Healthbeat

Psychedelics offer exciting promise for mental health – if rolled out right

2026-04-29T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a global nonprofit that promotes economic mobility and well-being for vulnerable communities. Views expressed here are my own.

This week I am reminded how little we know about the brain and how that lack of understanding impairs our ability to address two of the most serious public health problems in America: severe mental illness and dementia.

A White House event was either a historic turning point for mental health or a dangerous workaround of the Food and Drug Administration’s safety regulations; and a new report found that Alzheimer’s drugs have almost no benefit.

We also saw updates to two important stories involving the Centers for Disease Control and Prevention and a chance to highlight one of the most important, but least well known, programs it runs.

Psychedelics and mental health: promising, but let’s do this right

In the past decade, there have been several positive developments in mental health, including a growing willingness of prominent people — athletes, elected officials, musicians — to talk about their struggles and reduce stigma. Unfortunately, there has not been an equivalent increase in access to services, and most treatment approaches have limited effectiveness or durability.

That is why there has been so much excitement recently around a new approach to serious mental illness: psychedelic-assisted therapy. We saw a remarkable event at the White House last week. President Donald Trump, flanked by Health and Human Services Secretary Robert F. Kennedy Jr. and podcaster Joe Rogan, signed an executive order directing federal agencies to accelerate research into psychedelic medicines and expand access to them for treating serious mental illness.

Psychedelics are a group of compounds either derived from naturally occurring organisms, such as psilocybin from “magic mushrooms” and ibogaine from a shrub found in Gabon, or synthesized in laboratories, such as LSD and MDMA. While chemically distinct, psychedelics have in common the ability to profoundly alter perception, cognition, and consciousness.

In mental health therapy, psychedelics work very differently from conventional pharmacology. Antidepressants and other approved psychiatric medications primarily seek to alleviate symptoms. Patients must take them daily, and symptoms recur when they stop.

In contrast, psychedelic therapy involves one structured session or a few sessions in which the person takes the psychedelic and undergoes talk therapy before, during, and after. Rather than suppressing emotions or thoughts as with traditional psychiatric medications, these compounds create a window of openness in which patients can access deeply buried feelings, e.g., grief, shame, trauma, and help to rewire the way people feel and think about problems.

As a JAMA editorial put it, the approach “addresses the cause of symptoms rather than merely suppressing them.”

Psychedelic therapy is primarily being evaluated for severe depression, post-traumatic stress disorder, obsessive-compulsive disorder, and substance-use disorders — conditions for which existing treatments often produce only modest, short-lived benefit.

The executive order commits $50 million to ibogaine research and directs the FDA to prioritize review of psychedelics holding the agency’s Breakthrough Therapy designation, reserved for drugs showing early evidence of substantial improvement over existing treatments.

I am genuinely excited about this research. And I am also concerned that the way it’s being rolled out could undermine its promise. While the early data are impressive, making therapy available at scale requires the government to ensure safety and efficacy the way we do for other medications.

The executive order expands access through the Right to Try Act, a pathway designed for terminally ill patients to obtain experimental treatments outside clinical trials. This administration has shown a fondness, unfortunately, for treating unproven compounds as standard consumer goods rather than medications.

For example, Kennedy has used a similar approach to peptides, arguing that individual freedom matters more than safety and efficacy. While there is substantial real-world data on the safety of most psychedelics, we need high-quality research to demonstrate the effectiveness of different dosages and treatment protocols. I believe this study on MDMA-assisted psychotherapy for PTSD, although somewhat controversial, shows what can and should be done to advance the field.

What I want is something modeled after the work of HIV/AIDS activists, such as Treatment Action Group. They believed — correctly — that access and evidence do not have to compete with each other. You can modernize trial designs to accelerate data collection and mobilize staffing to accelerate regulatory review, so that you can have safety, efficacy, and access.

Another more recent example was Operation Warp Speed for Covid vaccines. The result was faster access to medical interventions that actually worked. That is what I want for psychedelics.

Alzheimer’s drugs: when statistical significance isn’t enough

For decades, the leading hypothesis for Alzheimer’s disease has been that dementia is caused by the buildup of a protein called amyloid-beta in the brain, forming plaques that disrupt neurons and cause progressive cognitive decline. This “amyloid hypothesis” has driven billions of dollars in drug development.

The Cochrane Collaboration, an international network that systematically reviews the best available evidence, published an analysis this month of seven monoclonal antibody drugs developed to clear amyloid from the brain. The review examined 17 randomized controlled trials involving more than 20,000 patients and concluded that the clinical benefit of these drugs is, at best, trivial.

Cognitive function, dementia severity, and ability to manage daily activities showed little to no meaningful change after 18 months of treatment. The drugs can also increase the risk of brain swelling and bleeding, though in most patients these side effects cause no symptoms.

Some Alzheimer’s experts argue that the Cochrane review improperly lumps failed drugs together with the two most recently approved treatments. One critic compared it to mixing rotten ingredients with fresh food and declaring the meal inedible. While that is a legitimate methodological concern, even the trial results for those two recently approved drugs showed only modest slowing of cognitive decline, i.e., patients got worse, but just not as quickly as they would have without treatment.

Whether patients or their families can perceive that difference is genuinely unclear. As one Cochrane author put it, the benefit was “far below the minimal effect that’s needed to be noticeable at all for patients and caregivers.”

This points to one of the most underappreciated problems in pharmaceutical regulation: the gap between statistical significance and clinical significance. A drug can clear an approval threshold based on an effect large enough to be measurable, but too small to matter to anyone living with the disease.

One of the successes of public health is longevity: People are living longer across the world. But our ability to prevent and manage conditions of aging is not advancing fast enough. This latest study shows that even the best available pharmacological therapies are not worth using.

CDC: one step backward, one step forward, and one cause for celebration

Two weeks ago, I wrote about how the CDC had been blocked from publishing a study showing that Covid vaccines reduced hospitalizations by about 55% during the past winter season. An HHS spokesman confirmed last week it will not be published, citing methodological concerns, even though a flu vaccine study using the exact same methods was published in the Morbidity and Mortality Weekly Report just one week before the Covid study was blocked.

Unfortunately, this confirms what I have been worried about all along. Even with widespread uproar in the media that a methodologically sound study was being blocked, the current administration will continue to hide data that demonstrate the harms of the Covid virus and the benefits of Covid vaccines.

On a more hopeful note, the White House nominated Dr. Erica Schwartz, a former deputy surgeon general and retired Coast Guard officer, to serve as the permanent CDC director. Dr. Jennifer Shuford, Texas state health commissioner, was announced as incoming CDC chief medical officer. I think the public health community needs to see this as a minor victory in the ongoing battle to protect the CDC from further damage.

I have heard from many current and former CDC colleagues that they have concerns about Schwartz’s actions when she was deputy surgeon general, but they are absolutely elated by the choice of Shuford as chief medical officer.

Many people who have worked with Shuford in the past, including during the large Texas measles outbreak in 2024, have praised her knowledge, skills, and temperament and are holding out hope that she can serve as an effective counterbalance to some of the anti-science positions that HHS leadership continues to push.

Finally, I want to highlight the 75th anniversary of one of the most important and least known public health programs in the country: The CDC’s Epidemic Intelligence Service. I entered the program after completing my medical residency, and EIS taught me skills I could not have learned anywhere else.

I learned to design epidemiologic studies by investigating real outbreaks, received hands-on mentorship in policy development and public communication, and worked with government agencies at every level, domestically and globally over two years.

Since 1951, EIS has trained more than 4,300 people — including physicians, veterinarians, nurses, pharmacists, lawyers — who have investigated nearly every major public health crisis of the past seven decades: smallpox, HIV/AIDS, Ebola, influenza pandemics, the 2001 anthrax attacks, and Covid-19.

Today, 1 in 3 state epidemiologists in the United States is an EIS alumnus, and 4 of the 12 CDC directors in history completed the program. At a moment when the CDC’s institutional capacity is under serious strain, it is worth recognizing what 75 years of investment in training has built and what would be lost if that were allowed to erode.

While many lay people hear about the limits of science and turn away to other approaches, I think we should see those limits as a reason to demand more. We need more trials, more rigorous review of data, and more protection of the institutions, like EIS, that have spent 75 years turning science into health promotion and disease prevention.

Until next week,

Jay

Dr. Jay K. Varma, who is recognized globally for his leadership in the prevention and control of infectious disease, writes about public health for Healthbeat. He has guided epidemic responses, developed policies, and implemented programs that have saved lives across Asia, Africa, and the United States. He is based in New York. Contact Jay at jvarma@healthbeat.org.

How new weight-loss drugs may offer hope for curbing addiction

2026-03-12T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

Last week was an interesting one for me, as I had the chance to moderate a panel hosted by the French Chamber of Commerce here in Nairobi. I focused on a question I’ve been circling in my reporting for months: As global health aid retreats, who fills the gap? The panel included development experts and health care businesses, all wrestling with how and where the private sector can realistically step in.

On to the news: This week we take a look at an unexpected (and unexplained) benefit of GLP-1 weight-loss drugs, a reality check on artificial intelligence tools hunting down antibiotics, and a few other stories on social media bans, the Iran war, and … a drug trial for turkeys?

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A shot at fighting addiction

It’s hard to overstate how much GLP-1 drugs like Ozempic have upended weight-loss treatment and sparked an ongoing pharmaceutical gold rush.

Drugmakers are racing to develop ever newer versions of the drugs, and regulators around the world are approving them at an equally rapid clip. (China, for example, just cleared Pfizer’s newest injection Xianweiying last week.) But their explosive popularity aside, what I find most striking about this moment is just how little we actually understand about the ways these drugs affect our bodies and brains.

Take, for example, results from a new study of health records from more than 600,000 patients in the United States. As reported by the Associated Press, patients taking these GLP-1 drugs showed something remarkable and seemingly unrelated to weight loss: lower rates of substance use disorders.

Background: GLP-1 drugs like Mounjaro, Wegovy, and Ozempic mimic a natural hormone that regulates blood sugar and appetite. In general, they influence the body’s hunger and digestion signals, though researchers are still working to understand exactly how these effects unfold in the brain and body. The “GLP-1” name is an abbreviation for the molecule it mimics, which was originally developed as a treatment for diabetes.

The study found that those on the drugs were less likely to develop addictions “to alcohol, nicotine, cocaine, opioids, and other substances” as compared to patients on other diabetes medications. And for patients already struggling with addiction, the drugs were also “linked to lower risks of [addiction-related] hospitalization, overdose, and death.”

What is going on here? Why would a drug designed to control blood sugar and appetite also seem to affect cravings for alcohol, nicotine, or other drugs? To find out, I reached out to two addiction science researchers not involved in the new study to help me parse the connection.

First, the idea that these drugs might affect addiction did not appear overnight, Dr. Joseph Schacht, an addiction scientist at the University of Colorado told me. Animal studies going back to last decade have found that drugs in this class can reduce alcohol consumption. And as millions of people began taking the drugs this decade, similar reports kept surfacing with doctors. “I became interested in this area when a medical colleague told me that some of her patients [taking GLP-1 drugs] for weight loss had reported they found themselves drinking less alcohol and experiencing less craving for it,” he said.

Still, scientists don’t fully understand the basic biology behind “exactly how these drugs affect the brain’s reward pathways,” he said. What we do know is that the brain contains specific docking points for GLP-1 molecules in several regions involved in motivation and craving. “It is possible that GLP-1 [drugs] cross the blood-brain barrier and bind directly,” to those sites, he said. But that’s not actually been proven yet. Another possibility, he said, is that the drugs act elsewhere in the body and send some other signals that ultimately influence how the brain processes cravings. We simply don’t know yet!

I also reached out to Dr. Anna Lembke, an addiction medicine specialist at Stanford University, who said the research raises the possibility of new, preventative therapies.

After all, if these drugs truly quiet the brain signals tied to craving, they might reduce the risk of the disorder developing in the first place. “But lots of questions remain, including whether short- and long-term benefits outweigh the risks, especially when you’re thinking about giving the drug to people who don’t yet have a disorder,” she said.

Still, “addiction is a massive and growing problem across the globe. We need more tools to help combat it. The GLP-1s hold promise for a novel strategy to combat addiction, and we need all the help we can get,” she said.

AI: An antibiotic breakthrough … or dead end?

One issue I keep returning to is a coming crisis in antibiotic resistance: Essentially, existing antibiotics are failing faster than scientists are discovering new ones.

This is both a “today” and “tomorrow” problem. Already, antibiotic resistance is linked to roughly 5 million deaths a year worldwide as routine infections become harder to treat. And if nothing changes, we will eventually reach a failure point where we no longer stop many common infections … with enormous implications for everything from cancer therapies to simple surgeries.

Now, as we’ve covered before, there are reasons to be optimistic. A big one is artificial intelligence, which is speeding up the earliest stages of antibiotic discovery, as covered in a new essay in STAT News. The authors, an antimicrobial researcher and a drug developer, cite a study from last October in which AI tools discovered “hundreds of [new] molecules with promising anti-bacterial activity.”

That said, this essay is not one of optimism.

As the authors write, even as these early leaps in AI dramatically improve new antibiotic discovery, the economic incentives for actually developing them remain heartbreakingly weak. Put simply: “The antibiotic market does not reward innovation — it often punishes it.”

Why? Because the way we use antibiotics makes it extremely difficult for companies to recoup the enormous costs of clinical trials and later-stage development.

Consider that antibiotics are meant to cure infections over a matter of days instead of, say, lucratively managing a chronic disease for years. And because doctors want to slow resistance, the newest drugs are often used sparingly and held in reserve. It’s “a practice known as stewardship”, which “benefits future patients but crushes commercial prospects. Even a truly novel, lifesaving antibiotic will be used sparingly, priced modestly, and ultimately displaced by generics.”

What’s the takeaway? If “no amount of algorithmic brilliance or predictive learning can overcome a business model that guarantees financial failure downstream … only policymakers are empowered to remedy what ails antibiotic R&D,” the authors argue.

They propose a few solutions, including “subscription-style reimbursement models, in which governments pay for access rather than volume,” or lump-sum government payments “that provide predictable returns for truly innovative antibiotics.”

The alternate solution, they say, is watching helplessly as “world-class laboratories … keep generating promising AI-sourced discoveries that end up in the dustbin of academia.”

Two conflicts with hospitals under fire

We have a few updates on two not-so separate crises, in Iran and Gaza.

First, the World Health Organization says at least 13 hospitals and health facilities in Iran have been hit since the U.S. and Israeli bombing campaign began, The Guardian reports. While the WHO has not provided many details (nor attributed blame), Director-General Tedros Ghebreyesus has gone on record to say that “under international humanitarian law, health care must be protected and not attacked.”

Meanwhile, in Israeli-occupied Gaza, Reuters is reporting that “medical supplies [are] running critically low despite Israel’s reopening of a key crossing.” How low? “Supplies of some items such as gauze and needles have already run out,” and “fuel shortages continue to limit hospital operations.” Hospitals without needles and gauze? It’s a fairly condemnable state of affairs, especially considering that there has been a ceasefire for two months now.

What’s the connection? As Reuters is also reporting, “key humanitarian air, sea, and land routes are being constricted ‌by disruption from the [Iran war], delaying life-saving shipments to some of the world’s worst crises,” which includes Gaza. As the report puts, quite pointedly: “Aid to Gaza and Sudan is grinding to a halt and costs are soaring for help to the hundreds of millions suffering hunger crises around the world.” And that we should expect care to get even worse.

The takeaway? Honestly, I’m worried. If the past two years in Gaza have shown anything, it is that the Israeli and American-backed bombing campaign displayed a total disregard for humanitarian protections around hospitals and medical infrastructure.

That record should make the world prepared for the possibility of a similar humanitarian crisis unfolding in Iran’s health care system, if this war escalates.

Share, like, and subscribe to social media bans?

India’s state of Karnataka has become the latest government to move against youth social media use. It just announced a ban on social media platforms for children under 16, Reuters reports. (The tech-hub state is home to 61 million people and the capital city of Bengaluru, widely known as the “Silicon Valley of India.”)

The policy follows similar efforts across the world: Australia recently approved a nationwide social media ban for under-16s, and several European and U.S. jurisdictions are likewise debating or testing age restrictions.

What does the most up-to-date research actually say about the effects of limiting social media? Well, let’s look at two separate ways researchers combine results across lots of studies. (Fair warning: We’re about to go full data-nerd.)

We can start with an “umbrella review” of youth social-media research from 2025, organized by researchers in Canada, Ghana, and Ireland. (An umbrella review is basically a review of reviews, looking across dozens of previous research summaries to see what the field as a whole is finding.) In this case, they looked at 43 reviews that covered over 1,000 papers.

What did they find? Broadly, higher social media use among adolescents is linked with worse mental health outcomes, particularly on depression, anxiety, and other “psychological distress.” But the picture is complex. The harms appear strongest with heavy or “problematic” use (like passive scrolling or addictive behavior), and some studies found clear benefits for teens, including social support and reduced isolation.

It’s also worth looking at a recent “meta-analysis,” which is when researchers pull out data from many separate papers, and then crunch it all together. In a 2025 meta-analysis, Australian researchers combined 10 randomized controlled trials to understand what really happens when people (adolescents and adults) reduce or stop using social media.

The results? They found that people who cut back on social media have a small but statistically significant drop in depressive symptoms. The effect was modest, but research shows that limiting social media use can improve mental health … but reduction in use was about as effective as total abstinence.

(Honestly, together it’s less of a slam dunk case against social media than I would have thought!)

Turkeys on trial

We’ll end this week with a funky story. Scientists in the UK have launched what is essentially one of the world’s first clinical trials on turkeys, the BBC reports.

Researchers will vaccinate thousands of turkeys and monitor them for about six months, in an effort to see whether a new bird-flu vaccine can safely protect the poultry from the virus.

It’s big news for birds, but don’t just take it from me. Here’s an incredible quote from Mark Gorton, the founder of Traditional Norfolk Poultry, which is leading the trial:

“This is probably one of the biggest days in my poultry life and I think this is one step for poultry but one giant step for poultry kind."

So … why turkeys?

Well, chickens are already vaccinated against bird flu in many parts of the world, and France has been vaccinating ducks for several years. But British researchers chose turkeys for this study because they are particularly susceptible to the disease. In other words, if a vaccine can protect a turkey, it’s a pretty good sign it could work for other poultry, too.

And there’s significant money on the line. “Annual bird flu outbreaks cost the UK government and industry up to £174m each year,” or about $230 million. And as Gorton told the BBC, “it could be a huge economic cost to [turkey farmers] if we catch this disease and we have to have all of our birds culled.”

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

AI therapy can help in countries with scarce care, but experts urge regulation

2026-02-19T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week we’ve got interesting news about AI therapy, new gene-editing medicines, and other topics … but before that, I have to mention that TIME magazine just published its 100 most influential people in global health. It’s great for a laugh!

The list includes Chris Hemsworth, for being exceptionally good looking while talking about Alzheimer’s, and some very stilted wordsmithing around Robert F. Kennedy Jr., who is labeled a “Titan of Health.” Conspicuously absent are any of the heroes who responded to last year’s Ebola outbreak. But hey, there’s always next year.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Your therapist, ChatGPT

The Guardian just published a fascinating article on the global use of artificial intelligence chatbots as therapy tools, featuring vignettes from Nigeria.

As the story states, “AI platforms offering first-line mental health support have proliferated over the past year.” And for Nigeria in particular, there is an obvious appeal in easing access to mental health care in a country with just “262 psychiatrists for 240 million people” (!).

The article starts with a very compelling story about a woman named Joy Adeboye in the capital, Abuja, who turns to an AI chatbot out of desperation and need. The result? “For the first time in months, Adeboye says, she felt less alone.”

Still, in most countries regulation on this use of AI is basically nonexistent, and that makes several basic, open questions all the more pertinent: Do these tools actually work as therapy, are they safe, and should they be trusted with vulnerable people?

I reached out to Briana Vecchione, a researcher who studies this topic at the Data & Society Research Institute, a nonprofit focused on social implications of automation and AI. Vecchione provided some striking insight on both the history of chatbots for therapy (which, surprisingly, dates back to the 1960s), and how to think about the tension between potential harm and help.

We covered much more than I can fit here, but luckily for you, she’s moderating a talk on this very topic on Feb. 26.

On how or if these tools actually work: Vecchione was careful to balance where the research stands (outside of a few narrow contexts, “I don’t believe chatbots are as effective as talk therapy,” she said) with what many users report their lived experience to be. “We have definitely seen that people feel some sort of relief after using these systems,” she said.

“But you need to really be careful about what forms of other care you’re displacing,” and ultimately, she says, “I do not think it’s a replacement for therapy."

When it comes to potential harms, she points to the incentive structures of many of the companies making these AI systems. “These [tools] are typically optimized for engagement. They’re not typically optimized for helping you close the loop and step away, which is actually bad for the companies. They want you to come back,” she said. In Vecchione’s research, she hears users frequently say they “feel unsure when to stop,” or at worse, “feel overly dependent on these systems,” and feel significant shame about that dependence.

Another potential harm is privacy, which I acknowledged to Vecchione I’ve always thought of as an abstract or general concern. But Vecchione points out that the risk here is extremely acute. “These things have no fiduciary duty in the same way that therapists do. They are not protected by HIPAA,” the U.S. Health Insurance Portability and Accountability Act, which protects a patient’s sensitive information, or patient confidentiality, she said. This means that in many countries (the United States included) there is nothing stopping an AI therapy tool from immediately selling your data to a prospective health insurer.

Still, with the prospect of AI therapy filling what would otherwise be an incredible void in many developing countries, Vecchione is clear that “these kinds of supplements to care can be useful,” she said. “Is it better than nothing? Maybe, if it’s being used responsibly.”

What’s the takeaway? At least in the United States, Vecchione and her colleagues have authored a detailed public comment to the U.S. Food and Drug Administration on their recommendations for the future of these technologies. They argue that relevant AI systems should fall within the FDA’s “medical-device” definition for mental health, should be treated as such, and regulated as such.

Diet, exercise, and… gene editing?

We cover a lot of tropical diseases on the Checkup. But zoom out to the global picture, and the biggest threat to health is far less exotic. Heart disease remains the top killer.

As a disease, it’s a bit of a catch-all. A range of factors like high blood pressure, diet, and smoking can damage the heart in different ways. But all told, the major risk for heart disease lies in high LDL cholesterol, which is made by your liver. With too much of this waxy fat, it can build up in blood vessels and block blood flow.

But in what feels like a glimpse of science fiction, clinicians are increasingly experimenting with new gene-editing techniques to reduce LDL cholesterol production, the AP reports. These trials are early, but are showing shocking improvements in patients who did not respond to regular medicines.

How does it work? Basically, a patient is injected with an IV of microscopic fat bubbles, which the liver naturally absorbs from the bloodstream. The trick is that these bubbles are carrying a clever DNA-cutting protein (part of the gene-editing tool CRISPR) along with a short RNA “instruction” that tells it exactly what piece of DNA to cut out.

The clinicians are specifically targeting a gene called ANGPTL3 to edit away, and only in specific cases. In some people this gene goes haywire, and causes an overproduction of “LDL cholesterol and another bad fat, triglycerides.”

It’s a one-time therapy, because when the edited liver cells reproduce … the deleted gene can’t carry onward. These are of course early trials, and the article does a great job couching the caveats.

There are major safety questions to be answered, cautioned Dr. Joseph Wu of Stanford University, who wasn’t involved in either study. CRISPR-based therapies for any disease haven’t been used enough to know long-term safety — and the particles carrying the gene-editing tool can irritate or inflame the liver, he said. Another unknown is whether gene-editing hits only the intended target. That’s why for now, studies largely target people at very high risk.

The who’s who of the next WHO

The World Health Organization director-general’s term does not expire until August 2027, but the race to succeed Tedros Ghebreyesus is already heating up. Nominations formally open in April, and Health Policy Watch is tracking the top contenders circulating in the “rumor mill.”

These include would-bes from the reform-minded Budi Gunadi Sadikin, Indonesia’s minister of health, all the way to Sania Nishtar, the CEO of Gavi.

I’ll be honest, seeing this much speculation so early is a little funny. (The article has some strong “The Bachelor” season premiere vibes.) Still, this is a five-year term that often turns into 10, and is the most important job in global health. So, if we’re being fair, the early speculation is more a la papal conclave than reality TV.

Jokes aside, the job earnestly matters more now than ever. Even beyond the global funding shortfall, the article paints a rough picture of the current state of affairs inside the WHO:

“Internally, the organization is struggling with a 25% cut in staff following the loss of United States support, leading to a low in staff morale. The layoffs, a lack of transparency, sexual abuse scandals, and a fear of retaliation among staff who have raised claims of harassment and damaged trust in the organization’s leadership.”

The real question is, who can right the ship? We will see.

(One last note on the incumbent: It’s too early to assess Ghebreyesus’ tenure. He will be remembered for steering the WHO through Covid and the 2025 wave of austerity. How well did he do? Hard to say. Still, credit where it is due. This week he publicly condemned a controversial U.S.-funded hepatitis drug trial involving newborns in Guinea-Bissau. It is hard to imagine a similar trial within the United States surviving legal/ethical challenges.)

A new polio vaccine

The WHO has cleared a new polio vaccine for global use, Reuters reports.

Disease breakdown: Polio, or poliomyelitis, is a gut virus that spreads largely through feces. While most infections pass without symptoms, the worst cases can wither limbs or invade the spinal cord to cause paralysis or death. Importantly, the disease can’t hide in animals, and vaccines stop it cold. Although polio is ancient enough to have been carved into Egyptian hieroglyphs, two strains of the virus were eliminated in 1999 and 2020, and only two more remain.

We covered this back in October. Despite a 30% cut to the effort, humanity is on the verge of eliminating this disease altogether. (That would make it only the second disease eradication, after smallpox in 1980.)

As I wrote then, “the last wild strain of the virus (still hanging on in Afghanistan and Pakistan) is now expected to be stopped by 2027,” and a second “strain of the virus that bubbled up from earlier vaccine drives, and which is largely pocketed across the African continent,” is on track for elimination by 2029.

What’s the focus of this new, oral drug? It targets that second variant, the vaccine-derived strain behind the African outbreaks. The key upgrade here is that this new vaccine is far more stable, so it’s less likely to mutate and accidentally seed new outbreaks while we work to stop existing ones.

And it can’t come fast enough.

Last week, Malawi launched a new campaign with about 1.7 million doses of the older oral vaccine, after the second variant showed up in sewage in the country’s second largest city, Blantyre, ABC News reports. (You have to love sewage sampling for both its grossness … and its effectiveness at monitoring hundreds of thousands of people to catch diseases early.)

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How to support families through the trauma of deportation

2026-01-30T17:36:41+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The actions and impacts of immigration enforcement have been weighing heavily on my mind this week, and I know I’m not alone in feeling that. YLE founder Katelyn Jetelina’s post earlier this week deeply resonated with me. Reports of ICE raids and deportations don’t just affect the individuals directly targeted. They ripple outward, with real consequences for community health and well-being.

I’m sharing updates from a piece I wrote last year on the health effects of immigration enforcement and raids, along with PDF guides and resources below on how to support families. Our team has compiled these resources for caregivers, educators, and clinicians supporting children, students, and patients during these stressful times.

Immigration enforcement and Immigration and Customs Enforcement raids can cause intense stress for entire families — children and caregivers alike. These guides focus especially on supporting kids and patients, but if you’re feeling overwhelmed or unable to use every suggestion here, that is not a sign of failure. It’s a reflection of the extraordinary pressure you’re under. Know that you are doing your best in impossible circumstances.

Please feel free to print, share, display, or use the guides in whatever way is most helpful to you and your community.

Here is the original post, with some updates. And thank you to MK Haber and Maria Zoco for their support on these guides.

The ripple effects of deportations

Immigration is inextricably linked to public health. Regardless of one’s political stance, understanding the health consequences and downstream effects of immigration enforcement activities is crucial for protecting community health. It’s important to understand the data and look at the bigger picture — that’s what I’m here to do.

What are ICE raids?

ICE stands for the U.S. Immigration and Customs Enforcement, a federal law enforcement agency whose mission is to enforce immigration laws within the United States and investigate activities like human trafficking, smuggling, and visa fraud.

“ICE raids” are operations conducted by ICE officers to find people who don’t have legal immigration status or have broken immigration laws. When ICE raids happen, undocumented immigrants are often detained and deported.

ICE raids have profound health effects on individuals and communities

There is a direct health impact of trauma. (More on that in a moment.) But fear alone can lead people to avoid seeking health care, such as not calling 911 during emergencies or delaying treatment until an illness becomes severe. Hospitals and ERs are critical locations for catching and treating diseases early. When care is delayed, treatments are more costly and more deadly.

In 2023, after Florida passed a law to require hospitals to ask for immigration status, 66% of noncitizens reported increased hesitation to go to the hospital (compared to just 27% of citizens).
After a similar law was passed in Alabama, visits to county public health clinics among Latino adults decreased by 25%.

But this doesn’t just impact the health of individuals who are undocumented, it affects the health of the communities as well.

Infections have the chance to spread more widely. In Los Angeles, research shows that patients who fear immigration authorities are about three times more likely to delay seeking care for tuberculosis. Without treatment, TB is contagious and can lead to severe illness or death.
Mental health impacts, like toxic stress, are not limited to undocumented immigrants; it can affect the community at large. A 2008 raid at an Iowa factory resulted in the detention of 400 people, spreading news throughout the state. A study found that in the 37 weeks following the raid, there were more Hispanic babies born with low birth weight due to stress in mothers across the community, while birth weights in babies born to white mothers remained stable.
Delayed care among extended families and communities who step up and offer support. In one study, a clinician described an example: “(My patient)…from Uganda with HIV/AIDS and end-stage renal disease was unable to consistently keep appointments for dialysis because she needed to work to support her sister’s two children after (her) sister was arrested by immigration.”

Children are especially vulnerable

There are many “mixed” status families. But families tend to behave according to the person with the least documentation — and they may forgo services that children who are U.S. citizens are eligible for.

Traumatic events like watching a parent or classmate get arrested and deported can have lasting effects on children. Even outside of acute events like raids, the prolonged stress from fear of deportation, potential family separation, and difficulty accessing essential services like health care and education can lead to toxic stress in children.

Toxic stress is the prolonged stress response in the brain and body (e.g., increases in heart rate, blood pressure, and stress hormones like cortisol). It has long-lasting effects because it can prevent normal development of neural connections in the brain.

We are hearing of families who are afraid to take their kids to school out of fear of deportation. Missing school can deprive students of more than just learning — for many, schools are one of the primary ways kids access nutritious meals, mental health services, social support, and other essential services.

These challenges are compounded by the short- and long-term financial impacts on families who lose a primary income provider due to deportation or detainment, as well as the heightened risk of children being placed in the child welfare system.

How can we support children?

Children going through immigration and separation experiences need extra support. This document from the National Child Traumatic Stress Network gives recommendations for caregivers to address the needs of children going through these events. Some key points include:

Create a safe and supportive environment: Speak calmly, reassure children, and provide comforting actions like hugging (with permission) or reading.
Address emotional and behavioral needs: Children may exhibit behaviors like irritability, clinginess, or withdrawal. These could be signs of trauma, not “bad behavior.” Encourage calming or enjoyable activities like drawing, games, or music.
Foster family and cultural connections: Support contact with family members when possible (e.g., visits, calls, or video chats). Avoid speaking negatively about family. Try to celebrate and honor cultural traditions and foods.
Provide trauma-informed care: To help manage stress, teach calming exercises like slow breathing or muscle relaxing. Limit exposure to distressing media while providing accurate, age-appropriate information about their situation.
Create a family preparedness plan: Make a plan for child care, know your rights, talk to your children, write down any important instructions like medications or allergies, and inform family members and emergency contacts.

What can educators do?

All children should have access to education. In New York, the State Education Department and the governor and attorney general’s offices have offered guidance for New York schools to help continue providing equal access, regardless of immigration status. Key points include:

Protecting student information
- The Family Educational Rights and Privacy Act prohibits disclosing personally identifiable information without parental consent (except in some legal circumstances). Student information should not be shared with law enforcement unless required by law (e.g., a lawfully issued subpoena/court order) or permitted under a FERPA exception.
- Avoid collecting immigration or citizenship status information, and anonymize such data when collected for specific programs.
- Do not collect (or ask for) Social Security numbers.
Responding to law enforcement requests
- ICE or law enforcement should only be allowed into non-public areas of schools (e.g., classrooms) when there is a judicial warrant. For any ICE request, involve district counsel immediately.
Supporting families affected by immigration enforcement
- Encourage families to update emergency contact information, including secondary contacts.
- Schools may recommend legal and advocacy organizations to help plan and establish standby guardianship.

What can clinicians do?

Many immigrant and undocumented people may be hesitant to seek medical care. Clinicians, whose primary role is to ensure patient safety, can take actionable steps to support these communities within the clinical setting. There are different laws for every state, but here are guiding principles for New York:

Ensure confidentiality and reassure patients that their immigration status within medical records is confidential under HIPAA (Health Insurance Portability and Accountability Act) and should not be disclosed, except as required by law.
- Avoid collecting or documenting any non-required immigration-related information, especially within patients’ medical records. (This is required in Texas and Florida, but not in New York.)
- Stop asking for Social Security numbers.
Address barriers to care.
- Offer telehealth options or home visits if possible.
- Help patients set up home delivery of medications.
- Connect families with resources and support, including mental health resources.
Know the legal landscape and understand patients’ rights, such as their right to emergency health care regardless of immigration status, and communicate these rights to patients.
- Stay informed about policy, like New York’s Executive Order 170, which prohibits inquiring about or disclosing immigration status unless legally required.
Train staff to respond to ICE or law enforcement inquiries. If ICE does show up:
- Obtain the officer’s information (name, badge number, etc.).
- Ask for any supporting documents (e.g., judicial warrant or subpoena). Make copies or take photos of these.
- Immediately call the hospital’s Risk Management Office or immigration liaison. They can contact proper legal channels and advise on the next steps.
- If officers take action before immigration liaisons can be contacted, take videos and photos of any enforcement actions.
- Do not try to actively help a person hide from ICE.

Providing compassionate, trauma-informed care is always critical, especially for patients who may have experienced fear or discrimination due to their status. The Trauma-Informed Care Implementation Resource Center has toolkits.

It’s also important to recognize clinician well-being and burnout. Witness to Witness is a peer support program designed by and for clinicians who care for patients affected by trauma, migration, violence, and systemic inequities.

Bottom line

Immigration raids have big impacts on the public’s health—both individually and for communities. As a community, we can take action to lessen health impacts. When we protect the health and well-being of our most vulnerable community members, we protect everyone’s health.

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health advocate. She specializes in infectious diseases, outbreak response, and emerging health threats. She has led multiple outbreak investigations at the California Department of Public Health and served as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Donnelly is also an epidemiologist at Biobot Analytics, where she works at the forefront of wastewater-based disease surveillance.

Most Georgia parents support expanding cellphone ban to high school, Emory survey finds

2026-01-30T15:47:45+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

As Georgia schools move to enact cellphone bans during the school day for students in kindergarten through eighth grade, results of an Emory University survey released this week found strong parental support to expand the ban to high schoolers.

Nearly 71% of the parents polled said they support a ban at the high school level, many citing the belief that it would help improve their children’s academic focus, in-person socializing, and mental and physical health.

Among the 29% who oppose such a ban, three-fourths cited concerns about being able to reach their child during an emergency as the top reason.

Julie Gazmararian, a professor of epidemiology at Emory’s Rollins School of Public Health who is researching how Georgia school districts implement the ban, said those concerns are easy to address: Schools can ensure they have a way to rapidly contact parents in case of emergency and that pouches or lockers where students store cellphones can quickly be unlocked.

The state’s cellphone ban for younger students will take full effect before the next school year starts in the fall, but many districts have already implemented “bell to bell” bans. Districts can choose how they limit access – requiring students to keep phones in their lockers, using locked pouches, or storing them in a dedicated place.

State Rep. Scott Hilton, a Republican from Peachtree Corners, this month filed a bill to expand the ban to high schoolers effective at the start of the 2027 school year.

Hilton said he was spurred to action by the “tremendous results” seen in districts that have adopted the ban: “Kids are socializing and interacting.”

Gazmararian said middle school students and parents in Marietta City Schools have been pleased with that school’s ban.

“We found teachers reporting that it was like a totally different school, where kids were talking to each other, they’re interacting, they’re having conversations at lunch, and in the classroom, they’re much more engaged, and they don’t have the same distraction” or discipline problems, she said.

Students also reported liking the ban and that it had encouraged them to interact more with fellow students, Gazmararian said.

Cellphone use is a public health concern for children and teenagers. Social media use is linked to being bullied, feelings of sadness and hopelessness, and increased suicide risk in youth, according to 2023 data from the Centers for Disease Control and Prevention.

“The alarming rates of people with depression and anxiety and loneliness are all public health issues,” Gazmararian said. Excessive cellphone use also negatively impacts students’ sleep and physical activity.

Social media lead children and teenagers to compare themselves to others in an unhealthy way, Gazmararian said. “It’s such a tender age,” she said of the teenage years.

Parents mirrored some of those concerns in the Emory survey. Chief concerns driving support of the school day cellphone ban included the amount of time children spend on their phones (53.7%); that children are distracted from sleep, school, or physical activity (51%); and that they may be accessing harmful content (50.7%).

Other reasons parents cited for opposing a ban were that it should be a parental choice, that students need phones for health tools or schoolwork, and the idea that students need to learn responsible use.

Only 11.9% of parents said they had no concerns about their children’s cellphone use.

Emory’s data come from a population-representative survey of 1,002 Georgia parents conducted from Oct. 30 to Nov. 24 by the Emory Center for Child Health Policy.

There are steps districts can take to make the transition to a no-cellphone policy easier for students, Gazmararian said. Those include giving parents and students plenty of advance notice, collecting input from parents and students, and establishing clear procedures for handling emergencies.

School mental health staff need to be prepared to work with students who become anxious because they can’t reach their parents or for other reasons, she said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

When suicidal calls come in, who answers? Georgia Crisis Line response rates reveal gaps

2026-01-28T09:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Kaitlin Cooke of Cartersville, Georgia, was contemplating suicide when she started calling a statewide mental health crisis line in 2018. She said she would sneak outside and call the hotline behind her car, where her boyfriend would not hear her.

The counselors who answered her calls were there for her when no one else was, she said. Each time she called, they spoke to her for at least 45 minutes. And they told her that life “does get better.”

“If it weren’t for this resource, I might have been a statistic,” said Cooke, now 31, who found a local therapist.

Starting in March, the call response record for that resource, the Georgia Crisis and Access Line, and its newer national counterpart, the 988 Suicide & Crisis Lifeline, plummeted in the state. The 988 line was created during President Donald Trump’s first term.

National data show Georgia is one of several states that have struggled to keep their rates of disconnected or rerouted 988 calls low. Disconnected calls typically involve the caller hanging up, possibly after a long wait time. States are largely responsible for funding and staffing their 988 systems, with some money from the federal government. Mental health experts said proper funding for the 988 system in a state, through a well-staffed response network, can influence whether a caller is connected to a local counselor — or chooses to hang up.

The future of mental health services appears uncertain amid massive changes from the Trump administration, including Medicaid cuts that could limit access to care. The cuts could also lead states to consider reducing their allocations to crisis lines, said Heather Saunders, senior research manager for the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News.

The stakes couldn’t be higher for callers experiencing severe mental health crises.

“Some of the callers are actively experiencing suicidal thoughts,” Saunders said. “Sometimes they actively have a suicide plan, and it’s a very urgent situation.”

State official raises alarm over abandoned calls

Georgia has contracted with Carelon Behavioral Health, a unit of insurance giant Elevance Health, to run its crisis lines. When Carelon dropped a subcontractor that managed staffing the lines, performance plunged. Abandoned calls spiked, which means more callers were hanging up or disconnecting before a counselor answered the phone, Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, pointed out in a letter to Carelon.

The state requires a call abandonment rate of 3% or less, and, Tanner wrote, the current rate was 18%. After sending the letter, the state narrowed its definition of abandoned calls, lowering the current rate. The state now counts only calls disconnected after being on hold for more than 30 seconds and not those rerouted to backup centers.

Georgia nurses say fear of discipline keeps them from seeking addiction treatment

Carelon officials have acknowledged the dip in performance. They said it reflected a “necessary” transition from the company’s vendor and that they were hiring more staff to ensure the crisis lines could handle the demand. Carelon spokesperson Hieu Nguyen said the company is “committed to ensuring that every Georgian in crisis can access help through 988,” noting that calls not answered locally are routed to national backup centers.

With the help of some federal funding, Georgia is paying Carelon $17 million annually to manage 988 and its predecessor, the Georgia Crisis and Access Line, which is still operating. Crisis calls go to the same response team, whether someone calls 988 or the original state line. Carelon and state officials declined to disclose how much of the money went to the subcontractor, Behavioral Health Link, with Carelon saying it is proprietary information. The state can extend its contract with Carelon to 2032.

Camille Taylor, a spokesperson for the state Department of Behavioral Health and Developmental Disabilities, said in December that Carelon had improved its call response performance but that the state continues to monitor the company’s answer rates.

Many Georgia calls routed to national call center

Launched in 2022, the national 988 Suicide & Crisis Lifeline connects people experiencing mental health problems, emotional distress, or alcohol or drug use concerns to trained counselors. The free hotline, with the three-digit number mirroring the ease of dialing 911, aims to help avert mental health crises and reduce suicide risk. It also supports people who call for someone they care about.

“All behavioral health is having enormous challenges in terms of staffing,” said Margie Balfour, an Arizona psychiatrist and a member of a national 988 advisory committee. Being a crisis line counselor “is a very stressful job,” she said. “You’re talking to people at the peak of their crisis.”

In December, Georgia ranked near the bottom of the 50 states in percentage of calls answered that it kept in state, according to Vibrant Emotional Health, which administers the 988 line nationally. A high number of Georgia calls were routed to national call centers, data showed.

The latest national data also showed how different the response times to a 988 call can be. In December, it took one second on average if someone called from Mississippi. It took 74 seconds for a caller from Virginia.

While the unofficial industry target rate for answering in-state calls is 90%, more than half the states fell below that mark in December, according to the national data. In Georgia, the tracking data for 988 showed that more than 80% of crisis calls were answered within the state — until March, when the number dropped to 73%. Then it fell again in April, to 62%. The rate rose to 72% in October and reached 79% in December.

Local counselors “should be more familiar with the state infrastructure, mental health system, and resources that are available to people who live in the state,” Saunders said.

Pierluigi Mancini, interim president and CEO of Mental Health America, said it’s unlikely that an out-of-state counselor would know much about that state’s mental health system and providers. The service also sends many predominantly Spanish-speaking callers to out-of-state call centers, possibly hindering their connection to local help, Mancini said.

Since the 988 rollout, the volume of calls, texts, and chats to the crisis line totaled more than 19 million by November, according to the Substance Abuse and Mental Health Services Administration. A study found that with the national predecessor to 988, the National Suicide Prevention Lifeline, most suicidal callers who were later interviewed said their call helped stop them from killing themselves.

More than 49,000 Americans died by suicide in 2023. Nearly 17 million Americans ages 12 and older said in 2024 they had seriously thought about suicide in the previous year, according to the National Survey on Drug Use and Health.

For Generation Z adults, the oldest of whom are now reaching their late 20s, suicide is taking more lives than a decade ago when millennials were the same age, according to a Stateline analysis of federal death statistics. The largest increase in suicide rates for the age group was in Georgia, which jumped 65% from 2014 to 2024.

Mike Hogan, a consultant who ran mental health systems in three states, said recent Georgia data reflect “a bungled transition. It looks like performance fell off a cliff.”

For people calling a crisis line, he said, “counselors, with the right training, can talk people down and away from the suicidal crisis.”

Balfour noted that 988 has bipartisan support. The system can be improved, she said, emphasizing that it’s still an important resource that’s effectively helping people in crisis.

“988 is a success,” Balfour said. “And it’s work in progress.”

Andy Miller is a consultant for Healthbeat and a writer for KFF Health News. Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Federal funding cuts threaten help for NYC domestic violence survivors

2026-01-27T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Federal funding cuts under President Donald Trump’s administration are putting domestic violence survivor services at risk across New York City, particularly for nonprofits that provide culturally specific, trauma-informed care to immigrant and marginalized communities.

Advocates and service providers warn that the cuts could lead to reduced counseling services, longer wait lists, and fewer safe options for survivors — outcomes that public health experts say will have lasting consequences for physical and mental health.

Last February, the North Brooklyn Coalition Against Family Violence, an organization that serves survivors of domestic violence and sexual assault within Latinx, immigrant, and LGBTQ+ communities, applied for federal funding as it has every year since the organization was founded in 1998.

However, the grant language had changed in ways that felt exclusionary and potentially dangerous for clients, said Leana Pardo, the coalition’s executive director.

“I contacted the rest of the team immediately,” Pardo said. “It felt like a direct attack on the people we serve.”

How the Violence Against Women Act is affected

The Trump administration has argued that certain Department of Justice grant programs have funded initiatives tied to diversity, equity, and inclusion, feminist organizing, and what it characterizes as “cultural Marxism.” The administration has characterized these programs as progressive initiatives rather than ones focused on combating crime and protecting U.S. citizens.

Those priorities have translated into cuts and revised guidelines affecting programs funded under the Violence Against Women Act, a critical resource for survivors of domestic violence.

In New York, advocates say the survivors who rely on services offered in their native languages are likely to be among the first affected.

Organizations like North Brooklyn Coalition serve clients who speak languages other than English, requiring bilingual staff, translated materials, and culturally informed care.

Organizations like North Brooklyn Coalition serve clients who speak languages other than English, requiring bilingual staff, translated materials, and culturally informed care. Those needs increase operating costs, making federal support especially critical.

The revised grant guidance included terms such as “human trafficking,” “crimes linked to illegal immigration,” and “cartel operations,” language that raised concerns among providers that survivor services could be conflated with immigration enforcement or criminal investigations.

Pardo said her primary concern is client safety. About 21% of the coalition’s clients are undocumented, recipients of Deferred Action for Childhood Arrivals, or holders of U visas, an immigration protection program available to certain crime victims who assist law enforcement.

The new guidelines emphasize anti-trafficking efforts and include language linking trafficking to illegal immigration. Pardo worries that reporting requirements could pressure organizations to share information that puts survivors at risk.

“We’re concerned that under the current federal administration, this could lead to requests for confidential client information during reporting,” she said.

Under standard Office on Violence Against Women rules, organizations submit semiannual reports detailing how funds are used and what services are provided. With the updated language, Pardo fears increased scrutiny that could expose survivors — particularly recent arrivals, including Venezuelan clients who were trafficked for sexual exploitation before reaching the United States.

With funding shrinking or if reporting conditions become untenable, organizations may be forced to turn survivors away.

‘Domestic violence is a public health issue’

Public health experts emphasize that domestic violence is not only a criminal justice issue but a major health concern.

“These funds are not wasteful,” Pardo said. “Domestic violence is a public health issue.”

Research backs that up. The World Health Organization classifies domestic violence and sexual assault as public health crises due to their severe physical, mental, and reproductive health impacts.

ICE crackdown heightens barriers for immigrant domestic violence survivors

One in 3 Latinas will experience intimate partner violence in her lifetime, and 1 in 12 experienced domestic violence in the past year, according to Esperanza United, an organization focused on ending gender-based violence.

Dr. Denis Nash, an epidemiology professor at CUNY’s Graduate Center, said funding cuts disproportionately harm communities that are already facing barriers to care.

“Vulnerable communities that already struggle to access public health services are the first and worst affected,” he said. “Cuts like these reduce prevention, de-escalation, and safe exits from dangerous situations.”

Fewer resources available to meet higher demand

The Department of Justice supports survivor services primarily through the Office on Violence Against Women and the Crime Victims Fund, which distributes money under the Victims of Crime Act. Funds are allocated to states based on population, and in New York, the Office of Victim Services distributes grants to shelters, hospitals, and community organizations.

While some organizations have avoided direct cuts so far, the broader funding picture is grim.

“We’ve been fortunate not to lose funding outright,” said Kristen McGuire, development director for the Domestic Violence Project at the Urban Justice Center. “But we’re also not receiving new funds, even as demand continues to grow.”

According to the New York State Coalition Against Domestic Violence, many programs have lost staff due to funding shortfalls. That translates into fewer shelter beds, shorter hotline hours, and fewer advocates available to help survivors obtain orders of protection.

The organization said that 90% of the funding New York state uses to support domestic violence services comes from the federal government.

Data from the National Network to End Domestic Violence show that domestic violence programs in New York assist about 67 survivors every hour. Yet at least 1,717 survivors were unable to access services due to lack of funding, staffing, or resources.

New York state trying to fill gaps

The cuts are not just financial but political. New York Attorney General Letitia James has sued the Department of Justice, arguing that the federal government is unlawfully conditioning VOCA funding on cooperation with immigration enforcement.

According to the lawsuit, those conditions could undermine trust in survivor services and deter people from seeking help.

Gov. Kathy Hochul has attempted to offset some of the damage, allocating $100 million in state funding to cover anticipated VOCA losses. In January 2025, the Office of Victim Services opened applications for a three-year, $379 million state grant cycle — the largest in its history.

State Assemblymember Maritza Dávila, who represents North Brooklyn in Albany, said lawmakers are trying to fill federal gaps, but she acknowledged limits.

“We’ll do everything we can in Albany to continue supporting these organizations,” Dávila said. “Our priority is our community.”

Still, advocates warn that state funds alone cannot replace federal support, particularly for smaller, culturally specific organizations that rely heavily on grants to operate.

For decades, federal funding has been a financial backbone of domestic violence survivor services. Without it, providers say they face impossible choices: Reduce services, lay off staff, or close programs.

For survivors, the consequences can be devastating.

“These programs aren’t optional,” Nash said. “They are essential to safety, recovery, and long-term health.”

If you or someone you know is experiencing domestic violence, call New York State’s confidential hotline at 1-800-942-6906 or text 844-997-2121. Counselors are available 24/7 in Spanish and many other languages.

Ilvea Lezama is a freelance reporter in New York.

Georgia nurses say fear of discipline keeps them from seeking addiction treatment

2026-01-22T18:02:24+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Georgia nurses who have struggled with – and even overcome – addiction want to see the state adopt a less punitive approach to discipline that would remove some of the obstacles to treatment and employment.

A bill before the state legislature that has broad bipartisan support as well as support from the state nursing board would change how Georgia handles such cases. The bill’s supporters say it’s an important tool to keep nurses in the workforce amid a nursing shortage, and an acknowledgement that addiction is a disease, not “a moral failing.”

Healthbeat spoke to five nurses who have experienced addiction and to representatives of recovery organizations. They described how Georgia’s disciplinary system deterred them from seeking early treatment for fear of losing their licenses and their jobs.

That’s because to get or renew a license, nurses must report treatment for alcohol or substance abuse within the past five years on the application. The acknowledgement triggers a lengthy, public, and costly disciplinary process.

Courtney Robinson, who works at Northeast Georgia Health System, fought an alcohol addiction for years. She wanted to get treatment but worried that doing so would result in losing her license. When she finally got sober, she answered the question honestly during her license renewal, acknowledging a past addiction and stint in rehab.

That started a process of establishing a consent order with the state nursing board. Consent orders are posted in a spreadsheet and in a searchable database on the Board of Nursing’s website, allowing anyone to look up disciplinary actions for a particular nurse.

Robinson’s order requires that she participate in weekly support groups as well as regular and random drug screening for five years. It also requires quarterly reports from employers to the nursing board and restricts Robinson from working in some roles, including assignments through a nursing agency and in-home nursing.

“As far as jobs, it is very difficult, unless you have some connections or know somebody, to find a decent nursing job with a consent order,” Robinson said.

Nurses said the costs of medical evaluations and repeated drug testing can be a heavy burden for those working through a consent order. Ashley Walden, an occupational health nurse in Moultrie, said the annual costs for exams, drug testing, and program fees add up to more than $4,000 a year for her.

Ashley Walden is an an occupational health nurse in Moultrie, Georgia.

The proposed alternative to discipline program would make it easier and less punitive for nurses to get help with addiction.

Forty-four states have such systems in place, according to the National Council of State Boards of Nursing. The programs involve support and supervision, and they are typically confidential, unlike Georgia’s open process.

“The alternative to the discipline program would enable the nurse to be monitored, to continue to practice, to ensure the public safety, because they are under this specific monitoring contract, but it doesn’t show up as a disciplinary action against the nurse’s license,” explained Jim Cleghorn, deputy chief policy officer at the council and a former executive director of Georgia’s nursing board.

“If they violated any provision of that contract, then it can roll over into the more traditional discipline model,” Cleghorn said.

State nursing board, legislators support alternative to discipline

The Georgia Board of Nursing supports adopting an alternative to discipline program, said Natara Taylor, the board’s executive director.

“An ATD Program helps prevent unsafe practice by encouraging early treatment and monitoring, allowing nurses to recover while protecting the public,” Taylor said. She said the board and nursing organizations have been working “for years” to try to get the legislation and funding to establish such a program.

The nursing board took a total of 238 disciplinary actions in 2024, but it isn’t clear how many of those were related to alcohol or substance use. The Georgia Nursing Association, the state’s largest professional nursing association, sees 200 to 250 nurses in its Peer Assistance Program for addiction at any one time, the program’s Executive Director Felicia Chatman told Healthbeat.

A bill to establish an alternative to discipline program got unanimous approval in the state House last year. But it stalled out in the Senate and didn’t get a floor vote before the session ended.

The bill’s sponsor, Rep. Ron Stephens, a Savannah Republican who is also a pharmacist, said the legislature just ran out of time.

Because this is the second of the state’s two-year legislative session, the bill will start in the Senate, where Stephens expects it will be considered in mid-February. If the Senate approves the bill, it would then head to Gov. Brian Kemp’s desk for his signature.

“I don’t want it to fall by the wayside,” Stephens told Healthbeat on Wednesday.

Stephens said doctors and pharmacists have similar programs that have worked well. He’s not sure why nurses don’t, but he’d like to “close the loop” for them. The bill would also establish a similar program for professional counselors, marriage and family therapists, and licensed social workers, all of whom are governed by a separate board.

“It’s an effort to get somebody that has a problem to come forward, rather than continually hide the problem … so that a patient might get hurt,” Stephens said. The goal is “to get these people back into the workforce and being fruitful contributors.”

Georgia is projected to fall short of its registered nurse need by 25,110 RNs by 2038, according to a December analysis from the National Center for Health Workforce Analysis, leaving the state with 1 in 5 projected positions unfilled.

Recovery and nursing advocates speak at the state Capitol about a proposal to reform the state's discipline process for nurses who are fighting addiction.

Stephens said the alternative to discipline program isn’t expected to raise costs for the Board of Nursing because participants will pay for their own drug testing and other services. The board could also outsource the management of the program to another entity under the bill.

Nurses want ‘a safer environment’ for conversations about addiction

States began adopting alternatives to discipline in the early 1980s, starting in Florida, said Timothy Arehart, senior policy adviser at the NCSBN.

“It’s kind of a shift in culture for the U.S. overall, in which you went to more of a compassionate, non-punitive idea,” Arehart said. “It’s due to advances in the perceptions of substance use disorder and alcohol use disorder as a disease, as opposed to more of a moral failing.”

Robert Taylor is a former methamphetamine addict who got sober more than two years before enrolling in nursing school.

Though he passed his nurse licensing exam in January 2025, Taylor hasn’t been able to work as a nurse because of a past arrest for drug possession. The state nursing board required him to attend an intensive outpatient treatment program and complete other requirements before he could start practicing under a three-year consent order.

Taylor said his experience at Georgia Pines, a community service board that provides mental health services and treatment for addiction, inspired him to become a nurse. He’s been employed there as a medical technician while waiting for his license to be sorted out and will finally start work there as an RN in early February.

“I knew there would be some type of barrier, but I had no clue it would be so extensive,” Taylor said.

Like Robinson, he wants to see the system treat nurses in recovery with more leniency.

“Be just a little more lenient on your people like me that have actually shown that they’ve made a change in their lives,” Taylor said.

Cori Fletcher, a licensed practical nurse who works at a recovery center, said she’s grateful for the consequences imposed by the nursing board because they helped her become the nurse she is today. Still, the punitive system has limits, she said.

“The consent order was a no-go, and they didn’t want to hire me because of that,” she said of trying to find work during the disciplinary process. Now she is going back to school to become a registered nurse.

“What I would like to see different is a safer environment for these conversations to be had, a safer environment for nurses to feel like they can discuss these things without losing their job,” Fletcher said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Georgia lawmakers return as federal health funding uncertainty looms

2026-01-09T17:34:31+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

As uncertainty swirls around key health policy issues in Washington, Georgia lawmakers will return to the Gold Dome on Monday to plan next year’s budget and consider public health proposals that died on the vine last year.

The Georgia General Assembly’s main task will be deciding how to allocate state funds for the remainder of this fiscal year, which ends on June 30, and for fiscal 2027. This summer, Gov. Brian Kemp instructed state agencies to maintain current spending levels as part of “conservative fiscal management.” But that could be complicated by potential cuts to funds for health and other social service programs in Congress.

Here are three public health issues Healthbeat will be watching during this year’s session.

Georgia public health funding uncertain as federal budget in limbo

Each year, the state legislature takes up two budget bills. The “small budget” makes tweaks to the current year’s budget, while the “big budget” lays out the budget for the next fiscal year, which starts in July.

This year, Georgia’s “big budget” that would start on July 1 could be complicated by federal funding cuts to the U.S. Centers for Disease Control and Prevention. The state Department of Public Health receives about half of its nearly $940 million in funding from the federal government, much of it via the CDC.

If there are cuts to Georgia’s federal funds, “we will have to look at our budget and look for funds to put and fill holes,” said Rep. Darlene Taylor, the Thomasville Republican who chairs the state House’s appropriations health subcommittee.

Georgia ACA enrollment falls as federal changes push prices higher

For example, most of the state’s funding for HIV prevention work (nearly $26 million) comes from the CDC, with only $1.1 million coming from state funds for work providing pre-exposure prophylaxis drugs in Georgia, according to DPH spokesperson Nancy Nydam Shirek.

The federal budget is under negotiation in Washington, and it’s not clear when Congress will pass the spending plan and what it will include.

Taylor said she wants to make sure the state Department of Public Health and county health departments have the funds needed to do important educational work on topics ranging from diabetes to the harms of smoking. Still, she said, it will be hard to plan the state’s budget until more is known about the federal budget.

“I’m concerned about it. We are all watching it, and I’m sure the right decisions will be made when it comes to making sure that our people of Georgia have access to health care,” Taylor said.

Licensing for community health workers

A bill to establish licenses for community health workers got close to crossing the finish line last year but ultimately failed to get a needed floor vote in the state Senate.

Taylor, who sponsored the bill, said she plans to push for its approval this year.

Community health workers are similar to health care navigators and, increasingly, employed by health systems in Georgia, among other organizations. CHWs are not medical professionals but typically have close ties to the communities they serve, either because they live in those communities, come from similar cultural or linguistic backgrounds, or have experience with particular diseases like diabetes or cancer.

Georgia has training programs for community health workers. The bill would regulate standards for training and certification, overseen by the state DPH.

Certification could help pave the way for CHWs to be paid by the state Medicaid program and other health insurers. The hope is that CHWs could help Georgians stay on track in managing health conditions like diabetes or asthma and more easily navigate a complex health care system.

Helping people in recovery – especially nurses

Recovery advocates want to see Georgia join 44 other states in creating an “alternative to discipline” program to help nurses who are struggling with addiction.

Currently, nurses must undergo what many consider a “punitive” and public system before the state nursing board if they admit to seeking help with substance abuse. Georgia differs from most other states, which employ a more layered system that allows nurses a way to seek help without jeopardizing their licenses – typically called an “alternative to discipline” system.

The hope is that the recovery-focused alternative would allow nurses to get help sooner without fear of losing their right to practice – and their livelihoods. Nurses in recovery told Healthbeat the current system deterred them from getting help for alcohol or drug addiction even when they wanted it because they knew they would face disciplinary measures that could stop them from working.

‘Terrified’ to seek help: Georgia nurses can lose license if they admit addiction. Advocates want to change that.

A bill to establish the alternative system in Georgia failed to get a Senate floor vote last year after it was passed unanimously by the House. Rep. Ron Stephens, a Savannah Republican who sponsored the bill, said the legislative clock ran out, but he hopes it will get early Senate approval this year. The legislation will be taken up by the Senate when the session opens next week.

Recovery advocates also want to see the legislature implement uniform regulations for recovery residences, often called halfway houses, to ensure quality, said Laurisa Guerrero, executive director of the Georgia Council for Recovery.

A bill to do that failed to pass last year, but a study committee met to look more closely at the issue during the legislative “off season” and recommended creating licenses and quality measures for these residences that would be administered by the state Department of Behavioral Health and Developmental Disabilities.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Hochul proposes mental health first-aid training for all New York 10th graders

2026-01-06T13:42:53+00:00

This story was originally published at Chalkbeat. Sign up for Chalkbeat New York’s free daily newsletter to get essential news about NYC’s public schools delivered to your inbox. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

New York Gov. Kathy Hochul wants to make mental health first-aid training available to every 10th grader in the state.

The plan – announced Monday in a preview of the governor’s State of the State proposals – would expand a program that teaches students to recognize and respond to mental health and substance use challenges among friends and peers.

The Teen Mental Health First Aid program is a 4.5-hour course developed by the National Council for Mental Wellbeing, a nonprofit. It teaches teens to identify signs that their peers are struggling, understand the effects of school bullying and violence, and talk with friends and classmates about mental health. The program also gives young people tools to monitor and care for their own well-being.

As Healthbeat reported in September, researchers at Johns Hopkins University found that students who took the first aid training were more likely to intervene appropriately and empathetically with peers facing mental health challenges.

“We hear all the time, ‘Our teens are in crisis, our teens are anxious. But if you empower them with tools to have conversations about mental health, you see the impact right away,” said Katie Oldakowski, senior director of training and programs at Mental Health Association in New York State, which currently administers the first-aid training program in 43 schools.

New York state high schools train teens in mental health first aid

“When we give teens language to talk about mental health, we build resilience,” Oldakowski said.

New York state invested $10 million in the Teen Mental Health First Aid program in July, reaching close to 4,850 students since then, Oldakowski said. Under the governor’s new proposal, the program would grow to include 180,000 students annually. The governor’s announcement did not say how much the expansion would cost, and her office did not immediately respond to requests for information.

The training initiative is part of Hochul’s ongoing agenda to expand access to mental health support in schools. In the past five years, New York has increased the number of state-supported, school-based mental health clinics by nearly 50%, bringing the total to 1,300 clinics, based in 25% of the state’s public schools. Monday’s announcement did not include a commitment to increase funding for school-based clinics.

Any effort to expand school-based mental health support “is a great step in the right direction,” said Alice Bufkin, an associate executive director at the Citizens’ Committee for Children of New York, an advocacy group calling for increased investment in mental health service for kids and teens.

Experts warn mobile sports betting could be gateway to gambling crisis for young men in New York

However, schools and school-based clinics continue to struggle to pay for much of the essential work they do, Bufkin said. For example, clinics typically cannot bill for providing treatment to undocumented students, who are not eligible for Medicaid. Nor can they be reimbursed for work like helping teachers manage students with behavioral challenges, or intervening when students are in emotional crisis.

“Our state has a long way to go to fully support students in schools and communities. We are still facing a behavioral health crisis for children and families throughout New York,” Bufkin said.

In other efforts to tackle the teen mental health crisis, Hochul is trying to keep kids safe from social media-related threats and online gaming platforms by expanding age verification requirements, disabling AI chatbot features, and including “privacy by default” settings, giving parents control over who can connect with young people under the age of 13.

Abigail Kramer is a reporter in New York City. Contact Abigail at akramer@chalkbeat.org.

An addiction counselor’s ‘aha’ moment: When even saving a life isn’t enough

2025-12-22T14:15:01+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 3 at Manuel’s Tavern in Atlanta. Watch the full show here. Sign up to receive Healthbeat’s free Atlanta newsletter here.

I’ve been working in addiction counseling for a long time. And every now and then, a story sticks with you. This one — this one stuck.

I had a client who was referred to us from another agency here in Atlanta. Homeless. Strong opioid addiction. He was getting Suboxone through a county program at 10 Park Place. That’s part of the Fulton County Health Department. He’d come in every couple of weeks to get his dose.

We kept his medication locked up — two locks, two keys. That’s how we do it. When clients are in treatment, they bring in a 30-day supply of whatever they’re on — blood pressure meds, HIV meds, mental health meds, you name it. We monitor it, make sure they take it right, and lock it back up.

This guy — he was from South Georgia. Used to climb trees for a living. Had a whole Facebook page full of pictures of him way up in the branches, cutting limbs like it was nothing. Strong guy. You could tell he’d worked hard his whole life.

But addiction doesn’t care how strong you are.

Word got back to me that he was selling his Suboxone – that’s a medication used to treat opioid use disorder. Or maybe overusing it. Either way, I had to let him go out to get it. That’s part of the process sometimes.

Then one day, he’s in my office. I’m sitting with a veteran client, and my guy is slumped over at the desk. I hear him snoring, but something’s off. I tell the vet, “Wake him up.” Still hadn’t hit me yet.

The vet nudges him — and he slides out of the chair.

I’m like, “Lord, he’s going into cardiac arrest.”

I jump into action. Start CPR. If you’ve never done CPR by yourself — it’s a workout. I’m on speakerphone with 911, rotating compressions with the vet, yelling down the hall for someone to bring me the defibrillator.

But there’s no one. No staff. No other clients. Just me and the vet.

Finally, the ambulance arrives. They revive him. He’s on the stretcher, heart monitors on his chest, and the first thing he says is: “Mr. Smith, you saved my life. I’m never doing dope again.”

I believed him. I wanted to believe him.

But maybe 10 days later, he’s back. High as a kite. Shirt off. Causing a commotion in the parking lot. It’s wintertime.

I go out to talk to him. I say, “What about what you told me? That I saved your life?”

He looks at me and says, “I don’t remember that.”

I said, “That’s okay. But I’m gonna have to ask you to leave the property. You can’t be out here half-naked, making a scene.”

That was the last time I saw him.

And here’s the thing — this isn’t rare. But addiction is a disease. It’s not a choice. It’s not a moral failure. It’s a cycle. And sometimes, even when you save someone’s life, they don’t remember. Or they’re not ready. Or they’re just too deep in it.

But we keep showing up. Because every person who walks through our doors deserves another chance.

Johnny Smith is a certified addiction counselor and substance abuse case manager at Mercy Care, where he helps guide others through the same journey he once walked. A former top-ranked basketball player in Georgia and professional athlete overseas, his life took a dramatic turn due to addiction. After years of struggle, he found recovery at the Salvation Army, where he now also serves as a part-time chaplain.

A social work story: How the smallest human connection can shift the course of a life

2025-12-15T14:50:31+00:00

Early in my career, I was a social worker in Manhattan, helping older adults navigate life’s challenges. I had studied social service administrative practice at school and wanted to make big systems work better for people. But to do this I knew I first needed to “live” inside one to understand it.

The walk-in center where I worked was a converted storefront — a cramped space with nine desks and little room for privacy, but full of purpose and always teeming with people. My desk was just 10 feet from the door, with the waiting area tucked in between, and spitting distance from the receptionist, who would put calls on hold and then call out as if we were fields apart, “You’ve got a call on line 3!”

Many of the people I served shared similar struggles: loneliness, fading social connections, and confusion with the systems meant to help them. It was a humble, imperfect place, but it taught me something important, especially at the start of my career. We had scarce resources, there were no frills (the bathroom door hit the bookkeeper’s desk every time!), and we were met with constant challenges. But every day we showed up to help people figure things out.

One day in October, a little over a year in, something happened. I emerged from the stifling heat of the subway and felt the crisp fall air snap into my lungs. As I walked with the familiar waking rhythm of the city swirling around me, I thought of fall in New England, when green leaves always gave way to brilliant reds and golds that were swept away by a gust of wind only to gently fall and settle as a waiting pile that would elicit shrieks of joy from bounding children. That cycle was and is still a simple, natural, and predictable one; one where each action yields another, and every aspect of life is connected.

That October morning, my mind drifting with the leaves, I turned the corner to my workplace and stopped short. There, perched on the stoop in front of me was James — head tucked, body curled in on itself, rocking slightly, and oozing sadness.

James had been coming to the center for about six months. He had lost his partner of 20 years to complications from AIDS, and though he came in first for help with a heating issue, he regularly returned with small but compounding needs — each one seeming too big to handle, too confusing to navigate, too much to deal with. With each visit, James talked, and I listened to his stories of love, loss, and grief. I could see he had a growing sadness that was pulling him down like quicksand, slow and deliberate in its lasting grip. I saw it happening, but I struggled with what to do to “fix” it.

When I saw him that morning, wound tight with despair, I ushered him inside and sat with him. He cried; I listened. When his sobs finally slowed, he began to speak. The words he whispered that day have stayed with me ever since:

James told me he had woken that morning in the stillness of his life and thought of suicide. He dressed and walked to the stairwell leading to his building’s roof and stood there, staring upward. He put his foot on the first step and thought: I can go up to the roof and jump, or I can go talk to Aliki.

There were mornings after that day when I would arrive at work wondering, Will today be the day James chooses the roof? I think often of the simple power of that lesson for me. It was when my job became my purpose. When I realized I would carry an enormity and an intimacy in service to others. When I realized that the smallest human connection could shift the course of a life.

Now, years later, after many more years in public health service, I reflect on that time — on the tiny office, scarce resources, and endless challenges — I am reminded that the most powerful system of all is not born from policy, or organizational design, or quick fixes. It is in the simple, natural, predictable actions.

It lives in the smallest moments, the listening without fixing, the quiet power to make a difference, one person at a time. It is the shared joy of jumping in a pile of leaves and shrieking with glee.

Aliki Pappas Weakland has over 25 years experience in social services and public health. She currently serves as an associate director in the Centers for Disease Control and Prevention’s Office of Readiness and Response. Among her degrees is an MPH from Emory University’s Rollins School of Public Health.

Meeting ‘Ms. Mary’: The call that changed my shift – and my life

2025-11-24T12:00:00+00:00

“Grady Unit 695, respond to Metropolitan Parkway …”

When it comes to emergency medicine, unpredictability is part of the job. You never know if the next call will be a heart attack, a car crash, or a cry for help that no one else knows how to answer.

That morning, the radio crackled with a call that seemed routine enough: “52-year-old female off her medication, flashing drivers, walking in and out of traffic.”

It was my third hour into a 13-hour shift at Grady, one of the largest public hospitals in the South. My partner and I had a system: He drove, I handled behavioral emergencies. That division wasn’t random — it was personal.

My mother had lived with schizophrenia until her death at 42. In the 1980s, no one spoke openly about depression or psychosis. People just said my mother was “crazy.” I still remember her walking down Albany Avenue in Hartford wearing a pink tutu and white leotard, smiling at strangers who didn’t understand. I was too young to see that she wasn’t dangerous — she was sick, and society didn’t know what to do with her.

On the way to Metropolitan Parkway, all I could think was: Please, don’t let this woman be wearing a tutu.

Meeting Ms. Mary

When we arrived, Ms. Mary stood near a weathered Cutlass Supreme, her yellow sundress dancing in the breeze. She was poised, articulate, and surprisingly self-aware. “My daughter’s getting on my nerves,” she told us. “I need to go to Georgia Regional for 30 days.” Her honesty made me smile.

I invited her into the back of the ambulance, where it was cooler. As I checked her pulse, she explained that she had schizophrenia, high blood pressure, and borderline diabetes. She’d stopped taking her medication because it made her feel off-balance — something I’d heard before, and something I understood.

Then, with the blunt curiosity that often comes with familiarity, she looked me up and down and asked a question about my sexuality — one that could have stung in another setting. But her tone wasn’t cruel; it was matter-of-fact. Before I could respond, she added, “My grandson’s gay, too. And I love him. When we walk down the street, he holds my hand. Don’t let these folks bother you, baby. You just be yourself.”

The tension in that ambulance dissolved into something like grace.

A mirror in the back of the ambulance

Ms. Mary didn’t know she was speaking to someone who had spent a lifetime wrestling with identity. I’d always been aware of my otherness — the way I walked, talked, and carried myself. At 6 years old, a cousin once asked, “Why do you walk like that? You walk like a girl.” Later, my grandmother, whom I loved deeply, told me I had “a spirit” inside me — one I should pray for God to take away. I didn’t understand then what that spirit was, only that it seemed to make people uneasy.

Her words filled me with confusion. How could I pray away something that felt natural? Something that was, in fact, me? Years later, in the back of that ambulance, Ms. Mary unknowingly answered my grandmother’s question. She told me, without apology or hesitation, to live in my truth. Her message — “You just be yourself” — felt like the permission I’d been waiting my whole life to receive.

Beyond the emergency

After that call, I couldn’t stop thinking about the deeper patterns I saw every day. So many people like Ms. Mary were cycling in and out of emergency rooms, never getting the long-term care they needed. So many families, like mine, were left to cope alone. Too many conversations about health stopped at the body and ignored the mind — and the structural issues that shape both.

Being an EMT taught me to treat the crisis in front of me. But I began to realize that the bigger work lay in preventing the crisis before it started. That’s when I found my way to public health. Public health asked the questions that had been haunting me all along: Why do people like Ms. Mary fall through the cracks? Why don’t families like mine get the help they deserve? Why do stigma and silence still have such power over who gets well — and who doesn’t? I wanted to do more than respond to emergencies. I wanted to change the conditions that caused them.

‘You’ve got work to do’

Months later, I saw Ms. Mary again. I was sitting at a red light in Atlanta’s West End when I spotted her — black mini-skirt, red sandals, same confident stride. I rolled down my window, waved, and called out to her. She turned, met my eyes, and said with a knowing smile: “Don’t be late, baby. You’ve got work to do.”

Then she kept walking. Her words have stayed with me. Because she was right — I do have work to do. Work that honors my mother. Work that lifts people like Ms. Mary. Work that challenges the systems that silence the vulnerable and stigmatize the misunderstood.

That single 911 call didn’t just change a shift — it changed my purpose. That’s why I chose public health: not for the prestige, but for the people. For those who walk through the world labeled as problems when, really, they are prophets — reminding us all what care should look like.

Anaré V. Holmes is a firefighter with the Atlanta Fire Rescue Department and an award-winning journalist. He has been honored by the state of Georgia for excellence in trauma care.

A flu surge, NYC overdose decline, and a shift in emergency mental health services

2025-11-21T17:00:00+00:00

There’s a lot to cover before the holiday next week, so let’s jump right in.

Infectious disease ‘weather report’

Flu: Flu is increasing quickly. The most recent data show that cases and hospitalizations in the state have increased by 78% and 53%, respectively. In New York City, emergency department visits for the flu rose by 104%.

Cases of respiratory viruses in New York.

Earlier this week, YLE National reported on a new flu virus mutation that could potentially lead to a bad flu year in the United States. We don’t know exactly how things will play out, but the bottom line is that flu vaccination remains our best protection.

RSV: Also increasing across the state and in New York City, mostly in kids under 4. Statewide, hospitalizations increased by 70%, while emergency department visits in New York City went up by 40%.

Covid-19: Cases and hospitalizations are decreasing in both New York City and across the state.

As we head into Thanksgiving, when many of us will be traveling to see loved ones, flu and RSV are top of mind. To reduce the spread of illness, consider masking in indoor crowded spaces — I’ll be wearing mine on the train and in the airport — and reducing contact with others if ill.

Good news: Overdose deaths are declining in NYC — but progress is uneven

For the first time in years, New York City saw a significant drop in overdose deaths — a 28% decrease last year from 2023 — but that still totals 2,192 deaths: far too high.

Last year, 78% of overdose deaths in New York City involved an opioid, a reduction from 83% in 2023. Fentanyl remains the leading driver, involved in 73% of deaths, but that’s also down from 80% in 2023.

One success story is Staten Island, which saw the steepest drop in overdose deaths. A possible reason: the implementation of a hot-spotting strategy. Officials analyzed emergency medical services and hospital data to identify where overdoses were happening most. Then they deployed peer counselors to those areas with the life-saving opioid overdose-reversing medication naloxone (also known as Narcan), support services, and treatment referrals.

Over the summer, a hot-spotting program based off Staten Island’s was launched in the Bronx, as well. This is greatly needed as the Bronx still has the highest overdose death rate compared to other boroughs. I’ll be keeping an eye on the program’s progress and any outcomes reported.

Despite the encouraging drop, overdose is still a leading cause of premature death in New York City. And huge inequities still exist. Overdose deaths in Black and Latino New Yorkers remain about twice as high as the rate among white New Yorkers.

There are still actions we can take to continue to reduce the risk of overdose death among our fellow New Yorkers:

Carry naloxone (Narcan)

All New Yorkers can receive free naloxone and training from registered Opioid Overdose Prevention Programs on how to recognize the signs of an overdose and administer the medication.
Health Department vending machines: Locations can be found on this page.
Over-the-counter naloxone at pharmacies: Available without a prescription at most major chains (map here).
- Most insurance providers will cover all or part of the cost of naloxone, and New York state will cover copayments of up to $40.

There is also a hotline for individuals seeking support or treatment for substance use for themselves or their loved ones. Call or text 988, or visit the 988 website for 24/7, confidential support.

Changes to the B‑HEARD program

Last week, Mayor Eric Adams announced a shift to B-HEARD — the Behavioral Health Emergency Assistance Response Division, a pilot program launched in 2021 to respond to 911 mental health emergency calls with trained medical and mental health teams. Under the new model, teams will move from two emergency medical technicians and a social worker to one nurse, a social worker, and an ambulance driver — all employed by NYC Health + Hospitals.

These teams are dispatched in cases of nonviolent but urgent behavioral health crises: suicidal ideation, substance misuse, acute mental health episodes, and similar situations.

In the triage process, 911 operators route mental health‑related calls based on criteria around safety and risk. If a situation is assessed as nonviolent and primarily behavioral health driven, it may be routed to B‑HEARD instead of the traditional law enforcement/emergency medical services response. The program operates in Northern Manhattan, the Bronx, Central and South Brooklyn, and Western Queens, from 9 a.m. to 1 a.m.

Let’s give it a closer look.

Why does this program exist?

Historically, almost all mental health 911 calls in New York City were routed to the New York City Police Department, sometimes alongside basic EMS responders. Some experts argue that this approach often lacks the de‑escalation skillset, therapeutic lens, and follow‑up needed for mental health emergencies.

There is evidence that when police are first responders in a mental health crisis, outcomes can be worse: Individuals in crisis may feel criminalized, unsafe, reluctant to seek help, and in worst cases may face use of force. For example, in the United States, people with untreated serious mental illness are estimated to be up to 16 times more likely to be killed by law enforcement during an encounter.

By deploying mental or behavioral-centered teams, B‑HEARD tries to reduce unnecessary police involvement, deliver more appropriate care at the scene, and connect people to community‑based follow‑up.

Has B‑HEARD been effective so far?

A city comptroller audit earlier this year found the program is promising in concept but hard to evaluate due to limited data and implementation gaps.

Key findings:

Between fiscal years 2022 and 2024, B-HEARD covered 96,291 mental health-related 911 calls during operating hours.
Only about 25% (just over 24,000 calls) resulted in a B-HEARD response.
Around 60% were deemed ineligible (some due to safety concerns, others because no EMS operators were available to screen).
Even among eligible calls, 35% never received a response for unknown reasons.
Critical process steps (assessments, follow-up referrals) were often incomplete or not documented.

On the positive side, among clients surveyed, the results were strong:

99 % said they were treated with respect.
96 % said the team helped them.

In short, the idea is promising, but the current program lacks data to properly evaluate its effectiveness at meeting its goals.

Why the change?

New York faces a shortage of EMTs and paramedics and has long ambulance response times. By freeing up EMS workers for broader medical emergencies, the city hopes to improve ambulance response times across the city.

New York City average end-to-end response times for ambulances for life-threatening emergencies was 12 minutes and 53 seconds during the week of Oct. 20 (the latest week available).

Importantly, during a behavioral health crisis, if additional medical backup is needed (e.g., someone becomes medically unstable), the driver/nurse team can summon an ambulance. The nurse offers stronger clinical capacity on‑scene than EMTs alone, potentially improving care and triage.

Looking ahead and my thoughts

With longer ambulance wait times, it’s a logical step to free up EMTs to shorten response times. And if there are enough nurses at NYC Health + Hospitals to redirect some to B-HEARD teams without disrupting hospital operations, having advanced medical support on the response teams could be beneficial. But the bigger question remains how effective this program has been at responding to mental health issues, while maintaining safety for those experiencing mental health crises and for first responders.

The other question at hand is the timing of this change. Adams has one more month on the job before Mayor‑elect Zohran Mamdani takes the helm on Jan. 1. Mamdani has signaled plans to expand B‑HEARD city‑wide beyond the pilot, and fold it into a new Department of Community Safety. Will these changes hold in Mamdani’s new administration? If not, will shoring up EMTs in New York City for one month make any real difference in ambulance wait times? Will the program go through another overhaul, potentially further limiting our ability to assess its effectiveness? These are the things I’ll be looking out for over the coming months, and I will report back with any updates.

Bottom line

As we head into the holiday, I’m feeling especially grateful for New York’s public health champions — the heroes and systems working behind the scenes to keep us safe. The encouraging decline in opioid deaths, expanded mental health outreach, and strong infectious disease surveillance systems are testaments to that.

To everyone working toward a healthier state: Thank you for all you do. Your work makes New York better, every single day.

I’m wishing everyone a restful Thanksgiving — indulge in that pie, wear those stretchy pants, and I’ll see you after our break next week!

Love,

Your NY Epi

‘Terrified’ to seek help: Georgia nurses can lose license if they admit addiction. Advocates want to change that.

2025-11-20T23:29:09+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

It can be tough for anyone to decide to get help for substance abuse, but nurses in Georgia face a special set of barriers: They have to report seeking treatment to the state’s Board of Nursing, which can jeopardize their license or put long-term restrictions on their practice and job prospects.

Addiction recovery and nursing advocates are urging the state to adopt an “alternative to discipline” for nurses who want to get help for substance use issues. The aim is to keep nurses in the workforce and ward off serious crises for them and their patients. At least 41 states have implemented such programs, according to the National Council of State Boards of Nursing. Georgia has not, though all five neighboring states have.

A bill to set up such a system came close to passing in the state legislature earlier this year. Sponsored by Rep. Ron Stephens, a Savannah Republican, the bill passed the House unanimously but failed to get a Senate floor vote.

Advocates plan to renew the push during the next session, which begins Jan. 12. The Board of Nursing will also consider the idea at its December meeting, a spokesperson for the board’s parent agency, the Secretary of State’s office, said.

It’s much needed, said Greg Gardner, a peer recovery coach for the Georgia Council for Recovery. He said that of 25 nurses struggling with alcohol use disorder he has seen in emergency rooms as part of a peer support program, only one was willing to proceed with getting help.

“They feel they will lose their license, they will lose their job, even without an incident at work. Moms with kids, they can’t afford to lose their job. They are terrified of what’s going to happen if they ask for help,” Gardner said during a Thursday meeting of the Georgia General Assembly’s Working Group on Addiction and Recovery.

In 2024, the board took 238 disciplinary actions for all reasons, according to data from the Secretary of State’s office. The board wouldn’t say how many were related to addiction, citing confidentiality. The Georgia Nursing Association sees 200 to 250 nurses in its Peer Assistance Program for those struggling with addiction, executive director Felicia Chatman told Healthbeat.

Seeking treatment triggers disciplinary process

As part of their license renewal process, nurses must check a box stating they have not sought treatment for substance use within the past five years, even if they’ve had no incidents at work, Gardner said. Colleagues or supervisors can also report nurses, and nurses can choose to self-report as well.

Such reports, whether through the license renewal process or another way, trigger a disciplinary process with the state Board of Nursing – and can deter nurses from seeking help.

The reports typically result in a “consent order” that establishes steps nurses must take to maintain their license and continue to practice. That includes regular drug tests and participation in recovery support programs.

The details are public, and nurses may face difficulty finding employment even many years after completing all the steps and remaining sober because of the disciplinary record, several nurses told Healthbeat.

The initial process can take up to a year or 18 months to play out, during which time a nurse might move to another job or face worsening addiction, said Helen Diana Ware, a registered nurse in recovery who spoke during the Thursday meeting.

“That’s not protecting the public,” Ware said.

The formal disciplinary process isn’t foolproof, Alison Trinkoff, a nursing professor of the University of Maryland-Baltimore who studies nurses’ well-being and substance use, said in an interview. She added that some employers may fire nurses without reporting them to nursing boards.

Advocates say alternative system could head off more serious problems

Ware and others said providing an alternative to discipline would encourage nurses to get help before their problems become more serious or endanger patient safety.

“When they enter our program, they really do run into barriers with re-entry and finding employment because they have a consent order,” Chatman said. “The irony … is that those are the nurses that employers can hire that are really the safest nurses out there, because they’re being monitored” with routine drug and alcohol testing.

Chatman and others at the Peer Assistance Program want to see the state adopt the alternative-to-discipline program.

“Those nurses that … know that they’re getting into trouble, they’re not healthy. They want to get treatment. They can reach out to us and say, ‘Help, help. Yes, my house is not on fire yet. I’m not arrested. I haven’t stole drugs, and I don’t want to go down that path of destruction,’” said Barbara Austin, a nurse who helps facilitate recovery meetings through the Peer Assistance Program.

“It would be a phenomenal boost, not only to the nursing shortage, but to the health of nurses in Georgia,” Austin said. About 153,544 nurses worked in Georgia in 2024, and the state is short an average of 772 RNs each year, according to the Georgia Center for Nursing Excellence.

“We need every nurse we can get,” said Mary Lou Wilson, an administrator at the Northeast Georgia Health System.

Alternative to discipline programs are generally effective, Trinkoff said.

“It gives you options as a nurse. ‘Hey, I can hang onto my license. I can get better,’” Trinkoff said. “‘This is good. I don’t have to worry I’m going to be a danger to myself and to others.’”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

ICE crackdown heightens barriers for immigrant domestic violence survivors

2025-11-13T14:32:06+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The immigrant from India believed her husband when he said that if she wasn’t gone by the time he got to their Georgia home in 10 minutes, he would kill her.

She said her husband and his family, who are also immigrants, abused her throughout their marriage, beating her with a belt, pouring hot water on her, cutting her, and pushing her head through a wall.

“Several times I tried to escape, but they found me and brought me back home,” said the woman, who is in the country illegally and spoke on the condition of anonymity because she is afraid being identified would harm her chances of gaining legal status.

With no time to run after her husband’s call in July 2020, she dialed 911, even though she knew she could be deported. The police arrived to find the husband threatening her with a knife in front of their young children, she recalled. He was arrested but not prosecuted, she said.

The woman and her children sought services from the Tahirih Justice Center, a national nonprofit organization that serves immigrant survivors of gender-based violence. She is still winding through the immigration process five years later.

Besides immigrants’ increased vulnerability to sexual violence, they face a host of mental health and physical challenges, researchers say. They have high rates of post-traumatic stress disorder, depression, suicide, and anxiety, according to a 2024 study.

“Personally, I know anxiety related to the current political climate is precipitating expensive emergency room visits and negatively impacting people’s ability to get to work and make a living,” said Nicole E. Warren, a nurse midwife and an associate professor at the Johns Hopkins School of Nursing in Baltimore.

Immigrants without legal status also face increased rates of chronic conditions and higher death rates from preventable diseases due to their limited access to health care and their fear of seeking it, advocates say.

“One of our clients was so afraid to leave her home that she avoided seeking medical care during her pregnancy, out of fear of interacting with ICE,” said Miriam Camero, director of client advocacy, social services, at Tahirih.

Food banks have reported that many immigrants in need of food assistance have stopped coming, for fear of deportation.

It has always been difficult for people without legal immigration status to get help when they need it. The Trump administration’s crackdown on people in the country illegally has intensified the pressure. The situation has also hampered the advocates and attorneys who defend their rights.

“We’re working extra hours to do all the work,” said Vanessa Wilkins, executive director of Tahirih’s office in Atlanta. “The safety planning and added protection that clients might need, including documents just to make sure they are safe, can definitely make you feel overwhelmed.”

U visa application brings anxiety

For domestic abuse survivors without legal status, like the woman from India, going to the authorities seems more fraught amid the immigration crackdown, said Maricarmen Garza, chief counsel of the American Bar Association Commission on Domestic & Sexual Violence.

“There are just no guarantees,” Garza said, “especially with how law enforcement is intertwined in enforcing immigration law.”

In more than half of states, U.S. Immigration and Customs Enforcement agents can collaborate by formal written agreements with state and local law enforcement agencies to identify and remove people in the country illegally. Advocates say this can interfere with victims’ efforts to get a certificate to file for a “U visa,” which would allow them to live and work in the United States with the possibility of lawful permanent residency.

The battered woman from India recalls police telling her that if she did not press charges, she could get a certificate for a U visa. She agreed to their suggestion but recalls the anxiety of filing about five abuse reports over two years to get the certificate. “I got panic attacks just writing them down, because it meant I was reliving the situations again,” she said.

When asked for comment about the difficulties immigrant domestic violence victims face, White House spokesperson Abigail Jackson touted President Donald Trump’s efforts to crack down on illegal immigration. “The president’s successful effort to deport criminal illegal aliens is making all victims safer and ensuring they will never again be harmed by dangerous criminal illegal aliens,” Jackson said in a statement. She said “allegations without evidence” that immigrants have been told to drop charges “should not be taken seriously.”

Immigrant women without legal status can be particularly vulnerable to abuse and exploitation because of language barriers, as well as cultural and social isolation, researchers have found.

According to a 2023 report, lifetime rates of abuse by intimate partners range up to 93% in some immigrant groups, compared with about 41% of U.S.-born women experiencing such abuse in their lifetime.

As the Trump administration reshapes the country’s immigration system, survivors of violence who entered the country illegally have a tough time proving their abuse and trauma to get relief, advocates say.

A refugee health and asylum program at Johns Hopkins in Baltimore provides immigrant victims of abuse with free forensic evaluations to support their claims for humanitarian relief, including applications for U visas.

Warren, the program’s associate director for women’s health, said that in the past, a written affidavit of the clinic’s findings was enough to corroborate an applicant’s legal accounts of past trauma.

“Now, we are getting requests for our in-person testimony,” Warren said.

Applications for U visas backlogged

The woman from India applied for a visa after she received a certificate from law enforcement allowing her to do so in 2023. Hers is one of nearly 11.6 million pending visa applications, according to data through June — the highest volume of cases ever recorded by U.S. Citizenship and Immigration Services. The number of pending U visa applications is 415,000, according to the agency.

Only about 10,000 U visas are issued per year, and it can take more than seven years to process applications, Garza said.

Adding to the pressure, the Trump administration has reduced the availability of Section 8 housing, which helps low-income individuals and others pay their rent. As of September, people without legal authorization to be in the United States are not eligible to receive rental help over U.S. citizens.

“If Tahirih wasn’t behind me, I could be homeless,” said the woman, who said she can afford only half her rent.

Victims’ advocates say they are working harder than ever to support their clients but are stretched thin as they face federal funding cuts and increased demand.

The Tahirih center reported a 200% increase in call volume in the four months after Trump took office, compared with the same period last year.

“At the end of the day, there are a lot of emails and a lot of people we aren’t able to reach as quickly as in the past,” said Casey Carter Swegman, the center’s director of public policy.

To reach immigrant survivors of abuse who are afraid to come forward, advocates are “getting back to basics,” said Joanna Otero-Cruz, executive director and president of the Philadelphia group Women Against Abuse.

“We’re doing grassroots outreach to hairdressers and other small-business owners,” she said. “They’re the eyes and ears for us.”

In Riverhead, New York, a 38-year-old woman who emigrated from El Salvador said she has twice been the victim of domestic abuse but was too scared to report it to police.

She said the second assault was by a man for whom she cooked and cleaned in his home. The woman, who spoke on the condition of anonymity because of her sense of shame and her fears of deportation, said he raped her, took pictures of her naked, and threatened to put them on social media if she tried to go to the police. He then stalked her, she said.

Noemi Sanchez, Long Island regional coordinator for the Rural & Migrant Ministry, a nonprofit that supports farmworkers, is working closely with the woman to elevate her self-esteem and help her understand that “no woman deserves to have a man mistreat them.”

Meanwhile, the survivor from India received a temporary work permit in 2024 and is employed as a certified nursing assistant, which “helps me survive,” she said.

“I have really come a long way,” she added. “It wasn’t easy. I had great support behind me. They didn’t let me down.”

This story was originally published at KFF Health News, Healtbeat’s national reporting partner.

A Muslim youth center in Brooklyn is helping teens connect mental health to faith

2025-09-30T15:12:44+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Jana, a public affairs student at Baruch College, was raised in a devout Muslim family but had stopped coming to the mosque in high school.

Her family frequented the Muslim American Society Youth Center in Bensonhurst, Brooklyn throughout her childhood. She recalls fond memories of running around the center’s prayer area at 8 years old. It was like a second home. But by high school, she found herself retreating from the space. She was struggling with mental illness and feeling distanced from her religious upbringing.

“I’ve always dealt with issues of depression, anxiety, self-harm, the works,” said Jana, now 20, who began cutting herself at around 12 years old. Her last name is being withheld to protect the privacy of sensitive health information. “And in immigrant households, typically they don’t believe in [treating] mental health, or they’d rather you pray about it instead of going to therapy. They say ‘why speak to someone when you can speak to God?’”

In July 2022, while visiting the center with her mother, Jana came across a pop-up event hosted by the center’s Social Services Department. Tables were stationed in the center’s lobby with resources for self-care and mental health support. It jumpstarted a change in her life.

At her mother’s suggestion, she signed up for a referral and was paired with a therapist. She was later diagnosed with bipolar disorder, and the services she found were the catalyst for how she manages her mental health today. It has been over 2 1/2 years since she’s harmed herself, she said, she has a better grasp on her manic episodes and impulsiveness, and feels more connected to her faith than ever.

Jana now leads mental wellness programming under the very Social Services Department that connected her with crucial mental health resources. Her story is not uncommon and reflects an ever-present need for culturally competent mental health support.

Muslim Americans face barriers to care

Across New York and the United States, Muslims face outsized risk for mental distress, often worsened by stigma, generational gaps, and limited access to culturally aligned care.

These challenges are compounded by broader societal issues, including lingering effects of policies like the “Muslim ban” executive order from President Donald Trump in 2017 and increased scrutiny of Muslim Americans in the wake of protests over Palestinian rights. Many Muslims, like Jana, come from families where mental illness was either minimized or spiritualized, seen less as a medical condition and more as a test of faith.

Recent research shows Muslim Americans experience rates of anxiety, depression, and mood disorders similar to the general population, but they face unique barriers in accessing care. A 2023 national study found that about 15% of Muslim Americans had a lifetime mood disorder, and 10% had a lifetime anxiety disorder, rates comparable to other groups. Yet fewer sought help, with additional studies pointing to stigma, experiences of discrimination, and mistrust of a mental health system seen as lacking cultural and religious competence.

“The problem with Muslims in America is that we are often dehumanized,” said Ayah Issa, a licensed clinical social worker and trauma therapist based in Astoria, Queens. “You start to create stories about them based on what you were taught in this white-centric country, rather than letting that story come from the person in front of you.”

Nationally, nearly half of U.S. religious congregations offer some form of mental health programming — up from 23% in 2012, according to research from Duke University’s National Congregations Study. In New York, local efforts have followed suit, with the state’s Office of Mental Health partnering with faith leaders to develop faith-based initiatives and city-based nonprofits increasing behavioral health offerings tailored to immigrant and religious communities. These broader shifts toward faith-based mental health support mirror what’s happening at the MAS Youth Center.

The center formalized its Social Services Department in October 2020, initially launching as a virtual response to the mental health fallout of Covid-19. It was founded with the main goal of psychoeducation, sharing information and connecting community members with mental health resources. In the earliest days, the department operated online, offering virtual office hours, now done in-person on Saturdays, and a digital therapy referral system.

Aging together: South Asian seniors in Queens alleviate loneliness through ‘co-living’

Upon transitioning to in-person programming, they faced struggles, including staffing the department with enough committed volunteers, overcoming widespread stigma around mental health, and targeting core MAS community members.

“[It] made it difficult for people to come to our events. We had people who were interested in mental health, but it was very slow. And the people we were getting at our events weren’t the people at the MAS Youth Center,” said Roua Eltayeib, one of the department’s co-directors.

In response, the department shifted to meet the community where it was, organizing pop-up tables outside of halaqahs (religious study circles) and other center events. The first major in-person programming, including grief circles and Mental Health Mondays, began to break down barriers and draw broader participation, especially after a widely attended grief circle in 2021 in response to the loss of a young beloved community member to substance use. Over time, this outreach helped the department become not just a referral hub, but a trusted fixture in the center’s landscape.

“Trust is built through presence,” said Somer Saleh, the other department co-director. “We make it a point to show up regularly in spaces where young people already are, at prayer, and all of their events, whether it’s a regular Friday [gathering] or an annual revival.”

The Social Services Department is facilitated by a team of seven, and both co-directors, Saleh and Eltayeib, are licensed marriage and family therapists. The department runs programming in four broad areas: mental wellness, family wellness, preventative advocacy (focused on issues of domestic violence and substance use), and special needs.

Women and girls write and decorate reflective letters to their past or future selves at a self-care event at the Muslim American Society Youth Center in Brooklyn, New York, on July 25.

Youth Center works to connect personal growth to faith

An important factor in departmental planning is the Islamic concept of tarbiyyah, or spiritual development, emphasizing personal growth in connection to faith. An illustration of this can be seen at the Sisters Self-Care Night, a recurring event that combines creative activities with intentional conversations grounded in Islamic teachings.

At the July gathering, women and girls of all ages sat at round tables and bonded over conversation as they painted, made floral arrangements, got henna tattoos, and wrote du’aa (prayer) journals and letters to themselves. These activities were then momentarily paused for a communal prayer break, followed by a halaqah, where everyone gathered to reflect on a brief talk by Saleh about the religious importance of rest.

“Slowing down is not a luxury. It is actually a part of our deen [religion],” she said, describing rest as an “act of worship” and referencing the Islamic teaching that “our bodies have a right over us.”

Amina Barnes, an educator in early intervention who lives in Bedford Stuyvesant, Brooklyn, is one of many attendees finding community and a sense of spiritual grounding at the MAS Youth Center.

“I loved the self-care night,” she said. “The brief talk on rest as worship really stayed with me. It affirmed something I already knew in my spirit, but hearing it out loud in that setting made me feel truly seen.”

As a single mother of three sons, each with different neurodivergent needs — Asperger’s syndrome, autism, and ADHD — Barnes said the center and its environment were what she had been praying for, describing the space as “emotionally aware and religiously sound.”

The impact of this sense of belonging is echoed in research. A 2019 article from the National Alliance on Mental Illness highlights community connection as a protective factor against mental illness and aid in reducing stigma. Studies on U.S. Muslim communities show that mosque-based programs can build trust, improve access to culturally competent care, and normalize help-seeking.

“When we talk about breaking the stigma, that looks like creating a community. People need to be able to connect, to hug each other, make plans with each other, celebrate each other. Those are the things that are incredibly important in helping manage and navigate mental health gaps,” Issa said.

For Jana, that community has not only been a source of healing but also a place to give back.

“When you walk into a masjid [mosque], you’re not expecting to see a Social Services Department. It’s so interesting and honestly groundbreaking,” she said. “I was attracted to it because I wanted to be a part of it.”

This story was produced in partnership with the Health & Science Reporting Program at the Craig Newmark Graduate School of Journalism at CUNY.

New York state high schools train teens in mental health first aid

2025-09-22T19:12:39+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

High schools across New York state are training students on how to support their peers in crisis, as rates of teen anxiety, depression, and suicide continue to climb across the country.

According to the Centers for Disease Control and Prevention, more than 40% of U.S. high school students reported persistent feelings of sadness or hopelessness in 2023, with nearly 1 in 5 saying they had seriously considered suicide.

The training initiative is part of Gov. Kathy Hochul’s broader youth mental health strategy, which aims to equip young people not only to care for their own well-being, but also to support peers in crisis — and to recognize when to guide them toward professional help.

“Peer-to-peer support is something so integral at this stage of our lives,” said 17-year-old Jacob Wolmetz, a high school senior from Suffolk County who serves on the Governor’s Youth Council. Teenagers “might not feel comfortable talking to a school social worker or counselor. It’s easier to confide in people you trust.”

A new response to crisis: teens helping teens

Teen Mental Health First Aid was started by the National Council for Mental Wellbeing, a nonprofit focused on mental health policy and social change. This training program created for teens 15 to 18, helps them recognize and respond to mental health and substance use challenges among their peers. In the course, students learn how to spot common warning signs, understand the effects of bullying and school violence on mental well-being, engage in meaningful conversations with classmates about mental health, and know when to involve a trusted adult.

To grow and expand this initiative in the state, Hochul announced $20 million in funding to expand Teen Mental Health First Aid and other early intervention programs across public schools earlier this year.

Mental Health Association in New York State was one of the organizations awarded some of the funding via a grant to implement teen mental health first aid in high schools throughout the state.

“It’s $10 million over the next five years to continue to build capacity and train about 2,500 adults and teens a year, and create about 200 new instructors across the state every year,” said Katie Oldakowski, director of training for MHANYS.

Here’s how Teen Mental Health First Aid works

Students ages 14 to 18 can become certified in Teen Mental Health First Aid, either through their high school or an outside organization. In schools, the training may be led by certified teachers or staff members, or by external instructors who come in to deliver the program on-site.

“We work with schools who already have funding, and for those who don’t, we help them from the very beginning — developing an implementation plan, offering technical assistance, and ensuring instructors are supported every step of the way,” Oldakowski said.

Jamie Hagenbuch, program manager of Mental Health First Aid at the Madison County Rural Health Council, visits high schools in multiple suburban and rural counties in New York, including Madison, Broome, Chenango, Otsego, Schoharie, and Onondaga.

Wolmetz was certified in TMHFA through Cohen Strong, a youth mental health advocacy program run by Northwell Health. Over six weeks, he attended weekly live sessions and completed interactive modules that covered topics like crisis response, active listening, and boundary setting.

“It was really interesting and helpful to get this training on how to support friends that are dealing with mental health struggles or crises,” Wolmetz said.

For students like him, the training was more than just academic. “I try to make sure that my friends know that I’m always available. I’ve definitely helped friends who are dealing with different mental health problems,” he said.

Program has promising results, but uneven access

Early studies suggest Teen Mental Health First Aid can improve students’ confidence in helping peers and reduce stigma around mental illness. Research conducted in collaboration with the National Council for Wellbeing and Johns Hopkins University indicates trained students are more likely to intervene appropriately, have greater empathy for those with mental health challenges, and can identify helpful resources for their friends

Metro Atlanta program looks to support high-schoolers responsible for caregiving at home

But not every New York high school student has access to the program, especially those outside well-resourced districts. Hagenbuch and her team are working to facilitate access in more rural parts of the state, to communities who need it most.

“We’re not in an urban community. Sometimes it takes an hour if somebody’s in crisis. We don’t always have mobile crisis teams. That’s why it’s so important to wrap services around teens in school,” Hagenbuch said.

Hochul’s office said the new funding will go toward expanding access statewide, prioritizing underserved communities. However, the rollout has been slow, and no clear public data exists yet on how many schools have implemented the program.

Peer training is not a replacement for professional care

While peer training can fill an important gap, mental health advocates caution that it’s not a replacement for professional care. The burden should not fall on teens to manage their friends’ mental health, especially without follow-up systems in place.

“We can’t, as young people, handle everyone else’s problems. We need to be able to refer them to help and resources so that they get the care they need,” Wolmetz said.

Another challenge is that it may not be feasible for teachers to provide the training to students, particularly in underfunded schools with limited staff. High turnover among school personnel and administrative leadership can also pose a barrier to implementing the program with in-house instructors, Oldakowski said.

“The issue is capacity — teachers want this training, but they don’t always have the bandwidth. That’s why we help schools bring in instructors or develop internal capacity in a way that works for them,” she said.

Still, advocates say the program offers a powerful starting point to make a difference in the lives of students.

“Helping community helps community — reducing stigma and opening up conversations — can save lives,” Hagenbuch said.

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Anika Nayak is a freelance reporter in New York.

Atlanta Track Club’s Peachtree Road Race: How the U.S.’ second-largest running org thinks about public health

2025-07-02T15:17:52+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

It’s time for the Peachtree Road Race in Atlanta. The city is gearing up for more than 50,000 runners to run, walk, or wheel down the city’s most famous thoroughfare on Friday. They’ll be cheered on by thousands of fans, bands, DJs, dance crews, and even a priest blessing runners with holy water.

The race is much more than the city’s sweatiest party, though. It’s a gateway to running and movement for health, said the Atlanta Track Club’s Natalie Cabanas, director of marketing and communications.

The club’s inclusive spirit aims to draw participants of all backgrounds and ages into the shared joy of racing through the city. Since its first run in 1970, the annual race down Peachtree Street has grown into the world’s largest 10K.

The club works to reach people where they are, whether through free running programs for children, training programs that focus on running and walking, and even advocating for better infrastructure for exercise, Cabanas said.

The club announced plans in 2023 to build a $100 million indoor track facility in the center of the city. CEO Rich Kenah said those plans are moving ahead, but a specific timeline hasn’t been announced.

Ahead of Friday’s 6.2-mile romp, Cabanas gave Healthbeat a look into how the country’s second-largest running organization thinks about how running contributes to public health.

First off, it’s going to be hot. The forecast predicts a temperature of around 73 degrees at the 6:30 a.m. start, going up to a high of around 93 during the day. Last year, high temperatures led organizers to issue a “black flag warning” mid-morning and halt the race, though by that time almost all participants had finished.

This year, organizers moved up the start time by 10 minutes. And the finish area in Piedmont Park will offer cooling towels and shaded recovery zones.

Tell us about the Atlanta Track Club and how it thinks about health, especially public health?

Our mission is to inspire and engage the community to live healthier, more active lives through running and walking. But we see health as much more than physical fitness. We think of it as a public good — something that strengthens neighborhoods, bridges communities, and supports emotional and mental well-being, as much as physical wellness.

That’s why our work extends far beyond the start line. From free programs like Kilometer Kids, which gets thousands of children moving every year, to training programs and infrastructure advocacy, we’re committed to making movement part of daily life in Atlanta.

Whether you’re walking your neighborhood, chasing a personal best, or participating in one of our 40+ events, including the world’s largest 10K, we want Atlantans to see movement as accessible, joyful, and life-changing.

What would you say to someone who stopped exercising but wants to get started again? Why is exercise important to public health?

Watching 50,000 people of every age, ability, and background move together down Peachtree Street is one of the most emotional and inspiring things you’ll ever witness. The Peachtree is more than a race. It’s a celebration of what’s possible when an entire city comes together around something positive.

To anyone who’s had a fitness lapse or doesn’t know where to begin: This race is for you. You don’t need to be fast or experienced. You just need to start. The Peachtree is what we call a “gateway race” — for many, it’s the first step back into movement. We have walkers, runners, and first-timers from age 11 to 96. And we have year-round programs designed to support you every step of the way.

Exercise is one of the most effective public health tools we have. It reduces the risk of chronic disease, improves mental health, fights isolation, and helps people reconnect with themselves and their communities. And when we move together, we heal together.

Why is ATC among the largest track clubs in the country? How do you unite people around something like the Peachtree Road Race in a time of division?

Atlanta Track Club is currently the second-largest running organization and nonprofit in the country. We’re on a mission to make Atlanta the healthiest city in the country. We create year-round opportunities for people to come together around a shared belief in health, movement, and belonging.

In times of division, the Peachtree is a powerful counterpoint. On July 4, people from all walks of life — veterans, elite athletes, parents, first-time 10K finishers — show up on the same start line. They cheer each other on, high-five strangers, and celebrate together. It’s not about where you’re from or what pace you run. It’s about showing up. That kind of unity is rare — and deeply needed.

Rebecca Grapevine, a reporter covering public health in Atlanta for Healthbeat, will be running the Peachtree Road Race this year. Contact Rebecca at rgrapevine@healthbeat.org.

16 U.S. state attorneys sue Trump administration over $1 billion cut to school mental health funding

2025-07-02T12:30:08+00:00

Public health, explained:Sign up to receive Healthbeat’s free New York City newsletter here.

A Trump administration directive terminating more than $1 billion in federal funding for school-based mental health services is the latest ruling being challenged by a group of 16 Democratic attorneys.

Led by New York Attorney General Letitia James, the lawsuit filed this week calls on the court to reinstate the grants, calling the cut unlawful, unconstitutional, and ideologically driven.

The grants were created by Congress under a bipartisan law passed after the 2022 school shooting in Uvalde, Texas, when an 18-year-old gunman killed 19 elementary school children and two teachers. The money was used to hire staff, diversify the mental health profession, and prepare educators to work with kids from diverse backgrounds — specifically in high-need, low-income, and rural schools — but with President Donald Trump’s attempts to root out programs incorporating diversity, equity, and inclusion, his administration pulled the funding for many states and schools two months ago.

Without offering evidence that the cuts were based on grantees’ performance standards, the lawsuit says the administration instead applied an ideological litmus test after terminating the program. The administration sent grantees boilerplate language, according to the lawsuit, which claims it was an “arbitrary and capricious” move that did not account for any individualized reasons for the change, nor consider the harmful impact to children dependent on the mental health services or the effect on the pipeline for the chronically understaffed mental health workforce across the nation.

“The cost to our children’s safety, well-being, and academic success is incalculable,” the lawsuit stated. “These grants were designed to respond to America’s school shooting crisis and fill a critical need in schools. Without them, many children in rural and lower-income schools will go without mental health services and will suffer the attendant consequences: short- and long-term health problems; lower grades; increased absenteeism, suspensions, and expulsions; and a higher risk of suicide and drug overdose.”

In the grant program’s first year, nearly 775,000 students received mental or behavioral health services, according to the lawsuit. The grants helped hire more than 1,200 school-based mental health professionals, and student wait times for services dropped by 80%. A sample of projects reported a 50% reduction in suicide risk at high-need schools, improved attendance, and stronger student-staff relationships.

The federal Department of Education did not respond for comment.

Among the decimated programs, Teachers College at Columbia University had begun training five graduate students to provide mental health services in Harlem and East Harlem schools serving large populations of newly arrived immigrants and families struggling to find stable housing. The program was in the process of sending out acceptance letters to eight more students when the funding was cut.

The $4.9 million, five-year grant aimed to prepare mental health professionals, many of whom were bilingual or first-generation students who couldn’t have afforded graduate school otherwise and planned to commit to working in school-based mental health for their careers. The cuts not only affected the program’s short-term ability to provide high-needs schools with critical services for free, said Prerna Arora, an associate professor of psychology and education at Teachers College who was overseeing the grant, but also decimated the future pipeline of professionals dedicated to this kind of work.

If the lawsuit is successful, restarting the grant would not be impossible, Arora said, but it would take time to scale services back up, and the program and the schools are on a typical school calendar, which could affect timelines.

“The funds are definitely needed to address the mental health workforce shortage in our school,” she said in an email. “However, because of the cuts, which were effective immediately, additional time would be needed to rehire staff, recruit and admit students to the training program, and restart the formal partnership with our community schools.”

In all, New York stands to lose at least $19 million in previously approved funding as a result of these cuts, including more than $7.6 million for the State University of New York system, James’ office said.

Chalkbeat senior national reporter Kalyn Belsha contributed reporting.

Amy Zimmer is the bureau chief for Chalkbeat New York. Contact Amy atazimmer@chalkbeat.org.

How to survive peak pollen allergy season: New York public health update

2025-05-07T12:36:16+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Today’s Dose covers pollen allergies, 988 crisis line and AmeriCorps funding cuts, and New York City composting.

Peak pollen (and allergy) season is here in N.Y.

My itchy eyes and fatigue confirm the data: We’re at peak allergy season in New York.

Most U.S. locales see three pollen waves — trees, grass, weeds. New York is ending tree season and sliding into grass. Individual allergy sensitivity can vary by type of pollen. I’m a grass pollen girl myself. 💅🏻🌱

Over the past few decades, allergy seasons in New York have gotten worse, partly due to climate change. The average allergy season has grown by over three weeks since 1970, with higher pollen counts. Longer and more intense pollen seasons can exacerbate allergies and respiratory conditions for New Yorkers.

To reduce pollen exposure and prevent it from entering your home, there are a few things you can do:

Check local pollen counts.
Leave shoes at the door and change clothes after outdoor activities.
Wipe off furry animals after they’ve been outside.
Shower before bed.
Keep windows closed during peak pollen times (midday).
Run air conditioning or HEPA filters.
Dust and vacuum regularly.

Dr. Zach Rubin, an allergy doctor, joined YLE on our podcast America Dissected last week and gave great tips on managing allergies:

To relieve sinus symptoms, it can help to rinse your nose with saline water (like a neti pot), but only with distilled or sterilized water.
For medications, second-generation antihistamines like cetirizine (Zyrtec) tend to have fewer side effects than diphenhydramine (Benadryl). Always talk with your doctor for more information.

Funding threats to the 988 crisis line

988 is a free, confidential call, text, or chat line that links people in mental or emotional distress to trained local counselors 24/7/365. Since its launch in 2022, the New York 988 Lifeline has responded to more than 778,000 calls and about 139,000 texts. Counselors provide help for mental health struggles, emotional distress, alcohol or drug use concerns, or just someone to talk to. It’s funded by federal, state, and local dollars. However, funding for this critical safety net is being actively debated in New York City.

There are two looming funding threats:

City cuts: New York City cut ~$12 million from the nonprofit that answers local 988 calls, Vibrant Emotional Health. Without additional support, Vibrant has signaled that it could lay off up to a third of its staff in the coming months.
Federal cuts: A draft federal budget suggests cutting funding for specialized 988 services that support LGBTQ+ youth, a group at heightened risk for suicide. Some 988 counselors are trained to serve these populations and often have similar life experiences. Since 2022, 988 has responded to nearly 1.3 million calls, texts, or online chats nationally from LGBTQ+ people.

Why it matters

No changes have been made yet. 988 will remain a resource and continue supporting and linking those in crisis with trained counselors. There is also a line that LGBTQ+ youth can continue to reach out to outside of 988: the Trevor Project’s helpline.

But if the layoffs in New York go through, callers may wait longer, more may hang up before help arrives, and fewer counselors will be available, especially those trained to support high‑risk groups like LGBTQ+ youth.

AmeriCorps funding cuts

AmeriCorps is a national service program that provides participants with living allowances to serve community needs, mainly in education and public health — kind of like the Peace Corps for our communities. Last week, the federal government abruptly cancelled $400 million in funding for AmeriCorps, roughly 40% of its total funding. New York was hit hard: $30 million was cut from New York programs, leaving 1,200 AmeriCorps workers in New York without income and benefits, and halting programs providing critical resources for New Yorkers. In response, New York Attorney General Letitia James joined 24 other states in suing the federal government to stop the dismantling of AmeriCorps.

Why it matters

AmeriCorps supports more than 24,000 volunteers and members statewide who have provided critical services in vulnerable communities for decades.

The New York programs abruptly cut last week provided:

Community health education
Peer mental health services
Food for unhoused New Yorkers
Disaster preparedness training

AmeriCorps supports many upstream public health needs: nutritious meals that keep chronic diseases in check, tutors who help kids read on grade level (a predictor of lifelong health), and counselors who connect families to benefits before crises snowball. With these cuts, coverage will become even more patchy — some neighborhoods will keep services, while others may lose them entirely. The program also provides young Americans with an experience of serving their communities where their skills are needed most.

What you can do

The litigation may help restore these funds, but if it doesn’t, community organizations will need to fill the gaps. What can help right now is spreading the word, contacting governmental representatives, and if you’re able, donating to or volunteering with affected organizations — they are scrambling for resources.

Composting is so in right now

In a city of 8 million people, how we handle our garbage is a frontline public health service. When garbage and food scraps sit out, they attract rats, roaches, and the pathogens those pests carry. That’s why, every day, the NYC Department of Sanitation carts away roughly 24 million pounds of trash, recycling, and compostables. The city is making it a lot easier for residents to compost our food waste.

There are good reasons to compost:

To prevent food scraps from releasing methane into the atmosphere as they break down, contributing to climate change.
Separating food scraps from other garbage helps fight the city’s rat infestation by removing their food source.
Repurpose food scraps into compost soil that can be used in city green spaces. Residents and non-profits can get free compost soil from compost give-back sites in Queens, Brooklyn, and Staten Island, as well as pop-up sites across the city.

Compost is now picked up weekly on your recycling day — find your collection schedule here.

Starting last month, owners of buildings with four or more units must provide bins for food waste or face fines.

Another option is to use the city’s “Smart Composting Bins,” which can be opened with a QR code. I use this option — we store compost in the freezer to keep it from smelling or attracting bugs, then drop it off in a Smart Bin down the street.

Bottom line

You’re all caught up on New York public health news! See you next week :)

Love,

Your NY Epi

Moms in crisis, jobs lost: The human cost of Trump’s addiction funding cuts

2025-04-25T14:39:57+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

When the Trump administration cut more than $11 billion in Covid-era funds to states in late March, addiction recovery programs suffered swift losses.

An Indiana organization that employs people in recovery to help peers with substance use disorders and mental illness was forced to lay off three workers. A Texas digital support service for people with addiction and mental illness prepared to shutter its 24/7 call line within a week. A Minnesota program focused on addiction in the East African community curtailed its outreach to vulnerable people on the street.

Although the federal assistance was awarded during the Covid-19 pandemic and some of the funds supported activities related to infectious disease, a sizable chunk went to programs on mental health and addiction. The latter are both chronic concerns in the United States that were exacerbated during the pandemic and continue to affect millions of Americans. Colorado, for example, received more than $30 million for such programs and Minnesota received nearly $28 million, according to health and human services agencies in those states.

In many cases, this money flowed to addiction recovery services, which go beyond traditional treatment to help people with substance use disorders rebuild their lives. These programs do things that insurers often don’t reimburse, such as driving people to medical appointments and court hearings, crafting résumés and training them for new jobs, finding them housing, and helping them build social connections unrelated to drugs.

A federal judge temporarily blocked the Trump administration’s cuts, allowing the programs to continue — for now — receiving federal funding. But many of the affected programs say they can’t easily rehire people they laid off or resurrect services they curtailed. And they’re unsure they can survive long-term amid an environment of uncertainty and fear, not knowing when the judge’s ruling might be lifted or another funding source cut.

The week it slashed the funding, the Trump administration also announced a massive reorganization of the Department of Health and Human Services, including the consolidation of the main federal agency focused on addiction recovery services. Without a stand-alone office like the Substance Abuse and Mental Health Services Administration, many advocates worry, recovery work — and the funding to support it — will no longer be a priority. Although private foundations and state governments may step in, it’s unlikely they could match the tranches of federal funding.

“Recovery support is treated as optional,” said Racquel Garcia, founder of HardBeauty, a Colorado-based addiction recovery organization.

Overdose is New York City’s leading cause of pregnancy-associated death, Health Department says

The federal cuts put at risk a roughly $75,000 grant her team had received to care for pregnant women with substance use disorders in two rural counties in Colorado.

“It’s very easy to make sweeping decisions from the top in the name of money, when you don’t have to be the one to tell the mom, ‘We can’t show up today,’” Garcia said. “When you never have to sit in front of the mama who really needed us to be there.”

Mental health conditions, including substance use disorders, are a leading cause of maternal mortality in the United States. And although national overdose deaths have decreased recently, rates have risen in many Black and Native American communities. Many people in the addiction field worry these funding rollbacks could reverse hard-earned progress.

HHS: ‘We aim to streamline resources’

U.S. Department of Health and Human Services spokesperson Emily Hilliard told KFF Health News that the department is reorganizing to improve efficiency, foster a more coordinated approach to addiction, and prioritize funding projects that align with the president’s Make America Healthy Again initiative.

“We aim to streamline resources and eliminate redundancies, ensuring that essential mental health and substance use disorder services are delivered more effectively,” she said in a statement.

But to Garcia, it doesn’t feel like streamlining. It feels like abandoning moms in need.

Between the time the cuts were announced and when the federal judge paused them, two women served by Garcia’s program gave birth, she said. Though her grant funding was in limbo, Garcia told her employee to show up at the bedside for both moms. The employee followed up with daily check-ins for the new moms, connected them to treatment or housing services when needed, and helped them navigate the child services system.

“I just can’t leave moms” without services, Garcia said. “I just can’t do it.”

Young People in Recovery is a national nonprofit focused on addiction recovery.

Nor can she abandon that employee, she said. Although the federal funding provided half of that employee’s salary, Garcia has continued to keep her on full time.

Garcia said she primarily employs women in recovery, many of whom spent years trapped in abusive situations, relying on welfare benefits. Now they’re sober and have found meaningful work that allows them to provide for their families, she said. “We created our own workforce of mamas who help other mamas.”

This type of recovery workforce development seems to align with the Republican Party’s goals of getting more people to work and reducing reliance on welfare benefits. The Trump administration’s drug policy priorities, released in early April, identified creating “a skilled, recovery-ready workforce” and strengthening peer recovery support services as crucial efforts to help people “find recovery and lead productive, healthy lives.” Many recovery programs train people for blue-collar jobs, which could support Trump’s goal of reviving the manufacturing industry.

But the administration’s actions appear to conflict with its stated goals, said Rahul Gupta, the nation’s drug czar during the Biden administration.

“You can’t have manufacturing if people can’t pass a urine drug test or continue to suffer from addiction or relapse,” said Gupta, who is now president of GATC Health, a company using artificial intelligence for drug development.

Recovery support helps people return to work

Even if jobs return to rural America, cutting funding for recovery services and the main federal office overseeing such efforts could mean fewer people are employable, Gupta said.

Research on recovery programs, particularly those run by people with personal addiction experience, suggests they can increase engagement in court-ordered treatment, reduce the prevalence of rearrest, bolster attendance at treatment appointments, and improve the likelihood of families reunifying and stabilizing.

Billy O’Bryan sees these benefits daily. As a state director for the national nonprofit Young People in Recovery, O’Bryan oversees about a dozen chapters in Kentucky that teach people in recovery life skills, such as balancing a checkbook and interviewing for jobs, and show them how to have fun in sobriety, through group hikes and glow-in-the-dark Ultimate Frisbee games.

Providing recovery services “is when we really invest in their future,” said O’Bryan, who is in recovery too.

Six of his chapters were affected by the federal funding cuts. That has meant dipping into his organization’s rainy day fund to pay staff and cutting back on community events, including cleanup days in which chapter members gather used syringes off the street, pass out the overdose reversal medication naloxone, and talk to people using drugs about the possibility of recovery.

He’s exploring fundraising efforts now, but not all his chapters have the same ability.

“In a city like Louisville, fundraising is not a problem,” O’Bryan said, “but when you get out into Grayson, Kentucky” — a rural area in the Appalachian Mountains — “there’s not a lot of opportunities.”

In Minnesota, Kaleab Woldegiorgis and his colleagues at Niyyah Recovery Initiative used to spend hours a day at soup kitchens, community events, mosques, and on the streets of East African and Muslim neighborhoods, trying to connect with people using drugs. They spoke Somali, Amharic, and Swahili, among other languages.

Those outreach efforts allowed them to “find individuals in need of recovery services” who “weren’t seeking it out themselves,” said Woldegiorgis, who previously attended Niyyah’s support groups when he was dealing with addiction.

After building relationships with people, Woldegiorgis could help them connect with formal recovery services that bill their insurance, he said. But help couldn’t always wait for a contract.

One afternoon shortly before the federal funding cuts, Woldegiorgis and his colleagues spoke with a man who began weeping, recounting how he had wanted to get treatment a few days earlier but had lost his belongings, returned to using drugs, and ended up on the street. Woldegiorgis said he helped the man reconnect with a sister and begin exploring treatment options.

With the federal funding cuts, Niyyah may no longer be able to support this type of outreach work. Woldegiorgis fears it means people won’t receive the message of hope that can come from interacting with role models in recovery.

“People don’t pick up pamphlets to receive these messages. And people don’t read emails, and people don’t look at billboards and find inspiration,” he said. “People need people.”

This story originally published at KFF Health News, Healthbeat’s national reporting partner.

Metro Atlanta program looks to support high-schoolers responsible for caregiving at home

2025-03-19T13:25:44+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Aaliyah Taylor, a 16-year-old high school sophomore, is used to having more responsibilities than a typical teenager. She helped her dad feed and tend to her grandmother until she died in 2023, tasks that frequently stressed her out as she was trying to manage her own health issues, like her scoliosis.

“I felt like every 5 seconds I was called for something, even though I just sat back down,” she said.

Mariyah Carson, Taylor’s best friend and a 15-year-old freshman, managed similar family duties as her uncle struggled with diabetes-related immobility and blindness until his death a few years ago. She remembers planning with her siblings how they would approach his care.

“We’d take turns. Like, if you’re doing homework, it’s my turn, and I go down there and watch him,” Carson said. She and Taylor said they continue to help out with other loved ones.

Michelle Bolden, founder of Call for Caring Inc., congratulates students for completing her inaugural Young, Gifted and Caregiving class at Charles Drew High School in Riverdale, Georgia, March 12.

On a recent afternoon inside a Charles Drew High School auditorium, the two sat next to each other at a table topped with plastic bags, fragrant oils, and sugar pouches. The girls quipped and giggled over the instrumental jazz background music while they made body scrub bags, kits intended to help them relax at home.

Carson and Taylor are students at the school in Riverdale, just south of Hartsfield-Jackson Atlanta International Airport. The body scrub station was the opening activity for this school year’s final session of the Young, Gifted and Caregiving program, a new Atlanta-area initiative to support high-schoolers responsible for taking care of adults or children.

While most of the over 50 million unpaid family caregivers in the United States are adults, experts estimate that there are millions of adolescent Americans who provide this type of work every year. Research on the experience of teenage caregiving is limited, but studies suggest that young caregivers struggle to care for themselves and are at higher risk of anxiety and depression, chronic diseases, and dropping out of school.

These risks are what Young, Gifted and Caregiving aims to address. Once a week throughout February and March, Michelle Bolden, a registered nurse and the founder of the Atlanta caregiver support nonprofit Call for Caring, traveled to Charles Drew to lead lessons for 10 students.

She and an array of guest speakers — like attorneys, nurse practitioners, and mental health specialists — have tried to teach the students how to manage caregiving responsibilities while maintaining their own well-being and ambitions.

It’s the first time Bolden, who recently finished a Chamberlain University doctoral nursing program, has hosted in-person classes for high-school caregivers.

“We couldn’t create that community without them being in-person,” Bolden said.

Charles Drew High School students Zahion Mikell (from left), Mariyah Carson and Aaliyah Taylor listen to Dr. Adrienne during the Young, Gifted and Caregiving inaugural class at Charles Drew High School in Riverdale, Georgia, March 12.

Erin Kent, a caregiver research associate professor at the University of North Carolina-Chapel Hill Gillings School of Global Public Health, said that while there’s strong evidence that support programs can help adult caregivers, there are few, if any, analyses that have examined the best ways to aid high-schoolers with these responsibilities.

But she said evaluating new programs, like the Charles Drew program, is how researchers like herself can determine what could help young people in that position. And school-based initiatives could be more effective at finding teenage caregivers than programs in other settings.

“School is probably going to be the place that reaches more youths,” she said.

School supports teens with caregiving duties at home

Tangela Benjamin had only been Charles Drew’s principal for a few months when she was called to address a student meltdown in October 2023. The sleep-deprived girl complained about how the school’s rules conflicted with family duties.

“She said, ‘A lot of parents don’t parent, and responsibilities that should be on adults are on teenage kids,‘” Benjamin said. “And she was like, ‘I happen to be one of these kids with all of these responsibilities.‘”

The principal knew there were plenty of students in Riverdale, where the median household income is $16,000 below the national number, who face hardships at home even without tending to their loved ones’ needs. Learning that some faced an extra set of duties, Benjamin said she felt obligated to find a way to extend the school’s support.

“It was very much a great eye opener, and it quickened my spirit a bit,” she said.

Michelle Bolden, founder of Call for Caring Inc., speaks with students during the Young, Gifted and Caregiving inaugural class at Charles Drew High School in Riverdale, Georgia, March 12.

It’s a big reason why a year later, when she met Bolden and heard about her work, she jumped at an opportunity to bring a program tailored for high-school caregivers to Charles Drew. Last fall, the Charles Drew staff put together an email survey to find students who have been informal family caregivers. The administrators identified 30 students, and they invited 10 to join the Young, Gifted and Caregiving program.

Bolden wanted to help all 30, but she said it would be difficult to create deep connections with that many students.

“Once it gets too large, they’re not going to talk,” she said.

Those 10 students, including Taylor and Carson, were invited to attend four weekly classes throughout the winter to learn about how to balance their family responsibilities and their own well-being. Among the skills facilitators taught in each session were basic CPR techniques, chronic disease management, and supportive strategies.

An exit survey is filled out by Charles Drew High School students during the Young, Gifted and Caregiving inaugural class at Charles Drew High School in Riverdale, Georgia, March 12.

The Young, Gifted and Caregiving program also hosted a Charles Drew charity 5K run, a fundraiser for the school and for a program to give caregivers breaks from their family duties. Bolden said one of the caregiver students on the Charles Drew cross-country team won the race.

At the start of the high school program, Bolden wasn’t sure how long it would take the students to feel comfortable sharing about home lives and experiences with caregiving. But she said it was clear from the first session that they were open to it.

“I thought it would go really slow,” she said. “But they just picked up and really engaged right away.”

Program helps teens balance caregiving with self-care

At the final session this school year, Bolden invited two guest speakers to share how the students could make plans to prioritize their own health needs while tending to their family members.

It’s a balance some of the Charles Drew caregivers are still trying to figure out. While working at a local farmers market over the summer, Zahion Mikell, a 16-year-old sophomore who helps care for his siblings and great grandmother, remembers scampering from one task to the next when another employee asked to check his blood pressure.

“I was just ripping and running, ripping and running,” said Mikell, who also serves as a Youth County Commissioner.

The screening showed that he was at risk of hypertension, and the other employees told him to take care of his health.

Mikell said he tried to do that. But at the first student session of the Young, Gifted and Caregiving program, when Bolden and the other facilitators were teaching the students how to use a blood pressure pump cuff with their family members, they used Mikell’s arm in a demonstration. Once again, his numbers concerned the adults around him.

Since then, Bolden and the Call for Caring workers have made sure to check Mikell’s blood pressure at their weekly meetings. While reading his levels at that final session, Bolden told him he had moved from the “red zone” to the “yellow zone.”

“So that’s good,” Mikell said.

“But for you that’s high,” Bolden responded. “No, not good.”

“I like yellow though,” Mikell replied as the adults around him laughed.

Charles Drew High School freshman Zahion Mikell listens to speakers during the Young, Gifted and Caregiving inaugural class at Charles Drew High School in Riverdale, Georgia, March 12.

Some of the students expressed the mental and emotional toll that caregiving has taken on their well-being. Tiandra Hodge, another 16-year-old sophomore, has only lived in the metro Atlanta area over the summer. She’s from the British Virgin Islands, but she left her parents and life in the Caribbean to finish her education in the United States last summer.

Hodge lives with her sister and helps feed and bathe her sister’s children, all under age 6. When the stress of adjusting to a new country, a new high school, and a new set of family responsibilities becomes overwhelming, Hodge said she can forget to eat.

She said she has few options to vent about her problems with anyone in-person.

“It’s very difficult,” she said.

That’s one of the reasons she said she’s found the Young, Gifted and Caregiving class helpful. At the end of that fourth session, in response to Bolden asking the student caregivers to share one thing that stood out about the class, Hodge focused on the shared community the program had created.

“I don’t have nobody to talk to about this,” Hodge told everyone in the auditorium.

Caregivers get continued support as they dream big about future

Bolden is excited for Young, Gifted and Caregiving’s future. She plans to lead another session at Charles Drew next school year, hoping to engage and support the other caregiver students who couldn’t fit in the first year.

She also hopes to recreate the program in at least two other Georgia schools this year. Bolden wants to host a series at one of Atlanta’s high schools and a middle school in Sandy Springs.

Charles Drew High School freshman Mariyah Carson listens to speakers during the Young, Gifted and Caregiving inaugural class at Charles Drew High School in Riverdale, Georgia, March 12.

With these plans of expansion, she said she wants to make clear to this year’s Charles Drew students that support for them won’t wither away. Throughout the final session, Bolden brought up multiple times that her nonprofit would continue to engage with the inaugural class members and help with any challenges they might continue to experience.

She even suggested that they could be student ambassadors for the next Charles Drew caregivers in the program.

“These are adults you can trust and still be able to network,” Bolden told the students, gesturing at the Call for Caring workers and the Charles Drew staff who had joined the session. “I don’t want you to think that because you’re here in this situation, it’s not going to get better.”

Kent, the University of North Carolina professor, said one long-term benefit she’d expect from a program like Bolden’s is that the students now know that they are caregivers. With that knowledge, she said, the teenagers can start to seek out help for any issues that may come up.

Just before getting some cake to celebrate the class’s completion, Taylor, the 16-year-old who cared for her grandmother, talked about her future aspirations. She envisions moving to Houston and working as a chef or an entrepreneur.

Charles Drew High School freshman Mariyah Carson, (second from left) poses for a photo with Charles Drew High School principal Tangela Benjamin (left), Call for Caring Inc. founder Michelle Bolden (second from right) and Dementia educator Carrie Harris (right) during the Young, Gifted and Caregiving inaugural class at Charles Drew High School in Riverdale, Georgia, March 12.

But if she’s put in a position where she has to care for adults again, like her parents, Taylor said she feels more prepared to meet that task. She’s a little nervous about forgetting the lessons of the past month, but she now knows there are resources for people in her position.

“I would be more experienced to help my mom and my dad once they get a little bit older.”

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Political climate linked with Georgia women’s mental health outcomes, Emory study finds

2025-03-13T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

While politicians can make decisions that have direct effects on keeping the public healthy, new research from Emory University highlights how policymakers may also have indirect impacts on their constituents’ wellbeing.

A study published in Social Science and Medicine in January examined some of the potential mental health effects related to the current political climate. Previous research has suggested that politicians’ actions and media outlets’ coverage of the events can have a chronic stress effect on those who watch national political news.

From fall 2023 to spring 2024, the paper’s authors — comprised of researchers at Emory, University at Albany, and Northern Arizona University — surveyed 148 Georgia women between 18 and 40 years old. They asked the participants a series of questions to estimate how much political events caused them stress, in addition to measuring how much anxiety, depression, and overall stress they experience.

Ultimately, the authors found an association between increased stress from politics and symptoms of the three mental health measures. Stephanie Eick, an assistant professor at Emory’s Rollins School of Public Health and the paper’s senior author, said the paper is consistent with other research that found these symptoms often persist beyond the results of a presidential election.

“Even when it’s not election season, I do think that it’s important to think about the political climate as a source of stress,” she said.

The study participants were just surveyed once, so the authors could not determine what caused the negative health impacts. Additionally, most of the participants have earned college degrees, identify as liberal, and live in the metro Atlanta region — making it difficult to know whether these trends hold true among all Georgia women.

One national issue Eick and her coauthors noted could be an especially stressful event for the mental health of women was the U.S. Supreme Court’s decision to rescind national abortion protections. That ruling, paired with Georgia’s six-week abortion ban, is cited by the authors as a reason why the mental health of women in the state is important to be monitored.

“As somebody who’s a woman of reproductive age living here, it seems that a lot of the restrictions related to abortion access are salient here,” she said.

Asked to comment on the study, Frank Sloan, a health policy and management professor emeritus at the Duke Global Health Institute, said in an email that the relatively small number of women studied who identified as politically conservative or had not received a college degree make it difficult to determine how different groups’ mental health are affected by following politics.

Sloan added that it would have been helpful if the authors had examined whether the mental health outcomes changed before and after the 2024 presidential election.

Eick said these limitations are important to be addressed in future studies, and she would like to see her group or others pursue a study that tracks women’s health with political engagement over time. But she said the results seem consistent with other researchers’ observations on the topic.

Because the measures of general stress, anxiety, and depression can be screened for by primary care doctors, Eick said this study could be a call for clinicians to be on the lookout for attending these symptoms among women of reproductive age.

And as federal lawmakers proceed with actions that may further distress some Georgia residents, such as a plan to cut hundreds of billions of dollars from government health care services, Eick said it’s important for people to be proactive about seeking mental health treatment when available.

“Even if we can’t mitigate some of the political stressors … maybe we could mitigate some of the mental health outcomes through existing resources.”

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Amid wildfire trauma, L.A. County dispatches mental health workers to evacuees

2025-01-21T15:37:41+00:00

As Fernando Ramirez drove to work the day after the Eaton Fire erupted, smoke darkened the sky, ash and embers rained onto his windshield, and the air smelled of melting rubber and plastic.

He pulled to the side of the road and cried at the sight of residents trying to save their homes.

“I could see people standing on the roof, watering it, trying to protect it from the fire, and they just looked so hopeless,” said Ramirez, a community outreach worker with the Pasadena Public Health Department.

That evening, the 49-year-old volunteered for a 14-hour shift at the city’s evacuation center, as did colleagues who had also been activated for emergency medical duty. Running on adrenaline and little sleep after finding shelter for homeless people all day, Ramirez spent the night circulating among more than a thousand evacuees, offering wellness checks, companionship, and hope to those who looked distressed.

Local health departments, such as Ramirez’s, have become a key part of governments’ response to wildfires, floods, and other extreme weather events, which scientists say are becoming more intense and frequent due to climate change. The emotional toll of fleeing and possibly losing a home can help cause or exacerbate mental health conditions such as anxiety, depression, post-traumatic stress disorder, suicidal ideation, and substance use, according to health and climate experts.

Wildfires have become a recurring experience for many Angelenos, making it difficult for people to feel safe in their home or able to go about daily living, said Lisa Wong, director of the Los Angeles County Department of Mental Health. However, with each extreme weather event, the county has improved its support for evacuees, she said.

For instance, Wong said the county deployed a team of mental health workers trained to comfort evacuees without retraumatizing them, including by avoiding asking questions likely to bring up painful memories. The department has also learned to better track people’s health needs and redirect those who may find massive evacuation settings uncomfortable to other shelters or interim housing, Wong said. In those first days, the biggest goal is often to reduce people’s anxiety by providing them with information.

“We’ve learned that right when a crisis happens, people don’t necessarily want to talk about mental health,” said Wong, who staffed the evacuation site Jan. 8 with nine colleagues.

Instead, she and her team deliver a message of support: “This is really bad right now, but you’re not going to do this alone. We have a whole system set up for recovery, too. Once you get past the initial shock of what happened — initial housing needs, medication needs, all those things — then there’s this whole pathway to recovery that we set up.”

Disasters on top of pandemic worsen mental health crisis

The convention center in downtown Pasadena, which normally hosts home shows, comic cons, and trade shows, was transformed into an evacuation site with hundreds of cots. It was one of at least 13 shelters opened to serve more than 200,000 residents under evacuation orders.

The January wildfires have burned an estimated 64 square miles — an area larger than the city of Paris — and destroyed at least 12,300 buildings since they started Jan. 7. AccuWeather estimates the region will likely face more than $250 billion in economic losses from the blazes, surpassing the estimates from the state’s record-breaking 2020 wildfire season.

Lisa Patel, executive director of the Medical Society Consortium on Climate and Health, said she’s most concerned about low-income residents, who are less likely to access mental health support.

“There was a mental health crisis even before the pandemic,” said Patel, who is also a clinical associate professor of pediatrics at Stanford School of Medicine, referring to the Covid-19 pandemic. “The pandemic made it worse. Now you lace in all of this climate change and these disasters into a health care system that isn’t set up to care for the people that already have mental health illness.”

Elaine Santiago had been celebrating her 78th birthday with family when she fled her home in the small city of Sierra Madre, east of Pasadena, California, on the night of Jan. 7. She drew comfort from being at the evacuation site. “It sort of gives me a sense of peace at times,” she says. “Maybe that’s weird. We’re all experiencing this together.”

Early research suggests exposure to large amounts of wildfire smoke can damage the brain and increase the risk of developing anxiety, she added.

At the Pasadena Convention Center, Elaine Santiago sat on a cot in a hallway as volunteers pulled wagons loaded with soup, sandwiches, bottled water, and other necessities.

Santiago said she drew comfort from being at the Pasadena evacuation center, knowing that she wasn’t alone in the tragedy.

“It sort of gives me a sense of peace at times,” Santiago said. “Maybe that’s weird. We’re all experiencing this together.”

She had been celebrating her 78th birthday with family when she fled her home in the small city of Sierra Madre, east of Pasadena. As she watched flames whip around her neighborhood, she, along with children and grandkids, scrambled to secure their dogs in crates and grabbed important documents before they left.

The widower had leaned on her husband in past emergencies, and now she felt lost.

“I did feel helpless,” Santiago said. “I figured I’m the head of the household; I should know what to do. But I didn’t know.”

Evacuees search for loved ones

Donny McCullough, who sat on a neighboring green cot draped in a Red Cross blanket, had fled his Pasadena home with his family early on the morning of Jan. 8. Without power at home, the 68-year-old stayed up listening for updates on a battery-powered radio. His eyes remained red from smoke irritation hours later.

“I had my wife and two daughters, and I was trying not to show fear, so I quietly, inside, was like, ‘Oh my God,‘” said McCullough, a music producer and writer. “I’m driving away, looking at the house, wondering if it’s going to be the last time I’m going to see it.”

He saved his master recording from a seven-year music project, but he left behind his studio with all his other work from a four-decade career in music.

Not all evacuees arrived with family. Some came searching for loved ones. That’s one of the hardest parts of his shift, Ramirez said. The community outreach worker helped walk people around the building, cot by cot.

A week in, at least two dozen people had been killed in the wildfires.

The work takes a toll on disaster relief workers, too. Ramirez said many feared losing their homes in the fires and some already had. He attends therapy weekly, which he said helps him manage his emotions.

At the evacuation center, Ramirez described being on autopilot.

“Some of us react differently. I tend to go into fight mode,” Ramirez said. “I react. I run towards the fire. I run towards personal service. Then once that passes, that’s when my trauma catches up with me.”

Need help? Los Angeles County residents in need of support can call the county’s mental health helpline at 1-800-854-7771. The national Suicide & Crisis Lifeline, 988, is also available for those who’d like to speak with someone confidentially, free of charge.

This article was produced by KFF Health News, Healthbeat’s national reporting partner, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Sign up for Healthbeat’s free national newsletter.

California falling short of enrollment goal as mental health courts roll out statewide

2024-12-03T16:27:54+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

California’s new initiative to compel treatment for some of the state’s most severely mentally ill residents — many of whom are living on the streets — is falling short of its initial objectives. But with the program expanding from 11 counties to all 58 on Dec. 1, state officials are projecting confidence that they can reach their goal to help 2,000 adults by the end of the year.

In the first nine months of CARE Court, 557 petitions were filed by first responders, families, or local health officials, all of whom can now request help for individuals who are ill. As of the end of June, 100 people had been placed in court-approved treatment plans, according to the latest data available.

“We’re pleased to see how many people have come through and how appropriate those referrals have been so far,” said Corrin Buchanan, a deputy secretary for the California Health and Human Services Agency, which oversees the program. “These are the right kinds of people we were hoping to serve.”

The Community Assistance, Recovery and Empowerment Act — the first law of its kind in the nation — empowers civil court judges to order adults into monitored plans that include housing, social services, and treatment for addiction or mental illness. Until now, counties such as Los Angeles, San Diego, and San Francisco have been piloting the program, which Democratic Gov. Gavin Newsom has called a “paradigm shift” to prioritize the Californians who are sickest and most in need.

But officials in counties that have launched the program said the low number of cases reflects the amount of time it takes — sometimes weeks or months — to find people and persuade them to enroll. And judges dismissed nearly 40% of petitions in the program’s first nine months, in part because of the program’s narrow criteria to target only those with untreated schizophrenia or other psychotic disorders.

State officials have estimated that between 7,000 and 12,000 people will be eligible for a CARE plan. The state has directed $358 million in one-time funding, and it projects it will spend $108 million a year on the program.

Treatment through CARE Court is voluntary

CARE Court is one of a raft of changes Newsom has spearheaded to address rampant homelessness, including overhauling the public mental health system and funneling billions of dollars for counties to execute those changes on the ground. Recent moves include loosening conservatorship laws and passing Proposition 1, a voter-approved measure that gives the state more control over mental health funding previously managed by counties.

Mobile teams treat New York's most vulnerable mental health cases where they are

Local health representatives say they’re juggling the governor’s initiatives as he demands results to reduce homelessness.

While CARE Court was meant to target people who cycle in and out of jails and hospitals and onto the streets, county officials said they’re encountering a substantial number of clients who have housing and, in some cases, private health insurance.

Many family members have had their hopes dashed when they find that only a small number of people qualify for CARE Court resources and that ultimately treatment is largely voluntary, county officials said. Unlike in a conservatorship, which hands all decision-making power over to the state or an adult guardian, counties can’t treat or medicate participants against their will. But counties can rack up steep court fines if a judge determines the county hasn’t provided help.

“There’s been a tremendous need for the management of expectations, especially with family members,” said Amber Irvine, program manager for San Diego County’s CARE Court. She added that while she considers the program a success, “we need to, as a whole, adjust our expectations of what can be accomplished in a year with such a complicated program and such a complex population.”

San Diego County’s program has been among the most robust, with 221 petitions filed since it launched in October 2023, although a third of the county’s participants were already under conservatorship. Irvine said 76 of the state’s 100 CARE plan participants are from the county.

But it’s not easy. It takes county outreach workers there an average of 54 days of casual conversations, encounters in encampments, and distributing food or supplies — activities the state doesn’t typically reimburse for — to persuade someone to accept services. In some cases, that number stretches to more than four months, Irvine said.

She and others credit the state for funding CARE programs, which has enabled county staff to conduct intensive outreach. San Diego County boasts the state’s first CARE graduate, a participant who was able to exit conservatorship and leave a locked psychiatric facility.

Though Irvine thought the county was overprepared with 15 new hires, the staff was able to take on less than half the anticipated caseload. Other counties have had to shift personnel from understaffed departments to prepare for CARE Court.

Staffing needs remain uncertain with the remaining counties set to launch CARE programs, said Jacqueline Wong-Hernandez, chief policy officer for the California State Association of Counties. In September, Newsom vetoed a bill that would have provided scholarships to mental health professionals if they agreed to work for CARE Court, citing budget pressures.

Alameda County’s contractor has prepared for the Dec. 1 launch by hiring a team of more than a dozen, including a full-time nurse, case managers, employment coordinators, and a clinician to prescribe medications.

Counties struggle to implement multiple initiatives

Officials there are identifying clients already known to cycle through crisis services, so they can file petitions on their behalf. And the county is figuring out how to tap state housing funds that allow clients to stabilize in short-term housing.

“It’s really a lot to set up,” said Kate Jones, who is helping to oversee the county’s rollout.

Mark Ghaly, who was the chief architect of the CARE program before leaving his post as California’s health secretary this fall, said he worked for many years at the county level and empathizes with counties struggling to implement multiple initiatives at the same time. He added that CARE Court was never meant to be launched in a vacuum.

“We’re going to have to see this whole tapestry of efforts come together to really make the kind of dent that I know we can as a state,” Ghaly said.

State Sen. Tom Umberg, a Democrat who co-authored CARE Court legislation, said that more health care providers need to be made aware of the program so they can help spot potential enrollees.

Still, one county representative worries that the public could conflate court-approved treatment plans for the severely mentally ill with solving homelessness. In 2023, California had an estimated homeless population of more than 180,000.

“The solution to homelessness in California is housing, and the more people are prevented from falling into homelessness in California, the fewer county behavioral health clients we will have,” said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California.

Christine Mai-Duc is a reporter for KFF Health News, Healthbeat’s national reporting partner.

Why mobile mental health care works for clients and social workers

2024-11-21T13:22:33+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Natasha Appleweis leaves her Flatbush, Brooklyn, apartment weekly to meet her intimate team of colleagues in an unmarked Brownsville office. Appleweis is a behavioral health specialist on one of New York City’s mobile treatment teams.

Inside the renovated loft, the meeting space is filled with bottled water, feminine hygiene products, and other supplies. At the center, a whiteboard lists the team’s 27 clients.

The seriousness of her job aside, Appleweis, 31, is quick to make a room laugh and rarely in a rush to get anywhere. Her nine-person crew, the Prospect team, serves some of the most vulnerable New Yorkers who are often experiencing the most severe cases of mental illness — schizophrenia, bipolar disorder, schizoaffective disorder, borderline personality disorder. The small and personal wins on the front lines keep her going.

New York City funds five nonprofit agencies to run these intensive mobile treatment teams as an alternative to inaccessible social services and law-enforcement interventions. Thirty-one teams serve 972 clients, most of whom have a diagnosed psychiatric disorder.

The city’s Department of Health and Mental Hygiene must approve clients to determine whether IMT is an appropriate level of care. Each team provides a range of services to their clients spread across the city’s five boroughs.

With nearly half of uninsured adults unable to receive the mental health services they need, this type of intervention, addressing underlying causes of mental illnesses where people are, is what the Centers for Disease Control and Prevention says can help achieve larger and more equal public health goals.

IMT clients receive services beyond medication, like career and housing guidance because, as the CDC says, socioeconomic status and education can affect physical and psychological health, making mental well-being a public health imperative.

An assortment of three- and four-letter acronyms representing mobile behavioral health teams hoping to support severe cases of mental illness have surfaced across U.S. cities. The spread of these teams has been amplified by fatal interactions between law enforcement and people in need of mental health care, such as Win Rozario, the Queens teenager fatally shot by the New York Police Department in March after calling for help.

“This type of care model is one of the only sensible psych care models for people with severe mental illness,” Appleweis said, referring to the intimacy of her team.

Team personality is part of the model for care

Bridgette Callaghan has overseen six IMT teams since the Institute for Community Living was brought into the city-funded program in 2018 as one of the five nonprofits. Without a lot of red tape, Callaghan said, the IMT model welcomes trial and error and is based on team personality and how people engage with services.

Within the national growth of mobile mental health care, models vary, but most center around meeting clients where they are. With labeled vans and matching uniforms, some teams operate as a 24/7 call center serving a continuously changing list of clients. The Prospect team follows a model focused on treating mental illnesses individually for sustained periods. Clients are referred to the Prospect team after unsuccessful experiences with traditional New York institutions.

Once on the Prospect team, clients can access services from substance weaning and antipsychotic medication to the occasional résumé assistance. Or they can be referred to nearly any outside service they need: clinics, care coordination, housing, and education. For day-to-day needs of clients — sending them through school to become security guards or buying a computer for job applications — Callaghan doesn’t have to ask for approval. She simply pulls from funds — nearly $1.2 million in 2023 for each team — allotted by DOHMH.

When working in the field Appleweis sports a rugged multicolored backpack. Absent uniforms or a company car, it isn’t obvious if she’s on or off the clock. The subway-dependent Prospect team is nearly unidentifiable at work.

With no stigmatizing “social services” labels across their bags or nametags, she could — to the lay commuter — be heading to the park, school, or any job. When a single off-putting interaction with a behavioral health professional can lead someone to have a distaste for the services they need, appearance matters. Callaghan tells the Prospect team to leave the collared shirts and bright vests at home.

Natasha Appleweis, who works on an intensive mobile treatment team in New York City, grew up in a Brooklyn Heights brownstone.

Prospect team members say their approach is a refreshing and non-exploitive model for a workforce often defined by their wages, the hours they work, and the trauma they inherit.

A New York City Comptroller’s audit this year measured the success of IMT as a whole by using data points such as the number of calls answered, prescriptions followed, and referrals made — not qualitative accounts of the client’s progress.

One of the audit’s findings said, “merely remaining in the program sets a very low bar.” However, disengagement from mental health services comes with devastating consequences for individuals with schizophrenia, according to research published in the National Library of Medicine.

“The audit found that DOHMH does not track individual progress of clients or report outcomes in the aggregate,” Comptroller Brad Lander, who is running for mayor, said in his written announcement. “Consequently, there is no effective measurement of the overall treatment rate of IMT clients and associated outcomes.”

Callaghan said IMT is reaching people previously unserved – a metric not properly quantified into the comptroller’s checkboxes. The audit calls out IMT staffing shortages, an issue not unique to the model. New York would need an additional 411 mental health care professionals to enter the workforce to meet the full demand as defined by KFF’s tracking of mental health care professional shortages.

For social workers, appreciation inhibits burnout

Appleweis’ early 20s brought an experience that propelled her trajectory. During a Rosh Hashanah gathering in 2014, her cousin told her, “I’ll see you at Yom Kippur.” By the time the High Holy Day came, he had died by suicide.

“He knew damn well he wouldn’t see me at Yom Kippur,” Appleweis said. The grief and anger that ensued propelled her interest in mental illness and led her to briefly work at Friends Hospital, the first private psychiatric hospital in the United States. Founded in 1813, the institution that was formerly known as the Friends Asylum for the Relief of Persons Deprived of the Use of Their Reason, still operates on a sprawling property north of Philadelphia.

Working with clients experiencing suicidal ideation is a frequent presence in Appleweis’ work. She credits her ability to continue onward to the intimacy of her team.

Social workers who feel their employer and team appreciate their work tend to inherit less trauma and burnout, said Carol Tosone, an expert in collective trauma and co-director of New York University’s trauma-informed clinical practice. “Even though [social workers] are in difficult circumstances, if you feel that what you do is valued and appreciated, and you also get a degree of satisfaction and gratification from your work, you’re going to fare better.”

Earlier this year during a weekly meeting, one of the Prospect team’s clients stopped by. A collectively excited “Brandon!” rang throughout the small loft as he entered, smiling and dropping his coat over a chair. The team’s registered nurse, Tatiana Baker, a Harlem-raised mother of three, stepped away to give Brandon his monthly antipsychotic injection. Rolling up the sleeve on his left arm, Brandon said he likes the independence he feels with the Prospect team, which has treated him for almost a year.

‘Work can be like a mini vacation for a few hours’

The intentional duty sharing among the Prospect team is a key reason they’re having success. But much of the clinical treatments can only be administered by Baker, the 33-year-old R.N.

Tatiana Baker, a registered nurse, joined the Prospect team, an intense mobile treatment team, in December 2022 after working at Harlem Hospital Center.

After getting her 9-, 7-, and 2-year-olds off to school and daycare, Baker commutes into Manhattan from Palisades Park, New Jersey. On a recent rainy Thursday in the Upper West Side, she visited a few clients.

Riding the elevator up one of 16 apartment buildings in the city owned by the Postgraduate Center for Mental Health, Baker explained that she was there to chat with a 31-year-old client and to administer an antipsychotic medication.

The medication is one of the most intense antipsychotics, so her client is at a heightened risk of side effects like paranoia and suicidal thoughts. However, once injected, the medication quickly became an afterthought as her client carried on in conversation. She asked about new bras and budgeting for groceries.

“You have to show up as yourself in these spaces, and then use the thing that you went to school for to help them in treatment,” Baker said later.

Inside a Midtown women’s shelter, Cindy, another client, sat with Baker, sinking into casual conversation and digging between vials and sanitizing wipes. Baker’s long braided hair nearly touched the continually ringing iPhones tucked in each back pocket of her jeans.

Unfazed and patiently waiting, Cindy, knowing how busy Baker was, joked about whether she needed to get to her next client. While understanding the question likely comes from past experiences with more traditional social workers, Baker reminded her there’s no time limit.

Cindy wasn’t interested in the injection that day, combatively disputing the dosage. Not a stranger to this conversation — and using skills learned as a teen in customer service at Home Depot — Baker struck a balance of an empowering communicator and a confident educator. Cindy welcomed the shot, and they carried on in conversation.

Like Appleweis and other IMT staff who spoke with Healthbeat, Baker experienced a dominant “white coat” sense of authoritative treatment in hospital settings that is absent in the mobile model.

“I get to be honest about myself, and my failures,” Baker said. “It totally humanizes the job. I don’t think a lot of nurses can say that they’re allowed to be human at work. We’re robots in certain settings.”

Her role on the Prospect team is unique, not because she is the only parent but because she technically isn’t a social worker. She enters spaces as a nurse. The rest is “Tatiana the mom and Tatiana the human being,” she said.

Outside the Prospect team, raising three kids, cooking family-style beef stew, and running between football and swimming practice, 95% of the day is dedicated to a mother mentality. “Work,” Baker said, “can be like a mini vacation for a few hours.”

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Owen Racer is a freelance writer for Healthbeat, based in New York.