The Salt Lake Tribune, March 15, 2021
Editor’s note • This article discusses suicide. If you or people you know are at risk of self-harm, the National Suicide Prevention Lifeline provides 24-hour support at 1-800-273-8255.
In an effort to lower the state’s persistently high suicide rate, Utah lawmakers passed a slate of bills that increase access to mental health services, limit firearm access for people in crisis and boost prevention programs.
The legislation comes at a time when many mental health advocates say the pandemic has laid bare the vast amount of need.
“COVID has revealed how problematic it is for a lot of people struggling with mental health issues,” said Rep. Brian King, D-Salt Lake City.
Utah has one of the highest suicide rates in the nation. And while a Utah Department of Health report recently indicated there was no initial evidence that social distancing and stay-at-home orders had led an increase in distress among Utahns in 2020, advocates say that doesn’t mean social isolation and economic uncertainty hasn’t had an impact on the state’s residents.
Dr. Mark Rapaport, head of the Huntsman Mental Health Institute, recently called mental health “a second pandemic”.
Increasing access to mental health services
The pandemic converted many face-to-face interactions to virtual ones.
Advocates have long pointed to telehealth services as an important part of meeting the needs of Utah’s rural communities, where providers are often scarce. During one committee hearing this session, Benjamin Christiansen, a clinical neuropsychologist from Davis County, told lawmakers that he’s had patients drive from St. George or Vernal to meet with him.
“That makes it hard to ask a patient to drive four or five hours for an hour appointment,” he said. “You have someone who’s in crisis — for example severe depression — you’re looking at a weekly travel where they’re constantly living in hotels.”
But expanding telehealth has been challenging when insurance providers often reimburse virtual visits at lower rates than in-person meetings.
Bills this session attempted to increase access to telehealth services, including SB161, which tried to equalize insurance reimbursements between virtual and in-person mental health visits.
Amid stiff resistance from insurance carriers, lawmakers watered down that aspect of the bill, said Rep. Steve Eliason, R-Sandy, although he expects the measure will put these insurance companies “on red alert” that legislators are paying attention.
The final version achieved another significant shift by bumping up Medicaid reimbursement rates for mental health care, said Eliason, who shepherded the measure through the House. And as these rates have lagged over the years, it’s become increasingly difficult for Medicaid recipients to find providers who will accept their insurance.
“Because Medicaid rates are already some of the lowest out there and because behavioral health services are pretty hard to come by, you get a good provider and they’d be like, ‘Why should I accept Medicaid patients?’” Eliason said.
Another major mental health bill focused on helping people reach out for assistance in the first place.
Even small children know to call 911 when there’s an emergency, noted Sen. Daniel Thatcher. But “grown adults have absolutely no idea where to turn for mental health.”
The West Valley City Republican successfully ran a bill that will free up nearly $16 million to hire clinical social workers and other staff to implement a new phone number — 988.
“I don’t know of any other behavioral health bill in the history of the Legislature that has allocated that much funding to a mental health cause,” he said. “So it’s really historic.”
The ongoing effort to establish a national 988 line for mental health emergencies has advanced with a push from prominent Utah politicians, most notably longtime former U.S. Sen. Orrin Hatch and U.S Rep. Chris Stewart. The hotline should be active across the United States by mid-July 2022.
While there are many suicide hotlines and crisis lines, Thatcher says having an easy to remember three-digit number where someone could seek help could save lives.
The 988 line will also help “decriminalize behavioral health,” he told his fellow lawmakers, since people who call 911 during a time of crisis are often met with police and may end up in the criminal justice system. That leads to increased costs for taxpayers and worse outcomes for people who are struggling, many of whom could be stabilized over the phone with no need for medical resources, ambulance transportation costs or a mark on their criminal record.
Thatcher, who has long worked on bills around mental health, told his colleagues the issue is personal for him.
“I have struggled with chronic depression since I was a teenager,” he revealed. “And I still to this day struggle with suicide ideation. It is something that I understand far too well.”
Firearms and police
Most suicidal crises are brief, experts say, and Utah lawmakers also took steps this session to keep people safe during these most dangerous moments.
Under one bill, people who are experiencing a mental health crisis could restrict their own access to firearms.
They could do this by adding their name to a “no-gun” registry that would prevent them from buying firearms for at least 30 days before the person could request removal. The restrictions would lapse automatically after six months unless the person asked for an extension.
One woman who spoke during the hearing on HB267, sponsored by Eliason, said her mother might still be alive if she’d had the ability to restrict herself from gun purchases. After repeatedly seeking psychiatric treatment, her mother died by suicide after impulsively buying a firearm.
“My mom would have signed up for this list because she did not want to die,” the woman said. “A voluntary waiting period to purchase a gun could have saved her life.”
Lawmakers also passed a bill that would bar police from shooting at people who are suicidal and pose a threat only to themselves.
State law currently says a police officer is allowed to use deadly force if a suspect poses “a threat of serious bodily injury to the officer or to others.” This bill, HB237, clarifies the law to say that police should not shoot if someone is only a threat to themselves.
“I know that our community wants better outcomes,” Rep. Jennifer Dailey-Provost, D-Salt Lake City and the bill’s sponsor, said during the debate of the bill. “I absolutely know our law enforcement wants better outcomes. No police officer wants to be in the situation where they are confronting someone who is attempting ‘suicide by cop.’”
Child mental health
The Legislature paid special attention to mental health during the formative years of early childhood, with a new University of Utah report finding the state has a higher prevalence of child and adolescent mental health disorders than other parts of the nation.
The Kem C. Gardner Policy Institute study from December also indicated many of these needs go unmet, a problem linked to long-term consequences such as poverty, homelessness and incarceration.
“When we focus upstream with our youngest children, infants, toddlers and preschoolers and their families, we literally change the trajectory of their lives,” Rebecca Dutson, president and CEO of the Salt Lake City-based Children’s Center, told lawmakers.
But in many cases, parents and daycare providers don’t know what to do. To address these gaps, Eliason sponsored a bill that would fund a campaign to educate care providers about mental health support for young children and sets aside money for family stabilization services. Altogether, the legislation, HB337, calls for spending about $1.6 million each year on early childhood mental health.
Eliason said he hopes the education and outreach campaigns will help identify children who are experiencing neglect, abuse or some other type of trauma so these kids can start receiving treatment as soon as possible.
Efforts to stop suicide will also start earlier than ever, as the Legislature approved a bill that will expand suicide prevention programs to students in kindergarten through sixth grades.
With data showing that suicide is the leading cause of death for Utahns ages 10-24, Rep. Brian King, the bill’s sponsor, argues that it’s important to provide age-appropriate information.
“There’s no doubt that the sooner you’re able to recognize, identify and address some of the issues that a child is having when they’re in elementary school, the more likely it is you don’t have problems or at least the problems aren’t as significant as they otherwise would be in secondary school,” he said in an interview.
Under the bill, HB93, programs for young students would focus on “life-affirming education,” with an emphasis on helping students learn healthy habits, self-care, problem solving and conflict resolution. Curriculum would also center around “strengthening the family” and “a youth’s relationships in the school and community.”
King hopes the weight put on building emotional life skills can help students learn how to better cope with setbacks from failing a test to a breakup with a boyfriend or girlfriend.
The bill includes funding to cover the costs of implementing the program at the state’s 1,002 eligible schools.
In another effort to improve mental health among Utah’s students, the Legislature approved a bill that would allow school kids to take a mental health day off. Such an absence would now be considered as “valid” an excuse as a physical illness, a family death, an approved school activity or another approved reason established by a school.
Cathy Davis, a suicide prevention education specialist with the Utah Board of Education, stressed the importance of efforts to address mental health among young Utahns. And she said she thinks the mental health bills that passed through the Legislature have “all kind of been building upon one another.”
“More than anything, the pandemic has heightened our awareness of just how important [mental health] is — because I think it’s not just our young people that have been affected by this, it’s everyone,” she said. “And collectively, we’ve got to focus on our own wellbeing for everyone’s sake. We’ve got to be there for one another.”