Issue Category: Substance Misuse and Mental Health

Pain in the Nation 2023: The Epidemics of Alcohol, Drug, and Suicide Deaths

Trust for America’s Health (TFAH)  will host a Congressional briefing, national webinar on our recently released report, Pain in the Nation 2023: The Epidemics of Alcohol, Drug, and Suicide Deaths.

TFAH’s Pain in the Nation 2023 report found that the death rate due to alcohol, drugs, and suicide increased by 11 percent in 2021. Deaths due to substance misuse and suicide have been rising in the U.S. for over two decades, with numbers doubling from 104,379 deaths in 2011 to 209,225 in 2021. The increase in 2021 death rates occurred among all ages, races, and geographic groups, but TFAH’s report found that increases were particularly high for youth suicides and drug overdoses among certain populations of color and in rural regions of the country.

 

Resources:

Trust for America’s Health

Crisis Text Line

Centuries of Systemic Racism Has Created Distinct Mental Health Challenges for Minority Communities

In 2008, July officially became National Minority Mental Health Awareness Month, originally designated as Bebe Moore Campbell National Minority Mental Health Awareness Month by the United States House of Representatives. Until her passing in 2006, Bebe Moore Campbell was an author, advocate, co-founder of the National Alliance on Mental Illness (NAMI) Urban Los Angeles, and a national spokesperson, dedicating herself tirelessly to promoting mental health education and eradicating stigma within diverse communities. National Minority Mental Health Awareness Month is observed to recognize the distinct hardships that members of minority communities often face concerning their mental health.

According to the U.S. Department of Health and Human Services Office of Minority Health, in 2021, “only 39 percent of Black or African American adults, 25 percent of Asian adults, and 36 percent of Hispanic/Latino adults with any mental illness were treated, compared to 52 percent of non-Hispanic white adults.” The 2023 Pain in the Nation Report by Trust for America’s Health (TFAH), also found an increase in suicide mortality “by 4 percent between 2020 and 2021 with the highest increases among American Indian/Alaska Native and Black people.” In addition, TFAH’s report also explained that youth who were American Indian/Alaska Native, Black, Latino, and multiracial had the “highest rates of poor mental health behavior and/or suicidal behaviors compared to other groups in 2021.”

Minority communities experience these disparities in mental health outcomes and care due to factors that are beyond their control. Among other social determinants of health (SDOH), discrimination and economic insecurity contribute to the disparities in access and treatment that members of minority communities can encounter.

Cultural and social stigma around mental health issues among minority communities also contributes to poor mental health outcomes in these populations and can act as barriers to necessary mental healthcare. Systemic racism and discrimination present in the healthcare field and among healthcare professionals also prevent individuals of various racial and ethnic groups from receiving the best mental health treatment available. Negative experiences due to these factors can undermine trust in healthcare professionals and result in patients feeling ignored despite serious mental health issues, which can deter patients from seeking or staying in treatment. Lack of trust can also arise from difficulties patients experience in finding providers from the same ethnic or racial group who share similarities in culture, literacy, and language.

Minority individuals are also more likely to be uninsured, raising financial barriers to seeking and receiving mental healthcare. According to the Kaiser Family Foundation, for example, “Nonelderly American Indian and Alaska Native (AIAN) and Hispanic people had the highest uninsured rates at 21.2% and 19.0%, respectively as of 2021.”

Policy recommendations to address these disparities and barriers can range from prevention efforts, increases in funding, and systemic improvements to the healthcare system. Policy recommendations by TFAH to advance health equity include enacting and funding the Health Equity and Accountability Act, as well as increasing funding for the Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health (REACH) program and its Healthy Tribes program to provide support for all approved applicants. As mentioned in TFAH’s Pain in the Nation Report, TFAH also recommends that Congress support policies and programs that address SDOH to better implement interventions at both an individual and community level; this should include increased CDC funding and a greater emphasis on the importance of screening for SDOH in the healthcare system. Continuous efforts to reduce stigma and bring positive messaging will also encourage individuals in minority communities to seek mental health screening and care. Efforts to ensure accessible mental healthcare, including through enforcement of the Mental Health Parity and Addiction Equity Act and passage of the Effective Suicide Screening and Assessment in the Emergency Department Act, should also be prioritized.

Mental health is a critical public health issue. It is important to understand and recognize the mental health disparities and unique struggles faced by racial and ethnic groups to better help these populations overcome mental health barriers. Acknowledging that minority communities continue to face disproportionate mental health challenges–and responding accordingly on the federal level–can increase awareness of this public health issue and help ensure individuals in minority communities achieve optimal health.

 

 

At One Year Mark Data Show 988 Suicide and Crisis Lifeline Has Improved Crisis Care Access and Response, and that Sustained and Increased Funding is Needed

This month marks the one-year anniversary of the 988 Suicide and Crisis Lifeline, which replaced the previous National Suicide Prevention Lifeline with a single three-digit number for mental health, substance misuse, and crisis services. With oversight and funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and assistance from partners like Crisis Text Line and The Trevor Project, 988 consists of independently operated and funded call and text/chat centers across the country. When individuals in crisis contact 988, trained crisis counselors at these centers listen, provide support, and share resources if necessary. Access to 988 can play a critical role in improving depressed, suicidal, or overwhelming feelings—in fact, SAMHSA estimates that 98% of individuals contacting 988 receive the crisis support they need in the moment. SAMHSA has also identified the current 988 system as a first step toward evolving crisis care to include mobile crisis units, which provide in-person responses, and stabilization centers, which provide a safe place to stay for individuals in crisis.

Even its current form, however, 988 represents a momentous advancement in the effort to connect more Americans with crisis services. In May 2023, for example, 988 answered 45% more calls, 52% more chats, and 938% texts compared to the previous lifeline in May 2022. In total, 988 answered nearly 160,000 more contacts in May 2023 compared to May 2022, and the average time to answer these contacts decreased from 140 seconds to 35 seconds. 988 has also launched specialized services for the LGBTQ+ population, and SAMHSA just announced the addition Spanish language text and chat services. Other specialized services will likely follow for hearing impaired individuals and American Indian/Alaska Native people.

 

In 2022, Congress supplemented the establishment of 988 with several pieces of legislation containing significant investments and policies to advance behavioral health. The Bipartisan Safer Communities Act (BSCA), passed in June 2022, for example, provided onetime support for 988 and increased support for the National Child Traumatic Stress Network. The BSCA also provided funding for Project AWARE at SAMHSA, which empowers education agencies through training for school personnel, increases awareness and detection of mental health issues, and connects youth and families to needed services. In addition, Congress directed the Centers for Medicare and Medicaid Services to assist schools with expanding school-based health services through Medicaid and funded initiatives at the U.S. Department of Education to hire and retain mental health professionals providing these services.

 

In the Consolidated Appropriations Act (CAA), enacted in December 2022, Congress built on these accomplishments by reauthorizing the Garrett Lee Smith Suicide Prevention Program, which funds mental health programs for college-age students, as well as several programs to improve the behavioral health workforce. The CAA also bolstered crisis-intervention programs by directing guidance and funding to providers and improving payment for their services.

 

The U.S. Department of Health and Human Services (HHS) also acted throughout 2022 to expand access to community-based mental health services. In partnership with the Department of Education, for example, HHS has worked to facilitate the use of Medicaid and Children’s Health Insurance Program funds to support school-based behavioral health services. SAMHSA also launched the Mental Health Crisis Response Partnership Pilot Program to improve access to mobile crisis services in high-need areas.

988 is part of a series of investments to address Americans’ mental health needs

Despite this progress, significant challenges remain in the effort to strengthen 988 and connect individuals in crisis to behavioral health services. For example, although state governments carry the responsibility for funding and operating 988 call centers, only a handful of states have passed legislation to secure long-term financial support for the lifeline through telecommunications fees. A recent study, moreover, found that only around half of states have earmarked sufficient funding to meet increased 988 center costs. Due in part to insufficient funding, call centers can also struggle to hire and retain qualified staff and answer rates can vary significantly by state. Improved data collection and analysis concerning 988 services is also necessary to help identify gaps in crisis care and improve lifeline implementation.

On the federal level, ongoing negotiations in Congress could result in cuts to appropriations for 988, which is an alarming prospect given that SAMHSA estimates outreach to the lifeline will increase by up to 50%—to a total of around 9 million contacts—in FY 2024. States will also require additional federal support to develop and implement mobile responses and stabilization units and publicize the full range of 988 services. A recent survey by the Pew Charitable Trusts, for example, found that only 13% of U.S. adults knew about the existence and purpose of 988; awareness was higher among white adults and individuals with a college education compared to Black adults and individuals with a high school degree or less.

Trust for America’s Health (TFAH) will continue to advocate for additional funding and resources to bolster the 988 lifeline and transform the behavioral health crisis system more broadly. Continued bipartisan support is necessary not only to ensure access to existing services, but also to build the next generation of care to meet the growing demand from Americans in crisis.

Recommendations for addressing Americans’ mental health needs and other issues are available in TFAH’s 2023 Pain in the Nation report.

 

 

 

U.S. Death Rate Due to Alcohol, Drugs, and Suicide Increased by 11 Percent in 2021

Increases occurred among all ages, races, and geographic groups, but were particularly high for youth suicides and overdoses among certain populations of color

(Washington, DC – May 24, 2023) – The rate of U.S. deaths due to alcohol, drugs, and suicide climbed 11 percent in 2021, according to Pain in the Nation 2023: The Epidemics of Alcohol, Drug, and Suicide Deaths, a new report released today by Trust for America’s Health (TFAH).

While an all-time record, 209,225 Americans lost their lives due to alcohol, drugs or suicide last year these deaths are part of a two-decade trend of sharply increasing fatalities due to substance misuse and suicide in the U.S. The 2021 data showed such deaths were up across the U.S. population, with the largest increases occurring among certain populations of color as well as people living in the South, West, and rural regions of the country.

  • Drug overdose deaths increased by 14 percent between 2020 and 2021, with larger increases among Native Hawaiians and Pacific Islanders, American Indian/Alaska Native people, and among youth and older adults. For the year, drug overdose rates were highest among adults ages 35 to 54, males, Black people, and young adults ages 18 to 34.
  • Alcohol-induced deaths increased by 10 percent between 2020 and 2021, with the highest increases among Native Hawaiians and Pacific Islanders, Latino people, and American Indian/Alaska Native people.
  • Suicide mortality increased by 4 percent between 2020 and 2021, with the highest increases among American Indian/Alaska Native people and Black people.

While the 2021 trends were not good news, they were an improvement over the 2020 data. For 2020, the number of alcohol, drug, and suicide deaths was up 20 percent as compared with 2019.

“The data continue to show alarming increases in deaths due to substance misuse and suicide,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “What is needed is urgent and sustained investment in policies and programs that prevent the root causes of substance misuse and suicidality. We need to prevent adverse childhood experiences and trauma and support mental health services in schools, within healthcare settings, and in community settings for all populations.”

Two Decades Overview
Deaths due to alcohol, drugs, and suicide have been on the rise for over two decades, doubling over the period from 104,379 deaths in 2011 to 209,225 in 2021.  Between 2016 and 2021, the escalation in the rate of drug overdose deaths was more than 60 percent. These increases disproportionately impacted Black and Latino populations.

Most of the upturn in deaths due to drug overdose involved opioid overdose, with additional deaths due to cocaine and psychostimulants. In addition, a new and growing threat is xylazine, a tranquilizer approved for veterinary use but mixed with fentanyl to create a highly toxic illicit drug combination.

During the last two decades alcohol and suicide deaths have also increased, but not as sharply as drug deaths.

Youth Suicide Risk
Over the last decade, alcohol, drug, and suicide deaths among youth ages 10 to 17 increased by 65 percent. While youth have a much lower suicide rate than the general population, the upward trend of youth suicide, beginning well before the COVID-19 pandemic—a 71 percent increase tween 2010 and 2021—is tragic and warrants immediate attention. Unlike for other age groups, an increase in suicide deaths among young people was the primary driver for the age group’s increased overall mortality.

American Indian/Alaska Native and LGBTQ youth are most at risk for poor mental health and suicidal behaviors.

Veteran Suicide Risk
Veteran suicide risk also needs immediate attention.  The suicide mortality rate for veterans was 32 deaths per 100,000 veterans in 2020, a much higher rate than the general population.

Evidence-based Programs Can Help Reverse Deaths of Despair Trends

In response to the growing deaths of despair crisis, a multifaceted approach to improving mental health and well-being in every community is needed. The report includes recommendations for steps federal, state, and local government and other stakeholders should take to address substance misuse and suicide deaths. The recommendations include:

  • Invest in prevention programs and conditions that promote health including programs that prevent or reduce adverse childhood experiences and provide trauma-informed services, student mental health services in schools, and strengthened crisis intervention programs, including the 988 crisis lifeline.
  • Prevent substance misuse and overdose by supporting syringe service programs, increasing naloxone and fentanyl test strips availability, and expanding funding for the Drug-Free Communities Support Program to bolster prevention programs for youth specifically.
  • Transform the mental health and substance use prevention system by increasing access to mental health and substance use healthcare through full enforcement of the Mental Health Parity and Addiction Equity Act, integrating mental health and substance use treatment with other healthcare services, and expanding culturally and linguistically appropriate care for populations of color and other underserved populations.

Read the full report

 

Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. 

 

 

 

 

 

 

 

 

 

 

 

 

COVID-19 and Drug Overdose Deaths Drive U.S. Life Expectancy Down

(Washington, DC – January 17, 2023) — Data released by the Centers for Disease Control and Prevention in December 2022 showed that U.S. life expectancy decreased from 77 years in 2020 to 76.4 years in 2021, the second consecutive year that U.S. life expectancy decreased. The last time the U.S. experienced a two-year decrease in life expectancy was during World War II.

Age-specific death rates from 2020 to 2021 increased for all age groups other than infants less than one year old. American Indian and Alaska Native females experienced the largest increase in death rates, jumping 7.3 percent in 2021. Lower life expectancy for some populations groups, disproportionately among people of color, have been attributed to the structural inequities and barriers to optimal health that those communities experience.

Heart disease remained the leading cause of death in the U.S. during 2021 followed by cancer and COVID-19. In addition, drug overdose accounted for over a third of all unintentional deaths. During 2021, 106,699 people died in the U.S. due to a drug overdose, a 14 percent increase in the overdose death rate over 2020.

“These data underscore the importance of TFAH’s work to advance public health, prevention, and health equity,” said TFAH President and CEO J. Nadine Gracia, MD, MSCE. “The COVID-19 pandemic has highlighted the impact of social and economic conditions on people’s health and a community’s ability to be resilient during an emergency. TFAH will remain steadfast in advocating for policies that promote optimal health and well-being for every person and community. Among our priorities are supporting policies and programs that will strengthen the nation’s public health workforce and data systems; investment in substance misuse and suicide prevention including school-based mental health services and primary prevention programs; increased investments in chronic disease prevention programs including obesity prevention; and addressing the social determinants of health.”

Learn more about the causes of declining U.S. life expectancy in this TFAH issue brief: U.S. Experienced Steepest Two-year Decline in Life Expectancy in a Century – TFAH

For more on TFAH’s recommendations to improve the nation’s emergency preparedness: Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism – TFAH

For more on TFAH’s recommendations on needed investments in the nation’s public health system: The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022 – TFAH

For more on TFAH’s recommendations on addressing the nation’s drug, alcohol and suicide crisis: Pain in the Nation 2022: U.S. Experienced Highest Ever Combined Rates of Deaths Due to Alcohol, Drugs, and Suicide During the First Year of the COVID-19 Pandemic – TFAH

For more on TFAH’s recommendations to address the nation’s obesity crisis: State of Obesity 2022: Better Policies for a Healthier America – TFAH

New CDC Data Shows 4 Percent Rise in Suicides in 2021

On September 30, the Centers for Disease Control and Prevention (CDC) released a new report on provisional data on suicide mortality in 2021. The new data shows a 4 percent increase in the national suicide rate—rising from 13.5 deaths per 100,000 population in 2020 to 14.0 deaths per 100,000 population in 2021. In contrast, the national suicide rate declined in both 2019 and 2020, though it had steadily increased over the previous two decades.

The report also includes additional information on suicide by sex, age group, and month. Key takeaways:

  • Suicide rates increased more among males (3 percent increase) than females (2 percent increase).
  • Suicide rates increased for people in nearly all age groups. The only exception was a 2 percent decline for people age 75 and over, though it was not a statistically significant change.
  • The largest statistically significant increase among all sex/age groups was for males aged 15–24, with an 8 percent increase in suicide rate from 2020 to 2021. Females aged 10–14 had the largest percentage increase in suicide rate (15 percent), though the change was not statistically significant due to a relatively small numbers of cases.
  • There were more suicides across all months of 2021 compared with 2020, except in January, February, and July. The largest increase across all the months was an 11 percent increase in suicide rate in October.

The report does not include racial/ethnic or geographic information, nor information on suicide method—all critical pieces to understanding the full picture. For example, data from 2020 showed higher rates of  suicide among American Indian, Black, and Latino people and of suicide by firearm—all in a year when the overall suicide rate declined. The National Center for Health Statistics will likely release final 2021 mortality data, including these additional data points, in December.

“The increase in suicide is devastating,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health (TFAH). “The new data underscores the need for more attention on this issue and action to prevent future suicides—by federal policymakers, the private and non-profit sectors, and every community across the nation. This study is a wakeup call that we continue to face a mental health and substance use crisis, but we can prevent these tragic deaths.”

The most recent Pain in the Nation report from TFAH includes 2020 data and an analysis of longer-term trends, as well as policy recommendations for reducing alcohol, drug, and suicide deaths. The new CDC report reaffirms the importance of many of these recommendations, including to:

  • Strengthen the continuum of crisis intervention programs with a focus on the newly established “988” lifeline.
  • Expand CDC’s comprehensive suicide-prevention efforts, including measures to strengthen economic supports, promote connectedness, and create protective environments.
  • Address the social determinants of health and promote resilience in children, families, and communities, including through economic supports, access to quality childcare, and prevention and early intervention efforts in schools.
  • Build grassroots community capacity for early identification and intervention for individuals with mental health and substance use disorders, including through community-based or non-traditional settings.
  • Limit access to lethal means of suicide, including drugs and firearms, among individuals at higher risk of suicide through state and federal laws, more funding of foundational research, and the adoption of counseling programs in healthcare systems.