Bipartisan 'momnibus' bill aims to improve health of mothers, kids

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, spoke with other female legislators at a press conference Wednesday to announce their "Momnibus" bill. (Legislative photo)

Kentucky Health News

Legislators are accustomed to seeing "omnibus" bills that deal with many subjects, sometimes related, sometimes not. Now the Kentucky General Assembly has a "momnibus" bill intended to improve the health of children and mothers, including expectant ones.

House Bill 10 was developed by an informal, bipartisan group of female legislators concerned about the state's poor maternal health, said its main sponsor, Rep. Kim Moser, R-Taylor Mill.

"Addressing Kentucky's high maternal mortality rate and saving mothers and babies is obviously a priority for all of us," Moser said at a Wednesday press conference. Kentucky had the nation's sixth highest maternal death rate, 38.4 deaths per 100,000 live births, from 2018 through 2021. The national rate for that period was 23.5 per 100,000.

More than 90% of the state’s maternal deaths are preventable, Dr. Jeffrey M. Goldberg, legislative advocacy chair of the Kentucky chapter of the American College of Obstetricians and Gynecologists, told a state Senate committee last year. Just over 14 percent of Kentuckians lack access to adequate prenatal care, according to the March of Dimes.

Moser, a mother of five who was a neonatal intensive-care nurse, spoke from her own experiences: “I’ve really worked with mothers and babies and sick newborns, in their newborn phase, oftentimes through their first year, and I was able to really see some of the reasons for poor health disparities, especially in our poor areas of our state.”

Citing the advocacy group Every Mother Counts, Moser said “The leading causes of maternal death in the U.S. [are] lack of access to health care, including a shortage of caregivers, a lack of insurance, inadequate postpartum supports and certainly socioeconomic disparities, including the stress of racism and discrimination.” In Kentucky, she added, the risks are greater because of the prevalence of heart disease and diabetes.

HB 10 would:

• Add pregnancy to the list of "qualifying life events" that allow people to get health-insurance coverage outside normal enrolment, which could encourage more prenatal care.
• Create the Lifeline for Moms Psychiatry Access Program, for which Kentucky has received a $750,000 grant. Moser said she will also ask for an appropriation in the state budget “to make sure that’s a sustainable program.” It would be required to operate a hotline from 8 a.m. to 5 p.m. Mondays through Fridays.
• Expand the HANDS (Health Access Nurturing Development Services) home-visitation program for new and expectant parents to include breastfeeding counseling and assistance, education on safe sleep, as well as expanding the program to include telehealth, which Moser said she believes will help “reach moms in underserved areas or areas where she may have a transportation issue.”
• Require the Cabinet for Health and Family Services to study and make recommendations about the role of doulas, who provide assistance with the birth experience. 
• Strengthen an advisory council that provides policy guidance to increase collaboration, improve data collection, and suggest additional improvements.

Some Kentucky Republican legislators began paying more attention to such issues after the U.S. Supreme Court eliminated the federal right to abortion, activating a state "trigger law" that bans abortion except to save the mother's life or prevent permnent damage to a life-sustaining organ. 

"The wide gulf between abortion-rights and anti-abortion lawmakers was felt when Moser invited Addia Wuchner, executive director of the Kentucky Right to Life Association, to speak at the end of the press conference," reports Rebecca Grapevine of the Courier Journal. "That prompted most of the assembled Democratic lawmakers . . . to quietly walk out of the room."

State Rep. Sarah Stalker

One Democrat who remained, Rep. Sarah Stalker of Louisville, told the Courier Journal, "If we're going to force people to have children when they are not prepared to, when they are not ready to, when they are not interested in the family, it is critical that we give them the access to the health insurance . . . It doesn't help me and it doesn't help Kentucky, you know, Kentuckians at large and particularly women, to dig in my heels."

The second listed sponsor of the bill is Rep. Nancy Tate, R-Brandenburg, a leading anti-abortion legislator. Other Republican sponsors are Reps. Danny Bentkey of Russell, Emily Callaway of Louisville, Stephanie Dietz of Edgewood, Robert Duvall of Bowling Green, Ken Fleming of Louisville, Mark Hart of Falmouth, Kiom KIng of Harrodsburg, Amy Neighbors of Edmonton, Rebecca Raymer of Morgantown, Tom Smith of Corbin, Nick Wilson of Williamsburg and Susan Witten of Louisville.

Besides Stalker, the bill's Democratic sponsors are Reps. Lindsey Burke and Cherlynn Stevenson of Lexington. Democratic Reps. Lisa Willner of Louisivlle and Rachel Roberts of Newport initially attended the press conference but left and are not listed as sponsors.

Information for this story was also provided by the Kentucky Lantern.

Pandemic stress caused premature aging in teenagers' brains; long-term effect uncertain, but some parents say impact will last

Shutterstock photo

American teenagers' brains prematurely aged by three years during the pandemic due to the stress of lockdowns, a study has found.

The researchers found changes similar to those seen in "children who have faced chronic stress and adversity," reports Katherine Reynolds Lewis of The Washington Post.

"The study, published Thursday in Biological Psychiatry: Global Open Science, was the first to compare scans of the physical structures of teenagers’ brains from before and after the pandemic started, and to document significant differences, said Ian Gotlib, lead author on the paper and a psychology professor at Stanford University."

Axios, citing Gotlib, reports, "Accelerated aging of the brain itself is not necessarily a bad thing," and quotes him: "These are 16-, 18-year-olds. They're not atrophying in the alarmist sense. For me, the cause for concern is their higher rates of depression and anxiety and sadness … it makes it even more important that we address that."

Gotlib had pre-pandemic images because he and his colleagues started the work eight years ago, with the goal of "better understanding gender differences in depression rates among adolescents," Lewis reports. "The researchers recruited 220 children ages 9 to 13, with a plan to take MRI scans of their brains every two years."

Then the pandemic hit, interrupting the third set of scans, but presenting an opportunity. Gotlib said they knew teens had higher “levels of depression, anxiety and fearfulness” than “before the pandemic. But we knew nothing about the effects on their brains. We thought there might be effects similar to what you would find with early adversity; we just didn’t realize how strong they’d be.”

The researchers "compared MRI scans of a group of 128 children, half taken before and half at the end of the first year of the pandemic, the researchers found growth in the hippocampus and amygdala, brain areas that respectively control access to some memories and help regulate fear, stress and other emotions," Lewis reports. "They also found thinning of the tissues in the cortex, which is involved in executive functioning. These changes happen during normal adolescent development; however, the pandemic appeared to have accelerated the process, Gotlib said."

Premature aging of children’s brains can make them more vulnerable as adults "to depression, anxiety, addiction and other mental illnesses, they can raise the risk of cancer, diabetes, heart disease and other long-term negative outcomes," Lewis notes. "Prior research has found dramatically higher levels of anxiety, depression, suicidality and other mental illnesses in adolescents since the onset of the pandemic."

Gotlib said, “The takeaway for me is that there are serious issues with mental health and kids around the pandemic Just because the shutdown ended doesn’t mean we’re fine.”

Jason Chein, professor of psychology and neuroscience and the director of the Temple University Brain Research & Imaging Center, said the study is important but he "cautioned against making broad interpretations based on the changes the researchers observed," Lewis reports. "brain regions can show nonlinear patterns of growth, so simply seeing a thinner cortex or larger amygdala volume doesn’t necessarily indicate an older brain, he said."

But there are anecdotal examples. "Stacy Gittleman, 54, of West Bloomfield, Mich., saw the pandemic derail one of her children," Lewis writes. "An aspiring musical theater actor, he was a junior in high school when school and theater shut down." Gittleman said, “So much of how my son thrives depends on moving, acting, doing hands-on work and interacting with others. He spent much of his time in bed, which was very painful as parents to watch, as my son before the pandemic was so lively and social.”

While "managing his mental health will be a lifelong task, she said," her son's older siblings, now 24 and 26, weren't as affected by the pandemic. “In the long term, the adversity thrown at the feet of our teenagers I believe will make them stronger and more resilient,” she said.

"Other parents aren’t so sure," Lewis writes, quoting Meg Martin, 55, of Gaithersburg, Md., whose son intended to apply to a four-year residential college, but now feels unmotivated and disengaged from school after years of online and hybrid learning: “I really think the way his high-school years unfolded are going to have ripple effects for years to come.”

Madisonville girl provides example of emerging teletherapy that can help overcome shortage of psychiatrists in rural areas

When Ron Gadley searched for a therapist who could help his daughter, Rebecca, with depression near their Madisonville home, he found that their options were shockingly limited.

The few child psychiatrists within driving distance told him that Rebecca would be waiting months for an appointment, and another refused to accept new patients at all, Emma Ockerman reports for Time magazine.

Gadley finally found someone who could see his daughter every week. Even better, the treatment could begin immediately. There was a catch, though: Rebecca and her therapist would be 250 miles apart. She would be able to hear and see her therapist like normal, but her "telehealth" appointments, therapy sessions conducted by video conference, meant that Rebecca might never see her therapist face to face.

Cincinnati Children's Hospital Medical Center
(Photo from theodysseyonline.com)

Gadley, a machinist for Warrior Coal, told Ockerman he had never heard of teletherapy before his daughter’s depression diagnosis. After struggling to find local treatment for her, he learned that his company’s relationship with Cincinnati Children’s Hospital Medical Center meant Rebecca could receive treatment for free.

Mental health advocates hope that teletherapy can ease some of the burden on psychiatrists, especially in rural areas like Rebecca's, which often lack such professionals. A shortage of child psychiatrists is of particular concern. Mental health advocates say the U.S. needs more than 30,000 child and adolescent psychiatrists, but has only 8,300. Advocates and therapists alike have been struggling for years for an answer to the complicated problem.

The American Telemedicine Association reported earlier this year that the number of states requiring private insurers to cover telemedicine in the same way they cover in-person services had doubled in the past four years. Kentucky law requires Medicaid and private insurance to cover "tele-mental health encounters," including appointments with licensed social workers.

As technology has become cheaper and more reliable, teletherapy has emerged as a practical approach to reaching more patients, Ockerman adds. However, teletherapy has its critics, who question whether computer-assisted appointments like Rebecca's are as effective as traditional sessions carried out in person.

A 2013 study in the American Journal of Psychiatry cautioned that video conferencing could affect the natural conversation and bedside manner that would normally occur between mental health provider and patient. The appointment might initially feel impersonal; the therapist might have to make up for that with small talk to encourage “feelings of connectedness in a clinical encounter,” Dr. Jay H. Shore, a Denver psychiatrist and author of the study, writes.

But when it comes to children, they are used to interacting with technology, Dr. Michael Sorter, director of child and adolescent psychiatry at Cincinnati Children’s, told Ockerman. Computers and smartphones are where they maintain relationships with friends. Because of that, Sorter says, it might not be so unusual for them to see a doctor the same way. “They seem like they can easily relate to the TV screen.”

Others take a middle ground, seeing teletherapy as just one promising part of what must be a broader, more comprehensive solution to the shortage of behavioral health care in rural areas.

"It is part of an evolving landscape that has to change to get kids the services they need, and this is one very good part of that,” Dr. Kathleen Myers, program director for telepsychiatry and behavioral health at Seattle Children’s Hospital, told Ockerman. “But if you take a child psychiatrist here and have them practice [telehealth], all you’ve done is redistribute the manpower. We really need more than that.”

For Rebecca's part, she says teletherapy has helped her in her battle against depression. "It helped me put a jumbled-up mess into perspective," she told Ockerman. "The therapy put everything everywhere I needed it to be in my life. I’m getting active, I talk to more people, I’m making more friends."

Doctor speaks up about battle with depression, leading cause of disability for people 15-44; only 20% with symptoms are treated

By Danielle Ray
Kentucky Health News

Pitman (Paducah Sun photo)

Dr. Jay Pitman knows what it's like to feel isolated. Pitman spoke out about his battle with depression in a recent essay in The Paducah Sun.

"I'm writing a piece about my depression, about things people don't like to talk about," he told Steve Wilson, editor of the newspaper. "I'm thinking it might help some people." Wilson wrote in his column about Pitman, whose essay was published a week earlier, along with a story about him.

Pitman's depression deepened after he was the victim of a near-fatal hit-and-run accident in 2013. He was found lying unconscious in a pool of blood. He had suffered a concussion, brain hemorrhage and a broken shoulder. His physical recovery was remarkable. In fact, he recovered well enough to compete in a triathlon the next year. But he has had a much longer road to emotional healing.

Pitman is not alone in his struggle. The Anxiety and Depression Association of America estimates that about 18 million Americans suffer from depression, and notes that depression is the leading cause of disability in people aged 15 to 44. The organization distinguishes two categories of depression: major depression and persistent depressive disorder, which is characterized by symptoms that last at least two years.

Pitman's essay garnered a lot of support, but he's more concerned with opening up an honest dialogue about the issue.

"My hope is that those coping with depression will seek help and talk openly about their disease without feeling ashamed or embarrassed," he told Wilson. "I've lost several friends to suicide."

Despite its prevalence, only about 20 percent of people with depression symptoms seek professional help, according to the online health network Healthline.

Tiffany Bryant, a Lexington counselor who specializes in treating depression, said many people don't seek help or speak out about depression because of a lingering stigma surrounding mental illness. She believes popular culture has created an environment that discourages people from representing themselves honestly, flaws and struggles and all.

"I think you can blame, to a certain extent, social media, because everybody wants to show their very best," she said. "A lot of people have this mask that they wear for other people, and they never really take it off."

Even with a fairly low rate of patients seeking treatment, Healthline estimates that the number of patients diagnosed with depression increases by about 20 percent each year.

The federal Centers for Disease Control and Prevention recommends early treatment. If not effectively treated, depression can become a chronic disease. Experiencing just one episode of depression places a person at a 50 percent risk for experiencing another episode in the future, according to the CDC.

While it can affect anyone at any time, women typically experience higher rates of depression than men. The CDC also noted that nearly 10 percent of people in their 40s and 50s report current depression. The good news is that 60 to 80 percent of all depression cases can be treated with either psychotherapy ("talk therapy"), antidepressant medication or a combination of both, says Healthline.

The American Psychiatric Association defines depression as a condition with any five of these seven symptoms for a continuous period of at least two weeks:

• sadness;
• loss of interest in activities that used to be enjoyable;
• change in weight or appetite, change in activity level;
• sleeping too much or too little;
• loss of energy;
• feelings of guilt or worthlessness;
• difficulty concentrating or having thoughts of death or suicide.

Depression has a variety of causes, including genetic, environmental, psychological, and biochemical factors. The CDC notes that everyone gets "down in the dumps" at times, but it becomes pathological when symptoms are persistent and interrupt daily life. To learn more about it, from the National Institute of Mental Health, click here.

Pineville Community Hospital restructures debt and creates a geriatric psychiatric unit; 326 jobs saved and 12 new ones created

A combination of local, state and federal efforts have saved more than 300 Pineville Community Hospital jobs and created 12 new ones, according to a Kentucky Highlands Investment Corp. news release.

KHIC worked with First State Financial and the hospital to restructure the hospital's existing debt into a $3.1 million Business and Industry Guaranteed Loan from the U.S. Department of Agriculture, which allowed the bank to provide private working capital through a $3 million line of credit from First State, according to the release.

“The $3.1 million USDA loan guarantee is important to the Pineville community in many ways: It provides residents access to quality health care, supports the employment of 326 employees and allowed for the creation of 12 additional jobs,” Tom Fern, Kentucky director for USDA Rural Development, said in the release. “In a time when the region has seen a significant loss of employment, these existing and new jobs being created by Pineville Community Hospital are critical.”

In addition to restructuring its existing debt, the hospital used some of the funds to convert an unused labor-and-deliver wing into a 12-bed geriatric psychiatric unit and used other funds for repairs.

“Research showed this type of service was not being offered within 30-mile radius, which affects more than 38,000 residents," hospital CEO Stace Holland said in the release.

U.S. Rep. Hal Rogers said in the release. “I commend the board of directors for not only diligently working to protect the jobs at this facility, but for having the vision to expand health care in an area under-served for mental-health concerns.”

Free lecture Tuesday, Jan. 12, in Louisville to discuss differences between forgetfulness and Alzheimer's; with time for Q&A

A behavioral health expert will sponsor a free lecture and question and answer session in Louisville Jan. 12 to explain the difference between the temporary forgetfulness that comes with aging and symptoms of age-related memory disorders, like Alzheimer's.

The event, "Memory, Aging and Alzheimer's Q&A," will begin at 7 p.m., Tuesday, Jan. 12, in Room 251 of Second Presbyterian Church, 3701 Old Brownsboro Rd. It is sponsored by the University of Louisville Depression Center, and will be led by Dr. Ben Schoenbachler, associate professor in the U of L Department of Psychiatry and Behavioral Sciences.

A 2015 study found that more than 75 percent of people can’t distinguish between signs of Alzheimer’s and the usual forgetfulness that comes with aging, according to the release. Schoenbachler’s presentation is meant to help participants learn more about those differences.

Alzheimers Association graphic

According to the Alzheimer's Association, there are over 68,000 Kentuckians with Alzheimer's disease; this number is expected to increase to 86,000 by 2025.

For more information, contact the Depression Center at 502-588-4450.

New outpatient psychiatric clinic in Louisville will accepts most insurance, including some Medicaid, which is not the norm

A new mental health clinic is opening in Louisville that will accept most forms of health insurance, including some Medicaid patients, which most smaller, outpatient psychiatric providers don't accept, Joe Sonka reports for Insider Louisville.

Ren Scheuerman, a psychiatric nurse practitioner and Louisville native who worked with PsychBC in Cleveland, is moving back to open up a PsychBC clinic at 10200 Forest Green Blvd. in the Hurstbourne area. He told Sonka that most smaller outpatient psychiatric providers operate on a cash-only basis.

“It’s going to be great for the patients in Louisville, because most people have mental-health coverage on their health insurance,” Scheuerman told Sonka. “We now technically have parity in mental health, but because so many providers don’t take insurance, it really creates a financial hardship for a lot of patients. Twenty-dollar co-pays are affordable, but going every month or two weeks for $150 is just not affordable for most people … and most primary-care providers don’t do psychotropics anymore, just because of legal liability.”

Alex D’Auria, PsychBC’s community relations director in Cleveland, told Sonka that the Louisville clinic will accept a wide variety of private insurers, in addition to Medicaid managed care organizations CareSource and CoventryCares.

Sonka spoke to experts who said smaller psychiatric clinics and private-practice psychiatrists don't accept insurance because they don't have the staff to manage all of the "red tape on claims" required by insurance companies and their managed-care subsidiaries, and because "reimbursement rates are too low." He also found that private psychiatrists "are not taking the really difficult cases either."

Dave Langdon, spokesman for the Louisville Metro Department of Public Health and Wellness, told Sonka that this lack of private providers is especially noteworthy for the considerable number of individuals who gained coverage through the expansion of Medicaid under the Affordable Care Act.

The “ACA aims to give parity between medical health and behavioral health services, but there are few psychiatrists or psychologists who take Medicaid,” Langdon told Sonka.

Psychiatric patients' demand for emergency-room care presents a problem the Affordable Care Act won't solve

Psychiatric patients' demand for emergency-room care has been a concern in hospitals, and it's going to get worse. Even though ERs are not properly equipped to help psychiatric patients, people still often go there with psychiatric concerns. Most ERs simply lack room to deal with such situations. According to a survey, 84 percent of emergency physicians say they have psychiatric patients "boarded" in their emergency departments awaiting transfer to a mental-health facility, Adrianna McIntyre writes for Vox.

"People having a mental-health crisis seek care in emergency departments because other parts of the health care system have failed them," said Alex Rosenau, president of the American College of Emergency Physicians.

A psychiatric patient who shows up to the emergency room may require immediate care at the hospital, and sometimes there isn't an open bed in the right department. Those shortages often necessitate psychiatric patients to wait in the emergency room, or board, until space elsewhere opens for them. Both the closure of psychiatric facilities and diminished state funding have contributed to the issue. "Between 1955 and 1997, total state spending on mental health fell 30 percent, a period during which most health spending grew rapidly," McIntyre writes.

If hospitals don't figure out how to deal with the problem, it's going to get worse. In fact, experts say the implementation of the Patient Protection and Affordable Care Act will only exacerbate the problem. Some studies reveal that insured patients are more inclined to go to the emergency room—even for non-urgent issues—because the cost usually isn't as high. Lower-income people are even more likely to do that, and this population will comprise many of the newly insured citizens.

Though hospitals want people to use the health system properly, they also want to make sure patients do visit the ER when it really is necessary. "We don't want to impose any barriers on people going to the emergency room," said Hans House, a clinical professor at the Iowa University Carver College of Medicine. "We don't want people to be afraid to go to the ER."

The Affordable Care Act has provided more funding for reimbursement of emergency psychiatric care in Medicaid, a service the public program doesn't generally cover. However, this doesn't address the lack of space in emergency departments. "We know that a lack of psychiatrists available and staffing patient beds is a barrier," House said. "That's a personnel issue." (Read more)

18 Kentucky hospitals cited as 'top performers' on accreditation board's annual list

Eighteen Kentucky hospitals have been included on the annual list of hospitals that have excelled at adhering to basic procedures for surgery and other treatment of common illnesses such as heart attacks, heart failure and pneumonia. The Joint Commission, the nation’s major hospital accreditation board, has released this year's list of 620 hospitals considered to be “top performers” for following recommended protocols at least 95 percent of the time. The top 18 percent of accredited hospitals make the list.

Among the Kentucky hospitals that qualified on all four measurements were Greenview Hospital in Bowling Green, Ephraim McDowell Regional Medical Center in Danville, St. Elizabeth Medical Center in both Florence and Fort Thomas, Central Baptist Hospital in Lexington.

Those qualifying in three categories were the Robley Rex Veterans Affairs Medical Center in Louisville (not in surgery) and the Appalachian Regional Hospitals in Harlan and Middlesboro (not in heart attack).

Qualifying in two categories were Twin Lakes Regional Medical Center in Leitchfield, Frankfort Regional Medical Center, the Hospital of Louisa and Jackson Hospital Corp., all for pneumonia and surgical care.

Recognized for pneumonia care were Parkway Regional Hospital in Fulton, Paul B. Hall Regional Medical Center in Paintsville, Logan Memorial Hospital in Russellville and the KentuckyOne Health Hospital in Martin.

Among behavioral-health hospitals, ranked on their in-patient psychiatric care, the Kentucky facilities on the list were the Universal Health Services facility in Bowling Green, the new Cumberland Hall Hospital in Hopkinsville.

According to Kaiser Health News, the Leapfrog Group, a nonprofit organization devoted to patient safety, aided in the rankings process, as did Consumer Reports. The Commission has its own metrics. It's worth noting that next month, Medicare will start using hospital quality rankings on its Hospital Compare website to set reimbursements. (Read more)

Searching for a fundamental 'particle' of mental health

The discovery of the Higgs particle, which gives matter its mass, was a huge breakthrough for scientists since "confirming its existence was imperative to a full scientific understanding of the world," and its has an equivalent that has yet to be found when it comes to mental health, forensic psychiatrist Erik Roskes writes for The Crime Report.

The equivalent of the "Standard Model" of mental health — Higgs plays an essential part in the "Standard Model" of physics — is a world in which "people are not penalized for their illnesses but rather than an array of tools from which to choose and which they can use to become mentally healthy," Roskes writes.

Though those tools have not yet been identified, there are paths down which researchers are going to find them, including molecular and pharmaceutical research; psychotherapies and rehabilitation. Research has led to pharmaceutical approaches, "not perfect, but far preferable to a world without them," he writes. It has led to cognitive therapy to treat depression, anxiety and, in some cases, psychosis. It has also led to advances in rehabilitation of mental illnesses and developmental disabilities like autism.

Like the search for the Higgs particle, finding its equivalent in the world of mental health is worth the search, Roskes concludes. (Read more)