Deaths in the United States related to alcohol, drugs and suicide hit an all-time high in 2021.
According to a May 24 report from the Trust for America’s Health’s, the death rate climbed to 209,225, marking an 11% increase from 2020. The breakdown of the study revealed that from 2020 to 2021:
- Drug overdose deaths increased 14%, totaling 106,699.
- Deaths related to alcohol increased 10% to 54,258.
- Suicides increased 4% to 48,183.
It is tempting to blame these drastic increases on the COVID-19 pandemic, but this has been a developing trend over the last two decades.
In 2011, all three categories amounted to 104,379 deaths. We have seen that total more than double in just a decade, with drug-related deaths increasing by 60% in just the last five years.
Increases in all three categories impacted every demographic but several trends stand out. Rural communities were impacted more than metro centers, and Native American, Alaskan natives and Pacific islanders bore the brunt of the increases.
Attempting to reverse the rising death rate and meet the needs of those who struggle with mental illness in at-risk communities, Congress passed two groundbreaking pieces of legislation in 2022.
The Bipartisan Safer Communities Act passed in June 2022 and appropriated funding for school personnel, training programs, additional funding for the National Child Traumatic Stress Network and for the 988 Suicide and Crisis Lifeline.
In addition, Congress enacted the Consolidated Appropriation Act in December 2022, which authorized funds for college-age suicide prevention programs, as well as funding to assist in hiring more crisis responders and training while expanding telehealth coverage for Medicare beneficiaries.
Unfortunately, this is not enough. More still needs to be done, as rates of mental illness are expected to continue to rise. Historically, rates of mental illness and substance abuse continue to rise for several years following global pandemics. This was seen after the Russian Flu of 1889, the flu pandemic of 1918 and the 2003 SARS CoV-1 scare.
Based on the TFAH report, the rise in cases will hit rural America and at-risk minority groups the hardest. Rural communities comprise 85% of land in the U.S. but only account for 20% of the population. They witness a similar rate of mental health disorders at urban centers, but a significantly higher rate of death due to drugs, alcohol and suicide.
This is a direct result of a lack of services. Therefore, individuals wrestling with mental illness frequently resort to self-medicating or substance abuse.
The American Hospital Association’s 2022 report on rural hospital closures revealed that, between 2010 and 2021, 136 rural hospitals closed their doors, with a single-year record of 19 rural hospitals closing in 2020.
Rural areas have a lower per capita income and a higher rate of poverty. Because of this, 29% of the nation’s rural hospitals are in danger of closing this year. That is over 630 facilities.
Unless this pattern changes, we can expect to continue to see a lack of services and an increase in deaths related to drugs, alcohol and suicide in rural communities.
But the problem is not just rural and at-risk communities. The nation has an inadequate mental health care system.
Prior to the pandemic, the U.S. already lacked the mental health resources to meet the current demand. For example, the U.S. currently has 11 mental health beds in general hospitals per 100,000 people, which is the lowest rate since the 1850s.
The per capita rate has been steadily declining since 1955 when the country had 430 mental health beds per 100,000 people. This is woefully inadequate compared to other affluent countries like Japan, France and Germany who have 66, 22 and 80 mental health beds per 100,000 people, respectively.
Therefore, more needs to be done to meet the current need. It is recommended that the U.S. maintain between 40 to 50 mental health beds per 100,000 people.
Yet, the bed count is only one aspect of the crisis. A September 2022 report from the Kaiser Family Foundation revealed that 47% of Americans live in an area that has a shortage of mental health care professionals.
This is expected to get worse in coming years, as the Association of American Medical Colleges projects that the nation will have a shortage of 14,000 to 31,000 psychiatrists, psychologist, and social workers.
All of this illustrates our current need and does not even address the lack of preventative services.
At this point, it would be tempting to demand that Congress pass legislation like the Pursuing Equity in Mental Health Act, push medical associations to develop more effective treatment guidelines, adequately fund health care providers and champion a call to establish clinics and tele-health services in at-risk communities.
The truth is, even this would not be enough. We cannot keep applying band-aids to address a broken mental health system.
What we need is to shift how we view mental illness and substance abuse and to demand that Congress and the White House create a mental health care task force that can develop a holistic plan to reimagine how we care for those in crisis from all demographics and not just those with privilege.
This is more than a moral issue; it is literally about saving lives.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
