There may be one big reason why suicide rates keep climbing in the US, according to mental-health experts
- Anthony Bourdain died on Friday, with early reports indicating that the beloved celebrity chef and TV host committed suicide. Earlier in the week, Kate Spade died by suicide as well.
- Their deaths are part of a nationwide trend. Since 1999, the national suicide rate has risen by nearly 30%, and mental illness is believed to be one of the largest contributors.
- Mental-health experts expect that the country's decline in funding for mental healthcare has contributed to the rise.
- Those who can afford out-of-pocket costs for mental health services are more likely to seek them out and receive treatment.
Anthony Bourdain, acclaimed chef who explored the globe in search of the world's best cuisine, died by apparent suicide Friday morning in France, CNN said. The report followed news of fashion mogul Kate Spade's suicide earlier this week.
Their deaths come amid a larger, alarming trend happening across the US: Since 1999, the national suicide rate has risen 28%, according to the Centers for Disease Control and Prevention (CDC). Nearly every state has seen a rise over that period.
While suicide is a complex response to trauma that often involves many factors, mental illness is one of the leading contributors, according to the CDC. But for those who have a mental illness and can't afford mental healthcare, their conditions are more likely to worsen.
According to many mental-health experts, that reality makes suicide a far-reaching, systemic public health crisis.
John Mann, a psychiatrist who studies the causes of depression and suicide at Columbia University, said several factors have likely contributed to America's rising suicide rate, including stress from the 2008 financial crisis and the current opioid epidemic. But they don't tell the whole story.
"We have a serious, national problem in terms of adequate recognition of psychiatric illnesses and their treatment. That is the single most effective suicide-prevention method in Western nations," he told Business Insider. "We're missing most of these cases. That's really the bottom line."
The larger majority of suicide victims who have a psychiatric illness - nearly 3 in 4 Americans - are not receiving treatment at the time of their deaths.
The US has made substantial cuts in mental health funding over the past decade
Making mental healthcare more affordable could help lower suicide rates in the US, Mann added. Following the 2008 recession, states were forced to cut over $4 billion in public mental health funding.
Trump's latest budget would also slash the key source of public funds for mental health treatment: the Medicaid program serving over 70 million low-income and disabled Americans.
"We have a national strategy for suicide prevention in the United States, but it's essentially unfunded and there is no government leadership in systematically implementing this strategy at the federal or state level," he said. "So we have a blueprint, but we do not act on that blueprint."
Today, many Americans simply cannot afford mental health services, which may be due to a flawed healthcare system. Of all practicing medical providers in the US, therapists are the least likely to take insurance. And only 55% of psychiatrists accept insurance plans, compared to 89% of other healthcare professionals, like cardiologists, dermatologists, and podiatrists, according to a 2014 study published in JAMA Psychiatry.
In the US, therapy can cost hundreds of dollars per session when patients pay out-of-pocket. Prices are usually even higher in cities, which also tend to have higher rates of depression than rural areas.
"This is a wake-up call for employers, regulators, and the [insurance] plans themselves"
Mental healthcare coverage can vary widely by state as well. In 2017, Milliman, a risk-management and health care consulting company, published a national study that explored geographic gaps in affordable mental healthcare access.
The researchers parsed through two large databases containing medical claim records from major insurers for PPOs - preferred provider organizations - covering nearly 42 million Americans in all 50 states and Washington, DC, from 2013 to 2015. In New Jersey, 45% of office visits for behavioral healthcare were out-of-network. In Washington, DC, it was 63%. In nine states, including New Hampshire, Minnesota, and Massachusetts, payments were 50% higher for primary-care doctors when they provided mental healthcare.
"This is a wake-up call for employers, regulators, and the [insurance] plans themselves that whatever they're doing, they're making it difficult for consumers to get treatment for all these illnesses. They're failing miserably," Henry Harbin, former CEO of Magellan Health, a behavioral healthcare company, told NPR in reaction to the study.
Because mental healthcare providers know that insurance companies won't adequately reimburse them, they will often require patients to pay out-of-pocket. As a result, many states do not have enough in-network therapists and psychiatrists to meet patient demand.
"Too many people have no health insurance; there have been too many budget cuts to treatment dollars, and there are too few providers available to deliver care," Fred Osher, director of Health Systems and Services Policy at the Council of State Governments Justice Center, wrote in The New York Times in 2016. "These obstacles should lead to a call to action, not a call to further confine people with mental illness."
Correlation does not equal causation, but many other nations with universal or near-universal healthcare, like the Netherlands and Estonia, have seen declines in suicide rates, Mann said.
Following reports of Bourdain's and Spade's suicides, many Americans on Twitter shared stories of their own battles with depression and mental illnesses. A number of people also expressed worries about not being able to pay for therapy visits and/or psychiatric medications, because their insurance plans did not cover them.