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The relaunching and rebranding of the nationwide suicide prevention line as 988 — designed to be a mental health counterpart to 911 emergency services — arrived amid a year of record-high suicide deaths, according to provisional federal data.
In 2022, 49,369 lives were lost to suicide, with the highest number of gun-related suicides on record nationwide.
Indiana hasn’t been immune to this increase, according to the health care policy organization KFF. Between 2011 and 2021, the age-adjusted suicide death rate per 100,000 residents jumped 22% in the Hoosier State, from 13.5 deaths to 16.4 deaths.
At the same time, Indiana reported one of the highest in-state response rates for calls to 988, meaning that Hoosiers in crisis were more likely to connect with a local counselor than their peers in other states.
“The state is using this as an opportunity to build an infrastructure that will change the way Hoosiers access behavioral health and crisis care, with a goal of building a system that can prevent and respond to mental health crises through the expansion of pilot programs to demonstrate their efficacy and cost-effectiveness,” said Michele Holtkamp, director of the Office of Strategic Communications and Public Affairs at the Indiana Family and Social Services Administration.
But challenges remain for an overburdened mental health care system, especially since lawmakers opted not to create a steady, ongoing funding stream in the form of telecom fees.
On ongoing crisis
The number of deaths due to suicide dipped slightly in 2019 and 2020 on a national scale before rebounding in 2021 and hitting a record high in 2022, according to an analysis from KFF of the Centers for Disease Control and Prevention WONDER data.
An Indiana Capital Chronicle WONDER analysis using the CDC codes for suicide shows an increase in the state across all four years with no dips and an identical age-adjusted rate of 16.5 for both 2021 and 2022. 2022’s data is provisional, meaning it is incomplete.
In particular, gun-related suicide deaths have increased in the last few years on both a national and state level. KFF reports that more than half, 55%, of all suicide deaths involved a firearm in 2021 and 2022. State with more permissive gun laws have higher rates of gun-related suicide deaths and suicide deaths overall.
People of color — particularly American Indian and Alaska Native people — men and people living in rural areas have the highest suicide death rates. The ongoing impact of the mental health fallout from the COVID-19 pandemic hasn’t yet been fully quantified.
A September 2022 report from the Indiana Behavioral Health Commission estimated that untreated mental illnesses cost the state $4.2 billion annually.
The report estimated that one in five Hoosiers experience mental illness each year and that for every four Hoosiers treated for mental illness, one additional Hoosier is left untreated. Up to 80% of Hoosiers with a serious mental illness are unemployed.
Of the $4.2 billion, the largest cost to the state was premature mortality at $1.4 billion followed by productivity losses at $885 million and direct health care costs at $708 million.
An uncertain future
To kick-start the development of the state’s crisis system, Indiana is using $133.6M in federal funds along with $100 million provided by state lawmakers earlier this year in the current two-year budget to support the continued development of the statewide crisis system.
Other states have used 988 phone bill fees, similar to how states fund their 911 emergency services. Lawmakers chose not to pursue that funding in the last legislative session after a revenue forecast predicted an additional $1.5 billion. But bill author Sen. Michael Crider, R-Greenfield, warned that stable funding needed to be secured in order to guarantee the service’s longevity.
A $1 surcharge on Hoosier phone bills would bring in roughly $90 million each year, covering more than two-thirds of the estimated $131 million annual cost. The $1 charge would have made Indiana’s telecom fee the most expensive in the nation — a sticking point for lawmakers.
Six other states have imposed fees, with fees in another three states pending. Fees range from $0.08 in Virginia to $0.60 in Delaware, according to KFF.
Pew Charitable Trusts identified three other challenges facing 988: workforce challenges, limited language access and access to ongoing care.
Services are widely available in English and Spanish, with translation services for over 200 other languages. However, neither the chat nor the text option is available in languages other than English and Spanish.
According to a national 988 jobs board, Indiana’s call center openings are few compared to other states — though three other entities are in the process of becoming centers, according to FSSA. Of the jobs listed at the Muncie-based A Better Way, Gary-based Crisis Center, Inc. and Lafayette-based Mental Health America – Wabash Valley Region, only the Muncie positions were still open as of early August.
But whether someone is there to oversee a long-term treatment plan is less certain since Indiana has a shortage of an estimated 286 mental health providers, meaning the available providers can only meet roughly 31% of the need.
On a brighter note, Indiana’s call rates ranked in the top tier of states whose 988 calls were answered in-state, with just 4.6% of 7,383 routed to outside call centers in April and May. That’s tied with Montana, which had just 1,502 calls. Indiana’s call volume is also larger than both of frontrunners: Mississippi answered 97.8% of its 2,233 calls and Rhode Island responded to 97.3% of its 1,259 calls.
Holtkamp said Indiana has maintained over a 90% in-state answer rate since November 2022, which reflects the dedication and effectiveness of the state’s call center staff in meeting the needs of Hoosiers.
And four mobile crisis pilot programs have been established, covering sixteen counties, expanding access and the interoperability of 988 and mobile crisis through dispatch.
Lastly, Holtkamp said FSSA has launched a marketing campaign to educate and encourage those experiencing a crisis to call the lifeline. A resource toolkit, accessible in multiple languages, on the 988 Indiana website, includes a collection of promotional tools to help spread awareness for the lifeline.
The Indiana Capital Chronicle is an independent, not-for-profit news organization that covers state government, policy and elections.
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