If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by calling or texting 988.
When Pooja Mehta’s younger brother, Raj, died by suicide at 19 in March 2020, she felt “blindsided.”
His last text message was to his college lab partner about how to divide homework questions. “You don’t say you’re going to take questions 1 through 15 if you’re planning to be dead one hour later,” said Mehta, 29, a mental health and suicide prevention advocate in Arlington, Virginia. She had been trained in Mental Health First Aid – a nationwide program that teaches how to identify, understand and respond to signs of mental illness – yet she said her brother showed no signs of trouble.
Mehta said some people blamed her. The two were living together during the COVID-19 pandemic while he attended classes online. Some said her training should have helped her see he was struggling.
But, Mehta said, “we act like we know everything there is to know about suicide prevention. We’ve done a really good job at developing solutions for a part of the problem, but we really don’t know enough.”
Starting in 2001, federal officials have launched three national suicide prevention strategies. The first focused on addressing risk factors and leaned on a few common interventions. The next called for developing and implementing standardized protocols to identify and treat people at risk for suicide. The latest, announced in April, calls for the implementation of 200 measures over the next three years, including prioritizing populations disproportionately affected by suicide, such as Black youth and Native Americans and Alaska Natives.
Yet from 2001 through 2022, the most recent data available, suicide rates increased most years, according to the Centers for Disease Control and Prevention.
The barriers to suicide prevention
Despite those disappointing numbers, mental health experts contend the national strategies aren’t the problem. Instead, they argue, the policies – for many reasons – simply aren’t being funded, adopted and used.
A chorus of national experts and government officials said even basic tracking of deaths by suicide isn’t universal. And without accurate statistics, researchers can’t figure out who dies most often by suicide, what prevention strategies are working and where prevention money is needed most.
Many states and territories don’t allow medical records to be linked to death certificates, said Michael Schoenbaum, a senior adviser for mental health services, epidemiology and economics at the National Institute of Mental Health. NIMH is collaborating with other organizations to document this data for the first time in a public report and database due out by the end of the year.
Further hobbling the strategies is the fact that federal and local funding ebbs and flows. And some suicide prevention efforts don’t work in some areas because of geography, said Jane Pearson, special adviser on suicide research to the NIMH director.
Wyoming, where a few hundred thousand residents are spread across a sprawling, rugged landscape, consistently ranks among the states with the highest suicide rates. State officials have worked on the problem for years, said Kim Deti, a spokesperson for the Wyoming Department of Health. However, deploying services, like mobile crisis units – a core element of the latest national strategy – is difficult in a big, sparsely populated state.
“The work is not stopping, but some strategies that make sense in some geographic areas of the country may not make sense for a state with our characteristics,” she said.
Looking nationally, despite evidence that screening patients for suicidal thoughts during medical visits helps head off catastrophe, health professionals are not mandated to do so. Many doctors find suicide screening daunting because they have limited time and insufficient training and because they aren’t comfortable discussing suicide, said Janet Lee, an adolescent medicine specialist and associate professor of pediatrics at Temple University.
“I think it is really scary and kind of astounding to think if something is a matter of life and death how somebody can’t ask about it,” she said.
The use of other measures has also been inconsistent. Crisis intervention services are core to the national strategies, yet many states haven’t built standardized systems. Besides being fragmented, crisis systems can vary from state to state and county to county. Some mobile crisis units use telehealth. Some operate 24 hours a day versus others that are available only 9 to 5. Some use local law enforcement to respond instead of mental health workers.
The fledgling 988 Suicide & Crisis Lifeline faces similar, serious problems. Only 23% of Americans are familiar with 988, and there’s a significant knowledge gap about the situations people should call 988 for, according to a recent poll conducted by the National Alliance on Mental Illness and Ipsos.
Most states, territories and tribes have also not yet permanently funded 988, which was launched nationwide in July 2022 and has received about $1.5 billion in federal funding, according to the Substance Abuse and Mental Health Services Administration.
Anita Everett, director of SAMHSA’s Center for Mental Health Services, said her agency is running an awareness campaign to promote the system.
Some states are taking other steps. Colorado officials added financial incentives to implement suicide prevention efforts through the state’s Hospital Quality Incentive Payment Program. In the past year, 66 hospitals improved care for patients experiencing suicidality, said Lena Heilmann, director of the state’s office of suicide prevention.
Experts hope other states will follow Colorado’s lead.
Despite the slow movement, Mehta sees bright spots in the latest strategy and action plan.
Although it is too late to save her brother, “addressing the social drivers of mental health and suicide and investing in spaces for people to go to get help well before a crisis gives me hope,” Mehta said.
Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – an independent source of health policy research, polling and journalism.
