ASHTABULA COUNTY MENTAL HEALTH AND RECOVERY SERVICES BOARD

MENTAL HEALTH 2022 NEEDS ASSESSMENT

OhioMHAS County Profiles- Areas of Concern/Needs Attention

The Ashtabula County Profile provided a comparison of state and county indicators for mental health and identified areas that need attention when the county indicator was identical to the state indicator and areas of concern when the county indicator was worse than the state indicator. The following mental health-related areas were identified:

• Area of Concern: Adult Suicide Rate- Ohio was 15.1 per 100,000 in 2020 and Ashtabula County was 19.4 per 100,000.
• Areas Needing Attention: Prevalence of any adult mental illness in the past year- Ohio was 23.84% and Ashtabula County was 22.58%. Prevalence of adult serious mental illness in the past year, Ashtabula County was 6.34% and Ohio was 6.60%. Access to adult mental health services by receiving mental health services in the past year, 2018-2020- Ohio was 19.33% and Ashtabula County was 17.69%. Prevalence of adults who had serious thoughts of suicide in the past year, 5.84% Ashtabula County and 6.06% Ohio.

Healthy Ashtabula County 2022 Priorities

16 potential priority health issues were identified from the 2022 CHNA with the following relevant to mental health: access to mental health resources (including transportation), mental health diagnoses, poor mental health days, suicide prevention, awareness, and intervention.  Nearly 20% of Ashtabula County adult residents have ever been diagnosed with a depressive disorder and about 22% with an anxiety disorder. The prioritized health needs of Ashtabula County residents, as identified by Healthy Ashtabula County, include: adult depression/anxiety prevention and treatment, access to health care, and obesity prevention. Adult depression/anxiety prevention and treatment and access to health care are tied as the highest prioritized health needs.

Ashtabula County Suicide Completions

In the calendar year 2021, Ashtabula County had 24 suicide deaths. 18 individuals were male and 6 were female. 23 individuals were Caucasian, and one was African American. Age ranges of decedents were as follows: one under the age of 18, one 19-24 years old, eight aged 25-44, eight aged 45-64, and 6 over the age of 65. Of the 17 deaths, 12 were due to firearms (the first time since 2016 this means has decreased), 8 were due to asphyxia, 2 due to overdose, and 1 was due to knife wound.

2021	2020	2019	2018	2017	2016
24	17	17	20	25	19

Over the past two and a half years, most suicide completions have occurred in Ashtabula City and Conneaut.

The following chart shows a comparison of the rate of suicide deaths in Ashtabula County, and the averages for the State of Ohio and nationally. Ashtabula County has exceeded state and national average suicide completions in the past ten years.

Rural Suicides in Ohio- National Public Radio

Sparsely populated, Ashtabula County does not have the highest number of suicide deaths, but the rate of people who die by suicide here is much higher than in some larger Ohio communities. Between 2015 to 2019, there were 103 suicide completions in Ashtabula County or an average rate of 20.6 per 100,000 population.

CDC Suicide Attempts 2020

2020 data from the CDC shows that for every person who died of suicide, there were eight suicide-related hospital visits and 27 suicide attempts. And firearms were used in more than half of suicide deaths.

Crisis Continuum of Care Gaps Community Planning 2022

The Board has not been able to develop an MRSS for youth due to workforce issues being experienced by local and regional Providers. The Board is in conversation with the OhioRise CME to see if some regional collaboration could help in solving this issue.

The Board continues to collaborate with our Provider to further expand our evidence-based mobile crisis. Having an expansion of this service would allow us to reach individuals in the rural parts of the county and more individuals of color where they reside. However, having a crisis stabilization center located in the county that is easily accessible to underserved populations, such as the Hispanic population and those in rural parts of the county would help in increasing access to crisis services as well as better integration into the outpatient care individuals need. Having a Crisis Stabilization Center would permit behavioral health screening, crisis assessment, and treatment in a community setting versus emergency hospital department. The Crisis Stabilization Center would provide suicide prevention services, address behavioral health treatment, and divert individuals from entering a higher level of care and addressing the distress experienced by individuals in a behavioral health crisis. A center is also a tool that law enforcement in our community believe would be an asset when they encounter an individual in need of behavioral health intervention rather than criminal justice involvement.

Crisis Services Utilization Review Fiscal Year 2022

There were 267 crisis contacts in fiscal year 2022 involving 189 individuals. Primary sites of contacts included:

145, 54% jail and an additional 6, 2% with law enforcement

47, 18% were at a hospital or emergency room

35, 13% were at the individual’s or a relative’s home

22, 8% were at a provider location

97 of 267 contacts, 36%, with 81 of 189 individuals, 43%, resulted in a hospitalization. The majority were transported to ACMC or another private hospital. The second highest number was persons taken to the state hospital.

46 of 189, 24% individuals served had between two to five crisis contacts.

31 were seen twice, 9 were seen three times, and 2 were seen four times, and 4 were seen five times

34 of 46, 74%, were seen at a jail location with 11 having an assessment requested by the jail and four having a court ordered assessment. The two largest reasons for contact were suicide ideation and psychosis.

24 of 46, 52%, individuals were hospitalized, and 12 of the 46 individuals were hospitalized more than once.

5 of 46, 11%, were homeless.

Behavioral Health Related Admits to Ashtabula County University Hospital Emergency Departments

In 2021, the University Hospitals facilities in Ashtabula County had a total of 4,450 ED admissions. Behavioral health related reasons for admission included: 263 suicide ideations, 260 altered mental status, and 42 hallucinations.

Ashtabula County Access to Services 2022

Data due from providers 12-12-22

1. Wait time for an assessment.  This should be the actual assessment not any pre-assessment contact to gather demographics or financial information. a. Same Day
2. What services have immediate access and are there current barriers to quick access. a. Psychiatric Med Management – access isn’t immediate, however we do have reserved slots for urgent access for high need (i.e. hospital discharge) b. Barriers are clients with private insurance/Medicare (especially children). The assessment can be immediate, but to get in with a paneled provider can take upwards of 30+days. We refer out for children under 12 with private insurance, unless one of the 3 of us has an opening.
3. Which Treatment and Recovery Support Services have a waiting list. a. As of today – NONEJ Supported Employment did, but our team is now fully staffed!
4. Are there any special populations that have a waiting list such as persons with Medicare, persons who need a recovery house that accepts MOUD, etc.  Also, average wait time if you know that information. a. Light House has a wait list. Wait list time varies based upon resident length-of-stay, and the size of room needed by the applicant. b. We refer out if we do not have availability for clients with Medicare and/or private insurance.
5. The top three barriers to persons accessing any needed BH services. a. Not enough paneled providers/prescribers. b. Staff illness/absence. c. Symptoms/access to resources can be a barrier

Ashtabula County 2022 Health Needs Assessment:  Adult Mental Health

20% of Ashtabula County adult respondents have been diagnosed with a depressive disorder and 22% have been diagnosed with an anxiety disorder. Ashtabula City adult respondents reported higher rates of depressive and anxiety disorder diagnoses than the county as a whole.

Diagnosis of Mental Health Conditions:

Ever been Told That You Had…	Ashtabula City (average n=69)	Conneaut City (average n=53)	Ashtabula County (average n=365)
A depressive disorder	36.4%	6.1%	19.5%
An anxiety disorder	35.8%	9.2%	22.1%

• Those in Conneaut are less likely to report a depressive disorder diagnosis than those in the city of Ashtabula or Ashtabula County overall.
• Those ages 18-34 are more likely to report a depressive disorder diagnosis than those age 35 or older: 35.0% v. 12.7%. One positive interpretation of this difference is recent efforts to destigmatize mental illness leading younger people to seek help.
• Females are more likely to report a depressive disorder than males: 27.3% v. 9.3%.
• Those with an annual household income of less than $75,000 are more likely to report a depressive disorder diagnosis than those with an annual household income of $75,000 or more: 23.7% v. 11.7%.
• Those ages 18-34 are more likely to report an anxiety disorder than those age 35 or older: 39.6% v. 16.0%.
• Females are more likely to report an anxiety disorder than males: 34.3% v. 7.6%.

Less than half of respondents (37%) indicated that they had at least one poor mental health day in the past month; among them, the average number of poor mental health days reported was 11 days.

Poor Mental Health Days in the Past 30 Days:

Poor Mental Health Days	Ashtabula City (average n=70) *(average n=35)	Conneaut City (average n=52) *(average n=18)	Ashtabula County (average n=386) *(average n=142)
Percentage who had poor mental health days	50.2%	33.9%	36.8%
Days of the poor mental health *(average)	12	8.9	11.0

• Females were more likely to have had at least one poor mental health day than males: 45.2% v. 26.0%.
• Percent who had at least one poor mental health day differed by education: 27.4% for those with a high school degree or less education, 59.0% for those with some college education, and 36.4% for those with a bachelor’s degree or more education.
• Days of poor mental health differed by annual household income: 5.1 for those with less than $50,000, 2.5 for those with $50,000 to less than $100,000, and 5.5 for those with $100,000 or more.
• Percentage of respondents who had poor mental health for four or more days in the past 30 days in 2019: 36%; in 2022: 27%.

Days When Poor Mental Health Affected Activities in the Past 30 Days:

Poor Mental Health-Affected Activities

	Ashtabula City (average n=70) *(average n=14)	Conneaut City (average n=47) *(average n=14)	Ashtabula County (average n=381) *(average n=51)
Percentage who had poor mental health days that affected activities	19.7%	29.2%	13.5%
Days of the poor mental health affecting activities *(average)	11.1	7.2	9.7

*Among those who had at least one poor mental health day **Low numbers of respondents – average may not be reliable

• Females were more likely to have had at least one poor mental health day that affected activities than males: 18.7% v. 7.8%.
• Those who had at least one poor mental health day that affected activities differed by annual household income: 19.4% of those with less than $50,000, 2.9% of those with $50,000 to less than $100,000, and 22.4% of those with $100,000 or more.
• For youth in the past 12 months, 36.9% of 1,838 respondents felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities.
• Ashtabula County had a lower suicide rate than the state of Ohio in 2019 (13.8 compared to 15.2)1. However, when looking at 5-year trends (from 2015-2019), Ashtabula County’s rate was higher at 20.6 compared to Ohio’s 14.7. Ashtabula County does not meet the Healthy People 2030 target for suicide rate (12.8/100,000)2.

Most respondents to the adult survey (62%) feel they always or usually get the social and emotional support they need.

Social and Emotional Support:

How often Respondents get the Social and Emotional Support They Need	Ashtabula City (average n=70) *(average n=14)	Conneaut City (average n=47) *(average n=14)	Ashtabula County (average n=381) *(average n=51)
Always	48.1%	42.5%	38.4%
Usually	19.1%	15.7%	24.0%
Sometimes	16.0%	29.1%	19.2%
Rarely	8.3%	0.0%	4.7%
Never	8.5%	12.7%	13.7%

Received Mental Health Care in the Past 12 Months	Ashtabula City (average n=70) *(average n=14)	Conneaut City (average n=47) *(average n=14)	Ashtabula County (average n=381) *(average n=51)
Talked with a psychiatrist, counselor, or other mental health care professional about how they were feeling	12.9%	2.6%	12.0%

• Those in Conneaut were less likely than those in the city of Ashtabula or Ashtabula County overall to have received mental health care in the past 12 months.
• The likelihood of receiving mental health care differed by annual household income: 5.4% of those with less than $50,000, 22.9% of those with $50,000 to less than $100,000, and 12.2% of those with $100,000 or more.
• About 40% of Ashtabula youth have received mental health care at some point during their lives.

 Received Mental Health Care (Youth)

	Ashtabula County (average n=1836)
During the past 12 months	28.6%
Between 12 and 24 months	4.6%
More than 24 months	6.3%
Never	46.0%
Not sure	14.6%

Nearly 20% of Ashtabula County youth reported seriously considering attempting suicide in the past 12 months. This number is alarmingly high.

Suicidal Ideation:

Suicidal Ideation	Ashtabula City (average n=70) *(average n=14)	Conneaut City (average n=47) *(average n=14)	Ashtabula County (average n=381) *(average n=51)
Seriously considered suicide in the past 12 months	3.8%	1.5%	18.4%

• Percentage of respondents who seriously considered suicide in the past 12 months in 2019: 6%; in 2022: 2%.
• 44.9% of youth who had seriously considered this reported that they attempted suicide in the past 12 months, with 24.3% of them attempting 1 time, with 15.3% of youth who had considered attempting suicide making 2 or 3 attempts.
• 21% of youth who attempted suicide in the past 12 months (33 individuals) had this result in injury, poisoning, or overdose that had to be treated by a doctor or nurse.

Youth Educational Attainment

This section displays relevant data about youth educational outcomes in Ashtabula County, beginning with the graduation rates for the county’s public school districts. The average four-year high school graduation rate across these public schools is 88.3%. This is lower than the average for public schools in Ohio overall (92.0%).

Ashtabula County School Districts	High School Graduation Rates in Ashtabula County
Ashtabula Area	75.6%
Conneaut Area	87.1%
Buckeye	92.1%
Geneva Area	94.9%
Jefferson Area	96.2%
Grand Valley	86.8%
Pymatuning Valley	97.8%

     Data are from 2020

The Health Policy Institute of Ohio’s 2021 Equity Profiles notes the following worse outcomes for Ohioans with less than a high school education and lower incomes when compared to Ohioans with higher educational attainment and incomes:

• Adult depression is 1.8 times worse for people with less than a high school education
• High school graduation is 3.3 times worse for people with low incomes
• Adverse childhood experiences are 2.1 times worse for children with parents with less than a high school graduation
• Disconnected youth were 1.8 times worse for people with less than a high school education

2022 OHYES Student Survey

Student Survey Questions	2019 (3284 responses)	2022 (1908 responses)
Felt down, depressed, or hopeless nearly every day	14.78%	16.51%
Reported being bothered by not being able to stop or control worrying nearly every day	13.87%	16.1%
Reported living with someone who was depressed, mentally ill or suicidal	30.26%	33.68%
Reported that during the past 12 months they had considered attempting suicide	19.58%	18.41%

2021 Mental Health Stigma Survey

250 Ashtabula County residents completed Mental Health Surveys :

Have you seen or heard of a person in your community who has a mental illness experiencing stigma because of their mental illness?	Total Sample Weighted (All Counties)	Ashtabula County (n=108 -YES n=126 – NO)
Yes	46%	46%
No	54%	54%

Of those who reported seeing or hearing of a person in our community experiencing stigma:

(Ashtabula County Specific Data)

Female	48%
Male	42%
Transgender	100%

The % of those who have seen or heard of people in our community experience stigma due to their mental health disorder, based on location:

(Ashtabula County Specific Data)

Locations of Stigma	General Community	Healthcare	School/work
Female	91%	53%	73%
Male	89%	44%	78%
Transgender / Other	100%	100%	100%
18-44	92%	60%	84%
45-64	89%	50%	74%
65 and Older	89%	47%	68%
Non-White / Non-Hispanic	100%	75%	100%
White Non-Hispanic	90%	49%	74%
HS Graduate or Less Education	86%	48%	67%
More than HS Graduate	92%	52%	78%
Personally Knowing One or More People with Lived Experience with mental illness	89%	48%	75%
Personally Received Treatment for mental illness	84%	50%	79%

1. Do you know of community members who are mentally ill who have experienced stigma in these settings that made it difficult for them to: (Top Ashtabula County Responses)

76% reported seek help or treatment

74% reported Begin Treatment

73% reported Getting Support with Treatment Progress

70% reported Figure out how to Pay for Treatment

Those Ashtabula Co. respondents who have personally received treatment for MH:

(top responses)

81% reported Seek Help or Treatment

81% reported Begin Treatment

74% reported Get Support with Treatment Progress

Have you personally seen or heard about people in our community with mental illness experiencing any of the following situations due to their mental illness?

(top responses):

76% reported being avoided by community members

58% reported being shunned from a friend group due to their mental illness

44% reported being refused a job (regardless of qualifications)

Those Ashtabula Co. respondents who have personally received MH treatment:

79% Reported being avoided by community members.

72% Reported being shunned from a friend group due to their mental illness

54% Reported being refused a job (regardless of qualifications)

ALL RESPONDENTS

Stigma Solutions	% Reported somewhat/very effective
Training law enforcement officers to improve the way they interact with people who have mental illness.	99%
Training social workers to improve the way they provide care for people who have mental illness.	99%
Training mental health providers to improve the way they provide care for people who have mental illness.	99%
Training health care providers to improve the way they provide care for people who have mental illness.	99%
Increase awareness that treatment for mental illness is effective.	98%
Increase awareness that recovery from mental illness is possible.	98%

 

Personally Received Treatment for Mental Illness

Stigma Solutions	% Reported somewhat/very effective
Training health care providers to improve the way they provide care for people who have mental illness.	100%
Training school staff to improve the way they interact with people who have mental illness.	99%
Training social workers to improve the way they provide care for people who have mental illness.	99%
Increase awareness that treatment for mental illness is effective.	99%
Training mental health providers to improve the way they provide care for people who have mental illness.	98%
Training law enforcement officers to improve the way they interact with people who have mental illness.	98%
Increase awareness that recovery for mental illness is effective.	98%
Increase awareness that using medicine (like antidepressants, Xanax, anti-anxiety medication) to treat mental illness is effective.	98%

Suppose you, a close family member or friend was experiencing thoughts or feelings about suicide. Would you contact any of the following if you wanted to talk about your thoughts or feelings about suicide? (Respondents who have received treatment for Mental Health)

Someone at a mental health center (counselor, psychologist, social worker, etc.)	91%
Someone in my friend group	74%
Someone in my family	70%
Someone at my doctor’s office (doctor, nurse, medical assistant, secretary, etc.)	69%
A suicide crisis hotline worker by phone	66%
Someone at the hospital (ER doctor or nurse, etc.)	64%
Someone at church (pastor, priest, rabbi, imam, minister, etc.)	48%
A suicide crisis hotline worker by text	40%

Ashtabula County Utilization Review Mental Health Services and Criminal Justice

July 2022

A quality improvement focus review was conducted at the beginning of fiscal year 2022 to assist with improving outcomes for persons with co-occurring disorders who are involved in specialized dockets. Service utilization and court records were reviewed to identify critical components of persons who successfully or unsuccessfully completed programming.  Findings indicated that the best outcomes obtained were for persons who maintained regular treatment and case management appointments in mental health services.  Persons who were unsuccessful were placed in residential treatment or a community corrections program where their mental health needs were not fully addressed.  This focus study also identified a gap in local services with regard to high risk and high need persons with a co-occurring disorder.  The local system of care would benefit from a higher level of care with intense service provision that addresses the individual’s needs as well as the community need for safety.

Current Trends Training with Detective Taylor Cleveland and Commander Greg Leonhard: October 2021

At the 2021 PART Conference Detective Cleveland and Commander Leonhard discussed the current trends with Criminal Justice in Ashtabula County. They explained that contact with persons with a Dual Diagnosis in Ashtabula County is increasing among Law Enforcement and there are not many options in how Law Enforcement can be proactive in linking them to beneficial services (treatment). Persons with a dual diagnosis are often not accepted into detox or treatment because of their substance use. In addition, mental health providers will not always accept an individual into treatment believing that the substance use must be dealt with first. Det. Cleveland stated that the involuntary admissions training was extremely helpful and believes that it should be offered on a yearly basis for all new or incoming police officers. Further trainings would also be beneficial around mental health placement as there is some confusion around whether there is a resource issue for mental health patients or if resources being underutilized because Law Enforcement does not know how to make those referrals.

Ashtabula County Hopeline

The 2020 Help Network reports of the Ashtabula County Hopeline noted an increase in the call volume from the beginning to the end of the calendar year. Hopeline staff noted most calls received are for reassurance due to isolation and anxiety. They also noted an increase in the number of senior citizens calling for mental health reassurance. It is uncertain how the change to 988 in 2022 will affect utilization of the Hopeline.

Ashtabula County Crisis Text Line Utilization

Since May 2016 through November 7, 2022, there have been 409 conversations by Ashtabula County residents using the Crisis Text Line.

Report of Screenings Completed on MHRS Board Website

Screening tools are online resources that are designed to quickly help determine if an individual or someone they care about are experiencing symptoms of a mental health or substance use problem. Screening tools are not an official diagnosis but can assist someone in determining if they might benefit from a thorough behavioral health assessment. Resources are provided following the screening if an individual may need additional services. Between 1/31/20 and 2/1/21, 271 screenings were completed on the Board’s website. Between 1/1/22 and 11/8/22, 119 screenings were completed on the Board’s website. The demographics of persons completing the surveys included: 21 aged 18-24, 34 aged 25-34, 24 aged 35-44, 21 aged 45-54, 13 aged 55-64, 3 aged 65-74, 1 aged 75-84, and 2 aged 85+. 75% were female, 44% were married or in a domestic partnership, 95% were white. 16 individuals completed the HANDs Depression screening and 5 reported thinking of ending their life some time and 4 most of the time. Three of the respondents indicated they would seek help.

Ashtabula County Youth Leadership Discussion, February 10 & 11, 2021

Bridget Sherman and Kaitie Park attended meetings with 30 high school juniors who are members of Ashtabula County Youth Leadership to discuss their beliefs around their Mental Health concerns in Ashtabula County. They stated that common responses when teens share feelings to adults about their own mental health are to “suck it up.” They reported often feeling like their feelings are compared to the feelings of others, as though parents and adults lack empathy for the feelings of youth (in a “you think you have it bad? Try living my life!” point of view). Youth questioned how to break the cycle of the “toughen-up” culture their parents were raised in to become more inclusive and open to discussion of feelings. One student mentioned that youth find it difficult to be vulnerable and show emotion.

COVID 19 caused many teenagers to lose some of their protective factors and as they stated in the meeting take a ‘huge mental hit’. Guidance Counselors have been less accessible and due to limited in-person class time teachers are increasingly less likely to allow students to take time to talk with a guidance counselor. To help deter this issue students suggested that mandatory meetings times be established to do mental health check-ins.

Another topic discussed was the idea around how information and mental health resources are shared. One student mentioned that flyers and palm cards are not particularly helpful as they “usually do not make it past a folder and are forgotten about.” Students thought it would be helpful for teachers to be educated about resources and take time during class to discuss what is available for mental health help.

Tri-Ethnic Community Readiness Assessment September 2020

Coalition members interviewed eight community members to understand local conditions and guide strategic planning. The Assessment includes questions pertaining to community knowledge of the issue, community knowledge of efforts, community climate, leadership, and resources. The Assessment evaluates responses related to the nine stages of community readiness to determine the degree to which a community is ready to take action on an issue that affects the health and well-being of a community. The combined scores of those interviews indicated that the Coalition is at stage four, or pre-planning stage. This stage indicates that community members believed that the issue of suicide prevention is important and are interested in knowing what can be done about it.

After reviewing these results, the Ashtabula County team noted that community knowledge about the issue is the lowest score. The team would like to focus on how the community consumes the information the Coalition is producing/presenting and find ways to ensure the information is reaching areas and populations in our county that have been previously untapped or challenging to reach. Some surprises from the interviews included a lack of community knowledge about where funding for suicide prevention in Ashtabula County comes from, as well as the strong scores for leadership. We expected the leadership score to be lower, framed within a conservative definition of “community leaders,” but interviewees revealed a broader definition of leaders, and expressed that more informal leaders are working hard for suicide prevention.

As a result of the Community Readiness Assessment, the Team decided to address three goals over the next 3-5 years:

• Increase community knowledge about suicidality and death by suicide in Ashtabula County.
• Increase Coalition Membership and Member Engagement.
• Normalize help-seeking behaviors and increase community connectedness.

Workforce Supply and Demand within Ohio’s Behavioral Health System

• Demand for behavioral health services increased 353% from CY2013-2019, with an average 29% increase per year
• Mental Health services account for 52% of the total behavioral health demand in Ohio.
• Demand for behavioral health services provided by nurse practitioners and physicians has increased since the behavioral health redesign
• Community behavioral health centers are the most common facility type for services
• As of CY2019 overall unmet demand is between 41-46%.

Protecting Youth Mental Health: The US Surgeon General’s Advisory (2021)

Even before the Covid-19 Pandemic, mental health challenges were the leading cause of disability and poor life outcomes in young people, with 1 in 5 children ages 3 to 17 in the US with a reported mental, emotional, developmental, or behavioral disorder. From 2009-2019, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%; the share seriously considering attempting suicide increased by 36%; and the share creating a suicide plan increased by 44%.

Early estimates from the National Center for Health Statistics suggest there were tragically more than 6,600 deaths by suicide among the 10-24 age group in 2020.

In recent years, suicides among Black children (below age 13) have been increasing rapidly, with Black children nearly twice as likely to die by suicide than White children. Socioeconomically disadvantaged children and adolescents—for instance, those growing up in poverty—are two to three times more likely to develop mental health conditions than peers with higher socioeconomic status.

Recent research covering 80,000 youth globally found that depressive and anxiety symptoms doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety symptoms.

In early 2021, emergency department visits in the United States for suspected suicide attempts were 51% higher for adolescent girls and 4% higher for adolescent boys compared to the same period in early 2019.

Trever Project National Survey on LGBQT Youth Mental Health 2021

The Trever Project surveyed 35,000 LGBTQ youth ages 13–24 across the United States with the following key findings:

• 42% of LGBTQ youth seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth.
• 12% of white youth attempted suicide compared to 31% of Native/Indigenous youth, 21% of Black youth, 21% of multiracial youth, 18% of Latinx youth, and 12% of Asian/Pacific Islander youth.
• 94% of LGBTQ youth reported that recent politics negatively impacted their mental health.
• More than 80% of LGBTQ youth stated that COVID-19 made their living situation more stressful — and only 1 in 3 LGBTQ youth found their home to be LGBTQ affirming.
• 70% of LGBTQ youth stated that their mental health was “poor” most of the time or always during COVID-19.
• 48% of LGBTQ youth reported they wanted counseling from a mental health professional but were unable to receive it in the past year.
• 30% of LGBTQ youth experienced food insecurity in the past month, including half of all Native/Indigenous LGBTQ youth.
• 75% of LGBTQ youth reported that they had experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime.
• Half of all LGBTQ youth of color reported discrimination based on their race/ethnicity in the past year, including 67% of Black LGBTQ youth and 60% of Asian/Pacific Islander LGBTQ youth.
• 13% of LGBTQ youth reported being subjected to conversion therapy, with 83% reporting it occurred when they were under age 18.
• Transgender and nonbinary youth who reported having pronouns respected by all the people they lived with attempted suicide at half the rate of those who did not have their pronouns respected by anyone with whom they lived.
• Transgender and nonbinary youth who were able to change their name and/or gender marker on legal documents, such as driver’s licenses and birth certificates, reported lower rates of attempting suicide.
• LGBTQ youth who had access to spaces that affirmed their sexual orientation and gender identity reported lower rates of attempting suicide.
• An overwhelming majority of LGBTQ youth said that social media has both positive (96%) and negative (88%) impacts on their mental health and well-being.
• In the past year, nearly half of LGBTQ youth have wanted counseling from a mental health professional but did not receive it.
• More than 80% of LGBTQ youth of all races/ethnicities said it was important that a crisis line include a focus on LGBTQ youth, should they need it. They also noted it would be helpful if the crisis line was available by phone, text, and chat. The Trever Project maintains a 24/7 crisis phone/text line.

Data Regarding Coalition Priority Target Populations National Information Senior Citizens

2020 Summary Assessment of Older Ohioans- Ohio Department of Aging

The percentage of Ashtabula County residents aged 60 and older is expected to increase to 29% or more by 2030. According to the Ohio Department of Aging, Ohio performs poorly on several indicators of mental health in older Ohioans:

• Depression. One-fifth (20%) of Medicare fee-for- service (FFS) beneficiaries in Ohio were diagnosed with depression in 2017, compared to 18% of Medicare FFS beneficiaries in the U.S. overall.
• Suicide. There has been an increase in death by suicide, from 12.6 deaths per 100,000 in 2009 to 17.8 deaths per 100,000 in 2018 among Ohioans ages 60 and older.

A barrier to service access for Ashtabula County senior citizens involves workforce shortages. There are waiting lists for services for persons who have Medicare funding only as services must be provided by a LISW and therapists with this credential are significantly limited.

The National Council on Aging 2020

The National Council on Aging presented information in 2020 regarding community-based strategies for suicide prevention among older adults. Data presented included the following:

• Older adults make up 16% of the U.S. population, but account for 18.8% of all deaths by suicide.
• As of 2018, the suicide rate for individuals over 65 in the United States was 17.4 per 100,000, compared to the national rate of 14.8 per 100,000
• For those who have been reported to die by suicide, there are five to 25 times more that are not reported as suicide, likely due to stigma and suicides that are mis-categorized as accidents.
• Social isolation plays a key role in the lethality of suicide in later life.
• Older adults completing suicide are more likely to be widow(er)s, live alone, perceive their health status as poor, experience poor sleep, experience loneliness, and experience a stressful life event such as financial discord
• Research shows physicians are less willing to treat suicidal older persons compared to younger patients and believe suicidal ideation among older adults is normal. Also, studies have shown that 20% of older adults who die by suicide saw their primary care physician within 24 hours of their death.
• Higher levels of pandemic-related resource loss (and lower levels of social support) were positively related to depression, anxiety, and psychological distress

OSAM Treatment and Support Services for Persons Living with SPMI MH Initiative Notes October 2021

The OSAM report provides information that was collected from consumers, service providers, and family members in June through November of 2020 to assess the availability of treatment services for those with a severe and persistent mental illness (SPMI) and how easily accessible those services are. Consumers in rural counties reported that service needs were met moderately well, while family members rated these services low, stating fewer services available and staff turnover as the biggest issues. Family members discussed that there is a lack of overall community awareness around treatment resources and that the BH system does not do a good job of explaining what services are available and how to access them. Consumers expressed dissatisfaction with the process of accessing treatment because they did not know what to do, had long waits for appointments, and struggled to find providers who accepted their insurance.

Family members reported mixed results when contacting law enforcement for assistance when their loved one exhibits behaviors they cannot control. Family members cited instances when police involvement escalated the situation unnecessarily and most advocated for social workers to respond to mental health crisis calls along with police. Law enforcement officials noted that it is often easier for them to get people into treatment than it is for someone trying to get in on their own. As for treatment retention, daunting amounts of work and a high level of commitment were cited as the reasons people leave treatment, by family members and providers. Consumers indicated that discontinuation of services is not always their choice and is often due to lack of transportation or being dropped by the agency for missing appointments. Other reasons for discontinuing services consisted of nonacceptance of diagnosis, lack of family support and stigma.

The most frequently discussed ideas for improving service accessibility were workforce development (recruit/retain staff), increase service capacity, heighten community outreach/education, employ navigators, provide immediate care (treatment on demand), expand crisis services, make follow-up care after crisis standard, expand transportation/telehealth options, open insurance options, and increase access to injectable long-acting medications. Peer Support was consistently rated as most valuable in helping consumers meet recovery goals, with case management also extremely helpful.

Respondents prefer messaging that offers hope, that recovery is a long-term process but is possible. Further, respondents prefer messaging that promotes viewing SPMI as a chronic illness, but does not define the person, that SPMI can be managed, those living with SPMI can contribute to society, and that it is okay to talk about MH/SPMI. Satisfied consumers named the following components of a positive life in recovery:  close network of support, employment, educational pursuits/volunteerism, adherence to a daily routine (hygiene, sleep, meals etc.), medication and therapy compliance, regular exercise, engagement in enjoyable pastimes, and sobriety/abstinence from alcohol & other drugs.

Adults Ages 26 to 55 Years Suicide Prevention Resource Center

• Suicide is one of the leading causes of death among adults ages 26 to 55 years.
• Serious life challenges, such as relationship problems, unemployment, substance abuse, and poverty may increase suicide risk among vulnerable adults.
• Although suicide rates are increasing in both middle-aged men and women, men are much more likely than women to die by suicide. Middle-aged men (ages 35– 64) represent 19 percent of the United States population but account for 40 percent of suicide deaths.
• The major risk factors for suicide that affect the general population also affect men in the middle years (MIMY). These risk factors include mental disorders, alcohol and drug abuse, lack of access to effective behavioral health services, and access to lethal means. Cultural expectations about masculine identity and behavior can contribute to suicide risk among men in the middle years. These expectations can amplify risk factors as well as reduce the effectiveness of interventions that fail to consider how MIMY think about themselves and their relationships to families, peers, and caregivers. These cultural expectations include the following characteristics: Being independent and competent (and thus not seeking help from others), Concealing emotions (especially emotions that imply vulnerability or helplessness), Being the family “breadwinner”—an identity that is challenged when a man is unable to provide for his family (due to job loss).
• Major protective factors against suicide for MIMY include the following: access to effective health and behavioral health care; social connectedness to individuals, including friends and family, and to community and social institutions; coping and problem-solving skills; reasons for living, meaning in life, and purpose in life.

Adolescents

• The Suicide Prevention Resource Center identified major risk and protective factors for adolescents:
• Major risk factors include depression and other mental health problems, alcohol or drug use, feelings of social isolation, and difficult life situations (abuse, bullying, and poverty).
• Major protective factors include life skills (problem-solving, coping), social support from family, friends, and others, and positive school experiences.
• Suicide is the second leading cause of death for ages 10-24 in the United States.
• According to America’s health Rankings, youth suicidal ideation, attempt and completion are on the rise. Far more adolescents have suicidal thoughts or attempt suicide and survive than those who die by suicide. Results from the 2019 Youth Behavioral Risk Factor Surveillance System show that in the past year 18.8% of high school students seriously considered attempting suicide and 8.9% attempted suicide.
• Nationally it is estimated that 13.4% of children and adolescents have a diagnosed mental disorder. A much higher proportion reports mental health symptoms such as depression or anxiety (30.4% and 23.3%, respectively).
• During the COVID‐19 pandemic, schools have frequently been closed or physical attendance has substantially decreased, which has been reducing or completely stopping school‐based mental health interventions. Schools play a key role in children and adolescents’ social development. During the pandemic, peer relationships, which are important to foster autonomy and independence in adolescence, are substantially affected. The increased use of social media, substituting real‐life peer relations, may result in pathological Internet use, a higher risk of cyberbullying and other negative health outcomes, such as anxiety, depression, and suicidality.

ASHTABULA COUNTY MENTAL HEALTH AND RECOVERY SERVICES BOARD

SUBSTANCE USE 2022 NEEDS ASSESSMENT

OhioMHAS County Profiles- Areas of Concern/Needs Attention

The Ashtabula County Profile provided a comparison of state and county indicators for substance use and identified areas that need attention when the county indicator was identical to the state indicator and areas of concern when the county indicator was worse than the state indicator.  The following substance use-related areas were identified:

• Areas of Concern: prevalence of Methamphetamine Use in the past year by those aged 12+, .97% Ashtabula County and .67% Ohio. Perceptions of great risk from having five or more drinks of an alcoholic beverage once or twice a week by those aged 12+, 39.6% Ashtabula County and 40.8% Ohio. Tobacco product use in the past month aged 12+, Ashtabula County 31.26% and 25.79% Ohio. Cigarette use in the past month aged 12+, 25.55% Ashtabula County and 20.6% Ohio. Perceptions of great risk from smoking one or more packs of cigarettes per day, 64.82% Ashtabula County and 67.75% Ohio.
• Areas Needing Attention: unintentional drug overdose deaths (2019-2020), 35.4 per 100,000 for Ashtabula County and Ohio. Heroin use in the past year by those aged 12 and older, .43% Ohio and .39% Ashtabula County. Illicit drug use disorder in the past year by those aged 12 and older, 2.96% Ashtabula County and 3.10% Ohio.  Pain relievers use disorder in the past year by those aged 12 and older (2016-2018, .80% Ashtabula County and .81% Ohio.

Healthy Ashtabula County 2022 Priorities

16 potential priority health issues were identified from the 2022 CHNA with the following relevant to substance use: binge drinking, substance use/abuse, overdoses (specifically, Fentanyl deaths), vaping/tobacco use pre-term smoking cessation, and maternal pre-term tobacco use.

2020 Summary Assessment of Older Ohioans- Ohio Department of Aging

The percentage of Ashtabula County residents aged 60 and older is expected to increase to 29% or more by 2030. According to the Ohio Department of Aging report: ‘overdose death is a growing problem among older Ohioans and that unintentional overdose deaths among Ohioans ages 65 and older more than doubled in the past ten years to 6.1 deaths per 100,000 in 2018. In 2021, one of 27 unintentional overdose deaths were of person aged 65 or older, 3.7%. Two of six persons aged 65 and over had other drug related deaths, 33.3%.

A barrier to service access for Ashtabula County senior citizens involves workforce shortages.  There are waiting lists for services for persons who have Medicare funding only as services must be provided by a LISW and therapists with this credential are significantly limited.

Summary Profile of Ashtabula County MHRS Board Clients Served by

Substance Use Diagnosis in the top ten primary diagnostic groups

Adults

Diagnosis	3/15/22	3/25/21	3/25/20	4/23/19
Opioid Use Disorder	358 (-)	376	389	416
Stimulant Use Disorder	186 (-)	190	190	122
Cannabis Use Disorders	115 (-)	169	187	157
Alcohol Use Disorder	191 (+)	163	191	262

Youth

Diagnosis	3/15/22	3/25/21	3/25/20	4/23/19
Stimulant Use Disorder	1			1
Cannabis Use Disorder	2	3	7	9
Alcohol Use Disorder			1	8

Fatal Overdose Deaths- Ashtabula County Coroner’s Office

2022 (10-31-22)	2021	2020	2019	2018	2017	2016
30	27	39	31	28	40	34

In 2021 there were 27 accidental overdose deaths. These includes 13 females and 14 males, 25 Caucasian, 1 African American and 1 Hispanic individuals. Fentanyl was present in 24 of the 27 toxicology reports, Methamphetamines was present in 15 of the toxicology reports. One overdose death was also ruled a suicide.

In 2022 through October 31, there have been 30 accidental overdose deaths.  22 male and 9 females, 30 Caucasian and one African American.

The majority of fatal overdose deaths in 2021 and 2022 to date have occurred in Ashtabula City and Ashtabula Township.

The following are the age ranges for 2021 and 2022 through 10-31-22:

	2021	2022 to 10-31
Under 18	0	0
18-24	0	2
25-34	9	12
35-44	5	7
45-54	9	4
55-64	3	5
65 Older	1	1

Primary cause of death other than the intentional/unintentional misuse of drugs, but autopsy or toxicology indicated drugs in the system.

2021	2020	2019	2018	2017	2016
15	18	7	9	9	13

Although provisional data from CDC’s National Center for Health Statistics indicate drug overdose deaths in the United States increased nearly 15% from 2020 to 2021 estimated drug overdose deaths, Ashtabula County drug overdose deaths decreased during the same time by 30.7%.

Quick Response Team:  Non-Fatal Overdoses (by calendar year)

2021	2020	2019	2018
285	205	222	228

Naloxone Distribution (by fiscal year)

FY 2022	FY 2021	2020	2019	2018	2017
1212	466	224	179	78	42

Ashtabula County Prosecutor Felony Case Data

Year	Total Felony Cases	Felony Drug Related Cases *	ECC/WCC Misdemeanor Drug Cases
2021	564		220
2020	651	234	125
2019	760	230	142
2018	820	436	178
2017	659	448	187
2016	723	343	181
2015	742	370	159

* In 2017 began tracking when drugs were involved but not necessarily charged. In 2020/2021 felony cases were down because the number of felony cases processed in 2021 was significantly lower than previous years due to fewer trials from October 2020 through April 2021. * Unable to track Felony Drug Related Cases (2021).

Health Policy Institute of Ohio- Addiction Evidence Project- Refocusing Ohio’s Approach to Overdose Deaths

The HPIO identifies the direct causes of overdose death are unsafe drug use, drug use conditions and drug supply. This includes, for example, frequent use, using alone, lack of access to naloxone and the presence of fentanyl in the drug supply. These direct causes are influenced by contributing factors in demand, the environment, and the drug supply, including limited access to treatment, social isolation, stigma, and illicit drug market dynamics. Contributors to substance use included: Limited reach of effective prevention strategies, limited access to quality treatment and recovery services, including Medication Assisted Treatment (MAT) (barriers such as lack of transportation or health insurance access, health insurance limits or long wait times), risk factors at the individual, peer, family and community
level (such as drug use initiation at young age, mental health challenges and exposure to trauma, community norms, poverty, housing instability, despair, lack of social connectedness, etc.). To improve overdose prevention, HPIO recommends: decreasing the demand for drugs, continuing to strengthen Ohio’s prevention-treatment-recovery continuum, building protective factors that can prevent addiction, such as social connectedness, housing stability and economic opportunity. HPIO further notes that Housing First programs, peer support, trauma-informed care and recovery housing can foster connections to treatment and long-term recovery.

Housing  TODO pending information 12-12-22

1. Light House has a waitlist. Waitlist time varies based on the resident length-of-stay, and size room needed by applicant.
2. Housing is consistently an issue with many service organizations we speak with. The Ashtabula Co Jail and the case manager often struggle with finding housing for individuals upon their release. Specialized dockets are sending individuals to NEOCAP and inpatient treatment, even if they do not necessarily meet that level of care, because housing options are so limited. We are also hearing that even those who are eligible to receive assistances, such as housing vouchers, are unable to find available safe and affordable housing. It sounds like there is a need for additional recovery housing, especially for adults with children

Recovery Housing Capacity for men: 30 (3 houses)agape, mayflower, opal

Recovery Housing Capacity for women: 20 (2 houses) light house and jefferson

Liberty House status to be determined

3 Recovery Houses accept individuals who are receiving MOUD (2 female houses, 1 male house

Ashtabula County 2022 Health Needs Assessment:  Adult Substance Use

Know Anyone with a Substance Use or Addiction Problem	Ashtabula City (average n=68)	Conneaut City (average n=52)	Ashtabula County (average n=378)
Alcohol	48.2%	35.8%	37.3%
Heroin	23.1%	16.3%	16.5%
Prescription Pain Medication	33.6%	18.0%	21.9%
Methamphetamines	21.9%	12.3%	18.2%
At least one of the above	57.6%	37.1%	42.0%

Tobacco and Nicotine Use

In Ashtabula County, 49.2% of adults reported smoking at least 100 cigarettes in their lives. Among them, 58.6% are former smokers – they currently do not smoke cigarettes at all.

Cigarette Smoking Frequency	Ashtabula City (average n=70)	Conneaut City (average n=52)	Ashtabula County (average n=383)
Everyday	20.2%	38.7%	15.9%
Some days	0.5%	1.3%	4.7%
Not at All	79.2%	60.0%	79.4%

E-Cigarette Smoking Frequency	Ashtabula City (average n=67)	Conneaut City (average n=45)	Ashtabula County (average n=352)
Everyday	2.1%	11.1%	3.9%
Some days	4.7%	0.4%	1.8%
Not at All	93.2%	88.5%	94.4%

Alcohol Use

Alcohol Use	Ashtabula City (average n=71)	Conneaut City (average n=53)	Ashtabula County (average n=389)
Binge Drinkers	37.7%	34.9%	38.8%

Marijuana Use in the Past 30 Days

Marijuana Use	Ashtabula City (average n=71)	Conneaut City (average n=53)	Ashtabula County (average n=389)
Used Marijuana at least once	7.8%	10.7%	8.0%

Abuse of Prescription Medication

Extremely low numbers of Ashtabula County residents reported using prescription medication that was not prescribed for them or taking more medicine than was prescribed to feel good, high, more active, or more alert in the past 30 days (1%)

Motor Vehicle Activity

The next table shows the counts of fatal motor vehicle deaths. The count of motor vehicle deaths in 2019 does not meet the Healthy People 2030 target of 10.1/100,0003.

Motor Vehicle Activity	Ashtabula County Rate*	Ohio Count Rate*
Motor Vehicle Deaths	15                       15.4	1,164                     10.0
Motor Vehicle Drug Related Deaths	9                         **	597                      5.1
Alcohol-related Motor Vehicle Deaths	5                         **	366                      3.1

Data are from 2019 *Rate per 100,000 population age 16 and over from 2019 ACS 5 year 5-year population estimates **Rates based on counts of less than ten are considered unreliable ***Includes calls for service: Reckless/OVI

Youth Educational Attainment

This section displays relevant data about youth educational outcomes in Ashtabula County, beginning with the graduation rates for the county’s public-school districts. The average four- year high school graduation rate across these public schools is 88.3%. This is lower than the average for public schools in Ohio overall (92.0%)

Ashtabula County School Districts	High School Graduation Rates in Ashtabula County
Ashtabula Area	75.6%
Conneaut Area	87.1%
Buckeye	92.1%
Geneva Area	94.9%
Jefferson Area	96.2%
Grand Valley	86.8%
Pymatuning Valley	97.8%

Data are from 2020

The Health Policy Institute of Ohio’s 2021 Equity Profiles notes the following worse outcomes for Ohioans with less than a high school education and lower incomes when compared to Ohioans with higher educational attainment and incomes:

• Adult depression is 1.8 times worse for people with less than a high school education
• High school graduation is 3.3 times worse for people with low incomes
• Adverse childhood experiences is 2.1 times worse for children with parents with less than a high school graduation
• Disconnected youth were 1.8 times worse for people with less than a high school education

Ashtabula County 2022 Youth Survey

1,908 youth in grades 7 through 12 completed the OH Yes Survey with the following results pertinent to substance use prevention planning:

• 24.86% of respondents disagreed or strongly disagreed that they felt like they belonged at their school, compared to 13% in 2019
• Approximately 20% of youth disagreed or strongly disagreed that they could go to adults at their school for help if they needed it, compared to 21% in 2019
• 59.6% of students report being bullied on school property in the last 12 months, compared to 25% in 2019. In 2022, the highest percentage of students reporting bullying stated they were teased, taunted, or called harmful names, and/or had mean rumors spread about them or were kept out of a group.

Last 30 days youth substance use:

	2019	2022
Cigarettes	7.35%	3.3%
Electronic Vapor Products	21.1%	13.3%
Alcohol	14.6%	13.9%
Marijuana	11.1%	7%
Prescription Medication	3.6%	1.59%

Ashtabula County 2022 Student Survey

Answer Choices	Response Percentage	Response Number
I have never used any of these substances in my life	95.63%	1684
Any form of cocaine, including powder, crack, or freebase	0.68%	12
Inhalants, sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high	2.16%	38
Heroin (also called smack, junk, or China White)	0.40%	7
Methamphetamines (also called speed, crystal meth, crank, ice, or meth)	0.51%	9
Ecstasy (also called MDMA, Molly)	0.57%	10
Hallucinogenic drugs, such as LSD, acid, PCP, angel dust, mescaline, or mushrooms	1.82%	32
Steroid pills or shots without a doctor’s prescription	0.51%	9
Synthetic marijuana (Spice, fake week, K2, King Kong, Yucatan, Fire, or Skunk)	1.70%	30

           Answered 1761, Skipped 147

2021 Stigma Survey (HRSA COP RCORP)

1,046 Total responses among the rural counties: Ashtabula, Fairfield, Sandusky, and Seneca.

Have you seen or heard of a person in our community who uses substance experiencing stigma because of their substance use?

OF those who reported that they have seen or heard of a person in our community experiencing stigma:

47% Female

42% Males

44% Transgender

Ashtabula County Specific Data:  Demographics

Locations of Stigma	General Community	Healthcare	School/work
Females	79%	53%	73%
Males	81%	27%	64%
Transgender	100%	100%	100%
18–44-year-old	80%	64%	77%
45–64-year-old	85%	44%	69%
65 and older	72%	26%	65%
Non-white/non-Hispanic	100%	50%	75%
White non-Hispanic	80%	44%	70%
Those who know someone with a SUD	81%	48%	73%
Personally Received Treatment	95%	55%	70%

Has the stigma you have seen people in our community experience because of their substance use made it difficult for them to: (top responses)

All Ashtabula Co. respondents:

62% reported Seek help or treatment

61% reported Begin treatment

60% reported Figure out how to pay for treatment

Those Ashtabula Co. respondents who have personally received treatment for SUD:

71% reported Seek help or treatment AND figure out how to pay for treatment

62% reported Figure out how to use insurance for treatment AND Begin treatment

57% reported Get support with treatment progress AND Get services/support after treatment.

Have you seen or heard about people in our community who use substance like alcohol or drugs experiencing any of the following situations due to their substance use?

(Top responses)

All Ashtabula Co. respondents:

72% Getting fired from a job

61% Being avoided by community members

54% Being shunned from a friend group due to their use of alcohol or drugs

Those Ashtabula Co. respondents who have personally received treatment for SUD:

90% Getting fired from a job

71% Being shunned from a friend group

62% Being avoided by community members

–

Ashtabula County Specific Stigma Solutions

	% Reported Somewhat/Very effective
Increase awareness that recovery from substance use is possible	99%
Make it easier for people to find a place to get treatment for SUD	96%
Increase awareness that treatment for substance use is effective	96%
Highlight real stories of people in our community that show substance use treatment is effective and recovery is possible	96%

–

Ashtabula County Specific Stigma Around Naloxone

	Somewhat/Strongly Disagree	Neutral/Unsure	Somewhat/Strongly Agree
Having Naloxone available encourages people to misuse opioids	25%	19%	56%
Naloxone should be made available upon request to anyone concerned about opioid overdose	15%	22%	63%
Local Community organizations should distribute naloxone to anyone who want it at special in-person or drive-thru events	47%	28%	25%
Naloxone should be available in public places as first aid for overdose emergencies just like devices that are available for heart attack emergencies.	29%	20%	51%
Naloxone is a lifesaving drug and people should have access to it as many times as they need it.	42%	26%	32%
Naloxone is a basic form of first aid and should be available to anyone in the community who would like to have it.	37%	25%	38%

–

Ashtabula County Specific Stigma Around Medication for Opiate Use Disorder

	Somewhat/Strongly Disagree	Unsure/Neutral	Somewhat/Strongly Agree
Treatment with MOUD should be offered in our community as a way to treat OUD	11%	25%	64%
When people use MOUD, they are substituting one drug for another	26%	37%	37%
People Prescribed MOUD should be in counseling	4%	11%	85%

–

Ashtabula County Specific Fentanyl Test Strips

	Somewhat/Strongly Disagree	Neutral/Unsure	Somewhat/Strongly Agree
FTS should be available to anyone in the community who would like to have them	21%	19%	60%
Local community organizations should distribute FTS to anyone who wants them	29%	25%	47%

Ashtabula County:  Children’s Services Profile

Ashtabula County Children Services reported that for January-November 8, 2022, 26% of the removals of children have been due to parental substance use. As of November 2022, there are 10 families and 20 children participating in START and are not in the custody of Children Services but are involved with the agency due to parental substance abuse.  Year to date 33 families with 64 children are participating in START.  The total number of children in custody as of October 31, 2022, was 137.  Reasons included: 43% neglect, 27% physical abuse, 12% sexual abuse, 11% multiple allegations, 3% emotional maltreatment, and 6% Comprehensive Addiction and Recovery Act referrals (children 12 months and younger screened due to substance use exposure).

PCSAO Factbook 2020

During State Fiscal Year 2020, 287 children were in the custody of Ashtabula County Children Services anytime during the year. Children who were screened-in by the agency were for: neglect-34%, physical abuse-22%, sexual abuse- 13%, multiple allegations, 12%, emotional maltreatment-1%, families in need of assistance-15%.  Parental substance abuse, 32%, was the primary reason for removal of a child from the home.  Other top reasons were 25% dependency and 20% neglect.

2021 Criminal/Juvenile Justice Key Informant Interviews

The Director of Community Engagement, Prevention and Planning conducted interviews with representatives of criminal and juvenile justice to assist in determining local conditions.

Detective Leonhard, CEAAC Task Force, reported that nationally ‘Waxies’ which are Gummies that are cooked to have a high purity of THC have resulted in some overdoses. Waxies have not been found in Ashtabula County, but nationwide people have been known to Overdose on them because some are laced with fentanyl. He reported that many drugs can be ordered through the internet with a simple google search. The charges for mail-order drugs are the same as if they purchased them on the street.

Detective Leonhard reported that people are still using heroin knowing they are getting fentanyl but call it heroin still. When it comes to prescription medication, it is no longer being trafficked, but some people will trade prescriptions for other drugs.

Stamped fentanyl (made to look like Xanax or Percocet) will be on the rise here soon.

Caron Fenton, Diversion Supervisor, at Ashtabula County Juvenile Court reported the following statistics for juveniles’ involvement with the court:

	2019	2020	2021
Vaping/smoking	62	28	59
Underage Consumption	19	15	7

Vaping citations go through diversion and must write a 3-page paper or do 5 hours of community service work. If they get a second citation, they must do both.

Caron reported Juvenile Court implemented a Pilot Program “Catch my Breath” with Grand Valley Schools for any student who was caught vaping on school property. They had the choice of being suspended and having charges filed with juvenile court, or the students and a parent could attend this program.

Current Trends Training with Detective Taylor Cleveland and Commander Greg Leonhard:  October 2021

At the 2021 PART Conference Detective Cleveland and Commander Leonhard discussed the current trends with Criminal Justice in Ashtabula County. They explained that contact with persons with a Dual Diagnosis in Ashtabula County is increasing among Law Enforcement and there are few options in how Law Enforcement can be proactive in linking them to beneficial services (treatment). Persons with a dual diagnosis are often not accepted into detox or treatment because of their substance use. In addition, mental health providers will not always accept an individual into treatment believing that the substance use must be dealt with first. Det. Cleveland stated that the involuntary admissions training was immensely helpful and believes that it should be offered on a yearly basis for all new or incoming police officers. Further trainings would also be beneficial around mental health placement as there is some confusion around whether there is a resource issue for mental health patients or if resources being underutilized because Law Enforcement does not know how to make those referrals. Commander Leonhard talked about the current trends in substance use and mentioned that Methamphetamine is the leading drug in Ashtabula County. Marijuana shipped from California is becoming a big problem and is 3-4x more potent than it traditionally has been. Along with Marijuana, Hallucinogens have increased a lot in the last year such as LSD and MDMA, especially among those in the 16-22 age range.

Ashtabula County Youth Leadership Discussion, February 10 & 11, 2021

Bridget Sherman and Kaitie Park attended meetings with 30 high school juniors who are members of Ashtabula County Youth Leadership to discuss their beliefs around their Mental Health concerns in Ashtabula County. They stated that common responses when teens share feelings to adults about their own mental health are to “suck it up.” They reported often feeling like their feelings are compared to the feelings of others, as though parents and adults lack empathy for the feelings of youth (in a “you think you have it bad? Try living my life!” point of view). Youth questioned how to break the cycle of the “toughen-up” culture their parents were raised in to become more inclusive and open to discussion of feelings. One student mentioned that youth find it difficult to be vulnerable and show emotion.

COVID 19 caused many teenagers to lose some of their protective factors and as they stated in the meeting take a ‘huge mental hit’. Guidance Counselors have been less accessible and due to limited in-person class time teachers are increasingly less likely to allow students to take time to talk with a guidance counselor. To help deter this issue students suggested that mandatory meetings times be established to do mental health check-ins. Another topic discussed was the idea around how information and mental health resources are shared. One student mentioned that flyers and palm cards are not particularly helpful as they “usually do not make it past a folder and are forgotten about.” Students thought it would be helpful for teachers to be educated about resources and take time during class to discuss what is available for mental health help.

January 2020 Ohio Substance Abuse Monitoring Network

Drug Trends Youngstown Region

(Ashtabula, Trumbull, Mahoning, Columbiana, Jefferson counties)

In the previous reporting period (January – June 2019), crack cocaine, fentanyl, marijuana, methamphetamine, Neurontin® (gabapentin), powdered cocaine and Suboxone® remained highly available in the Youngstown region. Changes in availability during the reporting period included: increased availability for marijuana and methamphetamine; and possible decreased availability for heroin and sedative-hypnotics.

While heroin remained available in the region, participants overwhelmingly expressed difficulty in discerning heroin from fentanyl and reported heroin unadulterated with fentanyl as nearly unavailable.

Treatment providers concurred that the availability of heroin had decreased during the reporting period; the drug had been supplanted by fentanyl. Several providers reported very few clients screening positive for heroin on urine drug screens while the prevalence of clients screening positive for fentanyl was high. BCI crime labs reported that the incidence of heroin cases they process from this region had decreased during the reporting period, while the incidence of fentanyl cases had increased.

Several respondents used the term “skyrocketed” when describing the increased availability of methamphetamine during the reporting period. Law enforcement confirmed that the available methamphetamine in the region was almost all imported crystal methamphetamine from Mexico and not “shake-and-bake” (user produced powdered methamphetamine). Law enforcement reported that drug cartels were pushing crystal methamphetamine and flooding the regional drug market with it. Participants attributed increased use of methamphetamine to heroin/fentanyl users switching to the drug out of fear of overdose death. They also noted the longer lasting high and the cheaper price for methamphetamine compared to crack cocaine as

making methamphetamine the preferred stimulant drug. However, participants noted that methamphetamine was cut with other drugs, specifically fentanyl and MDMA

(ecstasy/molly). BCI crime labs reported that the incidence of methamphetamine cases they process from this region had increased during the reporting period.

STATE Data:

Prevalence of Substance Use in Ohio

The National Survey on Drug Use and Health (NSDUH) (SAMHSA, 2019/2020) indicates there are 757,000 (7.7%) persons in Ohio with a Substance Use Disorder, and 353,000 (3.6%) of those reported illicit drug use in the past year. Fifty-two thousand (52,000) Ohioans aged 12 and older reported past year heroin use and 414,000 (4.5%) reported past year misuse of pain relievers. An estimated 88,000 Ohioans demonstrated past year pain reliever use disorder. The average prevalence of past-year opioid use disorder in Ohio was 1.45% of the population, or 142,000 people, which is higher than the national average. According to the 2017-2018 NSDUH over the past year 45,000 Ohioans 12 and older reported methamphetamine use, and 156,000 reported cocaine use. Five hundred and three thousand (503,000) Ohioans, or 5.1% of the population had a past-year alcohol use disorder.

In terms of substance use treatment, in a single-day count 66,296 Ohioans were enrolled in substance use treatment-an increase from 45,129 people in 2015. The number of individuals enrolled in substance use treatment in Ohio receiving Buprenorphine increased from 7,347 people in 2015 to 13,672 people in 2019. Survey estimates suggest that 271,000 (2.3%) Ohioans needed but did not receive treatment for illicit drugs.

Overdose Deaths

The Ohio Department of Health’s (ODH, November 2020) published annual drug overdose report revealed that while the 2018 unintentional drug overdose death rate was the lowest since 2015, from 2018 to 2019, the overdose death rate increased by 6.4% to a rate of 36.4 deaths per 100,000 population, which is similar to the 2016 rate. Additionally, beginning in the second quarter of 2017, the number of unintentional overdose deaths began to decrease, and this trend continued into the first half of 2018. However, the number of deaths began to increase in the second half of 2018, and 2019 deaths saw steady increases each quarter. The number of fentanyl-related overdose deaths increased 12.3% from 2018 to 2019, and fentanyl was involved in 76.2% of unintentional overdose deaths. The number of fentanyl deaths involving carfentanil increased 577.3% from 75 deaths in 2018 to 508 deaths in 2019. The percentage of deaths related to psychostimulants (e.g., methamphetamine) increased. In 2019, 20.5% of unintentional overdose deaths involved psychostimulants.

Workforce Supply and Demand with Ohio’s Behavioral Health System-released by OhioMHAS, April 2021

Demand:

• Demand for behavioral health services increased 353% from CY2013-2019, with an average 29% increase per year
• Demand for behavioral health services provided by nurse practitioners and physicians has increased since the behavioral health redesign
• Community behavioral health centers are the most common facility type for services
• As of CY2019 overall unmet demand is between 41-46%.
• Demand for substance use disorder services increased sharply in CY2018, correlating to a decrease in opioid overdose deaths and the introduction of new SUD services
• In adults, two-thirds of the demand is for SUD Services

Supply:

• The behavioral health workforce increased significantly from CY2013-2019 with a 174% increase over this period, averaging 36% growth per year
• The supply of Chemical Dependency Counselors is increasing most rapidly at a yearly average of 61%
• As of CY2019 Social workers make up the largest portion of licensed professionals at 31%, just 7% of the population is made up of physicians
• The behavioral health workforce is concentrated in densely populated counties, with less populated counties displaying lower numbers of practitioners per 10,000 residents
• Nursing degrees are increasing most rapidly year over year at an average of 54%, whereas physician related degrees increased 12%
• Nearly half of the behavioral health workforce, 44%, is between 25 and 34 years of age

Opiate overdoses linked to poor mental health- University of Cincinnati

The University of Cincinnati conducted a study to identify characteristics that put people at higher risk of a fatal overdose. Health interventions for opiates have focused on treatments such as the distribution of naloxone and other lifesaving remedies. But the study notes that said prevention could be effective if vulnerable populations can be identified. To that end, researchers found that white males ages 25 to 29 were most at risk of fatal opioid overdose followed by white males ages 30 to 34. The study also identified an increasing risk to Black males ages 30 to 34.

The study also found a correlation between fatal overdoses and mental and physical distress using surveys of physically and mentally unhealthy days. Mental distress increases the relative risk of dying from a drug overdose by as much as 39%. The researchers believed that mental health has deteriorated due to the COVID 19 pandemic for the entire population, and as a result there will be a surge in opiate overdoses.

Harm Reduction Ohio 2021

Ashtabula County is ranked 38th in Ohio’s 88 Counties for overdose deaths in 2021. What’s driving overdose death today is the expansion of fentanyl adulteration more broadly and deeply into the drug supply, especially into the meth supply.

But it can be mitigated somewhat by:

• making sure all people who use drugs have naloxone for themselves and others. This is especially true of people who use cocaine, meth, and fake pills.
• increasing drug checking. This is especially true at the micro level (fentanyl test strips, street level mass spectrometry testing, etc.) and at the macro epidemiological level by understanding broad adulteration trends in the drug supply.

National

U.S. Department of Health and Human Services- 2022 Budget Statement

HHS must address the public health crises associated with mental health and substance use disorders. This need is especially urgent given that both crises have accelerated during the COVID-19 pandemic. Calls to mental health helplines have increased across the country as Americans struggle with increased anxiety, depression, risk of suicide, and trauma-related disorders resulting from the pandemic. Younger adults, racial minorities, essential workers, and unpaid adult caregivers are particularly impacted. Similarly, preliminary data from 2020 suggests that overdose deaths, which were already increasing, accelerated during the pandemic. Provisional data suggest that over 90,000 drug overdose deaths occurred in the United States in the 12 months ending in September 2020. That represents a year-over-year increase of close to 29 percent.

CDC

Provisional data from CDC’s National Center for Health Statistics indicate there were an estimated 107,622 drug overdose deaths in the United States during 2021, an increase of nearly 15% from the 93,655 deaths estimated in 2020. The 2021 increase was half of what it was a year ago, when overdose deaths rose 30% from 2019 to 2020. According to the DEA, 66 percent of the 2021 deaths related to synthetic opioids like fentanyl. Last year, the United States suffered more fentanyl-related deaths than gun- and auto-related deaths combined.

DEA

Illicit fentanyl, primarily manufactured in foreign clandestine labs and smuggled into the United States through Mexico, is being distributed across the country and sold on the illegal drug market. Fentanyl is being mixed in with other illicit drugs to increase the potency of the drug, sold as powders and nasal sprays, and increasingly pressed into pills made to look like legitimate prescription opioids. Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug.

There is significant risk that illegal drugs have been intentionally contaminated with fentanyl. Because of its potency and low cost, drug dealers have been mixing fentanyl with other drugs including heroin, methamphetamine, and cocaine, increasing the likelihood of a fatal interaction.

Producing illicit fentanyl is not an exact science. Two milligrams of fentanyl can be lethal depending on a person’s body size, tolerance, and past usage. DEA analysis has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet.

• 42% of pills tested for fentanyl contained at least 2 mg of fentanyl, considered a potentially lethal dose.
• Drug trafficking organizations typically distribute fentanyl by the kilogram. One kilogram of fentanyl has the potential to kill 500,000 people.

National Council of Behavioral Health Authorities- Youth impact of COVID 19

A national assessment of 600 youth, ages 13-18, conducted in January 2021 found that 78% of youth felt the COVID-19 pandemic has increased stress for them and their family and 69% reported increased feelings of loneliness. Nearly a quarter of the respondents reported that accessing substances was easy or very easy during the pandemic. These impacts are not limited to the time of the current public health crisis/pandemic but will go beyond and will affect the behavioral health of today’s youth for years to come.

Harris Poll:  National Council for Mental Wellbeing- survey of 2000 U.S. adults, 2022 data

43% of U.S. adults who say they needed substance use or mental health care in the past 12 months did not receive that care, and numerous barriers to access stand between them and needed treatment

The unmet demand for substance use and mental health care is more than double the unmet demand for physical health needs, according to the survey. Specifically:

• 42% of U.S. adults report needing mental health care over the past 12 months and 24% report needing substance use care during that timeframe.
• 43% of U.S. adults who needed mental health care or substance use care (also 43%) in the past 12 months did not receive it, compared to 21% of those who needed primary care and did not receive it.

Barriers to Care are Universal

• Cost-related issues (no insurance, out-of-pocket costs) prevented 37% from getting mental health care and 31% from receiving substance use care.
• Inability to find a conveniently located provider prevented 28% from getting mental health care and 22% from getting substance use care. In some rural areas, providers may be hours away.
• Inability to find a provider who offers a visit format people feel comfortable with (e.g., in-person, telehealth) prevented 25% from getting mental health care and 31% from receiving substance use care.
• Inability to get an appointment immediately when they needed care prevented 21% from receiving mental health care and 28% from receiving substance use care. Wait times can range from weeks to months in some areas.

Those who did receive mental health or substance use care over the past 12 months also cite difficulties in getting that care:

• 81% of U.S. adults who received substance use care had trouble getting care.
• 67% of U.S. adults who received mental health care experienced difficulties getting care.

The survey also found that many U.S. adults, overall, believe insurance-related issues complicate access. Nearly 3 in 5 U.S. adults believe it is easier (59%) and faster (59%) to get mental health or substance use care if you pay out-of-pocket versus using insurance. In addition, 71% of U.S. adults would be more likely to get mental health or substance use care if they could receive it through their primary care doctor, if they needed it, and 67% think it is harder to find a mental health care provider than it is to find a physical health care provider.

People’s Lives are Impacted by Unmet Needs

Those with unmet mental health and substance use care needs say not receiving care had an impact on their lives. Among those who did not receive needed mental health care:

• 50% reported personal relationship issues as a result of not getting care.
• 45% reported work issues.
• 44% reported a decline in mental wellbeing.

Among those who did not receive needed substance use care:

• 49% reported work issues as a result of not getting care.
• 43% reported personal relationship issues.
• 37% reported a decline in mental wellbeing.

Our Workforce is not as Diverse as the People We Serve

The survey revealed that a workforce shortage may have made access to care more difficult. Those who received needed mental health or substance use care, as well as those who did not had difficulty finding culturally competent care. Many adults feel there is a lack of providers available to address cultural needs:

• 13% who did not get needed mental health care cite that it was because they could not find a provider who was a good cultural fit, and 17% who did not get needed substance use care say the same.
• 17% of those who received mental health care in the past 12 months say they struggled to get care because they were unable to find a provider who was a good cultural fit, and 24% who received substance use care say the same.
• 61% of U.S. adults overall feel there are not enough mental health care providers who are trained to address issues specific to race, ethnicity, sexual orientation, or socioeconomic status.

Men and Younger People are Most Impacted

• The need for care is greatest among men and younger adults. Men are more likely than women to say they needed substance use care in the past 12 months (30% vs. 19%), and Gen Z (ages 18-25) and Millennials (ages 26-41) are more likely than Gen X (ages 42-57) and Boomers (ages 58-76) to say they needed both mental health (59% and 64% vs. 42% and 18%) and substance use care (38% and 42% vs. 21% and 7%) in the past 12 months. Whether they receive the care they need depends on their ability to overcome the many obstacles they encounter.

 Areas of Focus:

Ohio Department of Mental Health and Addiction Services (OHMHAS): Strategic Plan 2021-2024

External Factors Affecting Behavioral Health Services

Knowledge of Mental Health or Substance Use Problems. Many are unaware of the signs and symptoms of mental illness or substance use disorders in self, friends, and loved ones.

Awareness of Behavioral Health Services. There is insufficient community knowledge of the availability of behavioral health and recovery support services.

Stigma. Stigma related to mental illnesses and substance use disorders contributes to Ohioans not seeking needed care.

Financial Constraints. Many Ohioans do not have the financial ability to pay for needed behavioral health services. Work continues ensuring that insurance coverage for behavioral health treatment is equal to that of other medical services. Financing needed services at the state level can be difficult with federally mandated funding requirements.

COVID Pandemic. The COVID pandemic has current and long-lasting impacts on the mental health and wellness of Ohioans.

Telehealth Services. Recent enhanced use of telehealth services due to the COVID pandemic has increased the ability of Ohioans to access and receive needed behavioral health services.

Medicaid Expansion. The expansion of Medicaid has enabled more Ohioans to access needed behavioral health services.

Overview of Strategic Focus Areas

There are several priorities that cut across all strategic focus areas of the OHMHAS Plan. These include the following:

• Health equity and cultural competency
• Communication and Collaboration
• Workforce Development
• Data collection and analysis

OHMHAS has identified the following four strategic goals:

1. Innovation- drive innovation to ensure access to culturally responsive, trauma- informed, prevention, treatment, and recovery services for Ohioans of all ages.

STRATEGIC GOAL 1.1

Build workforce capacity to deliver quality care.

STRATEGIC GOAL 1.2

Increase the capacity of youth and early childhood prevention, early identification and intervention, treatment, and recovery support.

STRATEGIC GOAL 1.3

Increase the capacity for prevention, early identification and intervention, treatment, and recovery support.

STRATEGIC GOAL 1.4

Promote health equity by addressing social determinants of health in a variety of community and institutional settings.

2. Advance the development of policies that promote quality, accountability, efficiency, and effectiveness.

STRATEGIC GOAL 2.1

Improve coordination of departmental policies and processes to promote efficiency and accountability.

3. Collaboration: strengthen and expand strategic collaborations and partnerships.

STRATEGIC GOAL 3.1

Build a big tent for new and existing partners.

STRATEGIC GOAL 3.2

Provide leadership and direction to Ohio’s behavioral health system.

STRATEGIC GOAL 3.3

Emphasize the importance of diversity and cultural competency throughout departmental activities.

4. Culture- reinforce a strong internal organizational culture.

STRATEGIC GOAL 4.1

Recruit, retain and develop a diverse, competent, and engaged workforce.

STRATEGIC GOAL 4.2

Embed opportunities for internal collaboration and innovation.

STRATEGIC GOAL 4.3

Develop a comprehensive data collection, analysis, and usage framework.

Health Policy Institute of Ohio Addiction Policy Scorecard September 2021

Challenges related to poverty, job loss, wages and transportation may contribute to higher rates of overdose deaths and other addiction related harms in communities with less economic opportunity. There is an indication that lack of economic and educational opportunities contribute to higher overdose rates in Appalachian and urban communities. On Average, Appalachian counties have the lowest percentage of residents with at least a high school diploma or equivalent (86% of Ashtabula County residents have at least a high school diploma). Given that the overdose rate is 15 times higher for Ohioans with less than a high school diploma compared to those with a bachelor’s degree, strengthening educational opportunities and pathways to employment in these communities would likely improve health. Access to safe and affordable housing is also necessary to support health. 11% of households in Appalachian and urban communities spend more than 50% of their annual income on housing costs (rent, mortgage, utilities…)

Addressing stigma is also a needed component to ensure those in need seek necessary treatment options. A 2018 Ohio poll found that residents of suburban and rural counties were most likely to believe that addiction is not a disease. Stigma surrounding addiction and Medication-Assisted Treatment is a barrier to seeking and receiving help. Stigma has led to reluctance to set up harm reduction or treatment services in regions with the most need.

-22 out of 88 counties have no recovery housing (certified or non-certified)—in SFY 2022 Ashtabula County had 6 certified recovery houses.

-66 of Ohio’s 88 counties do not have a syringe services program.

-62 of Ohio’s 88 counties have no methadone availability. Methadone patients in Ashtabula County are transported elsewhere to receive their Methadone treatment.

Addiction related harms, such as Hep C and overdose deaths are concentrated in Appalachian counties. Syringe service programs are an evidence-based approach to preventing transmission. The average rate of Hep C infections is 1.4 times higher in Appalachian counties than the average for all Ohio counties.

COMMUNITY STRENGTHS

The Ashtabula County Mental Health and Recovery Services Board’s primary community strengths include collaborations and partnerships, engaged community members and the utilization of local resources and assets.

The Ashtabula County Mental Health and Recovery Services Board provides leadership and structure for many of the county’s behavioral health coalitions, such as the Substance Abuse Leadership Team (SALT) which is the county’s opiate hub, The Ashtabula County Prevention Coalition, the Ashtabula County Suicide Prevention Coalition, and the Ashtabula County Housing Coalition. Many of the partnerships the board has within the county manifest within our coalitions and allow for strategic initiative implementation, collective impact processes, increased community involvement, and cross-systems access to community resources.

The Ashtabula County Substance Abuse Leadership Team (SALT) is made up of leadership throughout the county from our behavior health organizations, first responders (including law enforcement, fire, and EMS), city and county officials (city managers, county commissioners, prosecutor, coroner), city and county health departments, hospitals, schools, interested parties and child welfare. It is through these leadership team meetings that county-wide behavioral health concerns are discussed, and plans are put in place regarding the implementation of programs and initiatives to address common areas of concern. Major initiatives have included:

• implementing a Quick Response Team (QRT of Law Enforcement and Treatment Professionals who respond to non-fatal overdoses as a linkage to treatment and provide harm reduction education and resources.
• expanding Naloxone distribution totaling over 1200 kits in fiscal year 2021 by engaging partners and community members such as treatment agencies, first responders, the Ashtabula Co. Jail, libraries, YMCA, and faith-based organization. Through our partnership with these organizations, we have also been successful at installing and maintaining NaloxBoxes throughout the county. Examples of where the NaloxBoxes are placed include the local YMCA/YWCA, local libraries, the Ashtabula County Jail, and the Ashtabula County Court House.
• workforce development initiatives such as a CDCA training academy and providing regular Peer Recovery Supporter Trainings. SALT has also been successful at building a relationship with our regional college campus who will being offering a Bachelor of Social Work program in the Spring of 2023;
• developed a partnership with our local hospital systems to begin offering Buprenorphine in the Emergency Departments (ED) for those who are interested after receiving care in the ED following an overdose. Through this program we have been working with the hospital systems and behavioral health systems to ensure proper linkage is made to the necessary service providers to help ensure service engagement and retention. This has also become a high priority for one of our local hospital’s behavioral health units. Not only does this ensure linkage to appropriate care, but it also decreases the likelihood of future hospitalizations due to behavioral health
• coordinated CRAFT Model training to service provider who were interested in implementing groups in the community. Through our partnerships—not only with our provider agencies—but our community partners such as our local libraries and YMCA, we are able to implement programs like CRAFT and PAX Tools in the community. These locations offer a neutral, comfortable place for community members to gather.

The Ashtabula County Prevention Coalition’s mission is to implement effective, evidence-based strategies to prevent and reduce high risk behaviors and substance misuse among residents of Ashtabula County. The coalition is made up of a sector representation from parents, healthcare professionals, businesspeople, volunteers, media representatives, law enforcement, local government representatives, religious organizations, organizations involved in reducing substance misuse, youth-serving organizations, and the schools, through collaborations to better engage community members with prevention resources and assets. Major initiatives have included:

• limiting youth access to substances- Six medication Disposal drop-boxes are located throughout the county, many of which are located at 1^st responder buildings While those continue to be maintained, we also work with our coalition members and community partners (health departments, libraries, senior centers, hospitals, YMCA, treatment agencies, family support groups, funeral homes, Hospice, Children’s Services…) to distribute medication disposal bags. We also work with local restaurants and stores that sell alcohol to inform them of Alcohol Server Knowledge (ASK) trainings that are available.
• school-based Prevention—Biannually, the Prevention Coalition implements the OhYES! Survey with our eight school districts to gauge where we need to focus our prevention efforts among youth. We work with our local prevention service provider and the University Hospital’s outreach teach to implement the Botvin Lifeskills program in grades 3^rd-10^th. We also work with the schools to coordinate PAX Good Behavior Game Trainings in the Elementary and Middle Schools, and work with our prevention service provider to offer PAX Tools trainings in the Community the prevention coalition also coordinates the implementation of Rachel’s Challenge, which many of our districts utilize as a youth-led style prevention program as well as Girls’ Circle and Boys’ Council.
• training opportunities—The Ashtabula Co. Prevention Coalition, for the last eleven years, has produces a county wide Prevention, Awareness, Recovery and Treatment (P.A.R.T.) Conference to educate the community on what is happening here is Ashtabula County around these four topics. Not only does this conference provide overall education for general community members, it allows our treatment providers and other community partners to keep up to date on current trends and best practices, while also providing opportunities for professionals to receive CE credits.

The Ashtabula County Suicide Prevention Coalition’s mission is to instill hope, foster connectedness, and be a resource of information, advocacy as well as implement evidence-based practices in the community to reduce risk and increase protective factors to prevent suicide. The Suicide Prevention Coalition is made up of sector representatives from our local behavioral health treatment agencies, law enforcement, NAMI, libraries, health departments, and survivors of suicide. Major initiatives have included:

• Suicide Prevention Gatekeeper Trainings: Mental Health First Aid and Question Persuade Refer (QPR) are suicide prevention gatekeeper trainings. The Suicide Prevention Coalition works to expand the number of trainers and the number of trainings provided each year, identifying groups of people and locations for the gatekeeper trainings to be held.
• Incident Response Team and Local Outreach to Survivors of Suicide (LOSS) Team: The Ashtabula Co. Suicide Prevention Coalition coordinated the Incident Response Team (IRT) anytime a school experiences a sudden or traumatic loss of a student or employee. The Incident Response Team goes to the schools, or when needed, to meet with students and staff who would like someone to talk with to help them process the loss. The IRT is made of a collaboration of treatment providers. Local Outreach to Suicide Survivors (LOSS), is also coordinated through the Suicide Prevention Coalition in conjunction with the County Coroner’s Office. Any time there is a suicide, the coroner’s office calls the LOSS team to provide a response to the survivors. This team is made up of trained community members, many of which have experienced a suicide loss in the past.
• Suicide awareness and stigma reduction activities including an annual 5K Run/walk and an art show in partnership with the Ashtabula Art Center called Hope in Artistry.

The Ashtabula County Housing Coalition. The mission of the housing coalition is to ensure the execution of the County’s Housing Continuum of Care as well as the annual federal Point in Time Survey that is designed to measure the level of individuals struggling with homelessness in Ashtabula County.  Initiatives monitored by the Housing Coalition are:

• Recovery Housing
• Housing Emergency Assistance for individuals with a behavioral health disorder
• HUD Housing Grant Partners and Voucher Program
• Homelessness-Adult & Youth
• Community Transitional Housing
• Federal Point in Time Survey

The Mental Health and Recovery Services Board works with our service providers and community partners to ensure appropriate services are being provided to meet the needs of the community.

1. As part of the planning for the crisis continuum, the MHRS board worked with the local crisis provider to implement an Expansion of the Mobile Crisis Unit. This expansion was in support of individuals in behavioral health crisis that were encountering Law Enforcement during a response to crisis situations. The Board is also working with Law Enforcement to increase the number of CIT trained officers, and eventually dispatchers. The MHRS Board and Law Enforcement have been meeting regularly to plan an upcoming CIT training that will cover various areas of concern that our local law enforcement agencies are facing more often.  The Board has also worked closely with the Center of Excellence for Criminal Justice during this process.
2. Health Officer Training-The Board offers annual Health Officer training and includes anyone interested in ORC 5122 and the duties and responsibilities laid out in the statute. The Board trains approximately 50 individuals a year, including treatment providers, parole officers, patrol officers, Sheriff’s Department staff, hospital staff, etc.
3. Guardianship/payee programs—The Board has worked with community partners and Catholic Charities to expand payee services for individuals with mental illness as well as developing a guardianship program specifically for individuals with a severe and persistent mental health disorder. The goals of these programs are to provide support to those individuals to increase the quality of their lives and provide the recovery support services they need to be successful in their recovery and live their best lives.
4. Specialty Dockets—The Board has worked collaboratively with one Municipal Recovery Court docket, a Juvenile Court Family Court docket, and two Common Pleas Court Dockets for the past several years. The Board has also recently engaged with the local Veterans Court and is assisting an additional Municipal to develop a co-occurring disorder docket.  Along with ensuring that the courts have access to EBP treatment, including things like the Mission Program and MAT, the Board has been writing federal and state grants to fund the dockets since 2013.  The Board also invests local funds in the court to support court coordinators and assist in sustainability planning.
5. Ashtabula County Board of Developmental Disabilities—The MHRS Board works closely with our Board of DD on various grant writing projects, providing training for their staff and Providers, and on individuals with co-occurring mental health and developmental disabilities.
6. Ashtabula County Job and Family Services—The Board Director currently serves on the JFS Transportation Advisory Board. The MHRS Board also works closely with the JFS transitional youth/out of school youth programming including employment services and looking at homeless youth.
7. Ashtabula County Community Action Agency—The MHRS Board works closely with Community Action on housing issues as well as providing data for grant writing and offering training for their new employees.
8. Ashtabula County Children Services Board—The MHRS Board participates in the CSB OhioSTART program, assists them with their child abuse prevention month activities, and ensured that their staff are trained to administer Naloxone and distribute to their clients as needed.
9. Ashtabula County Family and Children First Council—The Board is a mandated member of the Family Council. The Board’s major contributions to the work of the Council centers around the Service Coordination process or High-Fidelity Wraparound service coordinated by the FCFC.  The Board has a staff member assigned to this process,
10. The Ashtabula County Commissioners are integral partners of the MHRS Board. The Commissioners support the mental health and substance use disorder work of the MHRS Board and offer whatever assistance they can to ensure continued services to improve the lives of Ashtabula County residents.  Commissioner Whittington is also the Chair of One Ohio.  The Board Executive Director is also actively involved with the Commissioners’ Community Correction Board and other committees.
11. Ashtabula County Sheriff’s Department—Along with the other law enforcement initiatives the MHRS Board has partnered with the Sheriff’s Department and the County Jail to bring assessment and re-entry services into the jail, provide recovery supports for inmates, and ensure Naloxone is available for distribution to inmates upon release from the jail. The County Jail also has seven NaloxBoxes on the various floors and in select areas of the jail.
12. Ashtabula County MHRS Board Director attends the Ashtabula County Crime Clinic led by the Sheriff’s Department and attended by the Police Chiefs, EMA, Ohio State Patrol, County Prosecutor, and local Prison to share information, problem solve support for persons with behavioral health concerns, plan mutual training, and cross-organization planning.