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September – October 2019
A message from Dr. William Beecroft
Suicides and suicide attempts among young people show a disturbing trend
 In a column in this newsletter a year ago, I wrote about how suicide deaths have climbed dramatically in the U.S. over the past 15 years. I thought it was time to revisit this topic and see what new research has emerged.
Suicide continues to be a major public health crisis and the second leading cause of death among youths age 10 to 18, persisting into early adulthood, according to the National Institute of Mental Health. The increase in suicides and suicide attempts among youth is particularly alarming. An analysis, published in JAMA Pediatrics on April 8, 2019, showed that hospital emergency department visits for suicide attempts and suicide ideation doubled among youth from 2007 to 2015.
Additionally, JAMA Network Open reported a significant increase in suicide rates for female youth. A cross-sectional study of 85,051 youth suicide deaths found a narrowing in the gap between male and female rates of suicide among youth age 10 to 19, with the most pronounced narrowing in younger individuals.
Research like this pinpoints the need for us to battle the suicide crisis on multiple fronts. For example:
- We need to continue to educate our group customers about the dangers of
carving out mental health services and pharmacy from their benefit plan. It’s only by integrating mental health into general medical care that we can safeguard the health of our members.
- We need to make it easy for our members to find the mental health services and substance use disorder treatment they need. With our Find a Doctor feature on bcbsm.com and the Blue Cross mobile app, members can search
behavioral health to find psychologists, psychiatrists and other behavioral health specialists in their area.
Unfortunately, some insurers are finding ways to deny mental health coverage to their members, Bloomberg Businessweek reported May 16. Even though the Mental Health Parity and Addiction Equity Act was passed more than a decade ago, some insurers are denying claims, limiting coverage and finding other ways to avoid complying with the law, Bloomberg reported.
This is especially tragic considering that 47,000 Americans died by suicide and 70,000 from drug overdoses in 2017. And many of them are young people. According to the Parent Resource Program, there are an average of more than 3,041 suicide attempts by young people in grades 9 to 12 each day in our country.
That’s why I was heartened to read in Bridge Magazine recently that one Michigan school district is fighting back against the suicide crisis following three student suicides in a 12-month period. Cedar Springs Public Schools, north of Grand Rapids, is investing $400,000 from its $38 million budget to add six mental health professionals to its staff, including three counselors and other mental health specialists. They’re part of a 13-member team that also includes social workers, other counselors and psychologists.
While this is a promising development, individual efforts like these need to take place on a broader scale. A bill in the Michigan House would require schools to have at least one counselor for every 450 students, but the bill is still in the Education Committee, Bridge Magazine reported.
Taking action to address the suicide crisis among young people is vital since suicide among people age 15 to 24 has increased nearly 50% in Michigan since 2009. While the causes of suicide among young people are complex, depression plays a major role.
Health of America Report
The 25th annual Health of America Report from the Blue Cross Blue Shield Association, released March 28 of this year, took a close look at how the nation’s behavioral and mental health patterns are changing. Major depression is an increasingly common diagnosis among commercially insured adults, teens and children, the report found. More than 9 million commercially insured people have been diagnosed with depression, representing a 33% rise since 2013.
Diagnoses for younger people, including teens and millennials, are rising faster than ever before. The rates of diagnoses for teens has increased by 63% and 47% for millennials.
Equally disturbing is that more than 2 million individuals aren’t receiving any type of treatment for depression — and 20% of the teens and millennials diagnosed with depression aren’t seeking care. This is a significant concern for health care providers and payers, the report noted, since depression is rarely found in isolation. Eighty-five percent of individuals also have another chronic disease, such as hypertension or diabetes.
In a statement about the report, Vincent G. Nelson, vice president of medical affairs for the Blue Cross Blue Shield Association, noted that it’s increasingly important that there’s continued research and resources allocated toward new ways to treat depression. I couldn’t agree more.
The association also suggests that providers continue to explore how to integrate mental and behavioral health care into the primary care environment. Blue Cross Blue Shield of Michigan has been working to make that happen over the past several years through Integrating Behavioral Health into General Medical Care, one of our many Physician Group Incentive Program initiatives.
On the medication front, I wanted to point out that esketamine, sold under the brand names Ketanest and Spravato, was recently approved by the FDA for use in adults with treatment-resistant depression. Research suggests it can be very effective in decreasing suicide risk when taken with other antidepressants.
Let’s continue to explore every avenue possible to address the problem of depression in this country and stop the alarming rise in suicide rates. I hope by next year when I write in this newsletter, I will have a more encouraging story to tell.
Dr. William Beecroft is the medical director of behavioral health for Blue Cross Blue Shield of Michigan and Blue Care Network.
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