Saint Joseph hospitals in Lexington, London and Mount Sterling seek applications for grants to improve well-being, health equity

By Melissa Patrick

Kentucky Health News

The CHI Saint Joseph Health hospitals in Kentucky are accepting applications for local nonprofit organizations to apply for grants aimed at supporting services to improve well-being and health equity in their service areas. 

The grants are part of the Community Health Improvement Grants program, which was created in 2019 when Catholic Health Initiatives and Dignity Health came together to create the national health system CommonSpirit Health.

Grants through Saint Joseph Hospital and Saint Joseph East in Lexington, and Saint Joseph London, can be as small as $20,000 and as large as $100,000. Grant opportunities are also available at Saint Joseph Mount Sterling to serve that area, ranging from $10,000 to $19,500.  Click here for the link to the application website. 

"Grant applications must include collaborating partner organizations helping to deliver services and not be solely about one agency’s work,” Michael Bilton, CommonSpirit Health's senior director for community health and benefit, said in a news release. 

The application period is open through Aug. 16. Grants are available to nonprofit organizations that address substance-use disorders, mental health, and issues involving weight, physical activity and nutrition. All projects must be planned for calendar year 2025. 

The priorities were identified in the hospitals' most recent community health needs assessment, which is conducted every three years. 

“We are deeply committed to the well-being of our community," Christy Spitser, interim market president of CHI Saint Joseph Health, said in the release. "Providing grants to local nonprofits is a vital part of our mission to give back and make a tangible difference in the lives of those we serve.” 

Interested organizations can learn more about the grant program, including eligibility criteria, how to apply, and a local contact for questions, by visiting https://www.commonspirit.org/communitygrants.

New website helps Kentuckians find mental-health treatment; has had 5,000 first-time users since it launched in March

The site is part of FindHelpNow.org, which also serves Tenenssee.

By Stephanie Ramsey
University of Kentucky

Despite growing awareness of mental-health issues, many people still struggle to find the right resources and treatment for mental health. The journey to receiving care can be confusing and overwhelming due to limited information on available services, long wait times and geographical barriers.

To address these challenges, the Kentucky Injury Prevention and Research Center has introduced an extension of its FindHelpNowKY.org website to include a dedicated website for mental health, FindMentalHealthNowKY.org. The new resource portal provides information on mental-health treatment options, helping to bridge the gap between those seeking help and the providers that offer it.

"This revamp is about breaking down the barriers to mental health care and making it easier for people to find the support they need. The new FindMentalHealthNowKY.org is a critical resource that offers near-real-time information on treatment options, reducing the stress and uncertainty that often come with seeking help," said KIPRC Director Terry Bunn.

FindMentalHealthNowKY.org was created by KIPRC as an agent for the state Department for Public Health in partnership and with funding from with the Department for Behavioral Health, Developmental and Intellectual Disabilities, both in the Cabinet for Health and Family Services.

The new website offers a comprehensive array of mental-health services designed to meet the diverse needs of its users. If someone is seeking individual or group counseling, the platform provides curated list of licensed therapists and counselors. For those requiring more intensive care, the site connects users with inpatient treatment facilities and hospitals equipped to handle more complex mental health conditions. The range of options ensures that individuals can find the right level of care, whether dealing with everyday stress or facing more challenging concerns.

Since its launch in March 2024, FindMentalHealthNowKY.org has seen significant engagement, with over 5,000 first-time users. Notably, more than 36% of these users have specifically been searching for mental health resources, indicating a significant demand for information and support in this area.

“Accessibility and convenience are key,” said FindMentalHealthNowKY Program Manager Catherine Hines. “FindMentalHealthNowKY.org provides a simple, user-friendly interface, allowing visitors to quickly locate the information they need. The prompt updates allow users to find openings for counseling, inpatient treatment or crisis intervention without the frustration of outdated or inaccurate information."

In addition to treatment options, FindMentalHealthNowKY.org is launching a comprehensive resource library on mental health topics. The library will contain thousands of entries, providing an extensive collection of information and support. These educational resources offer guidance on a variety of topics, empowering users to make informed decisions about their mental health.

One of the biggest barriers to seeking mental health support is the stigma associated with mental health issues. "Our goal is to provide reliable, accurate information that helps break down the stigma surrounding mental health,” Bunn said. “By offering comprehensive resources and educational materials, we aim to make it easier for people to seek help and encourage open conversations."

FindMentalHealthNowKY.org helps break down barriers by offering accessible, up-to-date and trustworthy resources. Its extensive resource library of educational materials foster a more open and understanding approach to mental health. If you're seeking mental health resources or support, visit FindMentalHealthNowKY.org.

Eastern State Hospital is 200 years old; ex-patient, who says it saved his life, urges those who need mental-health care to get it

By Melissa Patrick
Kentucky Health News

This story mentions suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

Eastern State Hospital in Lexington, which is celebrating its 200th anniversary this month, is the oldest continuously operating state psychiatric hospital in the United States.

When Eastern State opened its doors as part of the old Fayette Hospital on May 1, 1824, it was just the second state psychiatric hospital in the nation, according to a University of Kentucky news release. 

“We believe that health care is a right for all Kentuckians; this includes access to mental-health resources,” said Lt. Gov. Jacqueline Coleman, who spoke at the official observance of the anniversary. “For 200 years, Eastern State Hospital has provided care for Kentuckians in need of help. The staff at Eastern State Hospital is knowledgeable and compassionate. They deserve to be called health-care heroes.”

Lexington lawyer Bruce Simpson – who received treatment at Eastern State following a suicide attempt in January 2023 – shared his personal story and thanked the staff who helped him at the anniversary celebration. Below is a YouTube video, produced by UK, of Simpson telling his story. 

The UK news release notes that after his evaluation at Eastern State, Simpson began medication for his illness and began ongoing therapy, which he says has vastly improved his health. 

“I said, ‘I’m fine’ a million times. I was not fine,” Simpson said in the release. “But we need to talk openly about mental-health treatment. If you have a stomach ache, you’re going to the doctor. If your heart is palpitating, you’re going to the doctor. But if you have depression, you’re just as likely to not see anyone or even acknowledge you have a problem. That is a cultural correction we need to make. Mental illness is just as legitimate as cancer, heart disease, broken bones and a stomachache.”

For Simpson, who said he had dealt with ideas of suicide for nearly four decades, the stay at Eastern State completely changed his life.

“The clarity of my thinking now is so much better than it’s ever been,” he said in the release. “Eastern State got me on a different track. I want people to know that it is the best place to be if you’re in serious struggles with mental health. I wish I had gotten treated 40 years ago, and I don’t want anyone to suffer 40 years like I did. If things get difficult, don’t be afraid of going to Eastern State.”

"I can't say enough about the care I received at Eastern State along with my fellow patients," he said at the event. "But we're entitled to the same courtesy, respect and treatment as someone that's completely mentally healthy as human beings. And an Eastern State Hospital, I have 100% certainty that that takes place and I applaud the staff and I thank you for saving my life."

Health and Family Services Secretary Eric Friedlander said Eastern State's history "mirrors the many astounding developments in mental-health treatment over the past two centuries, from long-term custodial care in the 19th century, to the advent of modern medications in the mid-20th century, and the present focus on evidence-based, recovery-oriented services. Today the staff of Eastern State provide state-of-the-art care in a state-of-the-art facility to meet its unwavering goal of enhancing the behavioral health and quality of life of the Kentuckians it serves."

At the event, Kelly Gunning, director of advocacy and policy for the National Alliance on Mental Illness Lexington, said in 2002 she understood why her youngest son was "horrified" to be admitted to Eastern State Hospital -- and it had nothing to do with the dedicated staff.

"But the place itself was so foreboding and so off putting and so scary that it was stigmatizing for the patients that had to go there," she said. "Together, we decided we were going to start a campaign to make it better." 

Eastern State Hospital (Photo provided)

The state opened a modern, 300,000-square-foot Eastern State facility on UK’s Coldstream Research Campus in 2013 that houses 195 acute care beds and provides critical, recovery-focused psychiatric care for adults from a 50-county region of the state.

In 2021, then hospital became the first state psychiatric facility to achieve Magnet status, the gold standard for nursing excellence.

Later this summer the hospital will open its new Emergency Psychiatric Assessment Treatment and Healing unit, known as EmPATH. This program will offer an individual-centered, evidence-based care model designed to address the increasing needs for inpatient and emergency psychiatric care across Kentucky, according to the release. 

Louisville's 'Bos' Todd, national leader in mental health, dies at 93

Bosworth Todd

Kentucky Health News

Bosworth M. "Bos" Todd Jr., who co-founded a pathbreaking treatment center in Louisville for mentally ill youth and the foundation that makes the most mental-health research grants in the nation, died Jan. 22. He was 93.

Todd, a Frankfort native and University of Kentucky graduate, earned an MBA at Harvard Business School and worked in the investment industry. After his oldest son Sam was hospitalized with schizophrenia, he and his wife Joan, who died last year, joined with other parents to form the Schizophrenia Association of Louisville, now part of the National Alliance on Mental Illness.

In the early 1980s, he joined attorney Philip Ardery, real-estate broker Malcolm “Mac” Matthews Jr. and Barry Bingham Sr., editor and publisher of The Courier-Journal, to found Wellspring as a transitional home for young people with schizophrenia. "It now has a $40 million budget and offers a variety of services to 1,000 people at multiple locations across Louisville, The C-J's Andrew Wolfson reports.

Todd, Ardery and University of Louisville psychiatrist Herbert Wagemaker also launched the American Schizophrenia Foundation, which became the Brain & Behavior Research Foundation, "the nation’s top nongovernmental funder of mental-health research grants," Wolfson reports. "It has backed the research of more than 5,400 scientists in more than 599 institutions around the world."

A celebratory visitation will be held from 5 to 7 p.m. Friday, Jan. 26, at the River Valley Club on River Road in Louisville. Burial will be private. Wellspring is accepting memorial gifts in lieu of flowers.

Bipartisan bill would allow guns to be taken from people judged to be at risk of hurting themselves or others; opposition voiced

This story mentions suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

By Sarah Ladd
Kentucky Lantern

A Republican-backed draft bill aimed at temporarily removing firearms from Kentuckians at risk of harming themselves or others garnered mixed reactions from the Interim Joint Committee on Judiciary Friday morning.

State Sen. Whitney Westerfield (Legislative photo)

Republican Sen. Whitney Westerfield of Christian County said he will introduce t​he Crisis Aversion and Rights Retention Orders bill, or CARR, because of shootings that left children dead and people injured.

“The law has to allow us to protect people,” Westerfield told the House-Senate committee Friday. “I feel like it’s my obligation, and though I can’t speak for you, I believe it is your obligation, to not be afraid to have difficult conversations about the toughest issues that people of Kentucky face.”

Such laws have been enacted in 19 states, Louisville's WDRB reports. The nonprofit Whitney/Strong, formed by a Cincinnati woman to fight gun violence, says CARR generally works like this: 

• A concerned community member brings evidence about potential harm to one’s self or others, and law enforcement can then file a legal petition to remove that person’s guns temporarily.
• A judge will “approve or deny the temporary transfer petition after conducting a strict, independent judicial review.”
• If the judge grants the petition, guns belonging to the person in question are handed over temporarily to law enforcement or “a trusted person outside of the owner’s household.”
• A hearing is then held to determine next steps, which may include “identifying opportunities for important support services for the individual in crisis.”
• Once the person is not in crisis, the guns are returned.

It’s unclear what Kentucky’s specific legislation would look like. Westerfield is working on two draft options, he said, which may “change a lot.”

One version of the bill includes the option for law enforcement to approach the person in question and tell them someone brought concerns forward about their safety or the safety of others.

“It gives the respondent the option,” Westerfield explained. “You can have a hearing within X number of hours, near immediate. Keep your guns until then, not keep your guns — that’s up in the air. Or, you can give us your guns now, and we’ll have a hearing in a week.”

“The respondent has the burden of defending that in that particular case,” he said. Timelines are adjustable, he added, since there may be practical problems getting a hearing so soon.

There are other potential problems, Westerfield said.

“If you tell someone that you fear has … a mental-health issue, or a trauma, something that you’re worried they’re about to break, and then you don’t act with some near immediacy, you might actually provoke the act,” he said. “That’s the concern. And you’re balancing that risk and that concern with the Second Amendment right that they have and no one disputes that they have.”

The second version of Westerfield's proposal includes an ex parte hearing, in which the judge would hold without the gun owner present.

This version “still has the law-enforcement steps,” Westerfield said. “So, it’s not just anybody on a whim asking for a judge to get your guns. There has to be some articulated, specific reasons” for the move.

Westerfield said whatever version of bill he files will be “meaningfully different in a couple of ways” from so-called “red flag” laws. “First of all, the timelines are shorter,” he said. “The burden of proof is going to be higher.”

State Rep. Savannah Maddox (Legislative photo)

Rep. Savannah Maddox, R-Dry Ridge, reiterated her “longstanding opposition to this proposal” and concern that it has the potential to violate constitutional rights such as due process and protection against government search and seizure.

“When law enforcement comes to seize the firearms, do they automatically know where to find them?” she asked. “Are they told where to find them? Do they dig through the entirety of the house?” She said this could lead to a registry of some kind.

Westerfield said he isn’t proposing any kind of “search” or “ransacking of a home,” and “I think it’s on the honor system.”

Maddox said, “We must fervently resist any effort to pass gun-control legislation. And we must be serious about analyzing the data and putting a stop to these ineffective policies that put innocent citizens in harm’s way. And we have to encourage privately held entities to do the same.”

Whitney Austin, who co-founded Whitney Strong after surviving a mass shooting in Cincinnati, told the panel that “we know that misuse of firearms is not tied to law-abiding, mentally well gun owners. CARR was not created for them. CARR was created to surgically identify the small subset of gun owners, including those in lawful possession of a firearm, who are on the brink of misusing their guns to harm themselves or others.”

Sheila Schuster, a licensed psychologist and executive director of the Kentucky Mental Health Coalition, told the Lantern that she supports CARR, but “The truth is that people with a mental illness are 10 times more likely to be a victim of violent crime than to be a perpetrator.”

She explained, “At the point that someone commits an act, particularly hurting someone else, it’s very likely that they are suffering with rage, with paranoia and in terms of feeling like somebody has done something to wrong them and they’re gonna (get) revenge.”

Schuster added that suicidal people taking their lives happen at an “astronomical percentage higher if there’s a gun within reach than if there’s not.”

In a written statement to the lawmakers, Schuster said: “As a psychologist and mental health advocate, I am painfully aware of the stigma of mental illness and the confusion in the minds of many people that mass shooters are undoubtedly mentally ill. This is not the case and the CARR legislation does a very good job of not adding to nor reinforcing that false narrative.”

Kentucky has a law that requires mental-health professionals to warn potential victims if a client makes a threat to someone’s safety. Kentuckians who are mentally ill and at risk of harming themselves or others and can benefit from treatment can be involuntarily hospitalized if that's the least restrictive mode of treatment available.

Support at the committee meeting came mainly from Jefferson County. Westerfield's intended co-sponsor is Sen. David Yates, D-Louisville. Rep. Pamela Stevenson of Louisville, this year's Democratic candidate for attormney general, endorsed CARR, saying “with every right there’s a responsibility. . . . We’ve got to be brave enough to not let people just die nilly-willy.”

Jeffersontown Police Chief Richard Sanders endorsed CARR, saying police are “faced with things today that I’ve never seen before. . . . One of the biggest problems we face in law enforcement is people suffering from mental illness.” Some people, he said, “shouldn’t have access to a weapon.”

More than 1 in 10 minors ambulanced to ERs have behavioral issues, but EMS lacks guidelines in Ky. and most other states

Photo illustration by Maga Doctor News

Kentucky Health News

Here's another indication that the country has a youth mental-health crisis: More than 1 in 10 minors who were brought to the hospital by ambulance in 2019-20 had a behavioral-health emergency, and 85 percent were between 11 and 18 years old, says a study in the journal Academic Emergency Medicine.

“Our study found that pediatric behavioral-health emergencies requiring an ambulance were much too frequent,” said the study's senior author, Dr. Jennifer Hoffmann, emergency-medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and assistant professor at Northwestern University Feinberg School of Medicine.

But there are no national guidelines for emergency medical servcies to manage such patients, Hoffmann said in a news release: “We found considerable variation in the use of sedative medications and restraints across different parts of the country. There is a great need for standardized EMS protocols for pediatric behavioral health emergencies. Currently only four states have these available.” Those are Maryland, Michigan, Rhode Island and Utah.

Among children 6 through 11, the study found that children with developmental, communication and physical disabilities were three times more likely to be restrained than children without these disabilities.

“EMS personnel are likely less comfortable with weight-based dosing of sedative medications, and EMS agencies in most states don’t have pediatric-specific sedative protocols, which might contribute to the increased use of physical restraints for younger children while in the ambulance,” said Julia Wnorowska, a Northwestern medical student who was first author on the study.

“Also, protocols for EMS personnel are needed to help manage children with autism spectrum disorders and other neurodevelopmental disabilities. Specific interventions could be developed to prevent and reduce agitation in this population, such as personalized emergency information forms that delineate patient-specific triggers and de-escalation techniques.”

Hoffman said, “Future research should determine whether the use of restrictive interventions can be reduced, while simultaneously promoting staff safety, through strategies such as education and adoption of pediatric-specific protocols.”

Kentucky Justice Commission on Mental Health to hold five more town-hall meetings; the next one is set for Oct. 11 in Lexington

Kentucky Health News

The Kentucky Judicial Commission on Mental Health is hosting nine town hall meetings across the state through Nov. 29 to garner input for changing how the justice system addresses people with challenges involving mental illness, substance use and/or intellectual and developmental disabilities. Four of the town halls have already taken place, with five remaining.  

"The commission wants to hear from people and/or their families with lived experience in this area as well as business owners, civic leaders and anyone else with an interest," says a news release. "The findings will be used to help guide the work of the commission and associated groups and to design training for the state court system and its justice partners." 

Those who are unable to attend, but want to share their experiences of navigating the courts or the behavioral health system can do so by emailing JCMH@kycourts.net. ASL interpreters will be provided and those with other language or accessibility needs should email JCMH@kycourts.net.

The first four town halls were held in Owensboro, Covington, Ashland and London.

All of the meetings take place from 6 to 8 p.m. local time. Dates and locations for the remaining town halls are as follows: 

• Oct. 11 – Lexington, Central Bank Center, 430 W. Vine St.
• Oct. 25 – Paducah-McCracken County Convention & Expo Center, 415 Park Ave.
• Nov. 8 – Louisville, Kentucky International Convention Center, 221 S. 4th St.
• Nov. 15 – Pikeville, Appalachian Wireless Arena, 126 Main St.
• Nov. 29 – Bowling Green, Sloan Convention Center, 1021 Wilkinson Trace

The Kentucky Judicial Commission on Mental Health was established in August 2022 and is charged with exploring, recommending and implementing transformational changes to improve systemwide responses to justice-involved people with mental health challenges, substance use issues and/or intellectual and developmental disabilities. ​

Toward this end, the commission held its first Mental Health Summit in Louisville on May 31 through June 2, with more than 1,000 people in attendance. The town halls are expected to build on this success, says the release. 

Panel to study mental-health issues in criminal-justice system

Chief Justice Minton, Justice Lambert, Gov. Beshear

The Supreme Court of Kentucky has created a commission to investigate mental-health issues in the state's criminal-justice system. Its membership has not been announced, but it will be chaired by Justice Debra Hembree Lambert.

“I’m excited to focus on mental health and substance-use cases, but this will also be the first time there will be an all-hands-on-board effort to assess and improve the way the court handles intellectual disabilities,” Lambert said in a news release. “No group this broad and with this many resources has ever come together to tackle all three of these important issues.”

The Kentucky Judicial Commission on Mental Health "will potentially have a great deal of latitude," report John Cheves and Aaron Mudd of the Lexington Herald-Leader. "According to Lambert, the body will examine where the court system touches cases involving mental health, substance use and intellectual disabilities, she said in the news release. The commission will also be empowered to make recommended changes where appropriate," including training for judges, other court personnel, law-enforcement officers, mental-health providers and community advocates, she said.

Chief Justice John Minton, who named Lambert chair, said Kentucky is the latest state to tackle "the growing mental-health crisis in the justice system."

But Cheves and Mudd write, "This is not the first time the commonwealth has tried to address severe mental illness in the people caught up in the state’s justice system. So far, its efforts haven’t been all that successful." They note that "Tim's Law," which lets district judges order seriously mentally-ill people into outpatient treatment, apparently has been used only once, in Jefferson County.

The commission is scheduled to have its first meeting Sept. 22. It apparently will have some members from the executive branch of state government, since the Supreme Court announcement was accompanied by a photo of Minton, Lambert and Gov. Andy Beshear.

Feds say they are investigating whether state hospitalizes too many Louisville metro-area residents who have mental illness

By Melissa Patrick
Kentucky Health News

The U.S. Department of Justice says it is investigating whether adults with severe mental illness in the Louisville metropolitan area are being subjected to excessive institutionalization in psychiatric hospitals.  

“When people do not receive the community-based mental health services they need, they often get caught in a cycle of psychiatric hospital stays,” Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said in a May 24 news release. “This investigation also seeks to ensure that people with serious mental illness are not unnecessarily brought into contact with law enforcement.”

The department said it was acting under the Americans with Disabilities Act. The release said, "The investigation will examine whether Kentucky unnecessarily segregates people with serious mental illness in psychiatric hospitals and places them at risk of law enforcement encounters by failing to provide integrated community-based mental health services needed to avoid these results."

Gov. Andy Beshear said when asked about the probe two days later that he was "perplexed" by the announcement of it, saying his administration was notified about an hour in advance and the Justice Department had not gathered any data or information on this issue prior to issuing the release.

"I certainly wish, if they were going to claim they're announcing an investigation, they would have come to us and gotten facts to see whether putting out a release like that was appropriate or not," Beshear said, adding that his administration would cooperate with the investigation. 

"I hope we'll learn more and when we do we'll be completely transparent about it," he said. "If this is something that helps us do better, we want to do better. But this is something that requires both sides to be communicating. We look forward to communicating with them."

Individuals with relevant information are encouraged to contact the department via email at Community.Kentucky@usdoj.gov or through the Civil Rights Division’s Civil Rights Portal, available at https://civilrights.justice.gov/.

Had Covid-19? You're 60% more likely to have mental illness, study finds; researcher says it shows disease isn't 'like the flu'

Los Angeles Times photo

People who've had Covid-19 have a 60 percent higher chance of experiencing mental health problems, including anxiety, depression, and thinking of suicide, as well as drug and alcohol abuse and disturbances in sleep and cognition.

The results come from a study by researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. Using anonymous data from the VA, the nation’s largest integrated health-care delivery system, the researchers compared the mental-health outcomes of more than 150,000 patients who had mild or severe Covid-19 cases from March 1, 2020 to January 15, 2021, with the outcomes of two control groups: one of more than 5.6 million patients who did not have Covid-19 during the same time period, the other of more than 5.8 million people who were patients from March 2018 to January 2019, well before the pandemic. The study is published in the BJM (British Medical Journal).

People diagnosed with Covid-19 were 60% more likely to suffer from mental-health problems than those who were not infected, leading to an increased use of prescription medication to treat such problems and increased risks of substance-use disorders including opioids and non-opioids such as alcohol and illicit drugs, the study found.

“People need to know that if they have had Covid-19 and are struggling mentally, they’re not alone, and they should seek help immediately and without shame,” said Ziyad Al-Aly, the study's lead author. “It’s critical that we recognize this now, diagnose it and address it before the opioid crisis snowballs and we start losing more people to suicide.”

Al-Aly continued, “Our findings suggest a specific link between SARS-Co-V-2 [the novel coronavirus] and mental-health disorders. We’re not certain why this is, but one of the leading hypotheses is that the virus can enter the brain and disturb cellular and neuron pathways.”

To better understand whether the increased risk of mental-health disorders is specific to Covid-19, the researchers also compared the Covid-19 patients with 72,207 flu patients, including 11,924 who were hospitalized, from October 2017 through February 2020. Again, the risk was significantly higher in those who had mild and serious Covid-19 infections.

“My hope is that this dispels the notion that Covid-19 is like the flu,” Al-Aly said. “It’s so much more serious.” He stressed the importance of identifying and treating mental-health disorders in Covid-19 survivors.

“Our goal was to provide a comprehensive analysis that will help improve our understanding of the long-term risk of mental-health disorders in people with Covid-19 and guide their post-infection health care,” added Al-Aly. “Studies on Covid-19 and mental health have been limited by a maximum of six months of follow-up data and by a narrow selection of mental-health outcomes; for example, examining depression and anxiety but not substance-use disorders.”

4 Kentucky lawyers have killed themselves in the last 3 weeks; bar association head tells all, 'Take better care of each other'

Four Kentucky lawyers have committed suicide in the last three weeks, according to the Kentucky Bar Association.

"The suicides have prompted many to encourage colleagues to seek help if they need it and renewed calls for more continuing education about suicide, mental health, substance abuse and depression for the legal community," report Beth Musgrave and Valarie Honeycutt Spears of the Lexington Herald-Leader.

"Lawyers are 3.6 times more likely to suffer from depression than non-lawyers, according to the American Psychological Association. Substance abuse rates for lawyers are also much higher than non-lawyers."

Lexington lawyer Corey Fannin killed himself on Christmas.
(Lexington Herald-Leader photo illustration)

Three of the lawyers who killed themselves practiced in Lexington and one was from Paintsville.

Corey Fannin, 40, was "a highly successful Lexington trial lawyer who in 2015 won a $18 million verdict against a nursing home that included the largest award for pain and suffering in a nursing-home case," reports Andrew Wolfson of the Courier Journal.

"The president of the state bar association has taken the extraordinary step of emailing all 19,000 attorneys in Kentucky urging them to 'help take better care of each other'," Wolfson reports. Thomas Kerrick of Bowling Green also wrote, "I urge everyone reading this to lift up our friends and colleagues whenever and wherever we can."

Louisville lawyer Wilson Greene wants the bar association to require one hour of education for lawyers focusing on mental health, substance abuse, depression and stress management, partly so they are aware of how to get help. “This is a problem that lawyers have known about for a while,” Greene said. “Because of the stresses, lawyers are more prone to suicide and substance abuse.”

Greene and other lawyers told the reporters that many attorneys are afraid to get help or go into treatment, for fear of losing referrals from other lawyers. 

"Lawyers are also problem solvers and fixers," and can spread themselves too thin, the reporters note. "The legal profession is also adversarial. That sets up a win/loss situation."

Greene said, “Your clients are looking for positive outcomes and sometimes that doesn’t occur. That’s unfortunately a reality of the practice of law. But that drains you, and and can pull you down.”

In 2013, the director of the American Association of Suicidology told the Courier Journal "that the competitiveness and perfectionism that make good lawyers — and the lack of fulfillment many lawyers feel in practicing law — put them at high risk of alcoholism, drug use, depression and suicide," Wolfson writes. 

Also, during the pandemic, “Lawyers are hurting financially. It’s a grim period for the nation and practicing law, a grueling gig anytime, is even harder,” Shannon Ragland, editor of Kentucky Trial Court Review, told the Courier Journal. He initially reported the rash of suicides.

This story has been updated.

Beshear signs more than 35 bills amid pandemic, many related to health care; physician assistants get limited prescribing power

By Melissa Patrick
Kentucky Health News

The Kentucky legislature continues to pass bills despite Gov. Andy Beshear's plea that it just pass a budget and anything related to the coronavirus, due to the social distancing needed to thwart it. He announced Saturday that he had signed more than 35 bills into law, many of them related to health.

“While all of us should be focused on responding to the coronavirus as the number of cases grows in Kentucky, I will continue to evaluate the dozens of bills lawmakers are passing and sign those I believe will benefit the people of the commonwealth,” he said in a news release. “While all of these issues could be addressed after we defeat the coronavirus, my staff and I will continue to look out for the best interests of all Kentuckians in deciding which bills should become law.”

Beshear, a Democrat, earlier rebuffed the request of Republican legislative leaders to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. They plan to pass the budget and other bills April 1, and return April 14 to reconsider vetoed bills; he has vetoed two.

Here are some of the health-related bills Beshear signed:

Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, requires the state to hire a single pharmacy benefit manager to manage Kentucky Medicaid's $1.7 billion-a-year prescription drug business. This bill is designed to address many of the billing practices between pharmacy benefit managers and pharmacists, which pharmacists have long said are so unfair that they are putting some of them out of business.

House Bill 135, sponsored by Rep. Steve Sheldon, R-Bowling Green, gives physician assistants "modified prescriptive authority" for controlled substances in Schedules III, IV and V after they've practiced a year. Sheldon said all other states allow prescriptive authority for PAs and Kentucky will become the sixth state to place restrictions on them for Schedule II drugs, which includes a long list of narcotics used for pain management as well as several psycho-stimulants that are used treat attention deficit hyperactivity disorder, or ADHD.

SB 56, sponsored by Sen. Ralph Alvarado, R-Winchester, brings Kentucky law in line with the new federal law raising the legal age to purchase tobacco products, including electronic cigarettes, from 18 to 21. It also removes status offenses for youth who "purchase, use or possess" tobacco products, which are often called PUP laws. The bill allows the products to be confiscated and shifts the penalty to retailers who fail to adequately check buyers' identifications. The bill had an emergency clause so it became law upon Beshear's signature.

SB 42, sponsored by Sen. Denise Harper Angel, D-Louisville, requires any student identification badge issued to a public middle- or high-school student to contain the contact information for national crisis hotlines specializing in domestic violence, sexual assault and suicide. This contact information must also be on all IDs issued by public or private postsecondary education establishments. This information must be included on the IDs beginning Aug. 1.

SB 60, sponsored by Sen. Jimmy Higdon, R-Lebanon, adds spinal muscular atrophy, also referred to as SMA, to the list of  required tests run on infants for heritable disorders. Early diagnosis of this genetic disease helps babies receive treatment when it is most effective. Including SMA, Kentucky will now do 60 newborn screenings. Alvarado said at the bill's Jan. 29 committee hearing that this condition affects five or six Kentucky babies each year. 

SB 82, sponsored by Sen. Julie Raque Adams, R-Louisville, establishes the Kentucky Eating Disorder Council to oversee development and implementation of eating-disorder awareness, education and prevention programs. It will also identify strategies for improving access to adequate diagnosis and treatment services. and make recommendations on legislative and regulatory changes. Adams said 900,000 Kentuckians, including nearly 30,000 children, have been diagnosed with an eating disorder but the state has no residential, partial-hospitalization or acute-care programs.

SB 134, sponsored by Sen. David Givens, R-Greensburg, establishes the Optometry Scholarship Program with a trust fund supplied by state appropriations (determined with each biennial budget) gifts, grants, and federal funds. A minimum of one-third of the amount appropriated for scholarships must go to eligible students at an in-state institution -- a boon to the University of Pikeville's Kentucky College of Optometry, the state's only optometry school.

SB 125, sponsored by Sen. Tom Buford, R-Nicholasville, allows the Kentucky Board of Medical Licensure to determine the allowable scope of practice for athletic trainers in Kentucky, particularly related to their training. This bill has been in the works for about 10 years.

HB 153, sponsored by Rep. Kim Moser, R-Taylor-Mill, establishes a mental-health first-aid training program to show people how to best meet the needs of someone in a mental-health or substance-use crisis. Funding will come through a trust supplied by state and federal appropriations, grants and private donations. Advocates' hope is that this training will become as common as CPR.

Beshear had already signed several other health-related bills into law, including:

HB 129, sponsored by Moser, will overhaul the state public-health system, including how health departments are funded and how they prioritize their resources.  It is called the public health transformation bill. It was fully funded in the House budget but falls about $9.4 million short in the Senate's proposal, according to Randy Gooch, director of the Jessamine County Public Health Department. HB 129 is part of a three-phase approach submitted in the state House to create a sustainable solution to local health departments' pension-driven financial crisis.

SB 122, sponsored by Adams, modifies Tim's Law of 2017, which allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized at least twice in the previous year. SB 122 would make that two years. The goal of Tim's Law is to stop the revolving door of these individuals in and out of jails and state psychiatric hospitals, allowing more participants. The law is named for Tim Morton of Lexington, who was hospitalized involuntarily 37 times by his mother because it was the only way she could get him the psychatric treatment he needed. He died in 2014.

HB 99, sponsored by House Speaker David Osborne, R-Prospect, authorizing a $35 million state loan to the University of Louisville to support its recent acquisition of Jewish Hospital and other Louisville health-care facilities.

House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. A House-passed bill to make marijuana legal medicine in Kentucky has gotten nowhere in the Senate. 

Editorial: suicides a growing health threat in Hardin County, but many are reticent to seek help

Suicide is an increasing phenomenon in Hardin County, and such deaths are more than statistics, writes the editorial board of The News-Enterprise in Elizabethtown: "Our neighbors are hurting. Mental illness, depression, sub­stance abuse, desperation, whatever the cause, these are real issues which, without proper attention, can become a preventable death. Some people need medication. Others counseling or another form of professional treatment. In many cases, support groups have help people find ways to cope with their personal demons."

All people struggling with suicidal ideation need support and encouragement, but many are reticent to seek help, so we must be on watch for unusual behavior and care enough to reach out to our friends, family and neighbors, the board writes.

The National Suicide Prevention Lifeline is 1-800-273-8255.

Chronic disease can lead to mental-health issues, especially among seniors in isolated rural areas like Casey County

"Rural America has some of the highest rates of chronic disease in the nation – the more remote a community, the more heart disease, cancer and diabetes. And there’s a side effect from having a chronic condition many people don’t think about – depression, anxiety and even suicide," Lisa Gillespie reports for Louisville's WFPL. "This is especially true for older adults, who’ve lived their entire lives in places with little access to places to exercise, with diets high in fat and sugar and in a culture that still hasn’t given up tobacco."

Dennis and Gay Pond (WFPL photo)

Gillespie's example is Dennis Pond, 67, of Casey County. "He often feels useless, in large part because his diabetes has caused terrible pain and numbness in his feet, and that affects his ability to drive, to help out around the house, to even go out in the yard," she reports, quoting him: “The pain gets so bad that I actually feel like cutting my feet off or just taking care of myself, if you know what I mean Ending it.” But he doesn't tell his psychiatrist about such thoughts: “When they ask me those questions, I got to try to watch what I’m saying because if I don’t I’ll end up in the psychiatric unit,” he said. “I try to say no, but I have thoughts.”

"His dark thoughts are in part an outgrowth of the toll chronic conditions have taken on him. Every day, he takes blood thinners for blood clots in his lungs, pain medication for his bad back, insulin for his diabetes," Gillespie reports. "Then there’s the nerve damage from his diabetes – what he describes as thousands of needles piercing the bottoms of his feet when he walks."

Pond lives 30 miles from the nearest town and hospital, Gillespie reports, adding, "Rural residents often have a hard time accessing medical care for their chronic conditions and psychiatric care for the attendant mental health issues. That contributes to the increased risk of suicide in rural areas, which are already at higher risk because of a lagging economy and substance abuse. For example, "suicide rates in 2017 were 30 percent higher in Appalachia than in the rest of the country." Within the region, suicides were concentrated in Eastern Kentucky, West Virginia and East Tennessee, areas that struggle with high opioid-addiction rates and poverty.

Gina Piane, a professor at National University in San Diego, was one of the first researchers to link chronic disease and mental health. Giving rural youth more health and nutrition education is a key way to prevent such issues, she told Gillespie.

Psychologist John Fulton, who works in Casey County, said he tries to teach his patients coping skills and recommends that they develop a support system of friends and family if they don't already have one. "I try to say, you know, you’re sitting there focusing on the bad things, and all that’s going to do is drag you down deeper,” Fulton told Gillespie. "[I] try to get them to, you know, turn around and start thinking about, 'Well, I’ll go outside and look at dogs or I’ll watch wrestling on TV' — get their mind off the illness and how bad they feel."

"Fulton also recommends people try to develop a strong support system if they don’t already have one. That’s something Pond does have in his wife, Gay. They married in 2013 after he did work on her house," Gillespie writes. "And there might be hope for Dennis’ pain and diabetes. He’s likely going to get surgery that could increase blood flow in his feet, helping avoid an amputation."

Advocates worry Medicaid plan will cause the most vulnerable to be kicked off rolls, say 'medically frail' designation is inconsistent

By Melissa Patrick

Kentucky Health News

As Kentucky moves toward implementing a stricter Medicaid plan, a group of providers, consumers and health advocates say they worry that its penalties, work rules and "onerous reporting requirements" will cause people to lose their coverage, especially those in the state's most vulnerable populations.

The group participated in a Dec. 5 Insure Kentucky news conference. Insure Kentucky, led by Kentucky Voices for Health, is a coalition of nonprofits that promote policies to improve access to care for all Kentuckians.

The state calls its new Medicaid plan Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health." It is also referred to as the "waiver," since it is implemented through a waiver of normal Medicaid rules.

Among other things, the plan will require "able-bodied" beneficiaries to work, volunteer, participate in job training or go to drug treatment at least 80 hours a month, and then report the hours. Failure to report would result in loss of coverage, though it could be regained by taking a course in financial or health literacy.

The original version of the plan was vacated in late June just days before it was set to roll out. U.S. District Judge James Boasberg of Washington, D.C., ruled that, among other things, Health and Human Services Secretary Alex Azar had not fully considered the state's projection that in five years under the plan the state's Medicaid rolls would have 95,000 fewer people than without the plan.

Federal officials re-approved the plan Nov. 20. It is tentatively set to start April 1, with the work and community engagement requirements to be phased in regionally, but more legal action is expected.

Kentucky HEALTH has a long list of exemptions for "medically frail" people, including those who are chronically homeless, have a severe mental-health diagnosis or are victims of domestic violence. But advocates on the press call said the "medically frail" designation process has been inconsistent.

Krista Seymour, a freelance television producer, said that while she was able to work and had steady employment, her work schedule varies each month, often because a medication she takes for thyroid cancer makes her too sick to work. She said she must take the medicine for the rest of her life, or die.

Seymour said she has applied for medically frail status, but has been denied twice because the state says she's not frail enough to qualify. But Seymour says: "I cannot get anybody to actually give me a name or a criteria of what actually meets a medically frail designation."

Until Kentucky HEALTH is implemented, there is no official "medically frail" status.

Ramona Johnson, president and CEO of Bridgehaven Mental Health Services, said her organization has experienced similar difficulties in getting some of their members a "medically frail" designation.

“We’ve been advised on more than one occasion that anyone who is diagnosed with a severe and persistent mental illness will automatically be considered medically frail and therefore exempt from the work or community engagement requirements, but we really have not found this to be true with any consistency, and we’ve been submitting information on our members for several months," she said. "The managed-care organizations that we work with are receiving denials of medically frail status on some of our members, all of whom have a severe and persistent mental illness."

Johnson said her organization supports work programs for their members, but would like to see the requirements be based on a person's capacity to work, not a set number of hours. She said many of their members work in jobs that are tailored to their abilities, and they simply can't manage a 20-hour work week. In addition, she said the reporting requirements would be an issue for her members.

“For those of our members who can and do work, the 20 hours a week or the 80 hours a month expectation is really very arbitrary and quite unrealistic," she said. "When they lose Medicaid coverage as a result of this, then we have a group of very vulnerable people who are at risk of becoming symptomatic without treatment." She added that research shows that when this happens, people with severe mental illness often end up in the emergency room or jail, or homeless.

Andrea Miller of the Kentucky Coalition Against Domestic Violence voiced concern that victims of domestic abuse will have to self-report and identify as a victim to get a medically frail designation.

Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail that there is an appeals process for people who believe they are inappropriately denied a medically frail designation.

Hogan said there are three ways to be designated as medically frail: through an automated tool based on claims data; a provider's attestation for medical or mental-health conditions that don't have adequate claims data; or through self-attestation if the person is chronically homeless, a victim of domestic violence or if they have difficulty completing one of the "activities of daily living."

He added that providers have access to an online guidance for filling out the attestation forms, which  includes a long list of conditions that would qualify as medically frail.

"To be clear," he said, "Medicaid sets the state policy, and the MCOs [managed care organizations] administer according to policy, so that practices are consistent across the state."

The three organizations that filed suit against the waiver are expected to file an amendment to their case soon. Cara Stewart, an attorney with the Kentucky Equal Justice Center, one of the three organizations that filed the lawsuit on behalf of 16 Kentucky Medicaid recipients, said last week that they were working on amending their complaint, but first had to check with all of the plaintiffs since some of their circumstances had changed since the suit was filed.

Stewart is hopeful the plan can be blocked again. "It's hard to expect a different result with everything the same," she said.

Emily Beauregard, executive director of Kentucky Voices for Health, said "This waiver is nearly identical to the original plan with the same types of barriers and red tape, and completely ignores new evidence that reporting requirements only work to reduce coverage."

Beauregard was referring to the more than 12,000 people who have fallen off the Arkansas Medicaid rolls since the state implemented its work and reporting requirements, as well as a recent report that shows 10,000 Supplemental Nutrition Assistance Program (formerly food-stamp) recipients in Kentucky have lost this benefit since the state implemented similar work and reporting requirements.

2017 Kentucky law to allow mentally ill to be ordered into treatment under certain circumstances isn't being used

Faye Morton, left, joined other supporters of Tim's Law, named
for her son, to push for it in 2017. (Photo: John Cheves, Herald-Leader)

"Nobody is using a heralded 2017 state law that was intended to help hundreds of Kentuckians with serious mental illness break the perilous cycle of homelessness, jail and involuntary hospitalization," John Cheves of the Lexington Herald-Leader reports, based on interviews with court officials.

"Tim’s Law, which the legislature passed despite a veto by Gov. Matt Bevin, "created a petition process so that district court judges can order seriously mentally ill people, under certain specific conditions, into supervised outpatient treatment, including medication, counseling and enrollment in public assistance," Cheves notes. The law is named for Tim Morton, "a Lexington man who was hospitalized for psychiatric treatment dozens of times over 36 years, often involuntarily and in police handcuffs, because he did not recognize that he had schizophrenia."

So why hasn't the law been used? Cheves reports, "Part of the problem is a lack of public awareness, court officials said. But the legislature also failed to provide any money for more staff at community mental health agencies or courthouses, or — since respondents are entitled to a lawyer to represent them at hearings — public defender’s offices. All of these state-funded institutions already are struggling with their current caseloads. In fact, tucked into the nine-page law is a short note stating that it won’t take full effect until 'adequate funding' is made available." Also, "Some of the seriously mentally ill do not have responsible adults in their lives ready to intercede."

Read more here: https://www.kentucky.com/news/politics-government/article221640600.html#storylink=cpy

“It breaks my heart, it really does,” Faye Morton, Tim’s mother, told Cheves. “We’re very aware of the lack of interest in this.”

Jefferson District Judge Stephanie Pearce Burke told Cheves, “The petitions are going to have to be initiated by the hospitals — by Central State and Eastern State,” which need to identify people who are frequently admitted “and then get the process started for us before their patients are discharged from an involuntary stay so we can find a better way to handle this.”

Regional mental-health agencies could play a role, Cheves reports: "Bluegrass.org, a publicly funded nonprofit that provides mental health services in Lexington, is ready to receive Tim’s Law respondents for treatment, but funding “is very tight” already, said Don Rogers, chief clinical officer. Mountain Comprehensive Care Center, a sister agency in Eastern Kentucky, has a $500,000, four-year federal grant that could be tapped, if anyone in that area ever files a Tim’s Law petition, said project manager Martin Meade."

Read more here: https://www.kentucky.com/news/politics-government/article221640600.html#storylink=cpy

Celebrity suicides raise concern about 'contagion;' Ky. rate higher than most states; experts say we need to talk about it openly

Association For Suicide Prevention chart, based on data to 2016; click on it to view a larger version

"The suicides of fashion designer Kate Spade and celebrity chef Anthony Bourdain just days apart . . . have mental health professionals worried about the potential for what’s known as a 'contagion' effect, but at the same time they say media coverage may lead people to seek help," Marek Mazurek and Laney Ruckstuhl report for The Boston Globe.

“Anytime there’s a public figure, it affects a great many people,” Debbie Helms, co-chair of the Massachusetts Coalition for Suicide Prevention’s Northeast region, told the Globe. “Celebrities impact the whole country.” Calls to suicide-prevention centers rose after the two deaths.

Kentucky has a higher-than-average suicide rate, greater than five of the seven adjoining states (the exceptions being West Virginia and Missouri). The rate has increased in almost every state since 1999, to the point that suicide is the 10th leading cause of death in the U.S., with 123 per day, more than the number killed in automobile accidents, according to the federal Centers for Disease Control and Prevention. In Kentucky, suicide ranks 11th as a cause of death.

Kentucky's suicide hotspots are Marshall County, which had 49 from 2012 through 2016, and Grayson County, which had 35. Per 100,000 population, respectively, the counties' suicide rates were 29.2 and 26.2. The rate for the entire state was 16.79, 20th in the nation.

Suicides among teenagers are an increasing concern, especially in Kentucky. The number doubled between 2014 and 2016, from 19 to 44. The 2016 Kentucky Incentives for Prevention survey, given at participating Kentucky schools in even-numbered grades from 6 to 12, found that 15.4 percent of Kentucky high-school sophomores said they had "seriously considered" attempting suicide in the 12 months prior to the survey. The rates tended to be highest in Western Kentucky.

Young people have the greatest risk of being influenced by widely reported suicides, Boston psychiatrist Blaise Aguirre, who specializes in adolescents at risk of suicide, told the Globe. “When you have these young people already thinking about that and some of their idols are dying by suicide, it sort of — in their thinking — makes it more acceptable in a certain kind of way,” he said. “It seems like somewhere between 14 and 24, in that age range, they are particularly vulnerable.”

The "suicide contagion effect" seems to have been heightened by the rise of social media, Aguirre said: “For many years, if somebody famous died by suicide, you might read about it later in the newspaper, but young people weren’t necessarily in the habit of reading the papers. Now, there is the ability of this news to spread rapidly.”

Aguirre and other experts said that makes it all the more important to speak openly about suicide and reduce the stigma that often surrounds mental-health issues, "and making sure loved ones know they aren’t alone," the Globe reports. For warning signs of suicide, go to suicide.org.

In 1990-2016, Ky. had 4th highest increase in risk of death, 2nd biggest rise in death risk from mental or substance-use disorders

By Al Cross
Kentucky Health News

Life expectancy in Kentucky increased from 1990 to 2016, but by only 1.4 years, while it increased 4.4 years nationwide, so the state fell from 42nd to 46th in life expectancy, according to "the most extensive state-by-state U.S. health study ever conducted," as described by the Institute for Health Metrics and Evaluation at the University of Washington. The institute conducted the study and published it in the Journal of the American Medical Association.

The lagging life expectancy is driven largely by premature deaths, between age 20 and 55. From 1990 to 2016, the risk of premature death rose more than 10 percent in five states: West Virginia, Oklahoma, New Mexico, Kentucky and Wyoming. Kentucky rose from 12th to seventh in the estimated years of life lost from premature death; states ranking ahead of it, in ascending order, were Arkansas, Oklahoma, Louisiana, Alabama, West Virginia and Mississippi.

The study compared the risk of death from various factors. The risk of death from mental and substance-use disorders increased more in Kentucky from 1990 to 2016 than any state but West Virginia, another indicator of the depth of the opioid epidemic in Central Appalachia. Ranked by years of life lost from various causes, opioid use rose nationally from 22nd in 1990 to to 15th in 2016. The age-standardized U.S. death rate from opioids rose 343 percent, far more than any other factor.

In overall life expectancy, several states fell much farther in the rankings than Kentucky did. Kansas fell to 30th, from 12th; Idaho dropped to 23rd from eighth; Indiana went to 42nd from 27th; and South Dakota fell to 25th from 11th.

The greatest gains in rank were by California, which moved up to second from 24th; New York, which rose to fifth from 39th; New Jersey, which moved to eighth from 26th; and Maryland, which is now 21st after being ranked 38th.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Ky. nursing leaders call for a full-time nurse in every school to keep students safe and healthy, and therefore able to learn

Kentucky's nursing leaders are calling on state lawmakers to recognize the vital role school nurses can play "to support student learning in a safe and healthful environment," and are urging them to find "innovative funding" to put a nurse in every school.

"The school nurse is in a prime position to lead this effort but must be present in every school," lead author Kathy K. Hager,  president of the Kentucky Nurses Association, writes in an op-ed for the Lexington Herald-Leader. Only 54 percent of Kentucky's secondary schools have a full-time registered nurse, she notes.

Hager says that nationwide, an estimated 27 percent of students have a chronic health condition and 17 percent experience a mental-health issue each year. In addition, she notes that students are struggling with bulllying, drug-use and gun violence issues.

"In this climate of school violence, along with children’s increasing struggles with physical, behavioral and mental health challenges, much is being debated regarding strategies and resources to support student learning in a safe and healthful environment," Hager writes. She argues that a nurse in every school is the best way to address these needs.

Hager notes that daily access to a full-time nurse as part of the strategy to improve health and safety in schools is supported by the American Academy of Nursing and the American Academy of Pediatrics; the World Health Organization has also identified school health services as an important strategy toward this end.

A recent Academy of Nursing brief on this issue said, “School nurses deliver skilled health care to students, provide referrals to other providers, and assist families in gaining access to specialized care. Yet, despite these undisputed benefits, many schools do not have daily access to a full-time school nurse due to inadequate funding and lack of integration of school health services to the broader health-care system.”

Kentucky adults are overwhelmingly supportive of a law to require a nurse in every school, with 92 percent of them in the latest Kentucky Health Issues Poll saying they supported such a measure.

"We are fully aware of the current budget constraints in Kentucky; however, for the health and welfare of our Kentucky children, we must find innovative funding sources to place a nurse in every school as part of a comprehensive health and education system," she writes. "Contact your local school board and legislators and be the voice your children need. For the health, safety and welfare of our children, every Kentucky school needs a nurse and a comprehensive school health-care plan. Kentucky children are counting on you."

Patricia V. Burkhart, Carol Komara and Lois Davis, who represent the nurses association’s Kentucky School Nurse Committee, also contributed to the the op-ed.

Rural areas have many obstacles to mental health care, including lack of anonymity and fear of stigma

"Mental illnesses such as anxiety and depression are common among older adults in rural areas, affecting 10 to 25 percent of that population. But many of those people with them suffer in silence rather than seeking treatment," Emily Gurnon reports for Next Avenue as part of a special report for the John A. Hartford Foundation.

A study by researchers at the Wake Forest School of Medicine shed some light on why rural seniors often forego treatment. They questioned 478 adults aged 60 or older in rural North Carolina, and found that the most common answer was "I should not need help." Other frequently cited reasons were not knowing where to go, distance to access treatment, mistrust of counselors or therapists, not wanting to talk about private matters with a stranger, and fear of stigma.

The relative lack of anonymity in rural areas and small towns could contribute to a rural senior's refusal to seek treatment for mental health issues. Dennis Mohatt, vice president of the behavioral mental health program at the Western Interstate Commission for Higher Education and director of its Center for Rural Mental Health Research, told Gurnon, "Your neighbors don’t have a clue in a city if you’re going to go get some help. But everybody [in a small town] will know if your pickup truck is parked outside of the mental health provider’s office."

Some seniors may believe that seeking help for mental illness may signal to others that they are weak or unable to be self-reliant. A study of rural veterans, half of whom were seniors, found this to be a potent barrier to seeking mental health treatment. The veterans rated independence and self-reliance very highly, and cited an emphasis on stoicism and concern about stigma as reasons that would make them less likely to seek help.