A Path Forward: Mental Health and the U.S. Pandemic Response.

The COVID-19 pandemic presents a crisis of mental health in the United States (U.S.) alongside a crisis of infectious disease. Racial inequities in COVID-19 morbidity and mortality have brought health equity to the forefront of public health policy, exacerbating prior inequities in mental health care access and outcomes. This Commentary asserts that policymakers and advocates must prioritize mental health when responding to the pandemic. While the pandemic is an emergency of unprecedented scale, the authors argue that it also is an opportunity to implement broad-based mental health policy reforms in the U.S. that build on the successes of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act. Guided by innovative state and local policies to promote population-level mental health, we outline a series of empirically grounded strategies for federal and state policymakers to promote mental health equity in the wake of COVID-19.

In search of a genetic explanation for LDLc variability in an FH family: common SNPs and a rare mutation in MTTP explain only part of LDL variability in an FH family.

We previously identified a highly consanguineous familial hypercholesterolemia (FH) family demonstrating segregation of the JD Bari mutation in the LDL receptor as well as a putative cholesterol-lowering trait. We aimed to identify genes related to the latter effect. LDL cholesterol (LDLc) values were normalized for FH affectation status, age, and gender. Using genome-wide SNP data, we examined whether known SNPs gleaned from a genome-wide association study could explain the variation observed in LDLc. Four individuals with markedly reduced LDL levels underwent whole exome sequencing. After prioritizing all potential mutations, we identified the most promising candidate genes and tested them for segregation with the lowering trait. We transfected a plasmid carrying the top candidate mutation, microsomal triglyceride transfer protein (MTTP) R634C, into COS-7 cells to test enzymatic activity. The SNP score explained 3% of the observed variability. MTTP R634C showed reduced activity (49.1 nmol/ml) compared with the WT allele (185.8 nmol/ml) (P = 0.0012) and was marginally associated with reduced LDLc in FH patients (P = 0.05). Phenotypic variability in a FH pedigree can only partially be explained by a combination of common SNPs and a rare mutation and a rare variant in the MTTP gene. LDLc variability in FH patients may have nongenetic causes.

Suicide Prevention is Everyone's Business.

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Surgeon General's Report on Addiction: What Does It Mean?

A new Congress and a new President-elect mean changes are in store for 2017. But one topic that remains bipartisan is addiction. The Surgeon General's first-ever report on substance misuse and related disorders, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health, reminds us of the inequities in treatment of addictions and opens new opportunities for change.

Examining the Path Taken and the Road Ahead.

Much has changed in the world of addictions and mental health in the last decade. As we reflect on the changes to legislation and public attitudes of recovery, we must focus on what matters to continue the momentum to improve outcomes for people with mental illness and addictions into the next 10 years.

The Old Model of Addiction Treatment Must Change.

Thanks to the Affordable Care Act and Mental Health Parity and Addiction Equity Act, more people have access to addiction treatment, and investors are taking notice. But as new players enter this field, we must ensure that they invest in evidence-based treatment.

Is the Problem Cultural Incompetence or Racism?

Clinical competence-including asking about and understanding the impact of a patient's culture-should be what we all expect when we seek treatment. Behavioral health organizations have opportunities to create culturally competent and responsive services. But we need to add another call to action-acknowledging and addressing the disparities caused by racism.

Creating a Customer-Centric Experience in Health.

The Affordable Care Act means behavioral health will become part of "mainstream" health care. Here are three ways we can offer our expertise to support primary health providers in integrating behavioral health and three ways we can improve and better serve individuals as we move into the mainstream.

Brightening the future: supporting youth to reach their potential.

Mental illnesses are the chronic diseases of young people. By bridging research, practice, and advocacy for early intervention, particularly for first episode psychosis, we can reduce the debilitating outcomes all too common for these illnesses. Our vision for the future is one in which every young person has coverage for the care they need, early in the course of their illness, at a treatment organization that provides a comprehensive array of evidence-based services and supports to help that person navigate the journey into recovery.