FY 2024 Behavioral Health Service Expansion - Grace Health seeks to expand mental health and substance use disorder services, including MOUD in Bell, Clay, Knox, Leslie Counties in Kentucky. Located in the Appalachian area of the U.S., our rural service area is located in rural southeastern Kentucky, near Virginia to the east and bordering Tennessee to the south. The total population in the service area is 182,744, with 53.5% of the working-age population (adults 20-64 years) earning incomes below 200% Federal Poverty Level. Mental health diagnoses for serious problems independent from substance abuse are also proportionately higher in Appalachia than the rest of the nation, with serious psychological stress and major depressive episodes almost common in central Appalachia. Residents from the service area report an average of 4.69 poor mental health days, compared to a state rate of 4.8 days and a national benchmark of 3.1 poor mental health days within the last month. The lack of qualified providers combined with a cultural reluctance to seek mental health treatment results in a high mortality rate due to suicide and poisoning due to overdose. As the data suggests, many individuals in need of treatment do not receive mental health intervention, which may account for an age adjusted suicide rate average of 17.2 per 100,000 for the service area, in comparison to the national annual suicide rate average of 14.0 per 100,000. For those Kentucky residents between 15 and 35 years of age, suicide is the second leading cause of death in Kentucky. Death by suicide is second only to unintentional injury for those Kentucky residents between 15 and 34 years of age. The most recently report results of the Kentucky Incentives for Prevention (KIP) survey from 2021, conducted by the state’s regional prevention centers, show that the increase in the rates of suicide attempt in the past year for 10th-graders who have vaped in the past 30 days is striking, at 23.9% compared to all 10th-graders at 8.1%. The data are even more alarming for students who used cannabis (28.6%) and those who reported using both (30.6%). In addition, research shows that children whose parents have a substance use disorder are eight times more likely to develop an SUD as a result of the modeling of drug use, increased access to drugs, and neglect/abuse that so often occurs in families impacted by SUD. Substance use is also a factor in well-being of adolescents in the proposed area. The service area has a high rate of binge drinking at 19% compared to 14% across the state of Kentucky. The Kentucky Office of Drug Control Policy shows that 2,250 people died from a drug overdose in 2021, a nearly 15% increase from 2020. In the first year of the pandemic, the United States experienced the highest-ever combined rates of deaths due to alcohol, drugs, and suicide. According to a report released by Trust for America's Health and Well Being Trust, Kentucky's rate was second in the nation. Kentucky's combined deaths of despair increased by 36% between 2019 and 2020, second only to West Virginia, which had a 37% increase. In 2020, the latest Pain in the Nation: The Epidemics of Alcohol, Drug, and Suicide Deaths report shows Kentucky had 3,680 combined deaths from alcohol, drug, and suicide, an age-adjusted rate of 82.8 deaths per 100,000 people. Of those, 738 were alcohol-induced (37%), 2,187 were drug-induced (47%), and 801 were by suicide (7%). Grace Health will utilize behavioral health expansion funds to purchase a mobile unit and to add 7.7 FTE needed behavioral health providers and support staff to increase access to 520 mental health patients, 50 new SUD patients an 45 new MOUD patients by December 31, 2025.