In recent months, Dave (a close friend of mine, but not his real name) has been struggling with suicidal thoughts.
I’m the founder of a mental health company, and his situation still makes me feel scared. I know how hard it has been for him to get care, and I worry about his ability to find adequate support in time if his suicidal thoughts worsen into plans.
Unlike nearly every other cause of death in the U.S., the rate of suicide has doubled in the last 50 years. It’s the second leading cause of death in adults under 45 and the third leading cause of death for young people — the only leading killer without available prescription treatment.
Public resources designed to address the growing suicide crisis, including the national rollout of the 988 Suicide & Crisis Lifeline this summer, are an essential step in the right direction. Yet, on their own, they are not enough. While people considering self-harm are getting much-needed help in the moment, no one is yet asking the follow-up question: Will they harm themselves tomorrow?
Individuals who call 988 are routed to one of 200 centers for de-escalation. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), which maintains 988, these counselors are “trained to help reduce the intensity of a situation for the person seeking help, and connect them to additional local resources, as needed, to support their wellbeing.”
The type of de-escalation achieved by crisis hotlines is a vital function that can reduce the likelihood that someone follows through with self-harm. But, it isn’t (and isn’t intended to be) care that fully addresses the self-harm risk or underlying causes. When callers are “connected” with community resources, this often means counselors provide a list of non-profit organizations, Federally Qualified Health Centers, and other mental health support services in their area.
These organizations have the same challenges and constraints as most mental health resources right now: long wait times for appointments and staff not specialized in treating those at elevated risk of suicide. As a result, only a fraction of those seeking real help with suicidal thoughts get meaningful treatment to sustainably reduce their risk.
Notably, this same scenario occurs when people visit the Emergency Department or get discharged from an inpatient mental health hospitalization. They receive a list of local mental health resources but little support to secure follow-up care. Suicide rates are actually 100-200 times higher after inpatient psychiatric treatment.
Several factors make it difficult to find timely and effective follow-up care for severe and acute needs. First, we have a well-known and growing shortage of psychiatrists.
This problem is amplified by those mental health providers who opt to be paid directly rather than accept insurance reimbursement for their services. Additionally, only a fraction of mental health providers have specific training in delivering the care those with more severe needs require. Treating these patients can also be considered a liability risk, causing providers to avoid taking them on.
We must also examine how crisis care is delivered. As a result, there are massive inefficiencies in patient admission, triage, and evaluation – leading to overcrowding in emergency departments. The mental health ecosystem is fragmented and lacks effective tools to help patients find and engage the right providers for their insurance and their clinical needs, both before and after they call 988. These patients need more and better resources quickly.
Digital mental health care providers offer a new and powerful way to reach this population. These models can help address our provider shortage by smoothing supply across geographies, minimizing clinician administrative time, and allowing providers to be more efficient with patient care. Remote patient monitoring capabilities can also make telehealth well-suited for treating high-severity and acuity patients, often more quickly and effectively than traditional models of in-person care.
Finally, we must examine what happens after patients are discharged and the resources, including telehealth, local support, and referrals, that they are (or often aren’t) equipped with during discharge.
Collaboration between payers, health systems, clinicians in private practice and specialty telehealth providers will enable us to build a nationwide care pathway for individuals considering ending their lives. The launch of the 988 hotline was a massive win for mental healthcare in America, but it’s only the first step. The next is to continue working to ensure that everyone who needs timely, effective suicide care can be connected through crisis hotlines, emergency rooms, and discharges from inpatient care. My friend Dave, and millions of other Americans like him, need that support now.
Photo: Wacharaphong, Getty Images