Youth Suicides and the Mental Health Crisis: What Congress Is Doing

June 06, 2022 | Devon Page

A Black teenage boy sits sadly, back pressed against a stone wall, head in handsA few Sundays ago, I read an article in a New Yorker whose headline all but took the breath out of my lungs: “The Mystifying Rise of Child Suicide.”

Andrew Solomon told of America’s escalating mental health crisis through the story of Trevor Matthews. Trevor suffered from depression, and his symptoms often manifested in aggressive or abnormal behaviors. Despite the child’s strong network of community and familial support and socioeconomic comfortability, Trevor took his own life where he and his parents lived. He was only twelve years old.

Suicide is a leading cause of death in the United States and widely recognized as a crisis, specifically among our youth, a population in which incidences have been rapidly increasing. While the overall suicide rate increased by approximately 30% between 2000 and 2018 (before declining by 5% from 2018 to 2020), according to CDC data, the rate of death by suicide rose by over 57% among people aged 10 to 24 years old from 2007 to 2018, and the rate among children aged just 10 to 14 years old during that same period more than doubled.

Experts note that young people’s vulnerability to suicide is not completely surprising. A person’s prefrontal cortex, the brain’s executive control center, does not fully develop until well into someone’s twenties. This causes young people to engage in comparatively compulsive and risky behaviors. Furthermore, the social bonds cultivated over many years (e.g., marriage, posterity, professional relationships), are major preventative factors. Still, the sharp rise remains unexplained.

There is indication that the COVID-19 pandemic may have increased risk factors related to suicide. According to a CDC study on youth mental health threats during the pandemic, more than one third of high school students reported poor mental health and four in ten reported feeling persistently sad or hopeless during the past year. In June 2020, 40% of adults reported challenges with mental health or substance use. There is no question that the social isolation and economic hardship of the pandemic impacted mental wellbeing. But for some already vulnerable populations, the impact was more devastating.

A 2017 report conducted by the American Psychiatric Association found that, compared to non-LGBTQ+ people, LGBTQ+ people are 2.5 times more likely to experience depression, anxiety and substance abuse issues. And during the pandemic in 2021, almost half (45 percent) of young LGTBQ+ people seriously considered attempting suicide; those youth between ages 13 and 17 as well as Black and Indigenous LGBTQ+ youth color were more likely to consider or attempt suicide compared to other white LGBTQ+ youth. This intersectionality is an astonishing yet unsurprising risk factor for poor mental health and suicide, which has grown more evident as researchers have been more intentional about disaggregating data on suicide rates among racial and ethnic minority groups. Looking at data from 2001 to 2015, researchers found that Black children are twice as likely to die by suicide than were their white peers. From 2014 to 2019, the suicide rate for Black youth increased by 30%.

Although research identifies some reasons for these high rates, data on the subject is incomplete and not just with regard to suicide rates among Black people, but across the board on mental health. Compounding the issue, when there is mental health data, it is often of inconsistent quality, sparse, or incomplete. Some blame the fact that there is no authority or leadership within the mental health community, leading to stingy data practices and disparate information. Whatever the cause, this issue hampers the ability to develop thorough and comprehensive evidence-based prevention plans and practices and the ability to successfully advocate for increased funding.

While disparate data is an issue, there is no scarcity of legislative attempts addressing the matter. Suicide prevention and mental health support are issues that, unlike many others, enjoy expressed bipartisan concern, even though solutions vary radically depending on who you ask.

On March 29, 2022, Reps. Grace F. Napolitano (D-CA), John Katko (R-NY), Tony Cárdenas (D-CA), and Chris Stewart (R-UT) announced the formation of a new Bipartisan House 988 & Crisis Services Task Force under the Congressional Mental Health Caucus. Beyond that, several committees over the past several months have sought to better understand this crisis, especially the youth aspect.

The number of bills introduced in Congress is, admittedly, overwhelming. And from a political perspective, this offers both peril and promise—buzz is good until it becomes deafening. That is, attention is great, but too many individualized solutions can dilute the waters, limiting the possibility of a single solution finding broad support. But in another light, the large influx of bills could indicate some larger, more bipartisan forthcoming effort that will address mental health more broadly. There are multiple reasons to expect that this is the case.

Introduced in the beginning of May, a bipartisan bill entitled Restoring Hope for Mental Health and Well-Being Act (HR 7666) would establish a pediatric telehealth access grant program and reauthorize more than 30 SAMHSA and HRSA programs that support mental health awareness, prevention initiatives, and crisis services. It was recently approved by the House Energy and Commerce Committee. In addition, the Mental Health Reform Reauthorization Act (S 4170) would implement mental health parity laws and community mental health services. It has been referred to the Senate Committee on Health, Education, Labor and Pensions. Both pieces of legislation aim to support the mental health workforce.

Late last month, Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) of the Senate Finance Committee—joined by Senators Ben Cardin (D-MD) and John Thune (R-SD)—released a discuss draft for a bill expanding access to telehealth, particularly for mental health services. While it is entitled "Ensuring Access to Telemental Health Services," some have called it a "telehealth Bill of Rights." If passed, it would amount to just that. This follows a report on mental healthcare released by Senate Finance earlier this year which makes a case for further federal action based off legislative hearings.

Navigating an ocean of policy is no easy task. It is often difficult to identify what differentiates provisions and what makes one provision a preferable solution to the issue at hand. For this, the Surgeon General’s Call to Action on suicide prevention provides us some guidance. Policies should support comprehensive suicide prevention initiatives for states and territories through increased CDC and SAMHSA funding (particularly Grant Lee Smith youth suicide prevention grants) as well as funding for the infrastructure to support crisis care (e.g., Congressional support for the 5% SAMHSA Mental Health Block Grant set-aside, core services identified in SAMHSA’s National Guidelines for Behavioral Health Crisis Care) coupled with technical assistance for states looking to evolve crisis systems of care.

Furthermore, actions that aim to increase awareness of and take action to reduce access to firearms and other lethal means of suicide, including opioids and other medications, alcohol and other substances or poisons, and community locations where suicidal behaviors have occurred are critical. And combatting stigma surrounding suicide and poor mental health in general are paramount.

Addressing the mental health crisis requires a ubiquitous effort. The issue is affixed within an interconnected, complicated web of various other conditions of our nation, such as discrimination, structural inequality, violence, and poverty. However, it demands action. It should not be lost that suicide is preventable, and solutions through treatment and intervention and other holistic approaches are within the reach of our legislators.