Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

The Ready or Not 2024: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report identifies gaps in national and state preparedness to protect residents’ health during emergencies and makes recommendations to strengthen the nation’s public health system and improve emergency readiness. As the nation experiences an increasing number of infectious disease outbreaks and extreme weather events, the report found that while emergency preparedness has improved in some areas, policymakers not heeding the lessons of past emergencies, funding cuts, and health misinformation put decades of progress at risk.

 

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Ready or Not 2024: State-by-State Factsheets

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.