New KFF Analysis Shows Number of Suicide Deaths at Record Levels

From 2011 to 2022, over half a million lives (539,810) were lost to suicide, with 2022 showing the highest number of deaths on record. Within this period, the adjusted suicide rate increased by 16%. Recognizing the mounting mental health crisis and demand for accessible crisis care, the federal government introduced a new crisis number, 988available nationwide in July 2022. This easy to remember three-digit number connects callers who are suicidal or experiencing a mental health emergency to a crisis counselor at one of 200+ local crisis call centers. There, they may access crisis counseling, resources, referrals, and connections to other crisis services. Though suicide deaths slowed in 2019 and 2020, they began to increase again in 2021 and 2022, but the cause of this recent rise in suicides is unclear.

Key takeaways from an analysis of aggregate provisional data from 2022 and CDC WONDER data from 2011 to 2021, which represents the most recent and comprehensive data available before the mid-2022 launch of 988, include the following:

  • CDC’s provisional data for 2022 show a record high of 49,369 suicide deaths, coming after modest declines in 2019 and 2020.
  • In 2022, provisional data indicates the highest number of gun-related suicides on record; increases in firearm suicides are driving the increases in overall suicide deaths in recent years.
  • Suicide death rates in 2021 were highest among American Indian and Alaska Native people, males, and people who live in rural areas.
  • Suicide deaths are increasing fastest among people of color, younger people, and those who live in rural areas with many groups seeing increases of 30% or more from 2011 to 2021.
  • Suicide death rates varied considerably by state in 2021, as did the rate of change between 2011 and 2021.

Read the full report from KFF.

Input Needed for Crisis Intervention Systems for Youth with IDD

The National Association for the Dually Diagnosed has partnered with the National Association of State Mental Health Program Directors to conduct a study investigating services provided to teens and young adults who have intellectual/developmental disabilities and co-occurring mental health conditions (dual diagnosis).

The goal of this study is to identify best practices and improvements needed to ensure responsive, individualized and effective treatment and support for teens and youth with a dual diagnosis who are experiencing a crisis. NADD will utilize the information obtained from this study to identify strategies that build capacity within communities to better meet the needs of teens and youth who have intellectual/developmental disabilities and mental health conditions.

We are seeking volunteers to complete a short survey and participate in a follow-up phone or video interview.

Volunteer requirements:

  • Must be a behavioral health/mental health professional, parent/advocate, educator, emergency services personnel or first responder.
  • Must reside within the United States.
  • Must be 18 years of age or older.
  • Must work with or have provided services to teens and youth with intellectual//developmental disabilities.
  • Must be able to read and understand English.

Additional information:

Survey, phone interviews and video sessions will be completed through Monday, July 17, 2023.

Participation is voluntary and all responses will be kept confidential. You may exit the online survey or interview at any time. Before you participate, you will be asked to electronically sign an adult consent form. To protect your privacy, no names or any personally identifiable information will be collected outside of coordinating your phone interview or video session.

Please click here to take the survey.

Burnout Threatens Primary Care Workforce and Doctors’ Mental Health

CHARLESTON, S.C. — Melanie Gray Miller, a 30-year-old physician, wiped away tears as she described the isolation she felt after losing a beloved patient.

“It was at the end of a night shift, when it seems like bad things always happen,” said Miller, who is training to become a pediatrician.

The infant had been sick for months in the Medical University of South Carolina’s pediatric intensive care unit and the possibility that he might not improve was obvious, Miller recalled during an April meeting with physicians and hospital administrators. But the suddenness of his death still caught her off guard.

“I have family and friends that I talk to about things,” she said. “But no one truly understands.”

Doctors don’t typically take time to grieve at work. But during that recent meeting, Miller and her colleagues opened up about the insomnia, emotional exhaustion, trauma, and burnout they experienced from their time in the pediatric ICU.

“This is not a normal place,” Grant Goodrich, the hospital system’s director of ethics, said to the group, acknowledging an occupational hazard the industry often downplays. “Most people don’t see kids die.”

The recurring conversation, scheduled for early-career doctors coming off monthlong pediatric ICU rotations, is one way the hospital helps staffers cope with stress, according to Alyssa Rheingold, a licensed clinical psychologist who leads its resiliency program.

“Often the focus is to teach somebody how to do yoga and take a bath,” she said. “That’s not at all what well-being is about.”

Burnout in the health care industry is a widespread problem that long predates the covid-19 pandemic, though the chaos introduced by the coronavirus’s spread made things worse, physicians and psychologists said. Health systems across the country are trying to boost morale and keep clinicians from quitting or retiring early, but the stakes are higher than workforce shortages.

Rates of physician suicide, partly fueled by burnout, have been a concern for decades. And while burnout occurs across medical specialties, some studies have shown that primary care doctors, such as pediatricians and family physicians, may run a higher risk.

Read the full article from KFF.

Teen Health Crisis

Adolescent Mental Health & Wellbeing

A new CDC report points to record levels of violence, trauma, and mental health concerns for teenagers, with girls and LGBQ+ youth faring more poorly (the survey did not ask about transgender identity). The findings highlight how the pandemic made things worse for many kids.

  • Violence: Violence puts adolescent lives at risk and can lead to mental health problems, risky behavior, and reduced academic success. The CDC report contains data on violence among high schoolers, including sexual violence, feeling unsafe at school, bullying, and cyberbullying.
  • Technology: High use of social media is associated with mental health problems. Social media impacts how teens interact with one another during a developmentally important time in life. According to new research, limiting social media usage can make teens feel better about their body image.
  • Supporting Mental Health: Young people who identify as LGBTQ+ are less likely to feel depressed with parental support. Additionally, public schools and states are taking steps to expand access to mental health services.

Read more at NIHCM.

Suicide Among People with Disabilities

We may make assumptions about people with disabilities’ risk for suicide. A 2021 report published in the American Journal of Preventive Medicine found people with disabilities are more likely to think about, plan or attempt suicide than people without disabilities.

Please click the link below to learn more about:

  • Risk factors.
  • What you can do as a caregiver.
  • What to look for.
  • When to get help.

To see all other Care Provider Bulletins click here.

Suicide Among People with Disabilities

Medicare’s Mental Health Coverage: What’s Included, What’s Changed, and What Gaps Remain

How prevalent are mental health issues among Medicare beneficiaries?

About one in four Medicare beneficiaries live with mental illness — conditions such as depression, anxiety, schizophrenia, and bipolar disorder — but only 40 percent to 50 percent receive treatment.1 The prevalence of mental illness is about equal among beneficiaries enrolled in traditional Medicare (31%) and those in Medicare Advantage plans (28%), although variation in data sources and measurement make comparisons difficult.2

Mental illness is experienced most by those beneficiaries under age 65 who qualify for Medicare via disability, as well as by low-income beneficiaries dually eligible for Medicare and Medicaid.3 It is also more pervasive in beneficiaries from American Indian/Alaska Native and Hispanic communities relative to other racial and ethnic groups.4

Which mental health services does Medicare cover?

Medicare covers both outpatient and inpatient services as well as prescription drugs to treat mental illness.5 Traditional Medicare and Medicare Advantage plans generally follow the same coverage rules, and some also cover additional services, like grief counseling, or offer other tailored benefits through special needs plans catering to beneficiaries with mental illness.6

Inpatient services. Medicare Part A covers inpatient mental health services in both general hospitals and psychiatric hospitals, but the latter is limited to 190 total days per beneficiary across their lifetime. Traditional Medicare beneficiaries pay a deductible and coinsurance for each benefit period, which, for hospital services, begins on the day of admission and ends after a beneficiary has had no inpatient care for 60 consecutive days. Cost-sharing requirements vary across plans for Medicare Advantage enrollees.

Outpatient services. Medicare Part B covers outpatient mental health services delivered by psychiatrists or other physicians, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. The services covered include standard services like psychiatric evaluation, individual and group therapy, and medication management. After paying their annual deductible, traditional Medicare beneficiaries pay 20 percent of the Medicare-approved amount for covered services. As with inpatient services, cost-sharing requirements vary across Medicare Advantage plans.

Medication. For traditional Medicare beneficiaries, mental health medications are covered by Medicare Part D. Beneficiaries in a Medicare Advantage plan also may have a Part D prescription drug plan or another drug plan that follows Part D rules. All Medicare drug plans are required to cover antidepressant, anticonvulsant, and antipsychotic medications, as well as a wide range of other psychotropic medications like anti-anxiety drugs. Specific medications covered and out-of-pocket costs vary by drug plan.

Read the full article from the Commonwealth Fund.

Using New Federal Funding to Meet Children’s Behavioral Health Needs in School

Since the pandemic began, there has been an increase in suicide rates among young people, particularly Black adolescents. Rates of attention-deficit/hyperactivity disorder, anxiety, and depression have also continued to rise as the long-term impact of COVID-19 plays out. Seven of 10 public schools report that the number of students seeking mental health services has increased since 2020. With students back in the structured environment of school, educators are working overtime to meet their behavioral health needs. Fortunately, the federal government has responded with unprecedented levels of support and efforts are underway to help schools put these new or dramatically expanded resources to good use.

The American Rescue Plan Act’s (ARPA) Elementary and Secondary School Emergency Relief (ESSER) provides more than $122 billion to help pre-K through grade12 students recover from lost time in schools by supporting their mental health, as well as their social, emotional, and academic needs. Additionally, the Bipartisan Safer Communities Act of 2022 commits more than a billion dollars in the next five years to support schools in addressing youth behavioral health needs, including funding for school mental health workforce. The law also directs the Department of Health and Human Services (HHS) and the Department of Education (DOE) to create a technical assistance center that will help states and schools better use Medicaid dollars for school-based services. In July 2022, DOE and HHS issued a joint letter to governors encouraging partnerships at state and local levels and outlining resources to support youth with behavioral health needs.

Read the full article from the Commonwealth Fund.

New KFF/CNN Survey on Mental Health Finds Young Adults in Crisis

An overwhelmingly majority (90%) of Americans believe the nation is in the midst of a mental health crisis, and young adults appear to be suffering the most, a new KFF-CNN survey on mental health in America reveals.

A third (34%) of adults under age 30 rate their mental health as “only fair” or “poor,” compared to 19% of those ages 30 and older. Half (52%) say they “always” or “often” felt anxious over the past year (28% for older adults), and about a third say they always or often felt depressed (33%) or lonely (32%) in the past year, also significantly higher than for older adults (18% each among those ages 30 and older).

In addition, about a third (35%) of young adults say they have been unable to work or engage in other activities due to a mental health condition in the past year, a rate significantly higher than older adults.

Read the full article from KFF.

Medicaid’s Essential Role in Improving the Mental Health of America’s Most Vulnerable Youth

Since well before the COVID-19 pandemic began, the number of young people diagnosed with a mental health need has been increasing, particularly among ethnic minorities, low-income households, and those involved with the child welfare and juvenile justice systems. In response, there has been an increased focus over the past year on strengthening behavioral health services for children and adolescents. A recent report from the Surgeon General describes “a national emergency in child and adolescent mental health” and offers several recommendations, including expanding access to response teams and funding community-based care systems to connect families with evidence-based interventions in their homes, communities, and schools.

Prevention and screening are also essential to meet the needs of young people at risk of mental health challenges. Fortunately, in 2013, the Centers for Medicare and Medicaid Services (CMS) issued guidance outlining the need to provide mental health and substance use treatment to members under age 21, including behavioral health screening and preventive services. Medicaid, which covers approximately 27 million young people, addresses this priority by offering the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which requires states to provide medically necessary services to people under 21 who may be experiencing a mental health need. EPSDT is more comprehensive than commercial insurance benefits, ensuring access to physical and mental health care that promote healthy development and to treatment that addresses symptoms before they worsen. This is a powerful tool; Medicaid-eligible youth are entitled to EPSDT benefits regardless of whether the service is covered in their state’s Medicaid program.

The recent launch of the national 988 suicide and crisis hotline has spotlighted efforts to ensure the availability of behavioral health mobile crisis teams. But preventive services and behavioral health screening can prevent youth from requiring an intervention in the first place. The Center for Medicaid and CHIP Services estimates that 11 percent of youth have a mental health diagnosis, and that at least two-thirds of those youth were not identified as receiving any mental health service. Attending to the wellness of caregivers is also part of ensuring healthy children and strong attachment with caregivers. In 2016, CMS issued guidance allowing for maternal depression screens as part of the EPSDT benefit. A 2018 survey found 31 states and Washington, D.C., allow maternal depression screening to be billed under the child’s Medicaid.

Read the full article from the Commonwealth Fund.

988 Suicide and Crisis Lifeline Launches

988 is the new, nationwide, three-digit dialing code for the Suicide and Crisis Lifeline. The 988 dialing code connects people via call, text, or chat, to the existing National Suicide Prevention Lifeline (NSPL) where compassionate, accessible care and support are available for anyone experiencing mental health-related distress. 988 is the newest addition to the state’s network of crisis center providers and will not replace any crisis call centers in Washington. The current NSPL number, 1-800-273-TALK (8255), will remain active along with the new 988 dialing code.

“Thanks to the many partner organizations and agencies who have made this resource possible,” said Governor Jay Inslee. “In the same way 911 transformed our ability to respond to emergency safety or health situations, 988 will transform our ability to connect people to help in behavioral and mental health crisis situations.”

“Providing an easy-to-remember, three-digit number is an important step to accessing potentially life-saving support,” said Umair A. Shah, MD, MPH, Secretary of Health. “We are dedicated to enhancing and expanding behavioral health crisis response and suicide prevention services for all Washingtonians.”

In addition to activating a new dialing code for anyone experiencing suicidal or mental health-related crisis to call, the 988 Suicide and Crisis Lifeline also allows text messaging as part of increasing access to services for youth and individuals with different abilities. People can also dial or text 988 if they are worried about a loved one who may need crisis support. 988 will be available 24/7 and is free and confidential.

Call services will be available in Spanish, along with interpretation services in over 250 languages. Spanish speakers may reach the Spanish Language Line by pressing 2 after dialing 9-8-8 or 1-800-273-TALK (8255). Text and chat services are available in English only.

Veterans and service members may reach the Veterans Crisis Line by pressing 1 after dialing 9-8-8 or 1-800-273-TALK (8255). Soon, Washington will also be able to launch a Native and Strong Lifeline, dedicated to serving Washington’s American Indian and Alaska Native individuals.

People who are deaf, hard of hearing, and TTY users should use your preferred relay service or dial 711 then 1-800-273-8255.