By Varun Choudhary and Greg Dicharry

The impacts of suicide on population subsets

Suicide is a leading cause of death in the US.[1] It has become the hidden epidemic in our society that is spreading with the COVID-19 pandemic. Statistics show certain populations are more vulnerable than others. While a recent study shows that 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%), Hispanic people (19%), Black people (15%), unpaid caregivers for adults (31%) and essential workers (22%).[2]

Medical professionals have historically been at higher risk for suicide than those in most other professions.[3] Over 400 physicians a year commit suicide, yet the cause for such tragedy is not addressed.[4] A recent example was the suicide of Dr. Lorna Breen, the 49-year-old medical director of an emergency department in New York, who felt like she was drowning amid trying to save lives during the COVID pandemic. She had no history of mental illness and was considered an exemplary physician before succumbing to trauma of witnessing so much death.

Suicide has also been a silent killer within our military for several years, as troops dealing with trauma are unable to get the care they need. This was the case with the recent suicide of 34-year-old Master Sergeant Andrew Christian Marckesano, who had served six full tours in Afghanistan and was nicknamed the real “Captain America.” We must take a proactive approach to suicide prevention so we can help these heroes before they become tragic statistics.

Magellan’s approach to suicide prevention

Magellan is a national leader in suicide prevention and is addressing this health crisis that is devastating so many individuals, families and communities. We believe the first and foremost action that must be taken is to destigmatize the need to ask for help. There is still an ingrained culture in medicine and the military, as examples, that it is a weakness to address mental health needs. We need to build a culture of acceptance and promote the concept that reaching out is a strength, not a weakness. Changing this paradigm will take the effort of many mental health agencies and organizations.

Magellan is here to lead the initiative and use our expertise to bring awareness and training through a preventive model that pushes a zero-suicide approach. We were very successful in launching this campaign in Maricopa County, Arizona, and received international recognition for its effectiveness in reducing suicide. We are working with other organizations to promote this approach, so communities are aware of the signs and warnings of potential suicide, know how to engage suicidal individuals and are able to address the acute mental health needs of these individuals before they escalate.

In recent years, we have had the privilege of hosting a series of suicide prevention summits in Pennsylvania, Florida and Idaho. These events have brought together over 1,000 local and national leaders to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. In addition to this work, Magellan regularly supports local suicide prevention efforts in communities we serve, including sponsoring and participating in annual American Foundation for Suicide Prevention (AFSP) Out of the Darkness Walks around the country.

The Hope Rising for Suicide Prevention virtual summit, September 26, 2020

Most recently, we have established an internal suicide prevention innovations team to develop and implement a plan to enhance our suicide prevention efforts to create more awareness, training opportunities and support for our employees, members, providers, customers and the communities we serve.

Magellan is officially launching the initiative this month for National Suicide Prevention Awareness Month with the Hope Rising for Suicide Prevention virtual summit. This event is being planned and hosted in partnership with the nation’s leading suicide prevention organizations, including the National Suicide Prevention Lifeline, LivingWorks, American Association of Suicidology, Zero Suicide Institute, and numerous other national and international suicide prevention and mental wellness experts, lived experience advocates and people new to suicide prevention to share inspiration, information, wellness techniques and best practices.

This uplifting virtual event will empower attendees with the motivation, skills and resources needed to positively impact suicide prevention efforts in their communities.

Hope Rising for Suicide Prevention is just the beginning, as Magellan continues to create and support impactful suicide prevention initiatives that will help people find the hope and help they need to stay alive and thrive.

For more information about this and other Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.cdc.gov/vitalsigns/suicide/

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.

[3] https://www.healthline.com/health/mental-health/healthcare-workers-suicide-covid-19#3

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526882/

There are an estimated 1.2 million people in the US living with HIV, and roughly 1 in 8 people are undiagnosed. The virus attacks your body’s immune system and weakens its ability to fight infections. When HIV is untreated, it can lead to acquired immunodeficiency syndrome (AIDS), and the body becomes even more at risk for opportunistic infections.

While antiretroviral therapy has been available to treat HIV-positive patients for some time now, certain antiretroviral medications are also FDA-approved to be taken daily to prevent the risk of becoming infected with HIV. This treatment, known as pre-exposure prophylaxis (PrEP), is intended for people who do not currently have HIV but are at risk for contracting HIV. Overall, PrEP has shown to reduce the risk of contracting HIV through sexual contact and injecting drugs by 99% and 74%.

The main goal of any PrEP treatment is to prevent the transmission of HIV to an uninfected person. There are multiple treatments available to help reduce the risk. Regardless of which medication a patient takes, these medications must be taken consistently every day as prescribed. It is also crucial to not skip or miss doses. Possible side effects from PrEP medications primarily include nausea, but in general, these medications are well-tolerated. Despite this, it is still important to tell a healthcare provider about any side effects experienced.

Advances in antiretroviral treatments have made it possible for patients to live healthy, vibrant lives. That said, patient management programs are very valuable to patients whose ability to take their medications as prescribed has direct impact on the long-term success of their treatment.

Stress and anxiety caused by the coronavirus pandemic pose a serious challenge for all age groups. A survey published by the American Psychiatric Association in March 2020 showed that more than one-third of Americans (36%) feel that the coronavirus pandemic is having a serious impact on their mental health. Most Americans (59%) report serious impacts on their daily lives.¹ Calls to crisis hotlines have increased exponentially. In recent studies, adults aged 18 to 44 report emotional and mental health problems associated with the pandemic.

Given that mental-health problems among young adults were on the rise even before the pandemic began, some experts believe that the country is on the verge of a mental-health crisis. Worse, quarantine and closures of medical practices have, in many cases, made access to personal treatment difficult or impossible. Fortunately, state and federal regulations have enabled the expansion of telemedicine services, including treatment for mental illness. Virtual therapies may well be the answer to the needs of millions of people in the mental-health field.

Proven efficacy

Research shows that online treatments can have positive results for a range of mental health problems, including depression, panic disorders, PTSD, eating disorders, anxiety disorders and substance use disorders. Telephone and video-based psychological care and evidence-based treatments such as online cognitive behavioral therapy (CBT) have proven to be as effective as face-to-face therapy.²

The benefits for patients go beyond making treatment more accessible. Virtual therapy offers convenient modalities including live chats, text messaging, video and telephone sessions. Appointments are easy to schedule at convenient times. Virtual therapy is an attractive alternative for people with transportation problems or time constraints. People who are worried about being seen in a therapist’s practice, and those who are reluctant to use traditional mental health services may benefit from increased privacy. In many cases, virtual therapy sessions are more affordable than face-to-face sessions.

Best practices

It is important that therapists have the clinical expertise, licenses and qualifications to virtually treat patients. Reliable technology and secure platforms to ensure customer confidentiality are also crucial. Virtual therapy can solve many mental health problems. However, it is not suitable for patients who are suicidal, psychotic, severely mentally ill or have other illnesses that call for in-person care.

Due to the pandemic, health care is developing rapidly. Magellan Healthcare recognizes the need for additional telemedicine options and is now offering BetterHelp, the world’s largest online counseling service, to help Employee Assistance Program members access convenient therapy options quickly and easily. Click here to learn more about how Magellan is helping our members their mental health, emotional well-being and quality of life.

[1] Psychiatry.org. 2020. New Poll: COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially For Loved Ones; Older Adults Are Less Anxious. [online] Available at: <https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious> [Accessed 13 July 2020].

2 Gratzer, D. and Khalid-Khan, F., 2020. Internet-Delivered Cognitive Behavioural Therapy In The Treatment Of Psychiatric Illness

Telehealth services have been available for years to help remove geographical and other boundaries for people in rural and medically under-served areas; however, use has been limited. Driven by the COVID-19 pandemic, including shelter-in-place orders, social distancing, and federal agencies mandating use for certain programs, telehealth has grown exponentially since March.

While companies like Teladoc and MD Live have been operating telehealth platforms for nearly two decades, many platforms are dedicated only to physical health. Magellan Healthcare has maintained a telehealth network for behavioral health since 2014 and helps:

• Health plans offer a cost-effective alternative to traditional doctor visits, urgent care and the emergency room; provide access to valuable care that is convenient and available anytime and anywhere; expand existing programs and services focused on health and wellness; and attract new members by offering the modern convenience of an on-demand service.
• Employers improve employee access to healthcare; reduce tardiness and absenteeism; increase employee productivity; offer a competitive benefits package; improve employee satisfaction; and retain and attract the best employees.
• Members have more privacy; access a deep and specialized network; receive treatment before work, after work or on weekends; have more frequent touch points to improve compliance with treatment and avoid unnecessary hospitalizations; and avoid travel, lost time from work and weeks of waiting for an appointment.
• Providers reach out to members in remote areas or where specialties are needed; provide care to homebound members; provide behavioral health services from home, office or while traveling; reduce no-shows and cancellations; offer additional and/or non-standard appointment times; and expand the patient base and improve relationships with existing patients.

Although the benefits of telehealth are many, people may feel uncomfortable using services. That’s why Magellan Healthcare created a video called Telehealth: Get Care and Treatment Wherever You Are. This video can help people understand:

• How to schedule a telehealth visit
• What to do once a telehealth visit is scheduled
• How to get the most from telehealth

The more comfortable people are using telehealth for their behavioral healthcare, the more options they have available to them. This can lead to improved compliance and better health outcomes.

Watch the video here.

In light of recent events, Yagnesh Vadgama, BCBA, vice president, clinical care services, autism, Magellan Health, shared his perspective about how COVID-19 and racial and ethnic disparities may be combining to delay diagnosis and important early treatment for autism spectrum disorder in children.

 Magellan Health Insights: Yagnesh, thank you for chatting with us today. In the past there have been marked differences in the rates in which Black and Hispanic children are diagnosed with autism spectrum disorder (ASD). Why was that?

 Yagnesh Vadgama: For years, there was a disparity in the rates of ASD diagnosis of Black children versus White children – as recently as 2014 White children were 1.1 times more likely to be diagnosed with ASD by age 8. And in the 1990s, Black children were identified as having ASD later and were more likely to be diagnosed with conduct disorder or adjustment disorder than were White children. For the first time, the CDC has reported that this gap has closed as of 2016 for Black children, which is encouraging news, but was not the case in every state studied.

And, a gap still exists for Hispanic children. White and Black children were 1.2 times more likely to be identified with ASD than Hispanic children. Reasons for this difference include lack of access to healthcare services, differences in Medicaid vs. commercial insurance coverage of ASD services, parents and children speaking a primary language other than English, and potentially fear of seeking out care because of one’s immigration status. It’s still the case that Hispanic and Black children receive evaluations at a later age than White children. Often, children with Medicaid don’t get diagnosed until they begin attending school.

Magellan Health Insights: Why does age of evaluation and diagnosis matter?

 Yagnesh Vadgama: With ASD, time is of the essence. The earlier we get kids into services, the better the health outcomes are going to be. If an individual gets treatment early, there is less risk of developmental delays becoming permanent. A recent University of California San Diego study indicates children should receive ASD services as early as 18 months. During this time, the brain is able to acquire new skills at an earlier age. Also, as individuals get older, they are more likely to develop a comorbid diagnosis, so it’s important to begin services prior to the onset of other comorbidities.

 Magellan Health Insights: How might COVID-19 be affecting the age at which children are being evaluated?

 Yagnesh Vadgama: People are avoiding nonurgent care. Utilization rates of elective services have plummeted. Also, since school is the first place many children get evaluated for ASD, that may not happen with schools closed or moving to remote learning. And since many individuals’ health insurance is provided by their employers, many newly unemployed individuals may not be able to afford COBRA premiums and may lose coverage. Time is of the essence, and delays may have long-term or permanent effects.

 Magellan Health Insights: What can healthcare providers do to help ensure early, accurate diagnosis?

Yagnesh Vadgama: Healthcare providers should conduct early and frequent screenings as recommended by the American Association of Pediatrics. But, as important, providers should make appropriate recommendations for follow-up care and really help parents understand the next steps. They need to create a sense of urgency for follow-up care – encourage parents to act now, not to sit on it, see someone now. Then follow up with additional testing and screening on subsequent visits, because ASD can evolve over time. But never use a “just wait and see” approach, because time is of the essence.

Magellan Health Insights: What can parents do to help ensure a correct, early diagnosis if they have concerns?

Yagnesh Vadgama: Understand developmental milestones for your child’s age and the signs of ASD. Speak up about your concerns, especially where a child has a hearing impairment or an intellectual disability – because both situations could lead to a later ASD diagnosis. Be your child’s biggest advocate and ask about concerns and next steps.

One of the beautiful things is that in all 50 states, there is a mandate that commercial insurance carriers provide autism coverage. Covered members now have access to screenings, psychologists, developmental pediatricians and services that weren’t available when I began practicing over 16 years ago. And keep pushing until you get the care that best meets your child’s needs. Don’t wait!

Magellan Health Insights: We couldn’t agree more! Thank you, Yagnesh!

Prescription drug prices can be expensive. How can the average person save money on prescriptions in a quick, easy way? Pharmacy discount cards are available widely, but what are they and why should people use them? Here are five important things to know about pharmacy discount cards.

1. They can save you money!
   Pharmacy discount cards can be used to lower your costs on medications you need to fill that may not be covered by your employer’s health insurance plan. Using a discount card can save up to 80% off the cash price when you need to fill a non-covered drug. Comparing prices between your insurance and discount card is important to make sure you are not overpaying for your prescription. You should also check other pharmacies as prices do vary from chain to chain as well as independent pharmacy locations.

2. Using them won’t count toward insurance plan deductibles.
   Prescriptions filled using a discount card do not count toward your deductible or out-of-pocket maximum amounts. Discount card transactions fall outside of your health plan policy and should be used when a drug is not covered or if you are uninsured. Discount cards cannot be used in combination with insurance.

3. They are free to use.
   Most pharmacy discount cards do not require membership fees to use their cards, but some programs do require you to provide personal information. Make sure you review their privacy policy to ensure you are comfortable sharing information before using their services. The privacy policy is typically posted on their website.
4. No paperwork necessary.
   With pharmacy discount cards, there are no forms to fill out and no paperwork. When you present your discount card at the pharmacy, you are given the discounted prescription price at the counter and you pay the balance. There is no further obligation on your part to the discount card. You can use the card for future transactions, but typically there is no requirement to do so.

5. They work for pets, too!
   If you have pets, many discount cards extend their benefits to them as well. Many people fill their prescriptions at their veterinary office without realizing they may be overpaying. There are some prescriptions for your dog or cat that can only be filled by a vet, but many can be filled by your local pharmacy and usually at a much lower cost. You can ask your vet to write a prescription for your pet and have it filled at your neighborhood pharmacy. Make sure the vet includes their DEA number as most discount cards require this information to process the prescription.

There are many companies offering to save you money on your prescription drugs, which can sound too good to be true. Pharmacy discount card providers are only compensated when you fill a prescription using their card and the pharmacy benefits from your business. You get to save money on your prescription and improve or maintain your health of you or your loved ones.

The coronavirus disease 2019 (COVID-19) pandemic has taken a substantial toll on human life, not to mention our way of life. With over 14 million confirmed global cases and the death toll approaching 612,000, it is one of the most significant crises in recent history. In the United States (US), the country with the most cases and deaths, confirmed cases exceed 3.8 million and over 141,000 deaths have been reported as a result of this outbreak. As cases surge in certain parts of the country and the world, safe and effective vaccines and therapies are crucial to combatting this virus.  

Currently, there are no US Food and Drug Administration (FDA)-approved treatments or vaccines for SARS-CoV-2, the virus that causes COVID-19. Over 200 agents are being evaluated to treat the virus. These include new emerging molecular entities as well as approved drugs that are already available to treat other conditions and now being repurposed for COVID-19. According to the World Health Organization (WHO), 24 vaccine candidates have entered human trials and over 140 vaccine hopefuls are in preclinical evaluation.

Scientists around the world are working tirelessly to discover a vaccine for COVID-19. Vaccines candidates go through many stages of study. The average time to develop a vaccine ranges from 10 to 15 years. The Ebola vaccine, newly-minted in December 2019, only took about 6 years to be approved, whereas an HIV/AIDS vaccine has still not come to market after about 40 years. Given this pandemic’s magnitude, extraordinary measures from public and private stakeholders have been introduced to accelerate vaccine development.

COVID-19 has presented us with many challenges. Mitigation measures and safe and effective vaccines and treatments are key to restoring a new normalcy.

Q: What is the cumulative effect on mental health of COVID-19, social distancing and now the protests/riots on African-American and other BIPOC adults, both immediately and in the long term?

A: The COVID-19 pandemic has worsened longstanding ethnicity-based healthcare disparities that have resulted in disproportionate infection, morbidity and mortality rates for BIPOC adults, specifically Black Americans. Black Americans represent approximately 11.9% of the workforce, however they make up 17% of the front-line, essential workforce that is at higher risk for contracting and transmitting the virus[1]. At a time when the pandemic has resulted in an employment loss of 17.8% among Black workers compared to 15.5% among White workers, the risk to individual health safety is compounded by the risk of occupational hazards, job loss and financial insecurity[2]. As such, the compounded crisis of police brutality and increased social awareness of protest movements and civil unrest adds an additional layer of uncertainty, worry, fear, anger and sadness. Studies show that Black Americans are more likely to develop both physical and mental consequences to prolonged exposure to the chronic stress associated with discrimination and socioeconomic status, particularly high blood pressure, asthma, diabetes, depression and anxiety[3] [4]. In the week following the release of the George Floyd police brutality video, the rate of Black Americans experiencing depressive or anxiety symptoms increased from 36% to 41%, and among Asian Americans, the rate jumped from 28% to 34%[5].

Q: Are there unique signs of mental distress in African-American and other BIPOC adults that differ from those presented by Caucasians?

A: Though various forms of mental distress are characterized and diagnosed by commonly reported symptoms and behaviors, it is not unusual for individuals to have unique experiences that don’t look or sound the same, depending on who’s experiencing them. Additionally, cultural and spiritual norms specific to certain ethnic populations can influence the ways in which we communicate our pain, worry, sadness, anger and fear to healthcare providers, which often leads to misdiagnosis and/or ineffective treatment planning for ethnic minorities. Moreover, a 2019 study conducted by Rutgers University, indicates that Black Americans with severe depression are more likely to be misdiagnosed with Schizophrenia, which reveals significant provider bias in overemphasizing psychotic symptoms compared to mood symptoms[6] . In these instances, it appears that Black respondents’ endorsement of mistrust, hopelessness and paranoia due to extenuating sociocultural and political circumstances can result in unique clinical presentations that pose significant obstacles to understanding and healing, and that this effect is heavily influenced by the identity and implicit bias of both the patient and the provider. Ethnic minorities are also more likely to somaticize mental health symptoms, meaning they often report physical complaints like pain, fatigue or headaches, as well as sleeping difficulties as their chief complaints, rather than attributing the combination of symptoms to a mental health condition like depression or anxiety. This dichotomy often leads to further limitations in access to care, weakening of trust in the healthcare system, and escalating feelings of traumatization, oppression and isolation for marginalized demographics.

Q: How can African-American and other BIPOC adults help each other process their thoughts and emotions about the general unrest in our country?

A: It’s often said that there’s strength in numbers, and this is equally true as it relates to emotional support for marginalized communities in times of social unrest and collective trauma. Generational exposure to workplace and community discrimination is a shared experience for many ethnic minorities, and this commonality may make it easier for individuals who are feeling distress to share their thoughts with friends, family and providers who have a firsthand experience with the same issues in our society and across the world. This familiarity may also reduce mistrust within the healthcare system, if BIPOC patients feel they have an opportunity to share their feelings without judgment, misdiagnosis or repetitive traumatization and discrimination. Likewise, ethnic minorities are more likely to rely on spiritual or other cultural leaders for support and guidance in times of stress or civil unrest and are more likely to benefit from clinical behavioral health services when these alternative modalities are considered and integrated as fluidly as possible.

Q: Are there unique barriers to mental health treatment for African-American and other BIPOC adults?

A: Apart from generalized limitations in access to healthcare that have been noted for Americans across the spectrum, behavioral healthcare remains out of reach for millions of people, including those who actually have healthcare coverage. Shortages in available providers, clinics and hospitals means that there are longer wait times for appointments, and fewer resources available for maintenance of chronic mental conditions. Many mental health providers have moved to cash pay only practices, and this may serve as an obstacle for people who don’t have the disposable income available to pay out of pocket for psychotherapy or medication management. Inpatient bed shortages and the lack of long-term behavioral healthcare facilities are also shown to contribute to chronic homelessness, frequent ER visits and more interactions with the criminal justice system, which has become the largest provider of mental healthcare and boarding for chronically mentally ill patients over the last few decades[7]. Finally, stigma remains a very prominent barrier to seeking care for many ethnic minorities. In some cases individuals may fear judgment, mockery, maltreatment or discrimination due to their mental illness, while others may simply lack adequate information about the mental health field due to relatively less cultural reliance on these modalities within certain ethnic groups.

Q: What would you recommend to Caucasian individuals who want to reach out to their BIPOC friends and acquaintances and show their support, but don’t know what to say or are afraid it would not be received well?

A: In times of social division, strife and unrest, marginalized groups who are experiencing emotional distress and traumatization are likely to be concerned about safety, survival and stability. Allies and systems of support outside of ethnic peer groups can be helpful in building trust and solidarity across demographics, and this may aid in the development of healthier coping and conflict resolution strategies. It’s important that friends, family and coworkers be mindful that not every BIPOC person experiences distress or social events the same way and be open to simply listening to how the person feels first, before rushing to offer apologies or solutions that may not be indicated or helpful. MLK said that riots are the language of the unheard, and it is indeed the case that marginalized identities continue to live social and emotional experiences that so often go unnoticed, misunderstood and unaddressed by the ethnic majority. An expression of willingness to hear, care and help despite not knowing all the answers or solutions is sometimes all that’s necessary to convey empathy, sympathy and solidarity.

[1] https://www.epi.org/publication/black-workers-covid/

[2] https://www.epi.org/publication/black-workers-covid/

[3] https://www.ajmc.com/focus-of-the-week/high-levels-of-chronic-stress-high-blood-pressure-linked-in-african-americans#:~:text=African%20Americans%20who%20report%20high%20levels%20of%20chronic,serving%20as%20possible%20catalysts%2C%20according%20to%20study%20findings.

[4] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[5] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[6] https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800223

[7] https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/#:~:text=As%20sheriff%2C%20Dart%20is%20also%20responsible%20for%20Cook,considered%20the%20largest%20mental-health%20facility%20in%20the%20nation