Behavioral health disorders and suicide in Washington state

With behavioral health issues (mental health and substance use disorders) and suicide prominently positioned in the local and national news headlines nearly daily, we are called to action as nurses but often feel overwhelmed and disoriented by the depth and breadth of the problem. Understanding the prevalence and pervasiveness of behavioral health issues and who can be afflicted is often the first step in defining a strategic approach.

Nearly 45 million people in the U.S. (4.2 percent of the population) suffer from mental illness and at least 10 million of these people suffer from serious mental illness. It is reported that in 2016 less than half (43.1 percent) of those suffering received mental health treatment and nearly 45,000 lost their lives to suicide -- far more than the 19,362 who were victims of homicide in this country (The National Institute of Mental Health, 2018a, 2018b).

Suicide rates have steadily climbed, by 28 percent, since 1999, with Washington state carrying a relatively high suicide rate at 12.58-14.23 deaths per 100,000 compared with other states that are as low as 6.19-11.40 per 100,000. Women are more likely to seek help than men, and men are four times more likely to take their own lives than women (Regge, 2017).

Why do so many people need to unnecessarily suffer and die from these treatable diseases, and how do we get them the services they need? Stigma is at the helm of this problem and can be a barrier to seeking help. This stigma can also contribute to alienation from others who don’t understand the disease or how to help (Mayo Clinic Staff, 2018). Despite Washington’s robust mental health parity law (Washington State Legislature, 2010), struggles continue with health insurers who can create barriers to basic services and treatment for mental health disorders. Education and increased individual and public dialogue are key to continuing to diminish and hopefully, one day, erase societal stigma, allowing people to obtain the help they need so more lives can be saved.

There are many examples in health care, such as cardiovascular disease (heart disease) and acute myocardial infarction (heart attack), that illustrate the benefit of immediacy in response by the community and health care professionals. This facilitates the successful delivery of appropriate and timely care, and quality outcomes. However, this attention and immediacy of care – and allocation of resources – isn’t always available with behavioral health issues because of the associated stigma and failure to identify the presence of illness, and due to the significant challenges in access to care and availability of resources. Access is defined and measured by geographic proximity and time it takes to get to help, ability to secure a health care provider who is qualified to diagnose and treat the condition, existence of adequate funding (usually insurance coverage) and access to a residential (inpatient) facility when needed.

Both inpatient and outpatient behavioral health care are often insufficiently reimbursed. This financial caveat is a crucial consideration in designing successful pathways for accessing behavioral health services (National Council for Behavioral Health, 2017). Too often, the very people who are suffering from these disabling diseases are those who have significant barriers to care due to financial constraints and limited social resources. Until behavioral health care is appropriately valued in our health care system, these problems will persist.

As of 2014, Washington state has an average of 9.1 inpatient psychiatric beds per 100,000 people, which ranks Washington 46 out of 50 states in capacity for inpatient beds (Burley & Scott, 2015).

There are efforts to increase mental health resources including a new 120 bed behavioral health hospital in Tacoma Washington scheduled for completion in 2018 (Becker, 2017). Though this is a step in the right direction, much of the work ideally will be focused on primary prevention of acute episodes through secure access to outpatient treatment over the continuum, long before an inpatient bed is necessary.

Resources for outpatient treatment of behavioral health issues pose challenges. There is a paucity of available psychiatrists to see people suffering from severe mental illness (Center for Healthcare Workforce Studies & University of Washington, 2016). This number of practitioners with expertise in psychiatry can be doubled when psychiatric nurse practitioners are added; they are also specifically trained to diagnose and treat mental health disease. However, even these numbers remain inadequate to address the need. In reality, behavioral health issues should be predominantly diagnosed and managed by front-line health care professionals - nurses, primary care providers, including, nurse practitioners and other allied members of behavioral health teams, in order to prevent delay of much needed care and yield better outcomes.

We all play a critical role in early identification of behavioral health issues, opening access to treatment, facilitating ongoing care and suicide prevention. It is essential that anyone who is suffering with behavioral health issues or caring for someone challenged by them, understand that they can confidently reach out to a nurse, their local primary care provider or nurse practitioner for screening, evaluation and treatment for this spectrum of disorders. Awareness of the resources for you, someone you know, or a patient you are encountering and how to refer someone can save a life. In addition to prompt referral to a health care professional for a face-to-face visit, the following represent some Washington state and national resources.

Resources

National Suicide Prevention Lifeline at 1-800-273-TALK (8255) is a confidential service available to anyone 24 hours a day, 7 days a week. http://www.suicidepreventionlifeline.org

Crisis Clinic at KING COUNTY 2-1-1: DIAL 2-1-1, 1-800-621-4636 offers telephone-based crisis intervention and information and referrals to community services for youth and adults in Seattle-King County, WA. https://crisisclinic.org/

Teen Link at 1-866-833-6546 is a teen-answered help line. https://866teenlink.org/

Washington Recovery Help Line at 1-866-789-1511 is a statewide service offering emotional support and linkage to substance abuse, problem gambling and mental health services to anyone in Washington state. https://www.warecoveryhelpline.org/

Washington Warm Line at 1- 877-500-WARM (9276) is a peer-answered help line for people living with mental health challenges. https://crisisclinic.org/find-help/washington-warm-line/

Crisis Text Line is a free, 24/7 support for those in crisis. Text HOME to 741741 from anywhere in the U.S. to text with a trained Crisis Counselor. Crisis Text Line trains volunteers to support people in crisis. www.crisistextline.org

Substance Abuse and Mental Health Services Administration - SAMHSA’s National Helpline at 1-800-662-HELP (4357) is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. https://www.samhsa.gov/find-help/national-helpline