Policy Priority: Services and Care

Geographic and social isolation, inadequate access to health care providers or facilities, and social stigma can all contribute to suicide risk. AFSP seeks to address these issues and increase investment in upstream prevention as well as access to mental health and substance use (behavioral health) care and services through policy initiatives such as expanding the workforce, enhancing crisis response, and implementing innovative forms of prevention and treatment. AFSP also works to eliminate barriers to care and services such as limited or lack of insurance coverage, available providers, and treatment types or settings. AFSP recognizes that connecting individuals with behavioral health services and resources as quickly and safely as possible can help to reduce suicidal suffering and prevent suicide and can often reduce the need for more costly downstream interventions.

The transition to the 3-digit 988 Suicide and Crisis Lifeline number in July 2022 created a monumental opportunity to transform the way we as a country respond to suicide, mental health, and substance use crises, ensuring that everyone in the U.S. has someone to call, someone to respond, and somewhere safe to go when in crisis. A well-resourced continuum of crisis care will help stabilize individuals at risk so they are able to get through that intense moment of crisis and connect with community or wraparound care, as needed. The 988 Lifeline’s national and local contact centers and the community crisis response services that support those centers have experienced increased service demand as the public becomes more informed on 988 and the resources it provides. The transition to 988 also added substance use crisis care to the Lifeline’s scope, which necessitates additional training and investment, so all centers are equipped to provide this service moving forward. Continued funding and support are needed to ensure the full vision of 988 is realized.

• Increase diverse and sustainable funding and support for building capacity within the full continuum of crisis response, including but not limited to Lifeline contact centers (someone to call), mobile crisis response services (someone to respond), and crisis respite and stabilization centers (somewhere safe to go).
• Enhance training for counselors answering 988 calls, texts, and chats to increase effectiveness and cultural responsiveness and decrease unnecessary use of emergency services and active rescue.
• Strengthen coordination between 988, 911, and all services within the continuum.
• Bridge the gap between 988 and post-crisis supports through evidence-based suicide prevention and intervention services and suicide-specific treatments.
• Promote awareness of the 988 Lifeline as an available resource for 24/7 support during a suicidal, mental health, or substance use crisis.
• Improve accuracy and immediacy of access to the 988 Lifeline by ensuring that contacts to 988 are routed by approximate location of the caller/texter so contact centers are aware of local, relevant supports and resources for each contact.

AFSP works to advance policies in healthcare systems that will accelerate the adoption of risk identification and proven suicide prevention and intervention strategies.

• Promote culturally relevant training requirements for healthcare providers, including mental health and substance use disorder professionals and para-professionals, regarding best practices in suicide prevention, assessment, management, treatment, and postvention.
• Create funding opportunities for suicide risk screening and assessment in healthcare.
• Promote safety planning, lethal means counseling, post-discharge care, caring contacts, and other best-practice short-term interventions for patients at risk for suicide.
• Expand access to evidence-based telebehavioral healthcare and ensure coverage for those services at parity with in-person services, particularly within rural and other underserved communities.
• Remove financial barriers by healthcare systems to the implementation of comprehensive suicide prevention.

There is a critical shortage of behavioral health providers in the U.S. When accounting for the entire country, 88% of counties are considered a mental health professional shortage area and a mere .05% of counties are considered to have no provider shortage county-wide. Put another way, over a third of the U.S. population lives in an area with a shortage of behavioral health professionals, and nearly two-thirds of shortage areas are rural. AFSP supports efforts to build and expand an equitable and diverse behavioral health workforce, equipped to provide culturally and linguistically appropriate care that builds trust and fosters positive community interactions with health providers and para-professionals.

• Promote loan forgiveness, scholarships, and other financial incentives to expand and diversify the pipeline of behavioral health professionals nationwide and to address provider shortages in underserved areas, including in rural communities and for incarcerated populations.
• Promote access to peer support specialists and trained and supervised para-professionals who can provide support for suicide-focused care.
• Coordinate communication between interested parties to leverage existing federal and state scholarships and related programs.
• Increase access to clinical supervisors, training credentials, and peer support certification programs.
• Expand primary care and behavioral health integration, including through the Collaborative Care Model, adoption of electronic health record systems for behavioral health providers, and the development of learning collaborative partnerships.

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurers and health plans to cover behavioral health care at parity with coverage for other types of medical and surgical care. Even though this federal law was enacted over a decade ago, many insurers are still not in compliance with MHPAEA. Many consumers remain unaware of the law’s requirements or how to report insurer violations.

• Uniformly implement and enforce MHPAEA and state parity laws and regulations across plan types and extend parity assistance funds for states.
• Increase oversight and transparency by ensuring state commissioners request parity compliance analyses.
• Implement consumer and provider education efforts and require the promotion of accessible information on parity requirements and consumer rights under the law.
• Extend MHPAEA to the Medicare program.