“OK, cool,” his mother, J, remembered saying. (J asked to be identified by only her first initial, and Bug by his nickname, because the family fears harassment.)

“‘What do you need to be supported?’” she recalled asking next. “He asked to get healthcare.” 

This was the kind of moment J had been anticipating since the family had moved earlier that year from Texas to Massachusetts, for its more liberal and inclusive politics. She felt confident they could find the right medical experts. But she hadn’t realized that access to gender-affirming treatment could disappear even when their state’s laws and leaders supported it.

Individual hospitals all over the U.S., in red and blue states, have responded to President Donald Trump’s attacks on transgender healthcare by deciding to withdraw care on their own. At least did so in the first months of the Trump administration as it threatened to pull back federal funding or initiate fraud or wrongful-claim investigations, and such services have continued to drop off since.

Bug and his younger sister were born in Austin, Texas, but J and her husband became worried after the state outlawed abortion; dismantled diversity, equity, and inclusion programs; and limited medical and civil rights for queer and transgender people. The parents worried the support services they needed for the siblings, both of whom have autism, might be affected, too.

“I had a fear of being like the frog in the boiling water and not realizing what was happening until it was too late,” J said. “I needed to get the kids out of Texas.”

So when Bug came out as trans, J was relieved they’d landed in a state that not only has a to who offer but also is requiring commercial insurance, which Bug’s family has, to cover it.

After Bug’s gender announcement, J’s queries led her to the largest hospital system in the region, Springfield, Massachusetts-based , where they began the months-long process of getting set up to start hormone therapy.

Bug, an artistic 14-year-old who loves horses, cats, and making short films with friends, was too old for , but he was excited about the prospect of starting on testosterone. That would cause his voice to deepen, facial hair to grow, and muscles to get bigger.

“Every part of it sounds fun,” he said.

But this past February, two weeks before Bug was scheduled to start testosterone, Baystate announced it would no longer provide gender-affirming medications to minors, offering only counseling. A letter to patients’ families did not explain why.

Baystate spokesperson Heather Duggan sent a statement that said the decision to end treatment for minors reflected the fact that Baystate could lose “hundreds of millions of dollars in government reimbursement” as a result of the Trump administration’s plans. “Nearly 70 percent of Baystate Health’s patients rely on Medicaid and Medicare for coverage,” it said.

All Bug knew was that the care he’d eagerly awaited was about to vanish.

“I felt frustrated that they would do that,” Bug said.

“I bet there’s tons and tons of kids who are like: ‘OK, I’m going for trans-affirming healthcare. Yay!’” he said. “And then, like, tons and tons of kids were disappointed and sad and frustrated.”

J said it felt as if the floor had fallen out from under them. “Maybe this is naive, but I didn’t think that would happen in Massachusetts,” she said.

Baystate is among the providers still choosing not to offer puberty blockers and hormones as the issue wends its way through the courts. This spring, in , a federal judge concluded that it was unlawful for the Department of Health and Human Services to threaten federal funding for providers that offered gender-affirming care to minors. In June, another federal judge cleared 16 states, including Massachusetts, with another lawsuit against the administration over its push to criminalize gender-affirming care.

The American Academy of Pediatrics declined an interview request but said in a that young patients and their families should make decisions about gender-affirming care with their doctors, “delivered with compassion, and offered without political interference.”

One mother of a former Baystate patient said that before her child came out as a transgender girl, she had been severely depressed, battling suicidal thoughts. (The mother asked that only her first initial, L, be used, because the family also fears harassment.)

After Baystate doctors prescribed puberty blockers and estrogen, her daughter’s mood and grades rose markedly, L said. So when she received the letter announcing Baystate was ending the medical treatment, she was furious. L said she and other parents filed civil rights complaints with the Massachusetts attorney general.

The attorney general’s office did not respond to a request for comment.

“There’s a sense of, ‘How could you?’” L said. “And there’s also the awareness of the impact just pulling care could have on a youth — from a physical health perspective but also from a mental health perspective.”

L and J both found alternatives for their children. L asked the family’s primary care doctor to take over hormone prescriptions. Bug’s family was referred to in Northampton, Massachusetts, that said it has taken on about 50 of Baystate’s former patients.

“Transhealth has been staffing ourselves up for a while now in anticipation of the fact that this may be happening across the state,” said.

Erwin said Transhealth can weather the funding threats because the clinic gets large private donations and is not as dependent on Medicaid and Medicare as most hospitals. But Erwin said that doesn’t entirely reassure the broader LGBTQ+ community, including transgender adults.

“When you see something like that go down, people get scared that it’s ultimately going to happen to everyone,” Erwin said.

In May, Colorado’s Supreme Court in that state to resume medical treatments for transgender youths, while in Texas compelled a children’s hospital there to do the opposite — start the nation’s first “detransition clinic.” The Trump administration has continued to pressure providers, including by of transgender minors.

After Bug’s false start at Baystate, he was able to start taking testosterone at the new clinic in the spring.

His mother, J, said that the treatment is going smoothly and that Bug has learned how to give himself the injections. But J is nervous that the federal government will find other ways to stop his treatment again. She sometimes second-guesses the family’s move from Texas to Massachusetts, wondering whether they should have gone to Canada instead.

This article is from a partnership that includes , , and ºÚÁϳԹÏÍø News.

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Being a family caregiver is hard work. On June 17, ºÚÁϳԹÏÍø News Midwest correspondent Cara Anthony joined WAMU’s Health Hub to discuss her experience with parenting while also caring for aging parents. Listen in as she shares tips for other members of the “sandwich generation.”

Are you juggling the responsibilities of raising children and having aging parents?

Navigating that role can come with new responsibilities, stressors, and unexpected expenses, but claiming the caregiver identity can help. Researchers have found that people who identify as caregivers are more likely to use support services and feel a sense of community with others.

ºÚÁϳԹÏÍø News correspondent Cara Anthony joined WAMU’s Health Hub on June 17 to share her experiences as a parent with aging parents.

This <a target="_blank" href="/mental-health/sandwich-generation-caring-for-children-aging-parents-resources/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

His aunt sat at the dining table, sobbing. His father, who’d walked him to the bus stop that morning and promised to take him to dinner when he got back, wasn’t there.

Saúl Zermeño, a 45-year-old single dad, had gone to a routine check-in appointment at an Immigration and Customs Enforcement office that morning, a requirement he’d complied with for years. The father had deferred action that allowed him to stay and work in the U.S., according to his attorney. But that day, Oct. 3, officers deported him to Mexico, where he hadn’t lived since he was 9 years old. Zermeño had been Damian’s sole caregiver since he was a baby because his mother chose not to be involved in the boy’s life, the family said.

Suddenly, Damian, who was born in the U.S., found himself separated from his father by thousands of miles and a heavily guarded border. The previously cheerful 10th grader, who doesn’t have a driver’s license and can make a few basic dishes but isn’t used to cooking for himself, faced navigating his teenage years alone, his dad’s presence reduced to a two-dimensional image on his phone.

“I thought it wasn’t true,” Damian said. “I just went to my room. I didn’t want to leave. I didn’t even want to eat.”

Damian is among an estimated , most of them U.S. citizens, separated from a parent by the Trump administration’s deportation policies. Their mothers and fathers have been deported or locked for months inside detention centers, often from where their families live. These children are separated, , from the adults they depend on. Parents have been arrested while , , and at immigration check-ins with their children present. Most people detained have . (Being in the U.S. without authorization is typically a civil offense). With their parents gone, kids’ lives are plunged into fear and uncertainty.

As a result, a generation of children from immigrant families are exhibiting mental health problems that could .

Parents, therapists, and others who work with immigrant families said they’ve already encountered preschoolers with speech delays, elementary school children who talk of suicide, and teenagers too anxious to leave the house. Research has shown repeatedly that separating children from their parents . The stress of losing a primary caregiver creates havoc in a child’s brain and body, increasing their risk for mental and physical health problems, including depression, anxiety, post-traumatic stress disorder, a weakened immune system, and developmental delays.

“You can just see it in their faces; it’s almost like the light has been dimmed in their eyes,” said the Rev. Tanya Lopez, a pastor at Downey Memorial Christian Church who regularly visits immigrant families as part of a made up of Los Angeles-area religious leaders.

The health risks from this stress response are long-term. People who experience parental separation and other traumatic events as children are heart disease, diabetes, cancer, and other chronic conditions as adults.

In a statement, the Department of Homeland Security said ICE does not separate families, and that parents are asked if they want to be removed from the country with their children or to designate a safe person for them to stay with in the U.S.

However, by the Women’s Refugee Commission and Physicians for Human Rights found that many parents aren’t given that choice, and that ICE often doesn’t ask detainees if they have children or take steps to ensure that children left behind are safe. Saúl Zermeño said ICE officers didn’t ask about his son or check on Damian’s well-being when he was deported.

For days after his father’s deportation, Damian didn’t want to leave his room, eat, or go to school. He stopped talking to his friends. He stopped playing his favorite video game, Fears To Fathom. When he returned to school a week later, the teenager would cry in class or walk out overwhelmed with sadness. Even his favorite subject — English — lost its appeal.

Damian and his father were inseparable; family members joked that they never saw one without the other. Zermeño took Damian, who has attention-deficit/hyperactivity disorder, autism, and other health conditions, to his medical appointments. He cooked for him and combed his hair. He loved to take Damian to his favorite Thai restaurant or to get boba drinks after school. As much as they joked around and played pranks on each other, Zermeño also taught Damian the importance of work by bringing him along to construction jobs and to find supplies at Home Depot.

Damian used to get annoyed with his father’s motivational chats about responsibility. Now they’re one of the things he misses most.

“I thank my dad every day for teaching me to be strong before he left,” Damian said.

Elsewhere in Los Angeles, Jacob, a shy 9-year-old with cropped, curly hair, skinny limbs, and a serious expression, was missing his mom. On a Saturday in May, he clung tightly to his father’s hand as they walked among homeless people, street peddlers, and the stench of urine that hangs in the air outside the building where they live in a cramped apartment. He hoped his mom would soon be released from immigration detention so that he could hug her again.

“If my mom was here, I’d be happy,” he said. “Right now, I’m not.”

Jacob is in some ways a typical 9-year-old. He likes playing Roblox and Street Fighter. He dreams of becoming a police officer and of owning a guard dog, “because you can train them and they defend you.”

But he also endured a harrowing journey, even before being separated from his mom in January. Jacob’s family fled their home country of Colombia in 2024 because members of a paramilitary group threatened to kill them, his father, Andreis, said. During their journey to the United States, Jacob saw dead bodies while trekking through the jungle, was kidnapped and robbed at gunpoint with his parents, witnessed a rape, and had to sell candy and beg for money, his dad said. ºÚÁϳԹÏÍø News is not using the father’s or son’s real name because the family fears it would jeopardize their asylum cases.

After the family arrived in Los Angeles, Jacob suffered from nightmares and an intense fear of being alone. He started to recover once he began attending school and got connected to therapy through the school district, his dad said. For a short while, the family felt they had found peace.

Then, immigration officers detained Jacob’s mother at a check-in appointment while he and Andreis sat in the waiting room. The mother has a pending asylum application and no criminal record, Andreis said. The father said he and his son broke down when officers informed them of his wife’s detention, handing them a bag with her wallet and cellphone. They returned home without her, leaving Jacob inconsolable.

“He was terrified,” the father said, fighting back tears, his voice growing quiet as he recounted that moment. “He was crying with rage.”

After that, Jacob didn’t want to eat or go to school. When he went to school at his dad’s insistence, his teacher called home to ask why he was crying in class. Jacob couldn’t sleep. He acted out. He blamed his dad.

“When will my mom come back?” he asked his dad. “Why do they have my mom? I miss my mom.”

At the same time, Andreis said, he was going through his own crisis, trying in vain to console his son while wrestling with grief, worry, and desperation over what happened to his wife. He stopped his work as a laborer for two weeks to take care of Jacob, but that created financial stress and meant he sometimes couldn’t afford to fund his wife’s commissary account so she could buy better food and make phone calls. Jacob lived for those phone calls.

Jacob listed all the things he missed about his mom, including her cooking (rice with meat, corn cakes with egg), visiting the park together, and her taking him to get his hair cut, treating him to McDonald’s on the weekend, and bringing him to church. Most of all, he missed being close to her.

“I would lie down with her, and I’d watch videos with her,” he said. “My mom would hug me and I’d hug her.”

Sometimes he sprayed her perfume on himself so he could smell her.

After almost five months at the Adelanto ICE Processing Center, Jacob’s mother was released based on a habeas corpus petition in May. The family is still living in fear of detention or deportation. The father worries he too could be detained, and what that would mean for Jacob. Andreis is currently appealing a removal order for the two of them.

A published by the Brookings Institution estimates that over 200,000 children — including 145,000 U.S. citizen children — have likely had at least one parent detained since President Donald Trump returned to office. About a third of those children are under age 6. The number of children with detained parents is expected to grow as the federal government pours over $200 billion into immigration enforcement, including funding from the GOP’s and a appropriation Trump signed this month.

More than 4.6 million U.S. citizen children live with a parent at risk of deportation, according to the report.

Families Broken

Noemi, a Guatemalan mother and asylum seeker, stood in the parking lot at an ICE office north of Los Angeles, her three children wailing and clinging to her, glass from the family’s car scattered at their feet.

Moments earlier, immigration agents had smashed a window and forced her partner out of the car while he waited for Noemi and the kids to finish a check-in appointment. While they were inside, officers tried to separate Noemi from the couple’s children, ages 9, 7, and 1, but gave up after the kids started screaming, Noemi said. Meanwhile, her partner, a Mexican national who’s lived in the U.S. for almost 20 years, was sent to the ICE detention center in Adelanto.

“It was something tragic, something inexplicable that happened that day,” said Noemi, who asked to withhold her full name because she fears government retaliation for sharing her story. “It’s something that marks you for your whole life. My family was broken.”

Located in the Mojave Desert, the privately run Adelanto ICE Processing Center is the immigration detention center closest to Los Angeles and in the U.S. It held a daily average of as of April, and a facility next door called the Desert View Annex held an additional 426.

Since her partner’s detention in December, Noemi said, their children haven’t been the same.

Her 7-year-old daughter, till then usually happy and smiling, became depressed and refused to eat. Her once-high grades plummeted, and she forgot the names of letters and numbers in both English and Spanish. She and her 9-year-old brother struggled to sleep and asked constantly about their dad, wondering if he was taken because they’d done something wrong.

“Why is this happening to us?” they asked her. “We’re good. We’re studying.”

Noemi’s youngest daughter went back to crawling for three months, even though she’d already learned to walk before her father was taken. The little girl would cry out in her sleep, “Pa! Pa!”

Sofia Mendoza, a therapist who works with immigrant families at a community clinic in Los Angeles County, said separated children can experience a form of grief. It’s hard for them to come to terms with their parent’s absence because the parent is still alive, but not with them. This can disrupt the child’s bond with that parent and their ability to form trusting relationships in the future, she said.

Many children also become extremely anxious, angry, and fearful, Mendoza said. Young children often complain of physical symptoms such as stomachaches, develop separation anxiety, and regress to earlier behaviors like bed-wetting. Older children may have panic attacks, nightmares, and difficulty focusing, Mendoza said. Caregiver loss is also associated with and substance use in children.

Norma Gómez, a project manager for the Mixteco Indigena Community Organizing Project in Oxnard, said after immigration raids shook the community last summer, her 9-year-old daughter refused to go to school for a week and was afraid to leave her mom and dad, even though they’re legal U.S. residents. She’d seen other kids at school crying because family members had been detained. Gómez showed her daughter their U.S. residency documents to reassure her. The child asked to make copies for her classmates, hoping they would protect them too.

‘Time To Be an Adult’

Back in East Los Angeles, Damian is living with one of his aunts and struggling to adapt to not having his father around. He said his grades have dropped because he can’t focus in school. He no longer wants to do things he used to enjoy with his dad, such as going out to eat.

“Fun is over,” he said. “It’s time to be an adult right now.”

Being without his father has forced Damian to become more independent, he and his aunt Claudia Zermeño said. Before, his dad did almost everything for him. Now, Damian does his own laundry, helps with housework, and styles his own hair. He’s protective of his aunts, who are both devastated by their brother’s absence; he hugs them frequently and tells jokes to try to cheer them up. He doesn’t want to upset them more by showing his own sadness.

Damian receives therapy both in and outside of school. He said he’s learned breathing exercises that have helped, but he still feels sad and worried a lot of the time. Sometimes he feels angry.

“I try my hardest to think, to stay focused,” he said. “But with everything that’s going on, I can’t keep the facade of ‘everything’s normal’ when I feel heartbroken.”

Saúl Zermeño, now living in Guadalajara, said he’s worried about his son’s health. Damian has a genetic condition called , which causes tumors to grow on nerve tissue in his body, including one in his head that, if not checked regularly by a doctor and monitored by his family, could interfere with his brain. He also suffers from epilepsy and was born with only one kidney, which means he tires easily and doesn’t play sports. Saúl is afraid his son won’t get the care he needs without him there. As Damian’s legal guardian, Claudia Zermeño is doing everything she can for him, but she has two children of her own and is also caring for her mother, who has neurological problems from a stroke.

Damian talks with his dad as often as he can. He hopes to visit his father in Mexico, but he doesn’t have a passport and, as a minor under 16, there are more requirements to get one without his dad present. Saúl is working with an attorney to get permission to legally return to the U.S., but the process is complicated and uncertain.

So, for now, Damian’s hanging on to hope that his dad will be allowed to return and is trying to become the man he believes he should be. He’s making plans to get his driver’s license when he turns 16 this month. He’s given up his goal of going to college and instead wants to get a job right after high school to help his aunts and send money to his dad.

He still cries, but only when he’s alone in his room.

This <a target="_blank" href="/mental-health/immigrant-parents-ice-detention-deportation-children-mental-health-california/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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

Nearly every Tuesday for a decade, Steve Siple attended a bar trivia night with friends in Birmingham, Alabama. After moving to North Carolina, he developed a new ritual — on Saturdays to pick up trash along the city’s light rail.

These are more than fun outings to Siple. They help keep him alive.

Siple has battled suicidal thoughts in the past. He lost his father to suicide, and one of his sons has struggled with thoughts of hurting himself.

That’s made Siple vigilant about protecting himself and his family. In addition to seeing a counselor regularly and speaking openly about mental health, he prioritizes social connection.

“Loneliness was, over my lifetime, one of the greatest risk factors” for suicide, said Siple, a for the American Foundation for Suicide Prevention.

To some, this concept may seem obvious. Yet in the overall approach to suicide prevention, it’s often overlooked. Treatment of a serious mental illness that can lead to suicide, such as major depressive disorder, often centers on medication and talk therapy with little or no consideration of factors such as social isolation or financial duress. Now, there’s a growing movement to address loneliness not just through personal choices but also through public policy.

The research is clear: Among the various complex issues that contribute to suicide, is a . It’s a for older adults, who have and for youths, for whom .

Humans are social animals. When we feel cut off from one another, our , our , and ultimately we’re (by suicide or ). An concluded that being socially disconnected is as harmful to one’s health as smoking up to 15 cigarettes a day.

And it’s getting worse.

Mental health researchers and clinicians say a variety of factors are in America, including the , such as smartphones and ; increased ; the since the covid pandemic; and .

With suicide rates remaining stubbornly high — often ranking among the in America — some advocates and people who have lost loved ones to suicide say increasing pathways to social connection could be a new frontier.

In this ongoing series, ºÚÁϳԹÏÍø News is examining new approaches to suicide prevention that shift the focus from stopping harm in moments of crisis to efforts that give people reasons to live well before they make fateful choices.

“If we want to reduce suicide rates in our country, which is absolutely essential, then a key part of that has to be fostering social connection,” said who served as surgeon general under Presidents Barack Obama and Joe Biden. “We have more than enough data to support this as being an important area of focus.”

In 2023, Murthy released the first on loneliness as a public health issue, with more than 300 supporting citations. He’s also on the topic and is touring the country discussing the value of social connection.

“To help someone else feel less alone, to help them feel seen and understood and valued,” he told ºÚÁϳԹÏÍø News, “that can be one of the most powerful interventions that we make.”

A Role for Elected Officials

Curing loneliness may seem like the responsibility of families and neighbors, people making one-to-one connections. But Murthy says elected officials have work to do, too.

They can use their bully pulpits to turn this into a mainstream issue, he said. They can create microgrants to support grassroots ideas from community entrepreneurs and invest in “social infrastructure,” he added.

That term refers to things in the community that support the development of social connection, from physical spaces, such as libraries and parks, to policies and programs, such as building public transportation and fostering volunteer groups.

“These all matter and impact whether people gather,” Murthy said.

However, investing in public institutions and infrastructure is a costly endeavor that can seem unreasonable when local officials are struggling to balance budgets without increasing tax burdens.

That’s where creativity can kick in.

A health system and a museum in Charlotte have teamed up to for people to attend art classes or live performances together. In Tennessee, the city of Chattanooga is funding community ideas to increase connection and time in nature, where people can speak with volunteer listeners. And across the country, have popped up as places where men can work on projects side by side and discuss their mental health.

Meal Deliveries and Valentines

Marcie O’Neal knew she wouldn’t have much money at her disposal. She was hired in 2024 to lead suicide prevention efforts in the rural of western Kentucky after local leaders saw a rise in suicides among the elderly. Her grant was about $280,000 — less than .

But she knew the nine-county area had other strengths, such as dedicated meal delivery programs and high school clubs.

Drivers who drop off prepared meals to homebound residents “can be the only person that an older adult sees in the week,” O’Neal said.

The state had already been training some of those drivers to recognize warning signs of suicide among older people and alert county agencies to follow up with them. O’Neal thought there could be another component.

She reached out to high school , which focus on fostering leadership skills and volunteerism, across the nine counties and asked them to write cards that could be distributed to older residents along with meals. The response was swift, O’Neal said.

About 1,200 cards were delivered last May. They repeated the gesture in February for Valentine’s Day and again this May.

O’Neal said one of the older residents told her, “I don’t remember the last time I got a Valentine’s card.”

The students also enjoyed feeling as if they made a difference, O’Neal said. She’s helping one school set up an ongoing pen pal program with a nearby retirement community.

Locals affectionately call O’Neal “the suicide lady” — a term she considers “a badge of honor.”

Suicide prevention “doesn’t have to be sweeping huge things,” she said. “It’s a little thing you can do that can kind of snowball into more things.”

‘The Secret Sauce’

Siple, who has prioritized social connection through the trivia nights and volunteer clean-ups, felt most alone when he transitioned from a job at a commercial bank to working at home.

He spent most of his day analyzing Excel sheets, drafting grant proposals, and compiling recommendations for clients. The work felt important, but it was isolating, Siple said.

“If my wife or kids were around during the evening, I was safe,” he said. Holding meetings at coffee shops helped, too.

But when it was just him at his desk, “that’s where I got the darkest lonely feelings,” he said, including thoughts of suicide.

Breaking out of that required seeking new connections.

Siple said church was a great anchor for him and his wife — not just on Sundays but throughout the week at Bible studies and potlucks. They also go to see a variety of live music, including bluegrass and alternative rock.

“Being with folks that are into the same type of music that we’re into for a concert feels like connection,” he said.

Research suggests sports can play a similar role in some instances. At least two studies have found are associated with . The authors posit it’s because people coming together to support their team or to enjoy the event creates a sense of belonging, which is protective.

That concept resonates with , who has worked on suicide prevention efforts at the state and and helps run Sources of Strength, an upstream prevention program. Fostering that sense of belonging has played a central role in each of those initiatives, she said.

“We can’t eliminate hard stuff in our lives,” said Brummett, who lost five friends to suicide, starting in middle school.

“Belonging is really the secret sauce,” she said, “for how we, as humans, can navigate really hard things.”

This <a target="_blank" href="/mental-health/suicide-prevention-loneliness-social-connection-mental-health-eleven-minutes/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

The Department of Health and Human Services is seeking data from little-known state systems that allow hospitals and clinics to exchange detailed, identifiable patient information, ºÚÁϳԹÏÍø News has learned.

In private meetings, some public health leaders have objected to giving Kennedy’s team access to such data, raising doubts that it’s legal or that the information would even be useful.

They have also expressed concerns about allowing the federal government to peer into the minutiae of Americans’ medical records, which could mean viewing anything from doctors’ notes to prescription history. HHS has offered no insight into how it will protect or handle the personal health information it obtains.

But Kennedy told ºÚÁϳԹÏÍø News that medical records are key to investigating the cause of autism, vaccine safety, and chronic diseases. And millions of dollars in grant money has poured into a Nebraska nonprofit that has assisted Kennedy’s effort, according to state records.

He and his advisers have been frustrated that federal access to Americans’ medical records has been limited.

“We need a good health record system, and one of the things that really surprised me most when I came into office is that there is — that the systems are broken,” Kennedy said in a May interview. “We’ve had to go to the states and, luckily, we’ve got a lot of cooperation from the states, but we now have databases together that we can actually do the studies on. Those studies are in motion.”

HHS has not publicly announced any new projects involving medical records and autism or vaccine research. Kennedy faced blowback last year when he proposed compiling the medical records of people with autism to create a federal disease registry — which health department officials .

But Kennedy said in May, “We have a whole pipeline of studies that will be done over the next year.”

Though the White House has steered Kennedy away from further changes to U.S. vaccine policy ahead of November’s crucial midterm elections, President Donald Trump has regularly echoed Kennedy’s doubts about vaccine safety and last week signed an executive order calling for the U.S. to reduce the number of vaccines recommended for children.

Kennedy’s political appointees and allies — including William “Reyn” Archer III, a former Texas health official and whom Kennedy hired as a senior adviser — have led the initiative for the health department to collect and examine medical records.

Federal officials met with leaders of the state-run health information exchange systems several times over the past year and asked how the personal medical records they maintain could be used for vaccine research, according to seven people who participated in the discussions or were familiar with them.

Craig Behm, who runs the Maryland health information exchange, said Kennedy’s team asked about how the vast trove of medical records they store from hospitals and health systems could be used to study vaccines.

“If this administration wants to conduct research on the effectiveness of vaccines, are you saying you all can help us conduct that research?” Behm recalled being asked by a top official at HHS’ health information technology office.

Last June, Behm and leaders of other state exchanges met with Kennedy’s top advisers to discuss sharing more medical data with federal agencies. The state organizations followed up with a pitch in October for a new surveillance system that would give the federal health department “real-time, 24-hour data feeds on opioid and chronic disease trends” within a year, according to a presentation reviewed by ºÚÁϳԹÏÍø News. Under the proposal, HHS would get data from 90% of the population’s medical records by 2028.

Administration officials regularly asked during the meetings how the records could be used to monitor vaccine safety. Kennedy has rejected the federal government’s current vaccine-monitoring systems; decades of research has shown immunizations are safe and effective for most people.

“Vaccine safety, or whatever words you want to use, has come up pretty consistently in those conversations,” said John Kansky, CEO of the Indiana Health Information Exchange.

Kansky sees the potential value of sharing information from the exchanges for public health but is worried about the focus on vaccines: “It’s like, oh man, I wish you would have picked something that pushed fewer buttons for people.”

A System To Monitor Chronic Disease

Nearly every state has at least one health information exchange — often regulated by state laws and run by private companies or nonprofits — that enables hospitals and health systems to immediately share patients’ medical records with one another. The systems allow doctors and nurses to quickly pull up nearly anyone’s medical history and records at emergency rooms or share after-visit summaries and notes with patients’ primary care providers, for example.

In certain circumstances — most often dealing with cases of infectious diseases such as measles or flu — the exchanges notify public health authorities, like the state health department or the Centers for Disease Control and Prevention. Using the exchanges for broader public health purposes is not an unusual idea in itself. But it can present privacy, legal, and ethical complications, health officials say.

In the end, Behm said his organization in Maryland declined to share more data with the federal government for vaccine research, noting that sharing medical records for that purpose would require a rash of approvals from hospitals, state political leaders, and research boards. Any new data-sharing agreement should also have a clear, detailed framework outlining what would be shared and with whom, he added.

“A number of us said, ‘We can’t do anything our agreements don’t allow us to do, so no,’” Behm said. Indeed, most health information exchanges have contractual restrictions on who can access clinical data.

Kansky said Indiana is still weighing whether to provide additional data for Kennedy’s project, and that nothing has yet been shared.

HHS spokesperson Emily Hilliard did not answer questions about how many states are participating in Kennedy’s project, what new data the agency is collecting, how much the federal government is spending on the initiative, how it is protecting patient privacy, or who has access to the data.

“HHS is strengthening public health surveillance and modernizing data systems to better understand and combat the childhood chronic disease epidemic as part of Secretary Kennedy’s Make America Healthy Again agenda,” Hilliard said in an emailed statement. “Americans deserve robust systems to monitor the drivers of chronic illness.”

Kennedy has asserted, without evidence, that vaccines can cause chronic illness.

A Kennedy Partner in Nebraska

At least one state has been cooperative.

The former leader of Nebraska’s state health information exchange has led the effort to share data from medical records with the federal government.

Jaime Bland, former CEO of CyncHealth — the Nebraska health information exchange used by in the state — said several states are looking to “open up channels” to provide more analysis to Kennedy’s team.

“They’re looking at the data differently and providing some insights back to the CDC,” Bland told ºÚÁϳԹÏÍø News.

Bland was among a group who proposed that CyncHealth would help kick off the initiative, according to a 43-slide PowerPoint presented to federal officials during an October meeting.

CyncHealth and other state health information exchanges would “ingest data from hospitals, clinics, laboratories, pharmacies, payers, and social services agencies,” then “link claims and clinical records through a master patient index.”

Data from the exchanges “will be deidentified where appropriate,” according to one slide.

The federal government would pay the exchanges for furnishing the records, according to the proposal: $3 a person, annually.

Officials would “frame publicly that this is not a new database, but a federated trust model that delivers real-time data for all HHS missions,” the presentation reads.

After the meeting, Nebraska’s health department was awarded a large grant from the CDC, and CyncHealth in turn got millions of dollars from the state.

On Dec. 19, the CDC announced new funding under its , which sends money to state and local health departments for lab work, health information enhancements, and solutions for outbreaks.

Nebraska’s state health department was awarded $18.7 million — the most of any state last year, though Nebraska is the 38th most populous state. By comparison, Texas received $9.2 million, and California got $10.8 million.

CyncHealth was then awarded three contracts totaling $13.6 million from the state health department just weeks later, on Jan. 9 and Jan. 16, according to a publicly accessible database of state contracts.

Grace McNamara, a spokesperson for CyncHealth, said it retained $2.4 million of the funding for Kennedy’s project; the remaining money was distributed to “other participating states and various vendor organizations for implementation support.”

A former CDC official who was aware of the transaction, but not authorized to speak publicly about it, confirmed the money was intended for CyncHealth to supply data for Kennedy’s initiative to look at vaccines and autism. McNamara said that the “work is focused on improving outcomes related to acute and chronic illnesses.”

“The referenced project is not research, but rather a proof-of-concept project on how health information exchange and public health can work together to improve health outcomes and is not specific to autism,” she said in an emailed statement.

McNamara did not answer questions about what type of medical data is being provided to the federal health department or whether patients’ identifying information is removed.

Bland left her post at CyncHealth — where she was paid nearly — in December. She was named in April as the chief data strategist for the MAHA Institute — a think tank founded by allies of Kennedy and Trump to advance their Make America Healthy Again movement.

Bland agreed with Kennedy that data from state health information exchanges could provide more insight into autism’s causes or vaccine injuries.

“The data is so fragmented, so modeled when it comes to population health and public health, that we lose sight of the individual stories,” Bland said. She told a story she had heard about a woman who had a seizure after receiving the HPV vaccine.

“You know, the vaccine is safe — it absolutely is — but it wasn’t safe for her,” Bland said. “As public health officials, we say the vaccine is safe. But there are cases where it is not.”

Daniel Jernigan, a former top CDC official who left the agency last summer, said he tried to point Kennedy to data that would help the health secretary study vaccine safety and autism.

After 31 years at the CDC overseeing public health surveillance, emerging infectious diseases, and the influenza divisions, Jernigan thought the solution was simple. The secretary could work with researchers to obtain huge databases pulled from health systems nationwide and maintained by major electronic health records companies.

Those databases are deidentified, meaning they don’t include patient names or other information that can identify individuals. Jernigan said Kennedy didn’t seem interested.

Instead, as The New York Times first reported, the health secretary dispatched two top advisers — Archer and Hannah Anderson, his former deputy chief of staff — to the CDC’s headquarters in Atlanta last July to download millions of identifiable patient records directly from the Vaccine Safety Datalink, the system the health agency uses to investigate complications from vaccines. The records, though, were decades old.

Jernigan said the federal government has limited legal authority to access medical records from state health information exchanges. In any case, examining those records may provide a view of a person’s medical history that will not necessarily produce answers to Kennedy’s questions about vaccines and autism.

“If they’re just using the electronic health record data, there are limits to that,” Jernigan said. “If they’re only looking at electronic health record data, all you’re going to get is what was captured in the encounter. It’s not going to be very satisfying.”

ºÚÁϳԹÏÍø News data reporter Maia Rosenfeld contributed to this article.

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Baldwin, who is a member of the Senate Appropriations Committee and the Senate Health, Education, Labor and Pensions Committee, said lawmakers have been forced to take unprecedented action to ensure the Trump administration properly spends taxpayer dollars.

“In this most recently passed bill that Donald Trump signed into law, we had to put guardrails that we’ve never had to put into our appropriations laws before to enforce our spending bills,” Baldwin said. “And those laws have made it clear that we expect that they must spend what we have appropriated, and not just all of it at the end of the fiscal year, but in a timely manner throughout the year.”

The conversation also addressed the success — and Trump-imposed limitations — of the 988 Suicide & Crisis Lifeline. The resource, which was created through a bipartisan effort, has led to a notable reduction in youth suicide, according to in the Journal of the American Medical Association.

“It’s heartwarming to know that this work matters,” Baldwin said.

This interview aired May 14 on Episode No. 446 of What the Health? From ºÚÁϳԹÏÍø News: “In Search of a New FDA Commissioner.”

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He had rolled his wheelchair to the oven to keep himself warm as he tried to regulate his temperature, she recalled, and was drenched in sweat from an apparent infection.

In that moment, Quette knew that she and her son’s grandmother could no longer meet his medical needs on their own at their Illinois home just outside St. Louis. He had become paralyzed when he was shot in 2023, and, despite their efforts, they struggled to take care of him. But she never imagined that her quick call for help that day would turn into a months-long hospital stay for her son — even after he was well enough to be discharged.

She said their family had been begging hospitals for a home health aide to help care for his wounds, only to be accused of neglect. “They were like, ‘Well, y’all almost killed him,’” she recalled officials telling her. ºÚÁϳԹÏÍø News agreed to use only her nickname to protect the safety of her son.

“I had to give up. I just couldn’t take care of him anymore,” Quette said. “It was just a lot on me. It was something that I was not ready for.”

Once his immediate medical needs were addressed, her son didn’t leave the hospital. His grandmother, who was his legal guardian, had died and the teen ultimately became a ward of the state. He continued living inside a St. Louis children’s hospital for what’s commonly called a “social stay.” Also referred to as hospital boarding or delayed discharge, the practice of keeping children in hospitals “beyond medical necessity” has become a persistent problem — flummoxing officials in Missouri, Illinois, Minnesota, Georgia, and beyond — when there’s no safe place to care for the child.

Finding homes for foster kids is difficult across the country. They have spent nights in casino hotels in Nevada and offices in Georgia . This problem even has a name: “hoteling.” But add medical needs to the mix, and hospitals become the holding station for some kids.

Many children stuck in this limbo have mental health or behavioral issues, while some have chronic physical conditions or disabilities for which they need technology, equipment, or other assistance.

“It’s definitely a national problem,” said , a pediatrician at Boston Children’s Hospital and the chair of the American Academy of Pediatrics’ . “Every state has different options in terms of where kids can go post-acute care. But in general, there’s many of our kids with medical complexity who just don’t have access to the appropriate home nursing to bring them home safely.”

It’s gotten so bad that Missouri lawmakers have repeatedly to try to significantly reduce the number of hospital boarding days each year and eventually end the practice altogether.

Quette said her son was housed in a private hospital room while he waited for the state to find a place for him elsewhere. Other children spend weeks, months, and, in extreme cases, years in acute care hospitals while grown-ups scramble to find them safe places to go, according to Lynn Rasnick, a nurse and vice president at the Missouri Hospital Association. She said some children sleep on emergency room stretchers. They sit in windowless rooms. They miss school. And they’re exposed to all the trauma that comes through the hospital on any given day.

To keep young boarders safe, some hospitals hire “sitters” for kids with no place to go, while other institutions have passed along chaperoning duties to hospital workers.

But all that comes at a cost beyond the toll it takes on kids and families. When a child no longer needs hospital-level care, insurers don’t have to pay for their stay. Some hospitals eat the cost. Others ask the state for reimbursement if the child who is waiting for placement is in state custody.

According to the Missouri Hospital Association, the state’s Department of Social Services reimbursed $16.3 million to 19 hospitals for 9,943 boarding days last year — more than $1,600 a night. But association spokesperson Dave Dillon said that’s a substantial undercount of the problem and that hospitals often aren’t reimbursed for housing children.

One study found that boarding a child with a complex medical condition in Minnesota a day in 2017. And a 2023 Minnesota Hospital Association survey of about 100 hospitals of “unnecessary” patient stays for adults and kids at $487 million for 195,000 days of care.

Lin, the Boston-based pediatrician, said a shortage of home healthcare workers forces some families to keep their children in the hospital, even though they’re well enough to go home.

State Medicaid programs face new pressure from federal cuts in congressional Republicans’ One Big Beautiful Bill Act. Medicaid, which provides healthcare coverage for those with low incomes or disabilities, is expected to lose nearly $1 trillion in federal funding by 2034, so some states are already threatening to scale back optional home-care programs.

Quette, a single mom who once worked as a paid caregiver and now works as a custodian, said her family repeatedly asked hospitals for a home health aide but was told her son’s insurance wouldn’t cover it. Her son’s paternal grandmother, who had helped raise him, was in a wheelchair herself at that point. Quette’s son needed his bandages changed regularly, and she had to turn him around in his bed every four hours.

“I had to wake up out of my sleep to rotate him,” Quette said. “And I couldn’t do it. I was oversleeping.”

Parents across the country face similar challenges. Last year, Georgia officials said 500 children had been and turned over to the state’s Division of Family & Children Services due to complex behavioral or psychiatric needs.

In Colorado, a hospital worker emailed a state representative for help after an autistic 13-year-old boy at UCHealth Longs Peak Hospital in Longmont. After his father left him there, officials told hospital workers that it would take months to find a safe place for the boy to go.

Last fiscal year, the Illinois Department of Children and Family Services logged 304 cases of youth in psychiatric hospitals beyond medical necessity, according to an released by the state. About 43% of those cases were among patients ages 13 to 16.

This year, Missouri state Sen. , a Republican, introduced a bill that would require his state to move faster and pay for care when a child is stuck in a hospital. Similar bills died in committee and . This year, Burger’s bill remained stuck in committee when the legislative session ended May 15.

According to a attached to the bill, paying for hospital boarding could cost more than $148 million a year in a state that already to fund its upcoming $50.7 billion budget.

Over 18 months, the Mercy hospital system, one of the largest in Missouri, logged 2,687 boarding days, testified Patty Morrow, a Mercy vice president, in a March hearing on the bill. That included adults who also were stuck without a safe place to go.

“That was never really ever the intended purpose of a hospital,” Morrow told ºÚÁϳԹÏÍø News. “The current state cannot be the ongoing solution.”

The bill requires the juvenile court system to ensure that children are placed in “an appropriate setting,” which would entail involvement of social workers and other public servants.

Rasnick, with the Missouri Hospital Association, also spelled out the issue during the hearing. “You can’t just discharge a 9-year-old into the street,” she told lawmakers.

Quette’s son is still in state custody but no longer hospitalized. Illinois officials declined to let the teen share his story with ºÚÁϳԹÏÍø News.

His mother said she is still holding on to his brace, bandages, ointment, and other medical supplies in her home. “That’s all I have,” Quette said. “That’s the stuff I will never give away.”

This piece was supported by a grant from the Association of Health Care Journalists, with funding from The Joyce Foundation.

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

As a teenager, Rei Scott spent several weeks living out of a car with four family members and their dog. Each day, Scott worried about where they would spend the following night.

One day at school, Scott snuck away to the bathroom and called the national suicide hotline.

Scott, who is transgender and nonbinary, explained to the hotline counselor that the family had struggled with poverty for years. They had lived in crumbling homes with water leaks, or a family member’s basement with no privacy. Sometimes the family worried about having enough food. The stress and anxiety were constant, and Scott had been suicidal many times.

The counselor seemed shocked into silence, Scott said. Eventually, the person provided reassurance and kindness.

But what Scott really needed that day a decade ago and many times since was a fix for the economic difficulties that had become an unbearable weight.

“It can definitely help to have someone who can listen, but when you’re struggling to eat and you don’t have a roof to be under, I honestly don’t think words can go as far as you need them to,” said Scott, who now studies social work at Capital University in Columbus, Ohio.

Over the years, Scott has been directed to hospitals and therapists. But those generally don’t address core problems, such as a broken-down car or an eviction notice.

“There’s so many times in my life where I’ve thought if I had $5,000, I wouldn’t even be suicidal right now,” Scott said.

People don’t typically think of suicide as an issue of economics, but it often is.

Decades of research shows that , , , , and make people more likely to kill themselves. Conversely, things that bring down people’s cost of living — such as , , , and — are linked to lower suicide rates.

It makes sense. If someone can cover their basic needs, their life will feel better.

Other countries have been incorporating this understanding into their efforts for some time. But because suicide prevention in the U.S. has historically been seen as a medical issue — the responsibility of clinicians who can provide medication or therapy — economic solutions are frequently left out of the equation.

Some advocates and people with suicidal experiences, like Scott, are trying to change that. They say traditional approaches to suicide prevention haven’t succeeded. For decades, the U.S. has had among high-income countries.

To move the needle, “we all need to be challenged to broaden our aperture, to broaden the lens of what is mental health,” said , a national expert in mental health policy and an adjunct professor at the Stanford University School of Medicine.

The highest-impact interventions may not be adding crisis lines or screening more people in emergency rooms, Miller said, though those can be helpful. If he had to pick one strategy, it would be alleviating poverty.

That “allows us to reconcile and solve for these conditions that put people in places of despair,” he said. “I don’t know what stronger intervention one could possibly have.”

To be sure, suicides also occur among wealthy people. It’s a complex issue and almost never boils down to one reason. For most people, the decision to hurt themselves results from an intricate interplay of biological factors, relationship concerns, finances, trauma or abuse, and access to lethal means. That means suicide prevention requires a variety of approaches.

The argument for including economic policy as one of those approaches, many advocates and researchers say, is that policies affect entire populations. So even a small effect can save a significant number of lives.

‘Economic Uncertainty’ Builds

However, the push for an economic lens on suicide prevention is encountering gale-force headwinds from Trump administration policies.

and the have contributed to economic pressures. Meanwhile, the administration has increased hurdles for safety net programs such as the , often called food stamps, and , the state-federal health insurance program for low-income people. Experts estimate will over the coming years.

The administration has also , saying people who are homeless to receive support. The president’s 2027 budget request, which signals his priorities, that helps low-income people pay for heat and air conditioning.

Research suggests increase people’s risk for suicide.

“Anytime there is economic uncertainty, people will fear for their future and livelihood,” Miller said, and “this last few months have been terrifying.”

Notably, the administration’s actions directly contradict strategies that the promotes as having “the best available evidence to reduce suicide.” No. 1 on the page is “Strengthen economic supports.” It lists SNAP benefits and housing-first policies as examples.

, director of the CDC’s injury center, said the agency doesn’t work on economic policy directly but encourages state and local governments to look at the relationship between health and economics.

The Department of Health and Human Services supports suicide prevention through the 988 national crisis hotline, investments in treatment, and the Rural Health Transformation Program, which states can use to expand mental health care in rural areas, HHS spokesperson Emily Hilliard said.

Alec Varsamis, a spokesperson for the Agriculture Department, said the agency is providing states guidance on SNAP changes and “remains deeply committed to supporting the health and mental well‑being of all Americans.”

It’s too soon to tell how recent actions may affect suicide rates. And given the unique combination of factors at play in each death, it’s challenging to draw direct causal links.

The most recent data available shows nearly 49,000 people died by suicide in 2024 — a slight dip from previous years but still among the highest tolls since the late 1990s.

The concept of suicide prevention writ large has historically drawn bipartisan support, said , a New York University researcher who last year highlighting public policies shown to reduce suicide.

The details are where things get murky. For example, strong evidence suggests that increasing the minimum wage reduces suicides. (The is $7.25 per hour, with higher rates in certain states.) But such increases are often a hard sell for lawmakers facing the realities of balancing a budget and small-business owners struggling to stay afloat.

Closely tying suicide prevention initiatives to such politically charged and complicated issues could undermine their chances, Purtle said, adding, “We’ll see suicide get polarized.”

That’s why the focus often stays on areas of agreement, such as funding crisis hotlines.

View From a Crisis Line

is the chief clinical officer at Samaritans, a Boston-based nonprofit that has operated a suicide crisis hotline for more than 50 years and fields upward of 10,000 calls a month, including local calls to 988.

Although people might assume every call is an imminent crisis, Maitland said, many callers are struggling with everyday needs — financial problems, housing concerns, or unemployment.

“Whatever is going on in the world, we absolutely hear about that in real time,” Maitland said.

In November, when during a government shutdown, people affected called Samaritans.

“That in and of itself was a hit to suicide prevention,” Maitland said. “If people don’t have access to eat, to feed their children, to be alive, quite frankly, how are they able to move further through anything else?”

Samaritans volunteers are trained to listen with compassion and make callers feel less alone in what they’re going through. That validation and caring are powerful, Maitland said.

But she often wants to do more, to “dig in and fix” the root issue.

Research supports her instincts. found that increasing the number of people who receive SNAP benefits by 5% could have prevented nearly 32,000 suicides over 15 years. And a $1 increase in minimum wage roughly 8,000 fewer suicide deaths over a decade.

Although Maitland can’t change federal welfare policies, she and her co-workers are applying this approach locally. They recently started an initiative to provide blankets, socks, and water to people living on the streets of Boston.

“Suicide prevention doesn’t always look like a crisis helpline,” she said. “That’s what we imagine it as.” But “having your basic needs is also a form of suicide prevention.”

Continuing To Live

In the years since calling the suicide hotline in high school, Scott has turned to a number of resources to help overcome recurring thoughts of suicide. Crisis lines, hospitalization, medication, and therapy have all played a role.

But, Scott said, the biggest impact came from programs that helped fulfill daily needs — for example, a housing program for LGBTQ+ youths and another for former foster care children attending college.

Scott, who now lives close to campus because of the foster care program, said the ability not to “worry about ‘Where am I going to sleep tomorrow night?’” has provided a significant mental health boost.

Although some programs like those are under threat from the Trump administration, Scott is hopeful they will persist and rebuild.

Surviving difficult times has given Scott confidence to persist through more potential challenges ahead.

Despite “the policies and legislation that harm us, we continue to live, and I think that’s really important,” Scott said. “It gives me a lot of hope that things can be different.”

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The sweeping 195-page , published May 4, advocates for making access to treatment easier than getting drugs, preventing young people from developing addictions in the first place, increasing support for people in recovery, and reducing overdose deaths.

Those broad goals are widely supported by public health researchers, addiction treatment clinicians, and recovery advocates.

But accomplishing such goals will be difficult in the face of the administration’s , and community grants, that serve people who use drugs, and , the state-federal health insurance program for low-income people that is the largest payer for addiction and mental health care nationwide.

Many components of the National Drug Control Strategy are “things that we would agree with and that we fully support,” said , who leads overdose prevention efforts at the Global Health Advocacy Incubator, a public health advocacy group.

But there are “disconnects in what the strategy says is important and then what they’re actually going to fund,” she said of the Trump administration. “Those inconsistencies feel particularly loud in this strategy.”

The White House’s National Drug Control Strategy, released , is a touchstone document meant to lay out the federal government’s coordinated approach to what in recent decades has been one of the country’s defining problems.

Since 2000, have died of drug overdoses. Although deaths have , the numbers remain elevated compared with earlier decades, and overdose death rates among Black Americans and Native Americans are disproportionately high.

The strategy document published this week is the first of President Donald Trump’s current term. In keeping with the administration’s approach to addiction issues, it places heavy emphasis on law enforcement efforts to reduce the supply of illicit drugs. The document repeatedly refers to the ongoing “war” against “foreign terrorist organizations” — the Trump administration’s term for drug cartels — and touts increased enforcement at U.S. borders.

It also to implement artificial intelligence technologies to screen for illicit drugs brought into the country and wastewater testing to detect illegal drug use nationwide.

The second half of the strategy focuses on reducing the demand for drugs through public health prevention efforts, addiction treatment, and support for people in recovery. It promotes the role of religion in recovery and calls for the widespread use of overdose reversal medications, such as naloxone.

In a news release, the White House’s Office of National Drug Control Policy called the document a “roadmap” that will “continue dismantling the drug supply and defeating the scourge of illicit drugs in our country.”

The Trump administration did not respond to requests for comment about how the strategy aligns with its other actions.

In December, Trump signed a , which continues several grants related to treatment and recovery and the requirement for Medicaid to cover all FDA-approved medications for opioid use disorder. In January, he announced the , including a to address homelessness, opioid addiction, and public safety.

However, few details have been provided about the initiative, and in January, about a month after the SUPPORT Act passed, billions of dollars in addiction-related grants were abruptly within a frantic 24-hour period.

That “whiplash” left “a sense of instability and uncertainty in the field,” said , a national adviser with the Manatt Health consultancy. She led substance use treatment policy at the Substance Abuse and Mental Health Services Administration, or SAMHSA, under the Biden administration and left about six months into Trump’s second term.

That insecurity was exacerbated by the , which proposes cuts to several addiction and mental health programs and the consolidation of key federal agencies working on those matters. Jones’ group and nearly 100 others in the field have asking Congress to reject the proposals, as it did with similar requests last year.

The national drug strategy adds new, potentially contradictory information to this confusing landscape.

Increasing Access to Treatment

One of the most significant public health goals in the strategy, mentioned at least half a dozen times, is to make it easier to get treatment than it is to buy illegal drugs.

National data underscores the necessity: More than who need substance use treatment don’t receive it.

The administration’s actions on health insurance may make it difficult to improve that statistic.

Medicaid is the for adults with opioid use disorder. When implemented, the Medicaid work requirements in Trump’s One Big Beautiful Bill Act are projected to strip that coverage from with substance use disorders.

The last time Medicaid rolls were purged — after — many people who had been receiving medication treatment for opioid addiction stopped it and fewer people started treatment, according to a .

Olsen, who is also an addiction medicine doctor, said she loves the strategy’s emphasis on making treatment readily available to anyone who wants it. But she said that’s “hard to really imagine when now people may have to pay for it themselves because they may be losing their Medicaid insurance coverage.”

the upcoming Medicaid changes could lead 156,000 people to lose access to medications for opioid use disorder and result in more than 1,000 additional fatal overdoses per year.

People with private insurance may be affected, too.

The Trump administration has Biden-era regulations aimed at bolstering mental health parity, the idea that insurers must cover mental illness and addiction treatment comparably to physical treatments. And recently, the administration said it would altogether, raising fears that addiction treatment could become increasingly unaffordable.

The administration did not respond to specific questions about how it reconciles its actions on Medicaid and parity with the goal of increasing treatment.

Prioritizing Prevention

The strategy highlights preventing addictions before they begin as one of the keys to reducing demand for drugs. It calls for “promoting a drug-free America as the social norm” and implementing school and community-based programs that are backed by science.

“Investing in primary prevention, before drug use starts, saves lives and resources,” it says, citing about of such programs.

Yet, the president’s budget proposes cuts to these types of programs, and federal layoffs have decimated the agencies that would implement such work.

The White House’s proposes cutting roughly $220 million from SAMHSA’s and nearly $40 million from the program.

Since the new administration started, SAMHSA has , and the Centers for Disease Control and Prevention is . 

“It’s not clear to me that they’re really going to be able to have the funds or the people to be able to carry that out,” Olsen said of the strategy’s prevention goals.

Another wrinkle appears in the strategy’s discussion of marijuana. The document points to marijuana use as one of the drivers of increasing drug use disorders and reports that “convergent evidence from multiple sources” suggests cannabis use increases the risk of psychosis. It calls for developing new tools to treat marijuana withdrawal and addiction.

However, just two weeks ago, the White House medical marijuana to a lower tier of scheduled substances and is moving to to do the same for marijuana broadly.

“The administration, on the one hand, is moving in a direction of liberalizing access to cannabis,” Jones said, “but at the same time, in the strategy, it talks about the dangers of doing so.”

“There’s a disconnect there that just makes you question: Which one do you believe?” she added.

The administration did not respond to specific questions about its marijuana policies.

Stopping Overdose Deaths

One of the more surprising elements of the National Drug Control Strategy comes in the last paragraph of the final chapter. It focuses on public drug-checking programs, which often involve using test strips to help people who use drugs determine whether there are more-dangerous substances, such as fentanyl or xylazine, in the batch they bought. That helps them determine whether or how to safely use those drugs.

“Rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legal,” the strategy document says.

However, SAMHSA announced in that it would no longer pay for test strips, as part of the Trump administration’s “clear shift away from harm reduction and practices that facilitate illicit drug use.”

The administration has similarly attacked harm reduction programs in an and its budget . It did not respond to specific questions about how this position interacts with the drug control strategy.

, a Georgetown University professor who served as acting director of the Office of National Drug Control Policy during the Biden administration, wrote about the contradiction in : “It is the height of rhetoric over reality to champion a tool while simultaneously cutting off the funding used to acquire it.”

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When she graduated from high school, she enrolled at Brown University, the scene of another shooting in December 2025, while she was studying for finals in her dorm room.

As messages flooded in about an active shooter on campus, she felt pain where she had been shot in the stomach. The college junior experienced a phenomenon she called “phantom bullet syndrome,” similar to phantom limb syndrome, in which someone senses something is there that is not. It occurs whenever she feels extremely stressed, she said.

“It’s crazy to say that the first time, I was the lucky one because though I got shot, I didn’t get killed,” said Tretta, now an anti-gun violence advocate who is studying public affairs and education. “And the second time, I was the lucky one because I was a few blocks away.”

Tretta represents a cohort of young people who have lived through more than one shooting. She also embodies the findings of a recent study that links gun violence exposure to chronic pain.

The study, in January, found that both direct and indirect exposure to gun violence are linked to higher rates of among American adults.

Rutgers University researchers studied six types of gun violence exposure: being shot, being threatened with a gun, hearing gunshots, witnessing a shooting, knowing a friend or family member who was shot, and knowing someone who died by firearm suicide. Using a nationally representative survey of 8,009 people, they found that 23.9% had pain most days or every day, while 18.8% said they had a lot of pain.

Daniel Semenza, the study’s lead author, told The Trace that whether someone has lost a person to gun violence or they’ve been shot themselves, their mental and physical health are inextricably linked.

“Your body, through the experience of post-traumatic stress, is going to feel as if it’s happening over and over and over again,” said Semenza, the director of research at the New Jersey Gun Violence Research Center and an associate professor at Rutgers University.

Tretta to remove the bullet, she said, and later received a nerve block to address ongoing pain from her injuries. But the bullet fragments remain in her body years later, she said.

She was also diagnosed with psoriatic arthritis — a chronic disease causing swelling, pain, and stiffness in the joints.

“I have dealt with chronic pain, immunodeficiencies, and bodily differences ever since the shooting happened,” Tretta said. “Every time I get a fever, it’s a completely different thing than anyone else I know, or even pre-shooting for me. I shake uncontrollably, and it hurts to even touch my arm.”

The is one of the first to focus on outcomes like chronic pain as part of an emerging body of work on the physical health toll of gun violence exposure.

“It highlights the fact that, for the thousands of people who are killed every year, there are lots of people who knew those folks,” Semenza said. “The toll of gun violence is much broader than we originally anticipated.”

Efrat Eichenbaum, an inpatient psychologist who has treated gun violence survivors and their families at a Level 1 trauma center in north Minneapolis, said the study accurately reflects what she has seen in her clinical work.

“You can plainly see the trauma that follows an event like that,” she said. “Not just for the survivors, but for their families. It does not even limit itself to family members. This is an issue that touches entire communities.”

David Patterson, an emeritus professor at the University of Washington whose work focuses on pain, says the study shows, in particular, just how far the impact of gun violence fans out and how costly a problem it is for society.

“Chronic pain is a major health problem in itself, and it because it’s very hard to manage,” he said. “You can’t cure it; it has to be managed.”

Back in her dorm room at Brown, Tretta explained that medical care does not end when someone leaves the hospital after a trauma like hers. It goes on for years.

“Your body will never be the same as it was before,” she said. “There’s no time that you can’t feel the 7 or 8 inches of scar tissue running through the middle of your stomach. It’s just a constant physical reminder, because you can’t leave your body.”

This article was reported by The Trace, a nonprofit newsroom covering gun violence in America. .

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