New “Pain in the Nation” Issue Brief Focuses on How Healthcare Systems Can Help Address and Prevent Deaths of Despair

Washington, D.C., May 17, 2018 –Trust for America’s Health (TFAH) and Well Being Trust (WBT) released Pain in the Nation: Healthcare Systems Brief, which focuses on how healthcare systems can help address the deaths of despair due to drug and alcohol misuse and suicide.

According to the brief, hospital stays for mental health and/or substance use were the only categories of hospitalizations that increased from 2005 to 2014. Between 2009 and 2014, opioid-related inpatient stays increased 64 percent while emergency department visits doubled—placing hospitals and health systems on the front lines in providing and/or linking patients to behavioral health services and integrating mental health services across systems.

To address these issues, the brief recommends healthcare systems apply a careful systems approach that focuses on preventive interventions, clinical care and behavioral health services—building a “whole health” approach with integrated and linked programs.

The brief follows the release of the national report and projections: Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy, which found that, in 2016, 142,000 Americans—one every four minutes—died from the diseases of despair and two additional briefs focused on the education sector and an updated data analysis finding that—while drug overdoses were still highest among Whites in 2016—there were disproportionately large increases in drug deaths among racial/ethnic minority groups.

“Healthcare systems are often in a unique place to bring about clinical change that can impact countless individuals seeking care,” said Benjamin F. Miller, PsyD, Chief Strategy Officer, Well Being Trust. “We need better integration within healthcare so that people seeking help for mental health and addiction can have their needs met in a more seamless and timely fashion. Trying harder is not going to be enough – we need systems level change.”

The Pain in the Nation: Healthcare Systems Brief provides extensive recommendations that will enhance behavioral health services:
Better care integration and coordination—Many providers have never been trained in suicide prevention and lack the confidence to effectively deal with suicide. And, while behavioral health services have long operated in their own silo apart from the traditional medical care systems, systems and providers should continue to shift towards an integrated or “whole health” mentality to ensure coordinated medical and behavioral healthcare services and systems.
Boosting medication-assisted treatment—Enhancing behavioral health services requires ensuring providers are employing up-to-date treatments that have been proven clinically effective, notably medication-assisted treatment (MAT)—the use of FDA-approved medications in combination with therapy to treat substance use disorders. In addition to being clinically effective, MAT also makes fiscal sense. A 2015 study found that treatment of opioid dependence with methadone and buprenorphine was associated with $153 to $223 lower total healthcare expenditures per month than behavioral health treatment without MAT.
Improve pain treatment and management practices—Evidenced-based strategies should be used to better address pain. Healthcare providers have a responsibility to ensure they are working with their patients on increasing overall functionality and quality of life in ways that do not leave their patients vulnerable to substance misuse. Healthcare systems should develop practices that require physicians to treat pain responsibly, including: guidelines on appropriate opioid prescribing; training healthcare providers to identify early signs of opioid use disorders; and strengthening prescription drug monitoring programs (PDMP) and other tools to detect misuse.
Foster community partnerships—Prevention efforts are most effective when multiple sectors in a community work together to support prevention and identify at-risk community members to ensure they receive the support and services they need. For example, the Massachusetts General Hospital (MGH) Center for Community Health Improvement created four coalitions focused on take-back programs, naloxone distribution, connections to treatment through recovery coaches, and screening all patients for substance misuse. In one neighborhood, Emergency Medical Services responses for heroin overdoses decreased 62 percent over a seven-year period.
Screening for substance misuse, suicide and mental health issues—Healthcare systems should coordinate with schools and other community partners to implement screening and provide access to treatment for individuals identified as at-risk for substance misuse, suicide or other mental health concerns. Systems also play a role in supporting evidence-based primary prevention efforts in their community—including social-emotional learning programs.
Reduce access to lethal suicide means—Healthcare systems can encourage providers to counsel patients to safely store both firearms and medications. One method, the Counseling on Access to Lethal Means (CALM) at Children’s Hospital Colorado, found that parents of children being treated for suicide risk who were educated about safe storage of medications and guns made significant changes in their behavior. Additionally, take back programs can help prevent drug misuse.
Ensuring people have better access to behavioral health providers—A successful behavioral healthcare system requires sufficient providers. Currently, 55 percent of U.S. counties do not have any practicing behavioral health workers and 77 percent report unmet behavioral health needs. While it is incredibly difficult to close this gap, the nation should focus on innovative interventions—including telehealth—to ensure people have better access to the health providers they need to be well.
“By prioritizing prevention, working together and improving behavioral health services, healthcare systems can help mitigate the devastating crises of drug overdoses, alcohol-related fatalities and suicides,” said John Auerbach, president and CEO of TFAH. “Healthcare systems can and should advocate for the policies and resources necessary—both within and beyond the clinical setting—to reduce alcohol, drug and suicide deaths among their patients.”
Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. For more information, visit Twitter: @HealthyAmerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community wellness. Twitter: @WellBeingTrust