As the rates of suicide and drug overdose hit record highs, governments respond with more mental health programs

THE SUICIDE RATE IN THE UNITED STATES increased 43.2% between 2000 and 2022, with the CDC recording 49,449 in 2022.

The suicide rate for men is four times higher than for women, and is highest among American Indians and Alaska Natives, followed by non-Hispanic Whites. Between 2011 and 2021, the suicide rate for adolescents increased by 48% and 39% for young adults.

Drug overdoses

Another grim statistic: More than 1 million people have died of drug overdoses since 1999, with 106,699 in 2021. Approximately 75% of the drug overdoses involved opioids, particularly synthetic opioids, such as Fentanyl.

There is overlap between suicides and drug overdoses. Between 5 and 7% of overdose deaths were recorded as intentional. The actual numbers may be higher.

The increase in suicides and drug overdoses has been accompanied by a surge in mental health services and spending on those services. A study in JAMA Health Forum compared mental health visits between March 2020 and August 2022 for claims paid by self-insured employers. The time period spanned from before the declaration of a public health emergency through the post-acute phase of the emergency. During that time period, the number of visits increased by 39%, and spending increased by 54%. Most of the increased visits were for depression and anxiety.

Use of telehealth visits increased approximately tenfold during the pandemic and has remained high in the post-acute phase, according to the JAMA Health Forum study.

988 Lifeline

In July 2022, the federal government launched the “988 Suicide & Crisis Lifeline,” a three-digit service available to connect callers with crisis centers. (An earlier version of the program was known as the “National Suicide Prevention Lifeline.”)

In the first year of the program, 988 received nearly 5 million contacts. One million of the calls were made to the related service of the “Veteran’s Crisis Line.” The 5 million figure includes 600,000 texts and 740,000 chats in addition to regular calls. The data was reported by the Kaiser Family Foundation from information obtained from the federal Substance Abuse and Mental Health Services Administration

In 2023, the Lifeline added Spanish chat and text services and specialized services for LGBTQI youth and young adults.

During the first year, the average wait time nationwide for a response improved from 2 minutes and 20 seconds to 35 seconds. If a local center cannot answer a call, the call is directed to an out-of-state center.

Initial funding of approximately $1 billion for the program came from the federal government. State governments are expected to handle funding on a long-term basis. Several states are doing that by imposing telecom fees. Most fees for individual customers are less than 50 cents per month.

Mental Health Parity Act

In 2008, Congress enacted the Mental Health Parity and Addiction Equity Act. The act was designed to prohibit private health insurance companies from imposing requirements on mental health or substance use disorder benefits that are more restrictive than those imposed on medical and surgical benefits.

Nonetheless, the department found that “people seeking coverage for mental health and substance use disorder care continue to face greater barriers when seeking benefits for that than when seeking medical or surgical benefits.”

In 2023, the U.S. Department of Health & Human Services and other federal departments issued proposed rules to remedy the situation. Health plans will be required to “conduct meaningful comparative analyses” of multiple aspects of care, including prior authorization requirements, the rates at which authorizations are denied, availability of providers and payment rates.

For example, if a plan does not require prior authorization for most for in-patient medical/surgical benefits, the plan will not be able to require prior authorization for most in-patient mental health and substance abuse benefits.

Support from AMA and AHA

The American Medical Association and the American Hospital Association support the new regulations.

The AHA’s group vice president of public policy, Molly Smith, said, “By providing clear guidance on how health plans may and may not apply administrative restrictions to behavioral health services, patients are more likely to get the care to which they are entitled under the law, and providers can spend less time on burdensome and unnecessary insurance barriers and more time on patient care.” •