Long-term implementation of nationwide suicide prevention strategies hasn't notably reduced the fatalities.
Help is accessible if you or someone you're familiar with is wrestling with suicidal ideas or mental health concerns. In the USA: Dial or text 988, the Suicide & Crisis Hotline. Globally: The International Association for Suicide Prevention and Befrienders Worldwide offer contact details for crisis centers around the world.
Raj's final text message was to his college lab mate about splitting homework tasks.
“You ain't saying you're gonna take questions 1 through 15 if you're planning on offing yourself an hour later,” said Mehta, 29, a mental health and suicide prevention activist from Arlington, Virginia. She held certifications in Mental Health First Aid — a nationwide program that teaches how to spot, comprehend, and react to signs of psychological disorders — yet she mentioned her brother showed no warning signs.
Mehta elaborated that people regularly pointed fingers at her for Raj's demise given they were cohabiting during the COVID-19 pandemic while Raj was attending classes online. Others criticized her for not recognizing his plight with her skills.
But, Mehta asserted, “we act like we're experts on everything suicide prevention has to offer. We've put together some damn good solutions for part of the problem, but we're clueless about the rest.”
Raj's passing came during many years of fruitless attempts to reduce suicide rates nationwide.
During the past two decades, federal authorities unveiled three national suicide prevention plans, including one announced in April.
The first strategy, debuted in 2001, centered on tackling risk factors for suicide and leaned on traditional interventions.
The subsequent strategy suggested establishing and implementing uniform protocols for identifying and addressing individuals at risk for suicide with post-care support and treatment continuity.
The most recent strategy builds upon its predecessors and includes a federal action plan advocating for the execution of 200 actions over the subsequent three years, like prioritizing populations disproportionately affected by suicide, such as Black youth and Native Americans and Alaska Natives.
Despite these evolving plans, suicide rates increased in most years from 2001 to 2021, according to the CDC. Preliminary data for 2022, the most current statistics available, reveals deaths by suicide increased an additional 3% compared to the previous year. CDC experts predict the final number of suicides in 2022 will surpass this year's rate.
Suicide rates in rural states, such as Alaska, Montana, North Dakota, and Wyoming, have generally been twice those in urban areas, according to the CDC.
In spite of these consistently disheartening numbers, mental health professionals insist the national strategies aren’t the issue. Instead, they argue, funding, adoption, and implementation of these policies have been slow. This sluggishness was exacerbated by the COVID-19 pandemic, which negatively impacted mental health across society.
A consensus of national experts and government officials agrees the strategies have not gained widespread acceptance, yet they contend even essential tracking of suicide deaths isn’t universal.
Surveillance data is vital for driving healthcare quality improvement and has proved helpful in addressing cancer and heart disease. However, it hasn't been utilized in the study of behavioral health issues like suicide, argued Michael Schoenbaum, a senior mental health services consultant at the National Institute of Mental Health.
“We view handling behavioral health problems differently than physical health problems,” Schoenbaum said.
Without reliable statistics, researchers can't uncover patterns in who dies by suicide most frequently, examine which prevention strategies are effective, and determine where prevention resources are most needed.
Many states and territories prohibit connecting medical records to death certificates, Schoenbaum explained. However, the National Institute of Mental Health is working with a few other organizations to document this information for the first time in a public report and database scheduled for release by year's end.
Additionally, the inconsistent implementation of strategies is challenging, as federal and local funding fluctuates, and not all suicide prevention tactics work in every state or municipality due to challenging geographical conditions.
Wyoming, where a few hundred thousand residents are scattered across a vast, rugged landscape, consistently records some of the nation's highest suicide rates.
State officials have endeavored to address the state's suicide problem for many years, said Kim Deti, a spokesperson for the Wyoming Department of Health.
However, deploying services, like mobile crisis teams, a central element of the latest national strategy, is challenging in a large, sparsely populated state.
“We're not quitting the fight, but strategies that make sense in some geographical areas might not work in states like ours,” she said.
Lack of implementation isn't exclusively a state and local government concern. Despite evidence suggesting that screening patients for suicidal tendencies during medical appointments helps avert disaster, healthcare providers are not obligated to do so.
Many physicians find suicide screening daunting due to time constraints and insufficient training, and because they're uncomfortable discussing suicide, said Janet Lee, an adolescent medicine specialist and associate professor of pediatrics at the Lewis Katz School of Medicine at Temple University.
“It's absolutely terrifying and astounding to think if something is a matter of life and death, why wouldn't somebody probe about it?” she said.
The use of other measures has also been inconsistent. Crisis intervention services are crucial to the national strategies, yet many states haven't developed standardized systems.
Emanating fragmentation, crisis management systems like mobile crisis units differ from location to location, be it state or county. Some of these units employ telehealth, others operate round the clock, while others function from 9 to 5, and some even rely on local law enforcement for responses instead of mental health professionals.
Similarly, the emerging 988 Suicide & Crisis Lifeline encounters comparable, substantial hurdles.
Only 23% of Americans have knowledge of 988, and there's a substantial misunderstanding about the scenarios necessitating a 988 call, as revealed by a recent survey conducted by the National Alliance on Mental Illness and Ipsos.
The majority of states, territories, and tribal regions have not yet secured long-term funding for 988, which was made nationwide accessible in July 2022, receiving approximately $1.5 billion in federal aid, according to the Substance Abuse and Mental Health Services Administration.
Anita Everett, director of the Center for Mental Health Services within SAMHSA, is spearheading an awareness campaign to endorse the system.
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In some states, such as Colorado, innovative measures are being implemented. The state government has introduced financial incentives for undertaking suicide prevention initiatives and other patient safety protocols through the state’s Hospital Quality Incentive Payment Program. Annually, this program grants around $150 million to hospitals for distinguished performance. In the past year, 66 hospitals have positively transformed their care for patients grappling with suicidal thoughts, as per Lena Heilmann, director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment.
Experts anticipate additional states will emulate Colorado's approach.
Regardless of the slow progress, Mehta sees potential positive developments in the latest strategy and plan.
Although it's too late to rescue Raj, "addressing the social determinants of mental health and suicide, and investing in venues for people to seek help well prior to a crisis, gives me hope," Mehta said.
This article was compiled by KFF Health News, a national newsroom producing comprehensive journalism on health issues, and one of the primary functions at KFF , an independent source for health policy research, surveys, and journalism. Cheryl Platzman Weinstock’s reporting is backed by a grant from the National Institute for Health Care Management Foundation.*
Despite Mehta's certifications in Mental Health First Aid, her brother showed no warning signs of mental health concerns before his suicide. Implementing uniform protocols for identifying and addressing individuals at risk for suicide could potentially reduce suicide rates, according to the second national suicide prevention strategy.
