THE PROGNOSIS

Actress Glenn Close still remembers vividly the dramatic and troubling scene when her nephew, Calen, had a psychotic break as a 17-year-old living in Montana.

“He had to be put in a straitjacket and driven two hours to the closest place where he could get help,” Close said at a Washington Post Live event yesterday. 

The lack of accessible help for Calen -- and that he had to go to the emergency room instead of getting treatment prior -- is part of the reason she’s asking Congress to expand and extend funding for mental health care through a pilot program scheduled to expire on July 1.

Close became a mental health advocate after encountering serious illness within her own family — not just Calen, who has schizophrenia, but also her sister Jessie, diagnosed with bipolar disorder with psychotic tendencies.

She’s backing a program approved five years ago under a bill from Sens. Roy Blunt (R-Mo.) and Debbie Stabenow (D-Mich.), which the senators are now trying to expand from eight states to 19 states for another two years. The bill gives extra Medicaid dollars to community clinics in return for providing a wide range of mental health services. Its aim is to correct a shortcoming in the country’s health-care system, which often prioritizes care for physical ailments but not for mental conditions such as depression, anxiety or bipolar disorder.

Under the pilot, more than 350 health clinics serving a quarter-million Medicaid patients have been able to get fully reimbursed by the federal government for the full range of mental health care. If funding isn’t extended, the centers may have to lay off 3,000 newly hired staff, cut off medication-assisted treatment to 9,000 patients and reestablish wait lists for mental health services, according to estimates provided by the senators’ offices.

“We have seen psychiatric crisis services, 24-hour services, start up in the community,” Stabenow said. “So, someone's not going to the jail, someone's not sitting in emergency room for hours or maybe days trying to get help, and it's transforming those communities.”

Diagnoses of mental illness are on the rise in the United States, particularly among youth. Substance abuse, which often goes hand in hand with mental illness, has also spiked. Yet a large share of people don’t get the help they need, due to a variety of reasons including stigma, insufficient insurance coverage and the unique nature of mental illness, which can discourage patients from seeking care independently.

That was the case for Close’s sister and her nephew. She described her shock when Jessie confided in her that she couldn’t stop thinking about killing herself.

“Our family had absolutely no vocabulary for mental health,” Close said. “We just — we didn’t really get it…I had no clue. She was very good at keeping what she was going through from all of us.”

The Substance Abuse and Mental Health Services Administration estimates that half of adults and teens with any mental illness and one-third of adults with serious mental illness don’t get any kind of treatment. Blunt and Stabenow’s bill tries to get at the problem by expanding mental health services covered via Medicaid, the government program for the low income which is also the single-largest payer of mental health services in the United States.

To be eligible for the increased Medicaid payments, a clinic must be certified as a Community Behavioral Health Clinic. That involves showing it provides a comprehensive set of services including 24-hour crisis counseling, substance abuse treatment and mental illness screenings. Part of the idea is to make treatment more readily available to patients before they end up in emergency rooms or in the criminal justice system.

“For the better part of 50 years the emergency room and law enforcement have been the de facto mental health delivery system in the country,” Blunt said. “And nobody is well served by that or satisfied by that.”

Stabenow said she’ll never forget when the sheriff in Cook County, Ill., told her he had just hired a psychiatrist as a jail director.

“He said, ‘Well, it’s real simple. Over half the people in my jail have mental health problems,’ ” Stabenow recalled.

Then there’s the issue of stigma, a major reason people don’t seek out help before their illnesses make it hard to function. Both Jessie and Calen found the stigma around their illnesses was “just as painful” as dealing with the illnesses themselves, Close said.

“Calen lost all his friends,” Close said. “Jessie felt that she was frightened to tell parents about her bipolar disorder because she was afraid they wouldn’t allow their children to come and play with her young daughter at the time.”

There are signs that the stigma is starting to thin, as more public figures share their own experiences. Sen. Tina Smith (D-Minn.), took to the Senate floor on Wednesday to share her struggle with depression that started in college and returned in her 30s. She described the experience as a “spiral” and called herself “one of the lucky ones” because she had insurance that allowed her to see a therapist.

“Down and down I went, until I could no longer see hope on the horizon,” Smith said. “Now, I was never suicidal, but I was struggling to function. I definitely wasn’t living my best life; I really wasn’t living at all. And that’s the reality for mental illness for millions of Americans.”

But talking more about mental illness has raised another concern among advocates: that it’s possible to address the topic in unhelpful ways, ways that could even trigger people to act upon suicidal thoughts. The Netflix series “13 Reasons Why” recently came under scrutiny when a study purported to find a spike in youth suicides in the month after the show was released.

Close called the series “irresponsible.”

“My sister went through suicide ideation,” Close said. “She tried to end her life twice. And I think you have to take responsibility because there’s so much potential for impact with our social media. You really have to take responsibility for the stories that you tell.”

AHH, OOF and OUCH

AHH: It took 18 days last fall for the University of Maryland to inform its students about the presence on campus of adenovirus. It’s a virus that can appear with symptoms similar to a cold or flu but can be dangerous for people with weakened immune systems, making early detection critical.

The outbreak left one student, 18-year-old Olivia Shea Paregol, dead.

More than 40 students were sickened overall during the outbreak in November and December and 15 people were treated at hospitals, our Post colleagues Jenn Abelson, Amy Brittain and Sarah Larimer report in this investigation about the outbreak told through Olivia’s story. The reporters spoke with more than 100 people during the course of their reporting to explain how the university’s communication delay left the community in the dark.

After learning of the virus’s presence on campus, university officials “discussed — but decided against — notifying students with compromised immune systems and residents living in Elkton Hall, according to records reviewed by The Washington Post,” our colleagues write.

“Many parents and students have denounced the administration’s handling of the viral outbreak and the mold infestation, complaining its actions endangered thousands of students, faculty and staff on campus,” they add. “In recent statements to The Post, university officials defended their actions ... They said they went beyond what was legally required to address the adenovirus outbreak and public health officials advised that it was not necessary to inform the public about the virus.”

OOF: Five states — Virginia, Maryland, Kansas, Iowa and Wisconsin — said they will sue opioid manufacturer Purdue Pharma and members of the Sackler family that controls the company, for allegedly “deceptively pushing powerful painkillers and misrepresenting the drugs’ safety as the pills sparked the opioid crisis,” our Post colleague Lenny Bernstein reports.

The five states join at least 40 others that have filed suits against companies that are in some way involved in the making, distributing and dispensing of opioid drugs. Another 1,600 counties, cities and Native American tribes have filed claims that have been consolidated in a massive federal lawsuit in Cleveland.

"All but Kansas targeted at least one member of the Sackler family, former president Richard Sackler, and Maryland named seven family members but not the company in an administrative filing," Lenny writes. "In a news conference, West Virginia’s attorney general, Patrick Morrisey said his state was seeking to hold both the company and Richard Sackler responsible for deaths and other harms from the worst drug epidemic in U.S. history."

“Even when it became apparent that thousands of people were dying of opioid abuse, Purdue doubled down by continuing its relentless and deceptive campaign” to push physicians to prescribe OxyContin, Morrisey said at the news conference.

OUCH: The Ebola outbreak is only getting worse in Congo, as is widespread fear among health workers trying to combat the outbreak. The death toll has reached 1,136 this week, and the number of infections rose to 1,632.

Misinformation has driven distrust of those in medical uniforms, making some doctors battling what is the second-deadliest Ebola outbreak in history afraid to wear their scrubs, as our Post colleagues Danielle Paquette and Lena H. Sun report.

There have been 119 attacks this year against health workers, according to the World Health Organization, with 85 people wounded or killed.

“And the violence hampers the response effort in a more direct way: Ebola infections tend to spike after attacks, experts say, because emergency responders are forced to take cover and halt the distribution of immunity-boosting vaccinations,” Danielle and Lena write. “Concerns are growing that the crisis in Congo’s North Kivu province could become as lethal as West Africa’s battle against the hemorrhagic fever from 2013 to 2016, which killed 11,310 people across three countries.”

HEALTH ON THE HILL

— House Democrats passed legislation yesterday to lower prescription drug prices and to reverse some changes made by the Trump administration around the Affordable Care Act, a move that sets up the Democratic Party with yet another chance to tout a health-care message ahead of the 2020 election, our Post colleague Amy Goldstein reports.

In a 234-183 vote, five GOP members joined every Democrat in passing legislation to block rules from the Trump administration meant to encourage people to buy cheaper, short-term health plans that typically cover fewer services. The legislation also restores funding for advertising and other outreach to help people sign up for ACA marketplace plans. The package also includes three strategies to boost the availability of generic drugs, measures that initially had Republican support before Democrats packaged them with the measures to reinforce the ACA.

“The upshot was a barbed debate: Democrats accused Republicans of disregarding consumers’ need for affordable, quality health care, and Republicans accused Democrats of thwarting a rare opportunity for bipartisanship,” Amy writes.

House Speaker Nancy Pelosi (D-Calif.) Pelosi also took a jab yesterday at the Senate, which is not planning to consider the legislation.

“I have some news for the distinguished leader in the Senate, the Republican leader,” she said. “The support for these bills is alive and well among the American people. He will be hearing from them because these bills are a matter of life and death and certainly quality of life for America’s working families.”

— Gilead Sciences CEO Daniel O’Day defended the high cost of the manufacturer's highly effective HIV treatment, Truvada, before a House committee yesterday.

“We have taken the disease from a death sentence to a manageable clinical condition, but we’re not done yet,” O’Day said. “We have to be sure that Americans get our medicines at a price that allows us to invest in research.’’

During the hearing, lawmakers questioned the high cost of the drug and noted it was research conducted by governent scientists at the Center for Disease Control and Prevention that helped develop Truvada, as our Post colleague Christopher Rowland reports.

“This treatment was developed as a result of investment made by the American taxpayers. The problem is that Gilead, the company that now sells the drug, charges astronomical prices,’’ House Oversight Chairman Elijah Cummings (D-Md.) said. He pointed to how the price has shifted from $800 a month when it was introduced in 2004 to now about $2,000 a month. “How can Gilead do this? How can our system allow a company to take a drug treatment that was developed with taxpayer funds and abuse its monopoly to charge such astronomical prices?’’

Rep. Alexandria Ocasio-Cortez (D-N.Y.) asked O’Day why the drug’s list price is nearly $2,000 in the United States when it’s $8 in Australia.

“Truvada still has patent protection in the United States, and in the rest of the world it is generic," O'Day said. "I can’t comment on the price in Australia of the generic medicines, but it is generically available in other parts of the world and will be generically available in the United States as of September in 2020.” Christopher notes that scheduled generic availability is set to slash the company’s current earnings of $3 billion a year from the drug.

REPRODUCTIVE WARS

— House Minority Leader Kevin McCarthy (R-Calif.) said he opposes the new Alabama law that effectively bans all abortions in the state, saying it “goes further than I believe.” 

“I believe in exceptions for rape, incest and life of the mother, and that’s what I’ve voted on,” McCarthy said at his weekly news conference, as our Post colleagues Felicia Sonmez and Mike DeBonis report. He said rape and incest exemptions are “exactly what Republicans have voted on in this House.”

His remarks came the day after Alabama Gov. Kay Ivey (R) signed what is the country's strictest antiabortion law, outlawing abortions without any exceptions for rape or incest and which penalizes doctors who perform the procedure with up to 99 years in prison.

“Republicans are wary of a reprise of 2012, when they lost two key Senate races in Indiana and Missouri after the party’s nominees in those states made comments about pregnancies resulting from rape,” Felicia and Mike write. “The debate over the Alabama law also comes at a time when Republicans are looking to make inroads with suburban women, a voting bloc that they lost when Democrats recaptured the House in 2018.”

— Missouri’s Republican-controlled Senate made the state the latest in a slew of states to pass strict antiabortion legislation. Republican lawmakers voted 24 to 10 to pass a bill to ban abortions at eight weeks of pregnancy.

The bill is now headed to the state’s Republican-controlled House, as our Post colleague Lindsey Bever reports. Republican Gov. Mike Parson has expressed support for the measure.

Parson tweeted before the bill’s Senate vote:

The bill would penalize any doctor who performs the procedure with up to 15 years in prison. It includes no exceptions for rape or incest, and only allows women to get an abortion after the eighth week of pregnancy in cases of medical emergencies, which it defines as “a condition which, based on reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert the death of the pregnant woman or for which a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman.”

In a statement to The Post, M’Evie Mead, director of Planned Parenthood Advocates of Missouri, said the GOP lawmakers “are putting the health and lives of Missouri women at risk in their race to make our state the one that overturns Roe v. Wade at the Supreme Court.”

— And here are a few more good reads: 

Democratic presidential candidate Kirsten Gillibrand says that, as president, she’d seek to write into law the U.S. Supreme Court’s landmark ruling that legalized abortion.
Associated Press
Sweeping state-level abortion restrictions present a direct test of whether the newly constituted Supreme Court is willing to revisit Roe v. Wade.
Wall Street Journal
Politics
Nearly all of the men were Republicans.
Philip Bump
President Trump, through his appointment of judges who oppose abortion rights and his graphic language, is again speaking a language that evangelicals embrace.
New York Times
Politics
Vitter, wife of former senator David Vitter, has said she will be bound by the precedent of Roe v. Wade in her decision-making.
Colby Itkowitz
MEDICAL MISSIVES
Health & Science
Patients, doctors in less populated parts of the country seek contempt order against HHS and the nonprofit that runs the transplant system.
Lenny Bernstein
Politics
He was released on Thursday and plans to teach Sunday school this weekend, the Carter Center said in a statement.
Felicia Sonmez
Olympics
Four-time Olympian hopes to raise awareness to the pregnancy and childbirth dangers faced disproportionately by African-American women.
Rick Maese
“It’s a personal issue for me,” the Iowa Republican, veteran, and sexual assault survivor says.
Jacqueline Alemany
STATE SCAN
Public Safety
Officials say more victims of fatal shootings are suffering multiple wounds
Peter Hermann
DAYBOOK

Coming Up

  • The House Veterans Affairs Committee holds a hearing on military and veteran suicide on May 21.
  • The House Ways and Means Subcommittee on Health holds a hearing on surprise medical bills on May 21.
SUGAR RUSH

Sen. Kirsten Gillibrand (D-N.Y.) spoke to supporters in Atlanta after Alabama moved to ban nearly all abortions: