By Cheryl Platzman Weinstock for KFF Health News.
Broadcast version by Kathleen Shannon for Wyoming News Service reporting for the KFF Health News-Public News Service Collaboration

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.

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 covid-19 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 wrote this story for KFF Health News.


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Indiana families are preparing kids for back-to-school season, and mental-health experts say emotional readiness is just as important as school supplies.

Beth Trammell, a psychologist and professor at Indiana University East, said kids often carry anxiety into the new school year. She encouraged parents to help children identify those fears.

"We as parents or caregivers think, 'Don't worry, or don't stress.' Instead, we might want to say, 'OK, well, let's talk about what it is you're worried about. What is the worst thing you think could happen?' If we draw it out of them," she said, "it may give them space to kind of let that out."

Helping kids feel heard can reduce stress. But experts also urge balance, keeping mornings calm, easing into routines, and not overloading schedules the first few weeks.

Nicole Brady, chief medical officer at UnitedHealthcare, said mental-health support should remain a priority throughout the year.

"Though we want our kids to be involved in activities and be social," she said, "we have to watch their academic performance, their mood, those sleep patterns, and making sure that those are staying healthy."

Brady added that parents should talk regularly with kids, model healthy coping and seek help early if warning signs appear.


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After a legislative session which opened doors to expand mental health care services across Montana, a state commission said it is considering the Billings area to build the state's second forensic facility.

For people involved in Montana's justice system whom a judge has deemed not mentally fit for their own defense, there are 53 beds in the state's only forensic facility in Galen. The daily waitlist hovers at about 100 people.

Matt Kuntz, executive director of the National Alliance on Mental Illness-Montana, said it is not meeting the immense need.

"It's just a really bad situation for the people that are in the jails, for the people that are caring for them, for the taxpayers," Kuntz outlined. "It just doesn't work for anybody."

At a recent commission meeting, Montana Department of Public Health and Human Services Director Charlie Brereton said the state is identifying a location for a new facility. The department received nearly $27 million from the state in April to fund project planning.

Kuntz noted the Montana Legislature passed many bills this session centered on mental health care.

"We really were able to get big wins in access to outpatient care, access to crisis care and for people in need of forensic hospital," Kuntz explained. "Overall, it was really an amazing legislative session for Montanans with mental health conditions."

Other mental health legislation will boost school-based services, youth in residential care, the state's 988 crisis line and certified community behavioral health clinics.


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The California Parent and Youth Helpline is in serious jeopardy after Gov. Gavin Newsom cut it from the new state budget, saying the money was needed to support medical services.

Advocates said they are puzzled because the governor has championed the helpline for years, and lawmakers approved $3 million from a separate fund dedicated to mental health, which does not affect the deficit.

Lisa Pion-Berlin, president and CEO of the nonprofit Parents Anonymous, which runs the helpline, said it is still operating 24/7, for now.

"We're holding on for the next month or so," Pion-Berlin pointed out. "But we need the state to step up, or one of these well-off philanthropists who cares about having that immediate help for emotional support, which is so vital."

Advocates are hoping funding can be restored via a budget trailer bill in the next few weeks. People can call or text and reach the helpline's trained counselors at 877-427-2736. The free helpline has connected with more than 120,000 people since its inception five years ago, and the website CAParentYouthHelpline.org has reached a million more.

Pion-Berlin noted a study in the Journal of Technology in Human Services found a call to the helpline can quickly ease parents' suffering and feelings of isolation.

"The research said that 85% of the callers in less than 30 minutes feel more positive, more hopeful and able to address their issues," Pion-Berlin reported. "There is no other service or pill I know that can do that in 30 minutes or less."

Parents Anonymous also offers free weekly support groups to steer parents and kids through emotional crises of all kinds.