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Decades of national suicide prevention policies haven’t slowed the deaths
If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”
When Pooja Mehta’s younger brother, Raj, died by suicide at 19 in March 2020, she felt “blindsided.”
Raj’s 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.
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Mehta said some people blamed her for Raj’s death because the two were living together during the COVID-19 pandemic while Raj was attending classes online. Others said her training should have helped her recognize 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.”
Raj’s death came in the midst of decades of unsuccessful attempts to tamp down suicide rates nationwide.
During the past two decades federal officials have launched three national suicide prevention strategies, including one announced in April.
The first strategy, announced in 2001, focused on addressing risk factors for suicide and leaned on a few common interventions.
The next strategy called for developing and implementing standardized protocols to identify and treat people at risk for suicide with follow-up care and the support needed to continue treatment.
The latest strategy builds on previous ones and includes a federal action plan calling for 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.
Despite those evolving strategies, from 2001 through 2021 suicide rates increased most years, according to the Centers for Disease Control and Prevention. Provisional data for 2022, the most recent numbers available, shows deaths by suicide grew an additional 3% over the previous year. CDC officials project the final number of suicides in 2022 will be higher.
In the past two decades, suicide rates in rural states such as Alaska, Montana, North Dakota and Wyoming have been about double those in urban areas, according to the CDC.
Despite those persistently 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. That slow uptake was compounded by the pandemic, which had a broad, negative impact on mental health.
A chorus of national experts and government officials agree the strategies simply haven’t been embraced widely, but said even basic tracking of deaths by suicide isn’t universal.
Surveillance data is commonly used to drive health care quality improvement and has been helpful in addressing cancer and heart disease. Yet, it hasn’t been used in the study of behavioral health issues such as suicide, said Michael Schoenbaum, a senior adviser for mental health services, epidemiology and economics at the National Institute of Mental Health.
“We think about treating behavioral health problems just differently than we think about physical health problems,” Schoenbaum said.
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, Schoenbaum said, but NIMH is collaborating with a handful of 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 states and localities because of the challenging geography, said Jane Pearson, special adviser on suicide research to the NIMH director.
Wyoming, where a few hundred thousand residents are spread across sprawling, rugged landscape, consistently ranks among the states with the highest suicide rates.
State officials have worked for many years to address the state’s suicide problem, said Kim Deti, a spokesperson for the Wyoming Department of Health.
But 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.
Lack of implementation isn’t only a state and local government problem. 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 the Lewis Katz School of Medicine 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, such as mobile crisis units, can vary from state to state and county to county. Some mobile crisis units use telehealth, some operate 24 hours a day and others 9 to 5, and some use local law enforcement for responses instead of mental health workers.
Similarly, 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 the Center for Mental Health Services within SAMHSA, said her agency is running an awareness campaign to promote the system.
Some states, including Colorado, are taking other steps. There, state officials installed financial incentives for implementing suicide prevention efforts, among other patient safety measures, through the state’s Hospital Quality Incentive Payment Program. The program hands out about $150 million a year to hospitals for good performance. In the last year, 66 hospitals improved their care for patients experiencing suicidality, according to Lena Heilmann, director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment.
Experts hope other states will follow Colorado’s lead.
And despite the slow movement, Mehta sees bright spots in the latest strategy and action plan.
Although it is too late to save Raj, “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 — the independent source for health policy research, polling and journalism.
A judge in France on Thursday found the former husband of Gisèle Pelicot, who admitted to drugging and raping her repeatedly over the course of almost a decade and inviting dozens of other men to assault her as well, guilty of aggravated rape. Over the course of her trial, Pelicot — who insisted her full name be published and proceedings be made public — has been praised for her courage and become a symbol of the fight against sexual violence in France and around the world. The judge on Thursday was reading out verdicts for dozens of other men also accused of raping her.
Pelicot arrived Thursday at the court in Avignon, southeast France, where crowds had gathered outside holding signs saying: “Thank you for your courage.”
The trial began on Sept. 2, and almost every day, Pelicot came face to face with her former husband, Dominique, or one of the 49 other men charged with raping her. One other man faced a charge of aggravated sexual assault. She insisted that videos submitted as evidence, made by her ex-husband showing men sexually assaulting her while she appeared to be unconscious, be shown in open court.
The assaults took place between 2011 and 2020, when Dominique Pelicot was taken into custody. Police found thousands of photos and videos of the abuse on his computer drives, which helped lead them to other suspects. Some of the men testified they thought the unconscious woman was OK with it, or that her husband’s permission was enough.
“Gisèle Pelicot thinks that this shock wave is necessary, so that no one can say after this: ‘I didn’t know this was rape,'” her attorney, Stéphane Babonneau, told The Associated Press.
“It’s not for us to feel shame — it’s for them,” Pelicot said in court, referring to the attackers. “Above all, I’m expressing my will and determination to change this society.”
Controversial French laws
Pelicot’s case triggered protests across France, and there was hope among some demonstrators that the case could lead to changes in controversial French laws governing sexual consent.
France introduced a legal age of sexual consent in 2021 after a public outcry over the rape of an 11-year-old schoolgirl by a man who was initially convicted on a lesser charge. Since then, sex with anyone under the age of 15 has been viewed as non-consensual, but French law does not refer to consent in cases involving older victims.
Under French law, rape is defined as penetration or oral sex using “violence, coercion, threat or surprise,” without taking consent into account, according to the Reuters news agency. Prosecutors must, therefore, prove an intention to rape if they are to be successful in court, legal experts told Reuters.
Just 14% of rape accusations in France lead to formal investigations, according to a study by the Institute of Public Policies.
“Why don’t we manage to obtain convictions? The first reason is the law,” legal expert Catherine Le Magueresse told Reuters. “The law is written in such a way that victims must comply with the stereotype of a ‘good victim’ and a ‘true rape’: an unknown attacker, use of violence, and the victim’s resistance. But it is only true for a minority of rapes.”
“I’m trying to understand”
Speaking in court during the trial, Pelicot, who is 72, talked about how she had thought she was in a loving marriage with her husband and would never have guessed that he was drugging her.
“We would have a glass of white wine together. I never found anything strange about my potatoes,” Pelicot told the court.
“We finished eating. Often when it’s a football match on TV, I’d let him watch it alone. He brought my ice cream to my bed, where I was. My favorite flavor — raspberry — and I thought: ‘How lucky I am. He’s a love.'”
She said she didn’t have any sensation of being drugged.
“I never felt my heart flutter. I didn’t feel anything. I must have gone under very quickly. I would wake up with my pajamas on,” Pelicot told the court, adding that she would sometimes wake up “more tired than usual, but I walk a lot and thought it was that.”
“I’m trying to understand,” she said, “how this husband, who was the perfect man, could have got to this.”
The International Brotherhood of Teamsters says workers at seven Amazon facilities will begin a strike Thursday morning in an effort by the union to pressure the e-commerce giant for a labor agreement during a key shopping period.
The Teamsters say the workers, who authorized walkouts in the past few days, are joining the picket line after Amazon ignored a Dec. 15 deadline the union set for contract negotiations. Amazon says it doesn’t expect any impact on its operations during what the union calls the largest strike against the company in U.S. history.
The Teamsters say they represent nearly 10,000 workers at 10 Amazon facilities, a small portion of the 1.5 million people Amazon employs in its warehouses and corporate offices.
Amazon is ranked No. 2 on the Fortune 500 list of the nation’s largest companies.
At a warehouse in the New York City borough of Staten Island, thousands of workers who voted for the Amazon Labor Union in 2022 and have since affiliated with the Teamsters. At the other facilities, employees – including many delivery drivers – have unionized with them by demonstrating majority support but without holding government-administered elections.
The strikes happening Thursday are taking place at an Amazon warehouse in San Francisco and six delivery stations in southern California, New York City, Atlanta and the Chicago suburb of Skokie, Illinois, according to the union’s announcement. Amazon workers at the other facilities are “prepared to join” them, the union said.
“Amazon is pushing its workers closer to the picket line by failing to show them the respect they have earned,” Teamsters General President Sean M. O’Brien said in a statement.
“If your package is delayed during the holidays, you can blame Amazon’s insatiable greed. We gave Amazon a clear deadline to come to the table and do right by our members. They ignored it,” he said.
The Seattle-based online retailer has been seeking to re-do the election that led to the union victory at the warehouse on Staten Island, which the Teamsters now represent. In the process, the company has filed a lawsuit challenging the constitutionality of the National Labor Relations Board.
Meanwhile, Amazon says the delivery drivers, which the Teamsters have organized for more than a year, aren’t its employees. Under its business model, the drivers work for third-party businesses, called Delivery Service Partners, who drop off millions of packages to customers everyday.
“For more than a year now, the Teamsters have continued to intentionally mislead the public – claiming that they represent ‘thousands of Amazon employees and drivers’. They don’t, and this is another attempt to push a false narrative,” Amazon spokesperson Kelly Nantel said in a statement. “The truth is that the Teamsters have actively threatened, intimidated, and attempted to coerce Amazon employees and third-party drivers to join them, which is illegal and is the subject of multiple pending unfair labor practice charges against the union.“
The Teamsters have argued Amazon essentially controls everything the drivers do and should be classified as an employer.
Some U.S. labor regulators have sided with the union in filings made before the NLRB. In September, Amazon boosted pay for the drivers amid the growing pressure.
NEW YORK — The Teamsters union is launching a strike against Amazon at numerous locations across the country, including in Maspeth, Queens.
The Teamsters are calling it the largest strike against Amazon in United States history, and it’s set to begin at 6 a.m. Thursday. In addition to New York City, workers will be joining picket lines in Atlanta, Southern California, San Francisco and Illinois.
In a video announcement released Wednesday night, workers voiced their frustrations.
“Us being strike ready means we’re fed up, and Amazon is clearly ignoring us and we want to be heard,” one worker says in the video.
“It’s really exciting. We’re taking steps for ourselves to win better conditions, better benefits, better wages,” another worker in the video says.
The union says it represents about 10,000 Amazon employees and that Amazon ignored a deadline to come to the table and negotiate. The $2 trillion company doesn’t pay employees enough to make ends meet, the union asserts.
At the height of the holiday season, many are wondering what this means for packages currently in transit.
Teamsters President Sean O’Brien said, “If your package is delayed during the holidays, you can blame Amazon’s insatiable greed.”
Amazon says Teamsters are misleading the public
An Amazon spokesperson says the Teamsters are misleading the public and do not represent any Amazon employees, despite any claims.
“The truth is that the Teamsters have actively threatened, intimidated, and attempted to coerce Amazon employees and third-party drivers to join them, which is illegal and is the subject of multiple pending unfair labor practice charges against the union,” the spokesperson said in a statement.
An Amazon representative says the company doesn’t expect operations to be impacted.
