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EDITORIAL: Missouri spending on mental health goes down; suicide rate goes up

St. Louis Post-Dispatch (MO) - 5/4/2015

May 04--Missouri whacked the state's mental health department budgets from 2007 through 2012, and during that time the statewide suicide rate climbed 13 percent.

There has been no scientific study to connect those two facts, but it is hard to imagine they are not related. Suicides in Missouri now account for more deaths than homicides and drunken-driving accidents combined.

Untreated or undertreated mental illness is a leading cause of suicide, mental health experts say. Most people living with mental illness receive treatment from public mental health providers. When the state stops making money available for such treatment, people who can't afford care elsewhere all too frequently turn to suicide.

Data from the American Association of Suicidology show the rate in Missouri to be higher than much of the nation. The state's suicide rate of 15.9 per 100,000 people in 2012 puts it at 18th in the nation. The national average is 13 suicides per 100,000 people.

Missouri's mental health system is overwhelmed and underfunded. Nearly a third of the system's budget was cut in the five years between 2007 and 2012. There have been slight increases the past two years -- pushing it from $1.2 billion in 2012, including federal funding for Medicaid-reimbursed services -- to $1.6 billion last year.

Jacqueline Lukitsch, director of advocacy for the National Alliance on Mental Illness-St. Louis, said the budget increase "is not enough to meet demand."

The Missouri Department of Mental Health serves some 170,000 Missourians annually through state-operated facilities and contracts with private organizations and individuals. Mental health advocates say that about one in five residents get the services they need and that mental health providers have a perpetual waiting list.

The Missouri chapter of NAMI says that close to 223,000 adults and 65,000 children in the state live with serious mental health conditions. Nationally, suicide is the 11th leading cause of death overall, and the third-leading cause of death among those 15 to 24 years old.

Mental illness is a leading reason that teens drop out of high school, create friction in families and are frequently absent from work or school. In adults, mental illness is estimated to be responsible for workplace spending of more than $34 billion in direct and indirect costs, such as sick days taken, higher rates of short-term disability and lower productivity.

All demographic groups experience suicides, with middle-age white males now having the highest rate nationally. Missouri experienced that in a very public way with the recent suicides of state Auditor Tom Schweich, and the one a month later of Mr. Schweich's spokesman, Spence Jackson. Geographically, rural areas have higher rates than urban areas, due to less access to mental health services.

Historically, state mental health systems have served those with the greatest need for high-intensity services and who are most at risk for being ignored. Sharp cuts in state funding have eroded the system's ability to care for those who most need their services.

Suicides have become so prevalent in a wide swath of the country that there is now what is known as a Suicide Belt, a region that stretches from Idaho down to Arizona and New Mexico. Missouri -- with its 18th-highest suicide rate in the nation -- is unfortunately close to becoming a hole in that belt.

The western U.S. has had a higher suicide rate than the rest of the country since the 1800s. Academics have studied the region and suggest that factors such as social isolation, low-population density, higher rates of population change, weak social ties and social institutions contribute to the higher rate.

Guns are another factor, regardless of geography. Firearms account for about half of all suicides nationally and more than half in Missouri. Mental illness, alcohol and substance abuse and economics are among the leading risk factors, with loss believed to be the common trigger. The unwanted ending of a relationship or of a job may be the life-altering event, but mental health advocates say that usually follows a long trail of problems.

The Missouri Legislature passed a $26 billion budget last month that cut $40 million for social programs and mental health needs. The future is looking bleak with flat revenues and looming business and income-tax cuts that will be phased-in beginning in 2017.

Spending money to provide mental health care that could help drive down Missouri's high suicide rate should count at least as much as keeping corporate coffers filled. It's all about priorities.

Deb Peterson -- 314-340-8276

@debschmooze on Twitter

dpeterson@post-dispatch.com

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