Improving the health of Louisiana's mothers and babies

Understanding women’s experiences surrounding pregnancy and childbirth is a cornerstone of the Louisiana Department of Health’s (LDH) efforts to improve the health of Louisiana mothers and babies.

LDH’s Bureau of Family Health uses the Louisiana Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing surveillance system administered in partnership with the Centers for Disease Control and Prevention (CDC), as a primary source of quantitative and qualitative data around those experiences and maternal behaviors before, during, and immediately following pregnancy.

Who gets Medicaid in Louisiana?

Although almost half of all Medicaid enrollees in Louisiana are children, they account for about a fourth (26.5 percent) of State's total Medicaid spending. Louisiana’s two most vulnerable populations, people with disabilities and those who are aging, make up less than 20 percent of the Medicaid population but account for more than half of the State's total Medicaid spending, 60.4 percent.

We all have a part to play in preventing suicide

Author: Danita LeBlanc, LCSW- BACS

Every 40 seconds, a life is lost to suicide. The 800,000 suicide deaths that occur worldwide are more than deaths caused by homicide and war combined.

Suicide is a major public health issue. In the United States, 44,995 lives were lost to suicide in 2016. Louisiana reported 677 suicide deaths that same year. In the state, it is the 11th leading cause of death, the second for children between ages 10 and 14 and third for those between 15 and 34. Addressing suicide on a public health level, including access to care, is made more difficult by the stigma that accompanies suicide.

Although it sounds conflicting, people who are thinking about suicide usually also want to live. They share signs about living that their friends, family and neighbors see, hear, feel and sense They also share signs about ending their life, those signs are not always recognized as being about suicide. When these signs about wanting to die are presented, it is important to be willing to talk about suicide and ask if someone is suicidal. Neither of these actions put the thought of suicide in someone’s head, and they help break down the stigma surrounding suicide.

It’s especially important to be willing to talk about suicide as impulsiveness plays a role in some suicide attempts. While a person may have been thinking about it for a while, the decision to act can be fast.

We all have a part to play in preventing suicide. Here are some things you can do to help.

Learn the warning signs of suicide so you can recognize them.

• Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself.
• Looking for ways to kill oneself by seeking access to firearms, available pills or other means.
• Talking, writing about death or dying, or suicide when these actions are out of the ordinary for the person.
• Feeling hopeless.
• Feeling rage, uncontrolled anger or seeking revenge.
• Acting reckless or engaging in risky activities, seemingly without thinking.
• Feeling trapped as if there is no way out.
• Increasing alcohol or drug use.
• Withdrawing from friends, family and society.
• Feeling anxious, agitated or unable to sleep or sleeping all the time.
• Experiencing dramatic mood changes.
•  Seeing no reason for living or having no sense of purpose in life.

Reach out.

• Reaching out involves active listening and engaging with a person in a non-judgmental and supportive way – these skills can be taught to anyone.
• Reaching out to those who may be struggling or may have become disconnected from others and offering support can be a life-saving act.
• Reaching out involves linking people to relevant professional resources to ensure appropriate care and follow up for the person at risk. One resource is:

o   National Suicide Prevention Lifeline – 1-800-273-TALK (8255)

§  Veterans can dial “1” and be connected to a Veteran/Service personnel center; they also have the option to be called by the State VA Suicide Prevention Coordinators  within 24 hours

§  Spanish speaking callers can dial “2” and be connected to a call center with Spanish speakers

§  Chat option:  www.crisistext.org

§  Text option:  741741

Help make the environment safer if someone is thinking about suicide.

• Remove things that someone can easily use to hurt or kill themselves from the home (ex. unneeded or large amounts of  medications, firearms) or make them more difficult to access (lock up firearms, separate bullets from firearm; lock up medications or keep only small quantities on hand).
• Stay with them or help them find someone in their circle of support who can be with them until help can be obtained.

Reaching out to people bereaved by someone else’s suicide death gives them the opportunity to talk about their loss, in their own time and on their own terms, which can also be a lifeline (postvention or prevention).

The news media also has a role.

Reporters and other media professionals should take special care when reporting on suicide.

More than 50 research studies worldwide have found that certain types of news coverage can increase the likelihood of suicide in vulnerable individuals. The magnitude of the increase is related to the amount, duration and prominence of the news coverage. When the suicide method is explicitly described, copycat suicides may occur.

However, covering suicide carefully can change public misconceptions and correct myths, which can encourage those who are vulnerable or at risk to seek help.

A list of recommendations when covering suicide as a media professional can be found here.

Suicide is complex, and there are almost always multiple causes including psychiatric illnesses that may not have been recognized or treated but these illnesses are treatable and help is available.

If you need to talk to someone, please call the National Suicide Prevention Lifeline at 1-800-273-8255. The Lifeline provides 24/7, free and confidential support for people in distress and prevention and crisis resources for you or your loved ones, and offers best practices for professionals.

Additional Resources:

• SAMHSA Suicide Prevention Information
• Suicide Prevention Facts and Resources
• Suicide Prevention Wallet Card: Learn the Warning Signs
• Suicide Safe App

EDITORIAL: Being Prepared

Author: Dr. Rebekah Gee, secretary of the Louisiana Department of Health

Recently, the attorney general and others have made statements and have published letters that suggest my agency was premature in alerting nursing home residents and others of the possible impact on their health care and lives should the legislature not properly fund health care services.

To that false allegation, I would ask, “when do you fill your car up with gas … when the tank starts to get low, or do you keep on driving it until it’s empty and it stalls?” Responsibility is not intentionally driving your car until it runs out of gas. Instead, we keep an eye on the indicator and take action before it is too late. Being prepared is being responsible, not only when driving a car, but in all situations.

It was this sole reason that we made the most difficult decision to send letters to nursing home residents and others alerting them there was a strong possibility that the funds necessary to pay for their care would be eliminated. It was important to us to give vulnerable Medicaid recipients enough early warning so they could be prepared.

Going back to the running on empty example … the tank became half-full when the Legislature refused to address the known budget shortfall in 2017 and during this year’s special session. Then, when the House approved a budget that cut health care by more than $1.8 billion a few weeks ago, the tank had run dry.

Although there were some promises that health care funds would be restored during a special session, history of inaction during past sessions left us with little confidence. Those letters were written to give full transparency to those who are at risk for a life and health upheaval, and we have been busy since they were mailed.

We have had numerous meetings with providers, advocates and families to keep them fully informed. We have researched every Medicaid rule and how it affects individual situations to see if there are alternative solutions, and my team has visited every nursing home in the state to meet with patients, families and nursing home staff.

I have also visited several nursing homes and have seen first-hand the heartbreak and anguish on the faces of those whose lives are at risk, and my staff and I have told them the hard truths. As another special session is set to begin, I hope and pray our elected leaders have the courage to take the actions to fully fund not only vital health care services but all of the services that the people of Louisiana rely upon to live their lives to the fullest. 

When a disease outbreak hits, who you gonna call? Disease Detectives

Author: Theresa Sokol, epidemiology manager

When a case of an infectious disease such as measles is confirmed in Louisiana, the epidemiologists in the Louisiana Department of Health’s Infectious Disease Epidemiology Program act as disease detectives to track the causes and consequences of these diseases.

The Program studies the spread of infectious diseases in the community and carries out or coordinates programs that prevent the spread of communicable diseases. With incidents such as the measles case in a traveler from the United Kingdom that was discovered in New Orleans in April 2018, an epidemiological investigation is done.