Task Force resumes look at Missouri’s response to substance abuse

      A Task Force that hopes to advance Missouri’s response to substance abuse has resumed work. 

Representative John Black (Photo: Tim Bommel, Missouri House Communications)

      The Substance Abuse Treatment and Prevention Task Force met in the 2023 interim and developed recommendations for the legislature, some of which were enacted.  One of those was that it be continued this year, and its chairman, Representative John Black (R-Marshfield), is glad that was passed.

      “I think we’ll do more or less the same thing we did last year.  We’ll look at some of the issues that we’ve identified for review this year and then hopefully the Task Force will continue to refine those and come up with more issues.  The budget, of course, is a big deal,” Black said after the Task Force met Monday.

      Representative Del Taylor (D-St. Louis) is glad to be a part of the group.

Representative Del Taylor (Photo: Tim Bommel, Missouri House Communications)

      “Missouri, as our counterpart 49 other states, as well as most countries in the world, are really struggling with getting our arms around substance abuse disorder.”  He said the group heard from experts Monday that, “[Substance abuse] is kind of how we respond to our own different mental illnesses.”

      The Department of Mental Health’s Chief Medical Director, Dr. Angeline Stanislaus, opened the session with a discussion of the neurobiology of addiction.  She said much has been learned in the last three decades that can guide the state’s programs. 

      It was believed in the medical field some 20 or 30 years ago that when a substance was out of a person’s system and they resumed using it, it was by choice and they had an issue with discipline or willpower.

      “That was the mindset in which we were trained as physicians in the 1990s,” Stanislaus said.  “There’s been more research now to show that just because a substance is out of the system … but all the neurotransmitter changes the substance did before it got out, they’re still lingering and the body’s still working on them.  This is the new understanding over the last couple of decades, it took us this long to understand that.”

Dr. Angeline Stanislaus and Director Valerie Huhn with the Department of Mental Health (Photo: Tim Bommel, Missouri House Communications)

      Stanislaus said many people who abuse substances like alcohol, cocaine, and heroin do so because they were victims of childhood abuse or neglect that altered their brain chemistry.

      “The brain wasn’t connected the way to produce a natural level of dopamine and neurotransmitters that a brain needs for us to lead healthy lives … same thing with violence.  Witnessing a lot of violence changes the brain chemistry.  There’s a lot of fear.  The neurotransmitters that are impacted by fear will go up, so when you have so many fear neurotransmitters going on in your brain you may seek a substance to decrease that fear.”

      A brain disrupted by substance abuse will never return to what it was before, but it can heal.

      “The brain is such a wonderful organ.  It’s very neuroplastic, that can produce itself more neurotransmitters given enough time, given treatment, this is how treatment works.  Give them enough time for the brain to recreate all this dopamine and all those other neurotransmitters, either through medications, combination of therapy, combination of whatever needs to be put together … that’s the true potential of what the brain can possibly do and that’s what we try to do as treatment providers.”

      Former Missouri House Speaker Todd Richardson has been the Director of MO HealthNet since 2018.  Much of what the Task Force discussed with him was its recommendation from last year that a new state executive be created – what members have tentatively referred to as a “czar” – to oversee substance abuse issues across the various state departments that deal with those. 

      He said while the idea has merit and could work, giving one figure authority over three, four, and even five departments and asking that person to understand and take on all that is involved in substance abuse issues, could prove too much to ask.

      He thinks the effort the Task Force has set in motion should be given time to work.

      “I think it is incredibly important that the departments continue to collaborate in this space and make sure that our policies are complimentary of each other … I think that collaboration is better than it has ever been before.  While I think the idea behind having somebody to oversee this is the right thinking, I really think the best way to accomplish what you’re trying to accomplish is by trying to continue to encourage that collaboration between those departments.”

      To the Task Force’s credit, Richardson said, “I do think the focus that this task force has put on it has already led to more collaboration and coordination and discussion about this subject than I’ve seen in the 15 years I’ve been coming to Jefferson City.”

Representative Todd Richardson (Photo: Tim Bommel, Missouri House Communications)

      Taylor appreciates the different backgrounds brought to the group.  A budget-minded legislator himself, Taylor hopes to get more data about Missouri’s substance abuse response.  

      “Consistently I want to know:  what are the programs and how do we measure effectiveness?  Is the program actually working?  How much have we appropriated for that program and are we spending the money that we appropriate?  Let’s at least be honest and up front about how much of that is actually going to get used, how many people are you going to actually hire, and how much of that is going to lapse?”

      Some members weren’t present at Monday’s hearing due to technological or medical issues.  Black hopes more members will be able to attend in subsequent hearings.

      “The more people we have, the more involvement, the more good questions.  That would be beneficial, but I’m very happy that the Senate, the House, and the governor’s office are supportive of the continuing work of the task force.”

      The Task Force will meet again in July.

House Anti-Bullying ‘Childhood Hero Act’ gets Unanimous Passage to Senate

      A House bill passed this week aims to keep students who stand up to bullies in Missouri from being punished along with those bullies.   

      “Our goal is to make sure that a victim of violence, an immediate act of violence, isn’t automatically suspended from school for being involved.  It also allows a teacher to act in good faith to help a victim of immediate violence,” said Representative Tricia Byrnes (R-St. Charles), the sponsor of House Bill 1715, the “Missouri Childhood Hero Act.”

Representative Tricia Byrnes (Photo: Tim Bommel, Missouri House Communications)

      Byrnes said the language is meant to, “address some of the bullying and violence that we have seen in our schools across the state, and quite honestly in schools across the country, and I’m very proud that [we], in a bipartisan fashion, have come together to stand up for kids.”

      “This bill is very timely and it is appropriate,” said Representative Raychel Proudie (D-Ferguson)“I believe this bill prevents victims of bullying and physical violence from being victimized twice, both by the altercation and by being suspended pending investigation.”

      The Act would require that public and charter schools have anti-bullying policies and that those policies meet certain requirements.  It would restrict the use of “zero-tolerance” provisions that would punish a victim acting in self-defense, and require that administrators considering punishments consider a statement from any student who engaged in self-defense.   

      The bill specifies that a school employee or volunteer who intervenes in an incident of bullying or other violence is immune from liability when following certain procedures, and that a district or charter school is immune to civil liability for disciplinary actions if following specified procedures.   

      The bill would also extend school districts’ efforts to counsel and educate victims of bullying to those students who engage in bullying.  That provision was added by Marshfield Representative John Black (R), the sponsor of House Bill 2630, which has been paired with HB 1715.

      “As was mentioned in committee by one of the committee members, ‘hurt people hurt people.’  This tries to address the situation by addressing both the student being bullied and to try to get help to the student doing the bullying,” Black told his colleagues.   

      “As a teacher and school counselor myself, we are professionals, we are practitioners, and in as much, should have to answer for making sure that we are keeping eyes on children, and making and cultivating a safe learning environment for children,” said Proudie, who is a certified teacher and school counselor. 

Representative Raychel Proudie (Photo: Tim Bommel, Missouri House Communication)

      “[The legislation] really does put the onus on schools and school districts to do the appropriate amount of investigation to get to the bottom of what happened, and it also holds individual teachers or adults who are responsible for supervising children to account and to answer for where they are and some of the actions taken.  Anyone who’s been a parent and who has had to go to a school or a school district to continuously ring the alarm about their student being bullied and getting into these physical and even verbal altercations, and the school or school district kind of throwing their hands up and saying, ‘Well, both of them were participating,’ it’s just not fair.”

      Regarding investigations, the legislation would shorten the time in which a district employee who witnesses a bullying incident must report it from two days to one, and require that the report be in writing. 

      Results of investigations would have to be presented to all involved students and include a description of any interventions, initiatives, techniques, or disciplines.  In cases in which an investigation finds that bullying occurred the parents of the instigator must be notified.  If the finding is that the incident rose to the level of 2nd degree harassment, law enforcement would be notified, or in cases involving a student younger than 11, the state Children’s Division would be notified. 

      “I think we’re all familiar with the scenario where two kids get into a fight and they’re both kicked out of school, and that’s what we’re trying to prevent, and I think that’s what this bill prevents,” said Representative Ian Mackey (D-St. Louis)

      “It’s going to require a little more work on the part of administrators and on the part of adults in the school setting to actually investigate what happened, to actually make sure that perpetrators are suspended if they need to be, but that victims are not kicked out of school simply as a result of being bullied.”

      The House voted 150-0 to send that bill to the Senate.

House plan to create mental health courts advancing

     A House committee has advanced a plan to create treatment courts in Missouri that would focus on mental health issues, and offer offenders treatment options as an alternative to incarceration.  Its bipartisan supporters say it would be a meaningful expansion of the state’s successful treatment courts. 

Representative John Black (Photo: Tim Bommel, Missouri House Communications)

      The mental health courts that would be created by House Bill 2064 would be similar to the already existing veteran courts, DWI courts, drug courts, and family treatment courts.  In each of those, a defendant must go through a regimen of relevant treatment programs.  Those who succeed, or graduate, can avoid prison time or having a crime appear on their record.  

      “The goal is that they receive treatment to help them overcome, have the tools that they are now aware of, that they’ve experienced, which they have available to them to maintain a lifestyle without the problems that haunted them,” said Representative John Black (R-Marshfield), the bill’s sponsor. 

      He said this would be a continuation of the existing treatment courts, which are widely viewed as an achievement by Missouri’s legal system and a cost-effective way to avoid incarceration.  They allow offenders a chance to remain connected to and active in their communities while working and remaining with families.  They are also associated with reductions in crime and the need for foster care, and with ensuring timely payment of child support. 

      Black noted that perhaps most importantly, “The percentages of those folks who are able to avoid recidivism … with those folks who have actually completed the treatment courts, are very impressive.”

      The proposal is one recommendation to come from the Substance Abuse Treatment and Prevention Task Force, created under legislation passed in 2019 and chaired by Black.  That task force sought to get a handle on what is happening throughout the state of Missouri and across all agencies, to deal with substance abuse issues. 

      One of its recommendations was to see that existing treatment courts receive more funding, as well as the creation of mental health treatment courts. 

      Black said among the existing treatment courts there is already a lot of overlap with mental health.  

      “In fact, it’s called, ‘co-occurring disorder,’ and if put the mental health courts in the statute, specifically, then they’re also available for funding.  There are some people who are in jail and have a mental health problem and they’re there for that problem, when in fact it is a co-occurring disorder involving substance abuse.  This just allows a more comprehensive treatment.”

      Black said such courts would likely rely heavily on counseling that is specific to a given defendant’s circumstances, “and it is a tough program.  It’s not something that’s easy.  They have to invest a lot of effort in completing the program, so if there was a co-occurring problem – substance abuse would be the most likely – then the persons in that program would be referred not only to mental health professionals but also those folks that could help them with their substance abuse problem.”

      The bill has been unanimously endorsed by the House Judiciary Committee, where it was praised by members of both parties.  Ranking Democrat Representative Robert Sauls (Independence) said this is a subject that needs more attention.

      “I can unequivocally say that we do not do enough to address mental health in this country or this state.  I’ve seen it time and time again.  I’ve seen it as a prosecutor, as a public defender, I’ve seen situations where people, quite frankly, possibly, wouldn’t have committed crimes if situations were addressed prior to,” Sauls said.

      For any who question the effectiveness of the treatment courts Missouri already has, or the desire to expand on them, Black said one need only be present at a graduation.   He called them, “inspiring, humbling, you see people who are there fully acknowledging that the program has turned their life around for themselves and their families.  They show great gratitude to the elements of the treatment courts, including the prosecutor’s office, they usually organize the effort … it’s one of the things Missouri is doing well.”

House budget proposal aims to help people when they want help with addictions

      The budget proposal that the House will consider this week includes $4.5-million for a drug treatment network that targets people with addiction issues at a most crucial time:  when they are seeking help, and before they get discouraged and fall away.

      “This is [Federally Qualified Health Care Centers] money to address our, not just our opioid, [but] our addiction crises,” said Marshfield representative John Black (R), the sponsor of this funding item.  “The key language in the description,” he said, “is the [words] ‘prevention network.’”

      Black told his colleagues on the House Budget Committee that professionals in Missouri know there are many good treatment options available in the state for those who are dealing with substance abuse disorders, but those options aren’t always well connected.  It is the gaps between resources through which people seeking treatment often fall.

“A person who presents for treatment, by that I mean comes into a doctor’s office or a clinic’s office and says, ‘I’ve got a problem, I need help,’ may not be able at that time to see a psychiatrist or a physician and may need to come back for an appointment like everybody else, but people with those kinds of problems don’t do well sometimes with coming back.  There needs to be, if possible, someone who can work with them almost immediately to keep them in the network to try to get them back to the medical providers when it’s time to do that, by encouraging them, coaching them, helping them understand the process.”

      That’s where, Black said, the network supported by this budget item would come in. 

“There would be some professional – counselor, caseworker – that would be available.  That would be their purpose, to help people stay in a mentality to be able to take the next step.”

“This is an approach … to try to do something that we haven’t effectively done yet to deal with addiction problems … a comprehensive approach to try to develop networks to help these folks,” said Black.

The proposal was added to the budget on a unanimous voice vote.  Springfield Democrat Betsy Fogle encouraged other budget committee members to support it.

“We’ve had a lot of conversations about the substance abuse crisis our country’s facing and this is a great step,” said Fogle.  “Something I really like about this proposal is I think it addresses patients that don’t have insurance, patients who have Medicaid, patients who have private insurance; all Missourians for all walks of life.  We know there’s a shortage of providers for each and every one of those groups of people.”

      The proposed item includes a combination of state and federal money, half of which will go through a network in the Springfield area, with the other half available for any similar program elsewhere in the state that is ready to do the same work. 

      That spending proposal is part of the committee’s budget plan that will be debated by the full House this week, and from there could be advanced to the Senate for its consideration.  It is found in House Bill 11.

‘The Art of Being Me’ tackles mental health stigmas in the Missouri Capitol

      Those visiting the Capitol this week will see photos and stories from nearly 30 people living with mental health conditions.  Participants in The Art of Being Me hope to inspire others to share their stories, to seek help, and to reduce stigmas surrounding mental health issues.

The Art of Being Me on display in the Missouri Capitol (Photo: Mike Lear, Missouri House Communications)

      The exhibit, mostly found in the Capitol’s third floor Rotunda, features large portraits of each participant next to the text of a portion of their experience.  There is also a video that features 3-5 minutes of each participant. 

The project is a collaboration between the Burrell Foundation and artist Randy Bacon.  Burrell Foundation Executive Director Gabrielle Martin said it began with 22 volunteers and is now up to 27, talking about, “their very raw, very real experiences with mental health, substance use, sometimes suicide; it kind of runs the gamut.” 

“I think our youngest is 9 years old and it goes all the way up to a gentleman named Joe who’s in his mid-70s.  Every mental health diagnosis, every ethnicity; we wanted it so that anyone who comes in to experience the exhibit will be able to identify with someone or an experience with someone.  Maybe it’s not their own mental health journey but someone that they’re supporting or someone that they know.”

      The exhibit includes stories like those of Alia, a friend of Martin.  She shares not only her own story which began in her youth, but that of supporting her college-age son.

The Art of Being Me on display in the Missouri Capitol (Photo: Mike Lear, Missouri House Communications)

      “Her video is really powerful because she actually brought her son with her to it and so you see her sharing all of this really difficult content, and her struggles, and her coping mechanisms through it, with him, and he’s right there with her,” said Martin.  “We have some very great youths in there as well.  Lincoln and Eli, two boys that share their experience with anxiety, and I believe that one of them does have autism, and we have a young lady, Kate, who shares about her struggle with eating disorders and she is on the recovery side of that … and her video is so powerful.”

Eli, one of the subjects of The Art of Being Me, on display now in the Missouri Capitol (Photo: Mike Lear, Missouri House Communications)

      The Art of Being Me came to the Capitol after several legislators and other elected officials saw it last year at Bacon’s studio in Springfield.  After seeing it, some of them requested that it come to the Capitol.  

That included Representative John Black (R-Marshfield), who chairs the House’s budget subcommittee on Health, Mental Health, and Social Services.  He called the exhibit, “powerful.”

      “It’s encouraging, too.  Inspirational, actually.   A lot of those people have powerful testimonies, how they’ve overcome mental illness to lead productive lives.  The fact is, and it’s becoming more and more apparent to everyone, that mental illness is a root cause of many of our societal problems, specifically drug abuse and homelessness.  If we can address the mental illness issues then we have a lot better chance of helping people return to [being] productive and happy.”

      Another of those legislators is Representative Betsy Fogle (D-Springfield), who said a large part of addressing mental health issues in state policy is removing stigmas surrounding them, and she hopes having that display in the Capitol will help do just that.

The Art of Being Me on display in the Missouri Capitol (Photo: Mike Lear, Missouri House Communications)

      “It was beautiful.  You had children up to people in their 60s, 70s, and 80s that shared their struggle,” Fogle said of the exhibit.  I don’t know a single family in the world that hasn’t been impacted by mental health or substance abuse disorder and it’s about time we start talking about it and doing something in this building to make sure that future families don’t have the same struggles.”

      Those featured in The Art of Being Me are at varying points in their own mental health journeys, but Martin said the fact that they were willing to share their own stories is empowering for them as well.

      “These individuals were brave and vulnerable enough to share and to talk about their struggles and maybe it is a triumph, maybe it is a continued struggle, maybe it’s talking about their experience with finding therapy and finding ways to cope with maybe a situation that they will live with forever.”

The Art of Being Me on display in the Missouri Capitol (Photo: Mike Lear, Missouri House Communications)

      “These photos are not touched up.  You can see every pore, every hair, every tear, and we did that intentionally, and the size is intentional, so that when you’re there you’re truly feeling like you are looking through the eyes of these individuals and feeling what they’re feeling.”

      Martin adds, “We’re so excited that it’s going to be [in the Capitol] through the 10th, and we hope that it inspires others and we hope that people want to come forward and share their stories and continue the conversations that we so desperately need to continue sharing and seeking help for.”