Nat’l Suicide Prevention Efforts Yet to Curb Rising Deaths

When Pooja Mehta’s younger brother, Raj, took his own life at the age of 19 in March 2020, she felt completely unprepared and blindsided. Raj’s last communication was a routine text message to his college lab partner about dividing homework tasks. “You don’t say you’re going to take questions 1 through 15 if you’re planning to be dead an hour later,” said Mehta, 29, who is a mental health and suicide prevention advocate based in Arlington, Virginia. Despite her training in Mental Health First Aid, which equips individuals to identify and respond to mental health issues, she noticed no signs of distress in her brother.

In the aftermath of Raj’s death, some people blamed Mehta, given that they were living together during the COVID-19 pandemic while he attended classes online. Others argued that her training should have enabled her to recognize his struggles. However, Mehta reflects on the broader issue: “We act as though we have a complete understanding of suicide prevention. We’ve developed effective solutions for some aspects, but our knowledge remains insufficient.”

Raj’s death occurred against the backdrop of decades of national attempts to reduce suicide rates. Over the past twenty years, federal officials have introduced three national suicide prevention strategies, with the latest one announced in April.

The first strategy, launched in 2001, aimed to address suicide risk factors and employed several common interventions. The second strategy focused on creating and enforcing standardized protocols for identifying and treating individuals at risk, ensuring follow-up care and support. The most recent strategy builds on its predecessors, including a federal action plan with 200 measures to be implemented over the next three years. This strategy emphasizes prioritizing populations disproportionately affected by suicide, such as Black youth and Native Americans.

Despite these evolving strategies, suicide rates have generally increased from 2001 to 2021, according to the Centers for Disease Control and Prevention (CDC). Provisional data for 2022 indicates a 3% rise in suicide deaths from the previous year, with final numbers expected to be even higher. Rural states like Alaska, Montana, North Dakota, and Wyoming have experienced suicide rates approximately double those of urban areas.

Experts argue that the issue is not with the national strategies themselves but with their implementation. Many policies have not been adequately funded or adopted, and the COVID-19 pandemic exacerbated mental health issues, slowing the uptake of these strategies. Even basic tracking of suicide deaths is inconsistent.

Michael Schoenbaum, a senior adviser at the National Institute of Mental Health (NIMH), notes that surveillance data, which is crucial for improving healthcare quality in areas like cancer and heart disease, has not been effectively applied to behavioral health issues such as suicide. Accurate data is essential for understanding suicide patterns, evaluating prevention strategies, and allocating resources effectively.

States and territories often lack the capability to link medical records with death certificates, although NIMH is working with other organizations to address this gap in a forthcoming public report and database. Additionally, inconsistent funding and the challenging geography of states like Wyoming complicate the implementation of suicide prevention efforts.

In Wyoming, where residents are spread across a vast and rugged landscape, deploying mobile crisis units, a key component of the latest strategy, is particularly challenging. “The work is ongoing, but some strategies that work in certain areas may not be effective in a state with our unique characteristics,” said Kim Deti of the Wyoming Department of Health.

Moreover, despite evidence that screening for suicidal thoughts during medical visits can prevent crises, health professionals are not mandated to conduct such screenings. Many doctors find this task daunting due to limited time, inadequate training, and discomfort discussing suicide.

Crisis intervention services, such as mobile crisis units, vary widely in their implementation across states and counties. Some use telehealth, operate 24/7, or collaborate with local law enforcement rather than mental health professionals. The newly established 988 Suicide & Crisis Lifeline faces similar issues, with only 23% of Americans aware of the service and many states yet to permanently fund it.

In response, some states like Colorado have introduced financial incentives to improve suicide prevention efforts. The state’s Hospital Quality Incentive Payment Program rewards hospitals for enhancing care for patients experiencing suicidality. In the past year, 66 hospitals in Colorado improved their services in this area, according to Lena Heilmann of the Colorado Department of Public Health and Environment.

Despite these challenges, Mehta remains hopeful. “Although it’s too late to save Raj, addressing the social drivers of mental health and investing in support systems before a crisis gives me hope,” she said.