If you or someone you know is having thoughts of suicide or is in crisis, please reach out to the 988 Suicide & Crisis Lifeline by calling or texting 988.

Pooja Mehta was taken by surprise when her younger brother, Raj, died by suicide at just 19 in March 2020.

His final text was a simple message to a classmate about their homework: “You wouldn’t say you’re taking questions 1 through 15 if you’re intending to end your life an hour later,” remarked Mehta, 29, a mental health and suicide prevention advocate from Arlington, Virginia. Despite her training in Mental Health First Aid, which instructs on recognizing and responding to mental health issues, Mehta felt blindsided by Raj’s death as he showed no signs of distress.

Mehta faced criticism from some people who suggested that, since they were living together during the COVID-19 pandemic and he was attending classes remotely, her training should have helped her identify his struggles.

Nevertheless, Mehta pointed out, “We act as if we fully understand suicide prevention. There’s been significant progress in formulating some solutions, yet we still lack comprehensive knowledge.”

Since 2001, federal authorities have initiated three major national suicide prevention strategies. The initial strategy emphasized tackling risk factors using a limited number of common interventions. The second encouraged crafting and putting into action standardized protocols for identifying and aiding at-risk individuals. The most recent strategy, introduced in April, outlines plans for implementing 200 actions over the next three years, focusing on groups significantly affected by suicide, including Black youth and Native American populations.

However, between 2001 and 2022, according to data from the Centers for Disease Control and Prevention, suicide rates have generally risen each year.

Challenges in suicide prevention efforts

Despite these troubling figures, mental health professionals believe that the national strategies themselves are not to blame. Instead, they argue that the policies are not receiving enough funding, are not being widely adopted, and are not effectively put into practice.

A collective of national experts and public officials highlighted that even basic tracking of suicide data is not consistent. Without reliable statistics, it’s challenging for researchers to determine the demographics most affected by suicide, assess the effectiveness of prevention methods, and identify the areas most in need of funding.

Many states and territories have restrictions preventing medical records from being linked to death certificates, noted Michael Schoenbaum, a senior adviser with the National Institute of Mental Health. NIMH is partnering with various organizations to compile this data into a public report and database expected by year-end.

The strategies are further hindered by fluctuating funding at both federal and local levels. Some suicide prevention initiatives may not be applicable in specific regions due to geographical factors, explained Jane Pearson, a special advisor on suicide research at NIMH.

In Wyoming, a state with a low population spread across a vast and rugged terrain, suicide rates are consistently among the highest. State officials, like Kim Deti from the Wyoming Department of Health, have been addressing this issue for years. However, implementing essential services, such as mobile crisis units, poses challenges in a state characterized by its wide-open spaces.

“Our efforts are ongoing, but some strategies that work well in certain geographic areas may not be suitable for our state’s unique characteristics,” she said.

Nationally, despite strong evidence that screening for suicidal ideation during medical appointments can prevent tragedies, healthcare practitioners are not required to conduct such screenings. Many physicians find the process intimidating due to time constraints, inadequate training, and discomfort with discussing suicide-related topics, according to Janet Lee, a pediatric associate professor at Temple University.

“How can someone not inquire about something that is a matter of life and death?” she expressed.

The implementation of alternative approaches has also been irregular. Although crisis intervention services are pivotal in national strategies, many states have yet to create uniform systems. These crisis systems are often disjointed, as they can differ widely from state to state and even between counties. Some mobile crisis teams use telehealth services, while others are available around the clock, as opposed to those that function from just 9 AM to 5 PM. Additionally, some teams rely on local police instead of mental health professionals to respond to crises.

The newly launched 988 Suicide & Crisis Lifeline is encountering serious challenges as well. A recent poll by the National Alliance on Mental Illness and Ipsos reveals that only 23% of Americans know about 988, and there’s a considerable gap in understanding when to use it.

Most states, territories, and tribes have not yet established permanent funding for 988, which debuted nationwide in July 2022 and has received around $1.5 billion in federal assistance, as reported by the Substance Abuse and Mental Health Services Administration.

Anita Everett, director of SAMHSA’s Center for Mental Health Services, mentioned that her agency is running a campaign to raise awareness about the system.

Some states are initiating different measures. Officials in Colorado have introduced financial incentives to promote suicide prevention through the state’s Hospital Quality Incentive Payment Program. Over the past year, 66 hospitals have enhanced their care for patients facing suicidal thoughts, noted Lena Heilmann, the director of the state’s suicide prevention office.

Experts are hopeful that other states will adopt Colorado’s approach.

Despite the slow progress, Mehta sees positive developments in the current strategy and action plan.

Although it is too late to help her brother, Mehta said, “Addressing the social factors linked to mental health and suicide, and providing accessible resources for individuals in need before a crisis arises, gives me hope.”

Cheryl Platzman Weinstock’s reporting has been made possible through a grant from the National Institute for Health Care Management Foundation. KFF Health News operates as a national newsroom focusing on in-depth journalism regarding health issues, serving as one of the core programs at KFF, an independent source of health policy research, polling, and journalism.