC).  Researchers analyzed emergency department data from the National Syndromic Surveillance Program for certain periods in 2020 and 2021. The rate of ER visits for possible suicide attempts among adolescent females began to increase in May of 2020 and spiked to 50.6 percent between February to March 2021. For adolescent males in the same age demographic, the increase was 3.7 percent between that same period. Similar increases were not observed in males and females ages 18 to 25.
“The findings from this study suggest more severe distress among young females than has been identified in previous reports during the pandemic, reinforcing the need for increased attention to, and prevention for, this population,” the authors wrote.
 
The full CDC report, Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021, published June 18, can be viewed here.

North Carolina to Receive $40 Million to Address Vaping in Juul Settlement
NASMHPD has prioritized reducing tobacco use among individuals with behavioral health concerns. In particular, prevention and cessation of youth vaping has been of particular concern to states during the COVID-19 pandemic, with the 2020 National Youth Tobacco Survey finding that nearly 1 in 5 high school students currently uses e-cigarettes.

In 2019, the state of North Carolina sued Juul Labs, alleging that they specifically targeted young people in advertising their vaping products. This week, on June 28, a $40 million settlement was reached in North Carolina. The $40 million will be directed to vaping cessation and prevention efforts. The terms of the settlement include barring Juul from targeting its advertising to minors and puts monthly and annual limits on the volume of vaping products individuals in North Carolina can buy. At least nine other states have initiated similar lawsuits, and a coalition of 39 states is actively investigating Juul. Learn more about strategies to reduce youth vaping.

CMS Releases the Medicaid and CHIP Managed Care Monitoring and Oversight Tools Center Informational Bulletin
On June 28, 2021, the Centers for Medicare & Medicaid Services (CMS) released a Center Informational Bulletin (CIB) to introduce a series of tools and toolkits for states and CMS to utilize in improving the monitoring and oversight of managed care in Medicaid and the Children’s Health Insurance Program (CHIP) which will help increase beneficiaries’ access to care. This CIB also provides guidance setting the content and format of the Annual Managed Care Program Report required by CMS regulations at 42 CFR § 438.66(e)(1). Finally, the CIB introduces additional resources and technical assistance toolkits that states can use to improve compliance with managed care standards and requirements. Learn more here.

New! Child and Family CCBHC Learning Community Launching
Coming in January 2022! The Child and Family Certified Community Behavioral Health Clinic (CCHBC) Learning Community will meet monthly for peer learning opportunities that focus on design and implementation approaches to meet the unique needs of children, youth and young adults with behavioral health needs and their families. Topics include age-appropriate services, screening and assessments; staffing considerations; family and youth/young adult engagement; agency/provider and community partnerships; data sharing, outcome tracking and continuous quality improvement; and more. This new opportunity is jointly sponsored by the National Council for Mental Wellbeing, The Institute for Innovation and Implementation at the University of Maryland, School of Social Work, and NASMHPD.

Application Now Available for the Next Cohort of NCAPPS Technical Assistance
TA via the The National Center on Advancing Person-Centered Practices and Systems will be provided at no charge to selected States, Territories, or Tribes for up to 100 hours per year, for up to two years. TA recipients will work with national subject matter experts to develop a TA plan and achieve the outcomes identified in that plan.  Applications are due by July 30, 2021. Learn more. Download the application.


The team at the IPS Employment Center has defined the Individual Placement and Support (IPS) approach to supported employment. The center’s activities focus on employment for people with serious mental illnesses. The center offers training, educational materials, and consultation services.  Learn more about training available through the IPS Employment Center.

NASMHPD Learning Opportunities
Crisis Systems Transformation: Now Is the Time

Tuesday, July 13, 1:00 - 2:00 p.m. ET
Register Here

There is broad recognition that behavioral health crises have reached epidemic proportion, with drug overdoses and suicides having overtaken traffic accidents as the two leading causes of death among young Americans ages 25-44. The COVID-19 pandemic has further underscored the dramatic need for behavioral health services, including crisis services. Yet very few communities in the United States have a behavioral health crisis system that would be considered excellent, let alone ideal. However, important changes are underway to transform the system to better meet the needs of people in crisis.

Join the American Psychiatric Association (APA), the National Association of State Mental Health Program Directors (NASMHPD), National Council for Mental Wellbeing, and American Foundation for Suicide Prevention (AFSP) for a webinar focused on opportunities for transforming our nation’s crisis system. 

On-Demand Webinar Recordings:
TTI Informational Exchange Recording: Diversion and Treatment - Why Focusing on Trauma Makes a Difference. This panel discussion addressed the value of using a trauma responsive approach in both diversion initiatives and treatment inside detention and continuing in community. Perspectives from various points of contact as well as individuals with lived experience provided insight into why such an approach benefits all involved. View the recording.
TTI Informational Exchange Recording: Trauma - Understanding the Mind, Body, Spirit Connection. As humans, we are a mind, body and spirit people. These connections represent who we are as our most authentic and holistic selves. It’s important to understand trauma can sever those connections and any attempt at reconnecting and healing must begin from an interdependent approach. This session explored pathways to healing in an authentic and holistic manner. View the recording.
SAMHSA-Sponsored Webinar Recording: Alternatives to Police Response for People in Mental Health Crisis – Ideas, Barriers and Ways to Work to a Solution. While a problem that has existed for much longer, the events of the last year has greatly increased the discussion occurring throughout our country on alternatives to police response to emergencies involving individuals with serious mental illness. These discussions have included both non-police projects and programs that involve both police and mental health providers. This webinar explored one alternative being used and discussed in many parts of the country, the CAHOOTS program.  The webinar then turned, using the real life experiences of two advocates on opposite ends of the country, to some issues that need to be considered when discussing these alternatives, barriers to a solution, and ways to work together to achieve a successful outcome. View the recording.
SAMHSA-Sponsored Webinar Recording: Increasing Cultural Competency in Mental Health Care Settings. There are many barriers to care that prevents or limits an individual from receiving help. One of these barriers is a lack of cultural competency in the mental health care space. Racial/ethnic minority individuals often receive lower quality healthcare services, such as fewer diagnostic procedures and negative verbal and nonverbal communication styles from providers. People with other marginalized identities, like LGBTQ+ individuals, are more likely to experience mental health concerns than cisgender, heterosexual people but may receive ineffective care due to a provider’s reluctance to address gender and sexuality. This webinar focused on how to increase cultural competency on an individual and systemic level. View the recording.

Don't Miss These Headlines
Metro Atlanta Police Grapple With Mental Health Amid Violence, Stress And Scrutiny
K. Ridderbusch | Georgia Health News

High Suicide Rates among United States Service Members and Veterans of the Post-9/11 Wars
T. Howard Suitt | Costs of War Project

Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic
J. Bryant-Genevier et al. | CDC's Morbidity and Mortality Weekly Report (MMWR)

HHS Secretary Supports Telehealth Expansion, Emphasizes Need for Equity
S. Firth | MedPage Today

Wall Street Bets Big on Mental Health Care
B. Herman | Axios

Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status
B. Han et al. | JAMA Network Open

Biden Administration Eases Rules for Mobile Vans for Substance Use Treatment
J. Frieden | MedPage Today

World Health Assembly Recommends Reinforcement of Measures to Protect Mental Health During Public Health Emergencies
World Health Organization (WHO)

Americans Seek Urgent Mental-Health Support as Covid-19 Crisis Ebbs
R. Whelan | Wall Street Journal
 

Resource Roundup
Position Statement on the Routine Administration of Cognitive Behavioral Therapy for Psychosis as the Standard of Care for Individuals Seeking Treatment for Psychosis. This position statement details a rationale for sustainable CBTp implementation and delivers key recommendations to support broad intra- and inter-organizational adoption for individuals who have or are at risk of developing a psychotic disorder.
988 Model Legislation is Available. Please find the latest version of 988 Model Legislation here on the NASMHPD website.
Systems of Care: To Infinity and Beyond. On June 3, Dr. Gary Blau presented at the 2021 Training Institutes LIVE! on The Evolution of Systems of Care: To Infinity and Beyond. Watch the presentation. Learn more about the Evolution of the System of Care Approach.
Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders.  This SAMHSA guide reviews literature and research findings related to increasing access to treatment for SMI and SUD using telehealth modalities, examines emerging and best practices, discusses gaps in knowledge, and identifies challenges and strategies for implementation.
COVID-19 Vaccine Resources. NASMHPD has compiled various resources that may be useful to state behavioral health leadership as they work to effectively and equitably distribute COVID-19 vaccines. View them here.
SAMHSA Resource: Crisis Services: Meeting Needs, Saving Lives. SAMHSA has published Crisis Services: Meeting Needs, Saving Lives, composed of SAMHSA’s National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit and related papers on crisis services.
COVID-19 Information for SAMHSA Discretionary Grant Recipients. SAMHSA is allowing flexibility for grant recipients affected by the loss of operational capacity and increased costs due to the COVID-19 crisis. These flexibilities are available during this emergency time period. Flexibility may be reassessed upon issuance of new guidance by the Office of Management and Budget post the emergency time period. Learn more.
NASMHPD's EIP Resource Center. The Early Intervention in Psychosis virtual resource center, made possible by the Robert Wood Johnson Foundation, is designed to provide reliable information for practitioners, policymakers, individuals, families, and communities in order to foster more widespread adoption and utilization of early intervention programming for persons at risk for (or experiencing a first episode of) psychosis. Visit the resource center. These TA resources were developed with support from SAMHSA.
Crisis Service Resources: NASMHPD's 2020 Technical Assistance Coalition Working Papers. NASMHPD's 2020 TAC papers continue the Beyond Beds theme, highlighting different aspects of crisis services: 


EPINET is a national learning health care system from the National Institutes of Mental Health (NIMH) that links early psychosis clinics through standard clinical measures, uniform data collection methods, data sharing agreements, and integration of client-level data across service users and clinics. Clients and their families, clinicians, health care administrators, and scientific experts now have the opportunity to partner within EPINET to improve early psychosis care and conduct large-scale, practice-based research. Learn more about EPINET. Download a shareable flyer about EPINET. 
Visit the SMI Adviser website for evidence-based education, consultation, and resources on serious mental illness (SMI). Request a free clinician-to-clinician consultation. Access dozens of online courses and earn free continuing education credits. Learn about the My Mental Health Crisis Plan app. See data on serious mental illness in the U.S. Find resources on COVID-19, clozapine, and long-acting injectables.

New resource:

Reopening Your Mental Health Practice
Reopening your practice presents many topics to consider around employee safety, physical office space, and the safety of individuals and family members. It also presents an opportunity to assess a number of important areas. This includes: 
  • which treatment modalities work best for each individual. 
  • how to have conversations around safety-related issues, such as wearing a mask. 
  • staffing issues that you need to address to ensure there are no gaps in service. 
Use this checklist from SMI Adviser to help guide your preparation. It provides a list of important issues to consider for practices that serve individuals who have serious mental illness (SMI).
NASMHPD Staff
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National Association of State Mental Health Program Directors
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