Opportunities to make health equity progress in suicide prevention
Addressing health equity
While health equity is making progress, opportunities for improvement still exist, particularly in behavioral health and suicide prevention. The Centers for Disease Control and Prevention (CDC) defines health equity as the state in which everyone has a fair and just opportunity to attain their highest level of health.1 Achieving this level of equity requires our society, as a whole, to overcome obstacles related to economic, social, and racial barriers to obtaining healthcare; as well as eliminating health disparities.
Addressing health equity also requires focusing on health-related social needs, such as the environmental conditions in which people are born, live, work, play, worship, and age. All these factors affect individuals’ overall whole health.2
Health equity progress in suicide prevention
“Carelon Behavioral Health has been making strides in achieving health equity in suicide prevention,” says Dr. Linda Henderson-Smith, Senior Product Director, Carelon Behavioral Health. “We have modified our onboarding training plans, including those for the LGBTQ+ community. We have expanded medical rounds to allow for training and practice, providing resources for conditions such as neurodiversity. We hired Spanish-speaking staff to answer 988 calls and texts — staff who are part of the community are providing the services.”
Opportunities to make additional progress
Carelon Behavioral Health also partnered with the Kennedy-Satcher Center for Mental Health Equity on “Embedding Equity into 988,” a national policy brief outlining evidence-based recommendations on administering 988 equitably and effectively. The brief identified six areas of recommendations:3
- To advance equity by prioritizing historically excluded groups’ visibility.
- To use law enforcement as a response to mental health crises only when necessary.
- Mental health crisis response teams should include licensed mental health professionals and peer recovery specialists, with psychiatrists, nursing personnel, and medical interpreters available on call.
- Mobile crisis units should be available at local health clinics, comprising staff who reflect the cultural and linguistic environment of the community.
- Staff training should include skills training that promote equity.
- Callers should have options to consent to use of their geolocation, to remain anonymous, and to maintain confidentiality.
The brief also identified the following groups as the most historically invisible, and as 988 equity priority groups:4
- LGBTQ+
- Black, indigenous, and people of color (BIPOC)
- Rural communities
- Immigrants
- Refugees
- Non-English-speaking people
- People living with disabilities
- Older adults
- People experiencing homelessness or housing instability
- Formerly incarcerated or justice-involved populations
- Survivors of trauma
- Neurodiverse people
Historically, patients of color have been significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization. Black patients and patients who identified as other race or multiracial have been especially vulnerable.5
Looking ahead
Carelon Behavioral Health and the Kennedy-Satcher Center for Mental Health Equity will continue evaluating and reporting back on health equity in 988, as well as its effects on suicide prevention.
The goal is for states to use the data to create solutions that will improve equitable outreach to populations in need. “Communities continue to embed more crisis services into their regions. They have a tremendous opportunity to improve access for all people in need and to address inequities related to involuntary care,” says Wendy Martinez Farmer, Regional Vice President of Sales, Carelon Behavioral Health. “Crisis services are often the front door through which individuals access the behavioral health system. Unfortunately, this type of access is even more common in communities of color. Our hope is that access improves over time, transitioning to one of service provision prior to a crisis taking place.”
Sources:
1 Centers for Disease Control and Prevention: What is Health Equity? (accessed August 2023): cdc.gov .
2 Office of Disease Prevention and Health Promotion: Social Determinants of Health (accessed August 2023): health.gov .
3 Kennedy-Satcher Center for Mental Health Equity: Embedding Equity into 988: Imaging a New Normal for Crisis Response (June 2022): https://kennedysatcher.org/wp-content/uploads/2022/06/988-Policy-Brief_Final.pdf .
4 Shea T, Dotson S, Tyree G, Ogbu-Nwobodo L, Beck S, Shtasel D: Racial and Ethnic Inequities in Inpatient Psychiatric Civil Commitment. Psychiatric Services (August 2022): https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202100342 .