Monthly Highlights 

Mental Health Month

Every Encounter Matters: Advancing Mental Health in Clinical Practice

In 2023, nearly 49,000 Americans died by suicide. A recent CDC report found that 42.4% of adults knew someone who died by suicide, and 5.3% reported suicidal thoughts in the past year. Because suicide is preventable, the report highlights the need for routine depression screening, proactive risk assessments, and compassionate conversations that normalize seeking help. National Mental Health Awareness Month is reminder for clinicians that they are in a unique position to identify patients who may benefit from mental health services, and that every clinical encounter is an opportunity for reducing mental health stigma, early engagement and consistent follow-up – which can significantly improve outcomes. Training opportunities and resources to support your patients include:

• Zero Suicide: behavioral health training and resources for health care providers, including Counseling on Access to Lethal Means (CALM) training, an award-winning, 2-hour training
• The American Academy of Child and Adolescent Psychiatry
• Integrated Behavioral Health workflows and protocols (AHRQ)
• Suicide Prevention Resource for Action (CDC)

For people in crisis, the best option is the Center for Health Care Services (CHCS) 24-Hour Crisis & Substance Use Helpline: 1-800-316-9241 or 210-223-SAFE (7233). CHCS has mobile crisis response teams and collaborates with local law enforcement and first responders. This is preferable to calling 9-1-1; if calling 9-1-1, specify that the individual is experiencing a mental health crisis.

The NAMI Bexar Warm Line, from the National Alliance on Mental Illness, offers free pre-crisis peer support, referrals and resources in English and Spanish at 210-939-9999, from 8 a.m. to 11 p.m. daily.

HEALTH NEWS

Health Messaging Around Marijuana May be Missing the Mark

As cannabis becomes more accessible across the U.S., how people use it is shifting. A new CDC report from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) shows that 15.3% of adults reported current marijuana use, with 79.4% smoking it. Other common methods included eating (41.6%), vaping (30.3%), and dabbing (14.6%). Younger adults (18–24) were more likely to vape or dab, and about half of users reported using multiple methods.

Understanding these patterns is key to developing health messages that reflect how cannabis is actually used. While smoking remains most common, the rise of other methods calls for broader education and prevention efforts. Read the full MMWR here. For clinician resources on cannabis use from American Family Physician, click here.

Opioid Prescribing as a Risk Marker for Overdose

As stimulant-involved overdose deaths rise across the U.S., new findings from Pennsylvania reveal concerning trends in prescription histories in the three years prior to fatal overdoses. The data show that opioid prescribing was common before fatal overdoses, even when stimulants were the primary cause of death.

Among stimulant-only overdose decedents, 74.1% had filled opioid prescriptions in the prior 3 years, while only 11.6% had stimulant prescriptions. These findings suggest opioid prescribing is a key risk marker for overdose, regardless of drug type involved, while stimulant prescribing may not be. Understanding these patterns can guide targeted prevention and harm reduction efforts. Click here to read the MMWR. For clinician training on patient-centered prescribing and monitoring for opioid safety, click here.

Texas Measles Outbreak

The United States is undergoing its second-largest measles outbreak since elimination was declared in 2000. Nationally, 11% of patients have been hospitalized, according to a recent CDC report, a rate that is less than the historical average. Similar to previous years, nearly all cases have occurred in people who were unvaccinated or whose vaccination status was unknown. On April 23, DSHS issued a Health Alert for an Atascosa County case with possible community exposures on April 13. Stay current on the Texas outbreak through DSHS’s data page, updated Tuesdays and Fridays. Bexar County is not a designated outbreak county at this time.

Recommendations for Clinicians:

• Consider measles in patients presenting with the following symptoms, particularly those who traveled abroad or had contact with known measles cases:
  • Fever ≥101°F (38.3°C) AND
  • Generalized maculopapular rash lasting ≥3 days AND rash begins at the hairline/scalp and progresses down the body.
  • Cough, runny nose, or conjunctivitis OR Koplik spots (bluish-white specks or a red-rose background appearing on the buccal and labial mucosa usually opposite the molars
• Confirmatory testing, including PCR and genotyping, is available through DSHS and strongly recommended with highly suspected cases.  Providers must first contact Metro Health Epidemiology to ensure specimens are submitted correctly and meet testing requirements. Perform throat swabs (preferred) or nasopharyngeal or oral swabs (Dacron or rayon tip, synthetic shafts). DSHS specimen collection and handling requirements.
• Continue to promote MMR vaccination, which is 93%-97% effective. Children vaccinated outside of recommended intervals will need re-vaccination at the recommended times to meet Texas Administrative Code rules for schools and kindergartens.
• MMR vaccine (within 72 hours of exposure) or immunoglobulin (within six days of exposure) can be administered as post-exposure prophylaxis—read more here.

Resources:

• Printable DSHS measles outbreak sheet on MMR and IG recommendations.
• Measles 101 for Clinicians (The Texas Epidemic Public Health Institute (TEPHI)
• Informational Flyers for Clinics (DSHS)
• “Think Measles: Recognizing and Addressing Measles in Pediatric Practice” (American Academy of Pediatrics)
• Metro Health pop-ups continue to offer FREE vaccines to uninsured and underinsured children until June 30^th.

Measles is a reportable condition—notify Metro Health Epidemiology immediately about suspected, probable or confirmed cases at 210-207-8876 (24/7 line).

METRO HEALTH STI CLINIC UPDATE

RESPIRATORY VIRUS CORNER

• Vaccines for Homebound Seniors: Medicare covers in-home vaccinations provided by a doctor or care provider for COVID, influenza, hepatitis B and pneumococcal pneumonia. Read about eligibility and reimbursement here.
• RSV Vaccine Vote: The Advisory Committee for Immunization Practices voted on April 16 to recommend RSV vaccination for people ages 50-59 with risk factors for having a severe case of RSV. View risk-benefit considerations here. Current guidelines recommend the vaccine for people ages 60-74 with risk factors for severe disease, as well as everyone ages 75 and up. This committee recommendation awaits CDC approval.

MPOX

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