UK

Use of the term “postcode lottery” has changed dramatically over time – and means different things to different people, study shows

University of Exeter

Experts tracing how the phrase ‘postcode lottery’ became a cliché in British politics have found its meaning has changed dramatically over time – and that it means different things to different people.

New research shows the idea of the ‘postcode lottery’ was first used in 1997 to express concern about how access to NHS drugs and treatment varied from place to place. But its meaning has since broadened to include regional inequalities in state services generally, and even in poverty and life expectancy.

When austerity policies were introduced in 2010, ‘postcode lottery’ stories declined as news stories focused more on reducing the public financial deficit than on inequalities.

But as the impact of austerity policies mounted the phrase was increasingly applied to struggling public services beyond healthcare. Instead of stories focused on individuals and their access to specific treatments, the media paid more attention to regional ‘postcode lotteries’, comparing the quality of health services more generally.

The study was carried out by Grace Redhead and Rebecca Lynch from the University of Exeter.

Dr Redhead said: “It might feel to us as if the phrase has always been around, but that’s not the case. We have shown how it goes in and out of fashion and how its usage has changed a lot over time.

“The ‘postcode lottery’ means different things to different people. Some groups have talked about the risk of a ‘postcode lottery’ to try and protect the NHS and the idea of universal public services. But other people have pointed to the ‘postcode lottery’ as proof that universalism is impossible, and to justify NHS reforms. It’s a useful term for both sides because it compels so much outrage, but it’s not specific about the cause of the problem.”

Researchers analysed newspapers’ use of the term between 1997 and 2023. The concept of an ‘NHS lottery’ or a postcode lottery for health services first appeared in newspapers in the mid-1990s and followed the creation of the NHS ‘internal market’ in 1989–91. These reforms meant that the services available to patients might vary depending on where patients lived. Widespread news coverage of the reintroduction of the National Lottery in 1994 meant that soon people started to talk about a lottery in healthcare.

Dr Lynch said: “The popular slogan for the National Lottery, ‘It could be you’, was repurposed into anxieties about healthcare access – that ‘it could be you’ who gets substandard healthcare.

“But while the winners and losers of the National Lottery are determined by chance, the causes of regional inequality in health and healthcare are complex and deep-seated. It’s not about luck – it’s about the bigger picture of economic inequality and geographic disparities in investment in health and social care.”

Researchers warned that sometimes the fear of a ‘postcode lottery’ has been used to criticise extra state investment or tailored health services in more deprived areas.

The earliest use of the term ‘postcode lottery’ that the researchers could find was in a September 1997 Evening Standard article about a ‘postcode lottery’ for cancer drugs, which reported that an oncologist had falsified a woman's address so that she could access the new cancer treatment Taxotere. This was followed by a November 1997 Daily Mirror article, reporting on the ‘postcode lottery’ case of two women who lived 20 miles apart in Somerset and Avon, of whom only one could access the drug.

The term was quickly picked up in other news stories about patients who couldn’t access treatments such as IVF, or the MS drug beta-interferon, which were available in neighbouring health authorities. Health charities and politicians began to talk about ‘postcode lotteries’ in their campaigns.

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Journal

Health & Place

DOI

10.1016/j.healthplace.2024.103301 

Article Title

The unfairness of place: A cultural history of the UK's ‘postcode lottery’

INSTITUTIONAL RACISM U$A

UC Merced co-leads initiative to combat promotion and tenure bias against Black and Hispanic faculty

Research funded with $6.5 million in NSF grants finds systemic flaws in evaluation processes

University of California - Merced

Black and Hispanic faculty members seeking promotion at research universities face career-damaging biases, with their scholarly production judged more harshly than that of their peers, according to a groundbreaking initiative co-led by the University of California, Merced that aims to uncover the roots of these biases and develop strategies for change.

Junior professors are generally evaluated and voted on for promotion and tenure by committees comprising senior colleagues. In one of the studies conducted by the research team, results suggest that faculty from underrepresented minorities received 7% more negative votes from committees than their non-minority peers. Further, minority faculty were 44% less likely to receive unanimous votes of approval. The judgment of women minority faculty was particularly harsh.

The findings, published in the journal Nature Human Behavior, are part of a research program co-led by the University of Houston and funded by $6.5 million in grants from the National Science Foundation. The program began four years ago with a $2 million grant to identify bias in academic evaluations. Research under a current $4.5 million grant focuses on understanding what drives the biases and developing policies to mitigate them.

The current NSF grant also will fund a Center for Equity in Faculty Advancement at UC Merced. The center’s development is led by UC Merced psychology Professor Christiane Spitzmueller, a member of the university’s Health Sciences Research Institute and a lead investigator for the research initiative.

The initiative underscores and partially explains the lack of faculty from underrepresented minorities on U.S. campuses. Blacks and Hispanics account for only 14% of the nation’s assistant professors and 8% of its full professors, while those minorities make up 30% of the U.S. population.

This lack of representation not only hinders professional academics but impacts minority students, who look to faculty members for inspiration and mentoring. Learning from Black and Hispanic professors increases students’ likelihood of pursuing STEM careers or simply remaining on academic paths.

Faculty members’ ability to rise through the ranks and receive tenure — an earned guarantee of continued employment — is important not just for the recipients but for the universities, Spitzmueller said.

“Tenure is crucial for faculty, allowing them the freedom to explore innovative and sometimes controversial research without fear of repercussion,” Spitzmueller said. “It is vital that we rethink how tenure is awarded to ensure equity in the academic system.”

The initiative’s other lead investigators are Professor Juan Madera and Associate Provost Ericka Henderson of the University of Houston and Michelle Penn-Marshall, vice president for research and innovation at Texas Southern University. The initiative leverages the research strength of not just UC Merced, Houston and Texas Southern, but also Texas A&M University, Louisiana State University, Purdue University and Georgia Institute of Technology.

Prior studies have shown that faculty from minority backgrounds continue to face barriers in peer-review and grant-funding processes. The research initiative builds on that knowledge, highlighting how these challenges lead to biased promotion and tenure decisions that can dramatically alter a scholar’s career trajectory.

The team analyzed promotion and tenure decisions for 1,571 faculty members at five universities from 2015-2022. The data included promotion and tenure committee votes along with linguistic analysis of external review letters — an evaluation by an outside scholar of a candidate’s research, teaching and service. The letters are a key part of the evaluation process. The analysis accounted for differences in candidate assessment from campus to campus.

Analysis results challenge assumptions that the lack of minorities among full professors is caused by factors such as a toxic campus atmosphere, social isolation or a lack of professional support. The research initiative suggests the promotion and tenure decision process is in dire need of policies and training that can reduce bias and promote equity.

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DOI

10.1038/s41562-024-01977-7 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

UC Merced Leads Initiative to Combat Promotion and Tenure Bias Against Black and Hispanic Faculty

Article Publication Date

4-Oct-2024

 RACIST MEDICINE U$A

Black, Hispanic, and American Indian adolescents likelier than white adolescents to be tested for drugs, alcohol at pediatric trauma centers

University of California - Los Angeles Health Sciences

Injured adolescents from marginalized groups treated at pediatric trauma centers are more likely to be tested for drugs and alcohol than white adolescents, even when accounting for injury severity, a study led by researchers at UCLA and Children’s Hospital Los Angeles suggests.

The findings, to be published October 4 in the peer-reviewed JAMA Network Open, suggest that clinician biases could influence the selection of adolescents for biochemical substance use screening at pediatric trauma centers, said Dr. Jordan Rook, a general surgery resident at the David Geffen School of Medicine at UCLA and the study’s lead author. These inequitable screening patterns may lead to stigmatization and perhaps even legal implications for some injured adolescents.

“While screening can positively affect patients if it is followed by counseling and treatment, it can also lead to negative consequences,” Rook said. “We believe that existing guidelines on substance use screening may be inadequate to achieve equitable high-quality screening in adolescent trauma care. Stricter guidance and oversight and/or the implementation of universal screening protocols and equitable utilization of support services may be needed.”

The researchers used data from the 2017-2021 ACS Trauma Quality Programs for 85,400 adolescent trauma patients ages 12 to 17 years-old from 121 pediatric trauma centers. Of those adolescents, 67% were white, 82% were non-Hispanic, 72% were male, and 51% had private insurance.

Of the total number of adolescents, 25% were tested for alcohol and 22% were tested for drugs. Overall, American Indian, Black, Hispanic, female, Medicaid-insured, and uninsured adolescents were more likely to be screened for both alcohol and drugs, the researchers found.

Among the findings:

• For Black adolescents, the odds of alcohol and drug screening were 8% and 13% higher, respectively, than for white adolescents.
• For American Indian adolescents, the odds of alcohol and drug screening were 117% and 75% higher, respectively, than for White adolescents.
• For Hispanic adolescents, the odds of alcohol and drug screening were 20% and 12% higher, respectively, than for White adolescents.
• For female adolescents, the odds of alcohol and drug screening were 32% and 28% higher, respectively, than for males.
• For adolescents insured by Medicaid, the odds of alcohol and drug screening were 15% and 28% higher, respectively, than for adolescents with private insurance.

 

The authors note that there are some limitations to the study. The data the authors used do not describe if the tests resulted in treatment or intervention, so it was unclear if the benefits of the screenings outweighed any potential harms. Additionally, the data includes only biochemical screening tests and not interview-based screenings, thus underestimating overall screening rates.

The researchers are conducting more studies expanding on these findings to identify potential solutions to the inequities, Rook said. Using national data, they are studying whether individual hospital practices decrease screening disparities, and they will also examine the accuracy and effectiveness of interview-based screening versus biochemical screening.

“These efforts all seek to equitably increase substance use screening and support services for all adolescents,” Rook said.

The study senior author is Dr. Lorraine Kelley-Quon of Children’s Hospital Los Angeles and the University of Southern California. Additional co-authors are Dr. Catherine Juillard of UCLA; Dr. Ryan Spurrier, Dr. Cathy Shin of Children’s Hospital Los Angeles and the University of Southern California; Dr. Christopher Russell of Stanford University; and Dr. Steven Lee of Seattle Children’s Hospital.

The study was funded by the VA Office of Academic Affiliations through the National Clinician Scholars Program Fellowship, the Association for Academic Surgery Clinical Outcomes and Health Services Research Award, and a National Center for Advancing Translational Sciences UCLA CTSI Grant (UL1TR001881).

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2024.36371 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Disparities in Screening for Substance Use Among Injured Adolescents

Article Publication Date

4-Oct-2024

GREEN METHANE 

Innovative catalyst produces methane using electricity

A study by the Universities of Bonn and Montreal opens up new ways to produce important chemical compounds

University of Bonn

 

image: 

keeps the H2O molecules in the electrolyzer (top) away from the active center. At the same time, it removes hydrogen atoms from water molecules and transports them to the active center, where they react with the carbon atom to form methane.

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Credit: Image: Nikolay Kornienko

Researchers at the University of Bonn and University of Montreal have developed a new type of catalyst and used it in their study to produce methane out of carbon dioxide and water in a highly efficient way using electricity. Methane can be used, for example, to heat apartments or as a starting material in the chemical industry. It is also the main component of natural gas. If it is produced using green electricity, however, it is largely climate neutral. The insights gained from the model system studied by the researchers can be transferred to large-scale technical catalysts. The system could also be used to produce other important chemical compounds. The study was recently published in the prestigious journal “Nature Chemistry.” 

Many chemical reactions require energy to get started and this energy can be added by, for example, heating the reaction partners or subjecting them to high pressure. “We used electricity as the driving force instead,” explains Prof. Dr. Nikolay Kornienko. “By using climate friendly electricity, we can produce, for example, methane that doesn’t contribute to global warming.”

The researcher recently moved from the University of Montreal to the Institute of Inorganic Chemistry at the University of Bonn. He started his latest study while still in Canada and concluded it in his new home. “The production of methane – which has the chemical formula CH4 – is challenging because it is necessary to carry out a reaction between a gas and a liquid,” says Kornienko.

In this case, we are talking about carbon dioxide (CO2) and water (H2O). The researchers used a gas diffusion electrode to bring these two partners together. In the reaction, it is necessary to separate the two oxygen atoms (chemical symbol: O) from the carbon atom (C) and replace them with four hydrogen atoms (H). The hydrogen is sourced from the water.

Preventing side reactions

The problem with this process is that water would much rather undergo another reaction and will split into hydrogen and oxygen as soon as it is exposed to an electric current. “This is a competing reaction that we have to avoid,” emphasizes Kornienko’s assistant Morgan McKee, who carried out a large proportion of the experiments. “Otherwise, it would stop us producing any methane. Therefore, we have to prevent the water coming into contact with the electrode. At the same time, we still need the water as a reaction partner.”

This is where the newly developed catalyst – which is deposited onto the electrode – comes into play. It ensures above all that the carbon dioxide reacts more readily and quickly to produce methane. It achieves this with its so-called “active center” that holds the carbon dioxide and – in simple terms – also weakens the bonds between the carbon atom and the two oxygen atoms.

These oxygen atoms are then gradually replaced by four hydrogen atoms in the next step. The catalyst needs water at this stage of the process. However, it also has to keep it at a distance to avoid any undesired side reactions. “In order to achieve this, we bound long molecular side chains to the active center,” explains Prof. Kornienko, who is also a member of the Transdisciplinary Research Area “Matter” at the University of Bonn. “Their chemical structure repels water or, in other words, they are hydrophobic.”

Water-fearing molecular chains

This specialist term comes from Greek and literally means “having a fear of water.” The side chains not only keep the H2O molecules away from the active center and the electrode but they also act as a sort of conveyor belt. Figuratively speaking, they snatch hydrogen atoms from the water molecules and transport them to the active center, where they react with the carbon atom. In this way, the CO2 is converted into CH4 in several steps.

This process has an efficiency of more than 80 percent and the reaction produces hardly any undesired side products as a result. Nevertheless, the catalyst is not really suitable for the large-scale production of methane. “The reaction principles we have achieved with this catalyst could, however, be realized in other catalyst materials for use in large-scale technical applications,” says Kornienko.

The researcher believes that methane production is not the only area of application for this method. In his opinion, it could prove more lucrative in the production of other chemical compounds such as ethylene, which is used as the starting material for many plastics. In the medium term, the new catalyst method could thus be used where possible to make plastic production more environmentally friendly.

Participating institutes and funding:

The Universities of Bonn, Montreal (Canada), Swansea (Wales), Bayreuth, Oulu (Finland), Hohenheim, FU Berlin and the Synchroton SOLEIL in Saint-Aubin (France) participated in the study. The study was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC), the Engineering and Physical Sciences Research Council (EPSRC), the Higher Education Funding Council for Wales (HEFCW) and the Erasmus+ programme from the EU.

Publication: Morgan McKee et. al.: Hydrophobic molecular assembly at the gas-liquid-solid interface drives highly selective CO2 electromethanation; Nature Chemistry; DOI: 10.1038/s41557-024-01650-6, URL: https://www.nature.com/articles/s41557-024-01650-6

Der hydrophobe molekulare Katalysator 

hält die H2O-Moleküle im Elektrolyseur (oben) vom aktiven Zentrum fern. Zugleich entreißt er Wassermolekülen Wasserstoff-Atome und schafft diese zum aktiven Zentrum, wo sie mit dem Kohlenstoff-Atom zu Methan reagieren. 

Credit

Abbildung: Nikolay Kornienko

Journal

Nature Chemistry

DOI

10.1038/s41557-024-01650-6 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Hydrophobic molecular assembly at the gas-liquid-solid interface drives highly selective CO2 electromethanation

Article Publication Date

4-Oct-2024

 

Pharmacology: Venomous crustacean from Mayan underwater caves provides new drug candidates

Toxins from remipede crabs in Mexican cenote caves have pharmacological potential // Species' habitat threatened

Goethe University Frankfurt

 

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The researchers collect the underwater crab Xibalbanus tulumensis, which only occurs here.

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Credit: Björn M. von Reumont, Goethe University Frankfurt

FRANKFURT. Many animals use venoms for self-defense or hunting. The components of such venom, known as toxins, interfere with various physiological processes – which is also the reason why they are so interesting for the development of new pharmacological agents. While the venoms of some animal groups – including snakes, spiders, scorpions and insects – have already been quite well studied, the situation is entirely different for marine animal groups. Here, data exists only for individual animal species, meaning this group still holds great untapped potential.

It was only discovered a few years ago that there also exist venomous crustaceans, i.e. remipedes that look more like centipedes and live in marine underwater caves. A multidisciplinary research team led by Dr. Björn von Reumont, who first described the venom system in remipedes in 2014 and is currently a guest researcher at Goethe University Frankfurt, has now characterized a group of toxins from the Xibalbanus tulumensis remipede.

To that end, Reumont put together a team consisting of cooperation partners from Fraunhofer Institute for Translational Medicine (ITMP) within the framework of the LOEWE Center for Translational Biodiversity, as well as colleagues from the University of Leuven, from Cologne, Berlin and Munich – all of them also part of the European Venom Network (COST Action EUVEN).

The Xibalbanus tulumensis remipede lives in the cenotes which are the underwater cave systems on the Mexican Yucatan peninsula. The cave dweller injects the venom produced in its venom gland directly into its prey. This toxin contains a variety of components, including a new type of peptide, named xibalbine, after its crustacean producer. Some of these xibalbines contain a characteristic structural element that is familiar from other toxins, especially those produced by spiders: several amino acids (cysteines) of the peptide are bound to each other in such a manner that they form a knot-like structure. This in turn makes the peptides resistant to enzymes, heat and extreme pH values. Such knottins often act as neurotoxins, interacting with ion channels and paralyzing prey – an effect that has also been proposed for some xibalbines.

The study shows that all the xibalbine peptides tested by the cooperation partners’ doctoral students – and in particular Xib1, Xib2 and Xib13 – effectively inhibit potassium channels in mammalian systems. “This inhibition is greatly important when it comes to developing drugs for a range of neurological diseases, including epilepsy,” says von Reumont. Xib1 and Xib13 also exhibit the ability to inhibit voltage-gated sodium channels, such as those found in nerve or heart muscle cells. In addition, in the sensory neurons of higher mammals, the two peptides can activate two proteins – kinases PKA-II and ERK1/2 – involved in signal transduction. The latter suggests that they are involved in pain sensitization, which opens up new approaches in pain therapy.

Although the xibalbines’ bioactivity is exemplary of the untapped potential of marine biodiversity, the production of drugs from animal venoms is a complex and time-consuming process. “Finding suitable candidates and comprehensively characterizing their effects, thus laying the foundation for safe and effective drugs, is only possible today in a large interdisciplinary team, as in the case of our study,” says von Reumont.

Making matters more difficult is the fact that time is of the essence for the remipedes. Their habitat is under serious threat from the construction of the Tren Maya intercity railroad network, which cuts straight through the Yucatan Peninsula. “The cenotes are a highly sensitive ecosystem,” explains von Reumont, who, as an experienced cave diver, has collected remipedes in Yucatan during several cave diving expeditions. “Our study highlights the importance of protecting biodiversity, not only for its ecological significance, but also for potential substances that could be of crucial importance to us humans.”

Entrance to a cenote 

Cenotes were once sacred to the Maya, as the karst caves were considered the entrance to the divine underworld.

Credit

Björn M. von Reumont

Xibalbanus tulumensis contains toxins that are suitable for the development of active substances against neurological diseases.

Credit

Björn M. von Reumont

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Journal

BMC Biology

DOI

10.1186/s12915-024-01955-5 

Method of Research

Experimental study

Subject of Research

Animals

Article Title

Diversely evolved xibalbin variants from remipede venom inhibit potassium channels and activate PKA-II and Erk1/2 signaling

 

Neurotech is changing the way we treat disease and understand the brain; Are our medical and legal institutions ready?

The Dana Foundation launches Neurotech Justice Accelerator at Mass General Brigham (NJAM) to unite science and society and mitigate medical, legal, and ethical risks

ENTENTE Network of Companies

 

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Credit: ENTENTE

NEW YORK – October 4, 2024 – The Dana Foundation today announced the launch of Neurotech Justice Accelerator at Mass General Brigham, an integrated academic health care system and the nation’s largest hospital-based research enterprise. The five-year $8.6 million initiative aims to improve equitable access to beneficial neurotechnologies and to mitigate the associated risks in medical and legal settings.

“NJAM was developed to support field building and training to address the ethical implications of scientific advancement,” said Caroline Montojo, Ph.D., president and CEO of the Dana Foundation. “For example, emerging diagnostic technologies are likely to affect care or even end-of-life decisions for patients in a ‘vegetative state’. Clinicians and legal practitioners need to be aware of the potential and limitations of neuroscience and be equipped to make reasonable judgments given the evidence they provide.”

Under a team of renowned practitioners and scholars in neurosurgery, neuroethics, and neurolaw from Massachusetts General Hospital (MGH) – a founding member of Mass General Brigham – Harvard Medical School, and the University of Minnesota, NJAM integrates training in clinical practice, law, ethics, and neuroscience – disciplines that typically operate independently. Programs include:

• interdisciplinary research training on equitable application of beneficial clinical neurotechnologies, and on neuroscience as evidence in court and in criminal justice reform.
• community partnership and advocacy training to facilitate bi-directional learning between NJAM fellows and members of communities likely to be impacted by neurotechnology advancement.

NJAM is part of the nearly $20 million Dana Center Initiative launched earlier this year. It joins the UCLA-CDU Dana Center for Neuroscience and Society and the Dana Program for Neuroscience and Society at Loyola University Chicago.

"Neuroscience is moving forward in exciting ways, often so fast that it outpaces public discourse and training about potential benefits and risks,” said Steven E. Hyman, M.D., chairman of the board at the Dana Foundation. “Through the Dana Center Initiative, we hope to catalyze the cultural and institutional shifts needed to fully realize the positive impact of neuroscience while making sure it's applied fairly and responsibly.”

Advancing Ethical Application in Clinical Settings
From a medical perspective, emerging technologies and new applications of brain imaging, deep brain stimulation, and stimulus-based electroencephalogram hold great potential to improve outcomes for patients with neurologic diseases. They also promise to improve diagnosis and assessment of brain injuries and disorders of consciousness.

NJAM will provide a mixed-methods research training program to accelerate the responsible uptake of neurotechnology in clinical and other contexts. Through community-based participatory research, quantitative and qualitative methods, and big data analysis, NJAM fellows will identify barriers to access, solutions for preventing injustices, and pathways for addressing challenges in brain-based conditions.

“Due in part to lack of training in a clinical setting, some neurotechnologies are applied today in just a few hospitals and clinics throughout the world,” said Theresa Williamson, M.D., MPH, assistant professor of neurosurgery and neuroethicist at MGH and Harvard Medical School, and co-director of NJAM. “One of the major aims of NJAM is to ensure more clinicians and medical practitioners are trained to understand the potential of these technologies and how to apply them. Our work through NJAM is about ensuring more patients will benefit from advances in neurotechnology development.”

Promoting Responsible Use in Legal Settings
From a legal perspective, neurotechnological advances raise questions in areas such as the application of neuroscientific evidence in criminal sentencing and brain injury litigation. NJAM will offer an interdisciplinary neurolaw training program through which participants will identify barriers and opportunities of deploying neurotechnology as evidence in legal settings, collaborate with judges and lawyers, and improve access to neuroscience tools for resource-poor litigants.

“Judges and other legal practitioners are already being presented with evidence drawn from neurotechnologies that raise questions about justice, access, and privacy. This is likely to increase as new capabilities and applications are discovered,” said Francis X. Shen, J.D., Ph.D., a member of the University of Minnesota Law School faculty, MGH Hospital Center for Law, Brain & Behavior, Harvard Medical School Center for Bioethics, and co-director of NJAM. Shen, who is an expert in the intersection of law, ethics, neuroscience, and AI, added, “Is it ethical to use this neuroscience information? Will it promote or hinder just legal outcomes? And how do we ensure privacy? Today, legal practitioners have little practical guidance on how to apply group-level neuroscience research to individualized legal decisions. NJAM will train the next generation of neurolaw practitioners to change that.”

Engaging Community Partnership

Recognizing the important role local organizations play in supporting members of their communities, NJAM will also equip scientists with skills to listen deeply to members of communities affected by novel neurotechnologies and share their science in a way that informs policy solutions.

“It’s critical to train the next generation of scientists to engage with communities to incorporate their voice into research priorities,” said Gabriel Lázaro-Muñoz, Ph.D., J.D., assistant professor and neuroethics researcher at Harvard Medical School and the MGH Department of Neurosurgery, and co-director of NJAM. Lázaro-Muñoz combines his background in neuroscience, law, and bioethics to examine ethical, legal, and social implications of emerging technologies. “We seek to increase the role of patients and community members in the responsible development of neurotechnology. Training will enable scientists to create solutions with, rather than for, community members.”

About The Dana Foundation
The Dana Foundation advances neuroscience that benefits society and reflects the aspirations of all people. We explore the connections between neuroscience and society’s challenges and opportunities, working to maximize the potential of the field to do good. Find out more at dana.org.

 

Studies examine growing US mental health safety net

Reach of certified community behavioral health clinics reflects bipartisan support for investment in improving behavioral health

New York University

 

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A map of US counties served by certified community behavioral health clinics (CCBHCs)

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Credit: © 2024 Mauri Al et al. JAMA Health Forum

A decade after the establishment of the certified community behavioral health clinic (CCBHC) model, more than 60 percent of the US population has access to such facilities and the mental health and substance use disorder treatment services they provide, according to a new study led by researchers at the NYU School of Global Public Health. Moreover, these clinics are expanding the availability of crisis mental health services, including mobile crisis response teams and stabilization.

“Certified community behavioral health clinics have become a cornerstone of bipartisan strategies to increase access to and improve the quality of behavioral health care in the United States,” said Amanda Mauri, an assistant professor/faculty fellow at the NYU School of Global Public Health and the lead author of two new studies on CCBHCs. 

A new approach to community-based behavioral health care

CCBHCs fulfill federal criteria related to providing outpatient mental health and substance use care, including crisis services, regardless of patients’ ability to pay. The federal government established the criteria for the CCBHC model in 2014, and the first CCBHCs opened in October 2016. Clinics that become CCBHCs are typically community mental health centers that offered outpatient behavioral health care before becoming CCBHCs, but other types of facilities—like hospitals and federally qualified health centers—are also receiving CCBHC designation. 

“The creation of CCBHCs marks the first significant shift in federal involvement in community behavioral health care since the 1980s, when Congress converted the national community mental health center program to a block grant,” said Mauri. “Given this important policy change, it is essential to evaluate whether and in what ways CCBHCs change community behavioral health care, particularly for persons who are uninsured, underinsured, and enrolled in Medicaid.”

Over the past decade, federal funding for CCBHCs has increased—for instance, the Bipartisan Safer Communities Act, which became law in 2022, funnels $8.5 billion over 10 years into CCBHCs. Clinics can become designated as CCBHCs through two initiatives: Medicaid programs that make bundled payments to clinics on a daily or monthly basis, or through the Substance Abuse and Mental Health Services Administration (SAMHSA) Expansion Grant program. 

Despite the significant investment in CCBHCs, there is little research on these clinics: where they are located, what services they provide, and who they reach. To address this gap, Mauri and her colleagues created a dataset of CCBHCs and began exploring their reach and services.

The wide reach of CCBHCs

In a study published Oct. 4 in JAMA Health Forum, the researchers found that CCBHCs have a wide-reaching network, with the proportion of US counties and people residing within a CCBHC service area substantially growing since the first clinics opened in 2016.

As of June 2024, 39.43 percent of counties are served by CCBHCs (22.85 percent of counties served by Medicaid CCBHCs and 25.37 percent of counties served by SAMHSA-funded Expansion CCBHCs, with some served by both). More than half of CCBHCs serve multiple counties. In addition, the majority of the US population—62.26 percent—have access to mental health care through local CCBHCs (26.63 percent by Medicaid CCBHCs and 53.93 percent by Expansion CCBHCs, with some served by both).

While the researchers found geographic differences in where CCBHCs are located, they note that these disparities do not necessarily fall along partisan lines. For instance, Texas was an early adopter of CCBHCs, establishing statewide access through a Medicaid program. In contrast, North Dakota, South Dakota, Delaware, and South Carolina had no CCBHCs as of June.

“This is one of the few policy spaces where there's bipartisan support—we're seeing Republican and Democratically controlled states alike launching CCBHC initiatives, and we’ve seen significant investments in the program under the Obama, Trump, and Biden administrations,” said Mauri. 

Increasing crisis services

CCBHCs are required to provide the three main types of behavioral health crisis care: 24/7 call lines, mobile crisis response, and crisis stabilization. The need for crisis services has grown since the 2022 launch of 988, the new national number for the Suicide and Crisis Lifeline.

To better understand the crisis services provided, Mauri and her colleagues analyzed national survey data from the National Council for Mental Wellbeing on CCBHCs, along with the demographics and socioeconomics of the areas they serve. Their findings were published last month in the journal Psychiatric Services.

The research found that clinics receiving CCBHC Medicaid bundled payments had much higher odds of adding new crisis services when becoming CCBHCs than clinics not receiving these Medicaid payments.

“This suggests that the CCBHC Medicaid bundled payments matter and may be effective tools for increasing the availability of resource-intensive crisis care, like mobile crisis response and crisis stabilization services,” said Mauri.

The researchers also found that CCBHCs with higher staffing levels relative to the population they serve were more likely to directly provide crisis services, rather than contracting with third-party providers. 

In addition to Mauri, study authors for the JAMA Health Forum study include Nuannuan Xiang of  Columbia University Mailman School of Public Health, Danielle Adams of the University of Missouri-Columbia, and Jonathan Purtle of the NYU School of Global Public Health; additional study authors for the Psychiatric Services article include Saba Rouhani and Jonathan Purtle of the NYU School of Global Public Health. The research was funded in part by the National Institute of Mental Health (R01 MH121649).

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Journal

JAMA Health Forum

DOI

10.1001/jamahealthforum.2024.3001 

Article Title

Proportion of US Counties and Population Served by Certified Community Behavioral Health Clinics

Article Publication Date

4-Oct-2024