Suicide Prevention

Since 2000, suicide rates in Texas have steadily risen by nearly 37 percent.1 While there was a promising decrease in suicide rates across the country between 2019-20, a reversal of these effects were evident by 2021, as suicide numbers and rates increased in conjunction with the COVID-19 pandemic.2 This continued into 2022 with over 4,300 Texans losing their lives to suicide as the 11th overall leading cause of death in Texas.3

All Texans are impacted by suicidality, including suicidal thoughts and attempts, however there are variations across demographic characteristics, such as age, race/ethnicity, gender identity, sexual orientation, and more.4,5,6,7 Data illustrates White males, people in non-metro or rural communities, veterans, youth, and LGBTQ+ youth in Texas have some of the highest suicide rates in our state:

  • Males in Texas are almost four times more likely than females to die by suicide.8
  • White Texans are over two times as likely to die by suicide than other racial groups.9
  • Since 2000, suicide mortality rates in non-metro areas of Texas are about 30-45 percent higher than in metro areas.10
  • Higher rates of suicide in rural areas are correlated with lack of access to mental health services, high rates of gun ownership, and long distances to hospitals.11,12,13
  • Suicide is the second leading cause of death in Texans ages 10-24.14
  • One in eight Texas high school students report an attempted suicide, higher than the national average of one in 11 high school students.15
  • Over one in four Texas students report seriously considering suicide.16
  • A 2022 survey found almost half (47 percent) of LGBTQ youth in Texas seriously considered suicide in the previous year.17
  • The rates of death by suicide are approximately two times higher for veterans than the general Texas rate.18

Living with mental health conditions does not equate to experiencing suicidology, despite existing stigmas. However, individuals with a diagnosed mental illness are at higher risk of suicide, representing about 46 percent of deaths by suicide according to the Centers for Disease Control and Prevention (CDC).19

The Texas Suicide Prevention Council and Texas State Plan for Suicide Prevention

The Texas Suicide Prevention Network convened in 2001 to create the first Texas State Plan for Suicide Prevention to improve suicide prevention, intervention, and postvention outcomes for our state. The State Plan was closely modeled after the 2001 National Strategy for Suicide Prevention and The Surgeon General’s Call to Action. The Texas House Human Services Interim Committee recognized the Plan in 2002, which recommended the Texas Suicide Prevention Network be formally established as the Texas Suicide Prevention Council. The Texas Suicide Prevention Council coordinates and promotes collaboration across public and private partners to help ensure adequate and best practice suicide care across Texas.

The Council’s composition has grown to over 150 organizations and institutions across the public/private continuum since its establishment, including the Texas Suicide Prevention Network of local and university suicide prevention coalitions, statewide organizations, and state agencies including the Texas Health and Human Services Commission and the Texas Department of State Health Services.

Texas State Plan for Suicide Prevention

In its most recent update, the Texas State Plan for Suicide Prevention, 2023-2028 was developed with thorough input from Council members and key stakeholders concerning gaps and priorities, a review of the HB 3980 Report on Suicide and Suicide Prevention in Texas, the Report on Long-Term Action Plan for Suicide Prevention, and a review of national resources.

The plan recommends aligning programs, practices, and policies by the following key performance areas to move suicide prevention, intervention, and postvention forward in Texas:

  • Capacity Building
  • Workforce
  • Communications & Outreach
  • Research
  • Data
  • Postvention

Statewide Efforts

Report on Suicide and Suicide Prevention in Texas

During the 86th legislative session, HB 3980 was enacted requiring the Statewide Behavioral Health Coordinating Council (SBHCC) to report on suicide and suicide prevention in Texas, including prevalence, state policies and programs, and recommendations.20 The following legislative session included an additional requirement for SBHCC to publish a 2022 update and include data and recommendations specific to veteran and youth in foster care populations.

The almost 300-page report, Report on Suicide and Suicide Prevention in Texas 2022 Update includes:

  • Available data on suicide, suicide attempts, and suicidal thoughts from year 2000 to the present, for each dataset with special attention to the veteran and youth in foster care populations;
  • Identification of the highest categories of risk of death by suicide, suicide attempts, and thoughts of suicide, specifically addressing the age of the individual; the sex of the individual; and the individual’s veteran status;
  • Data disaggregated by county and recognized categories of risk, where available;
  • Texas policies and programs adopted across state systems to prevent suicides;
  • State statutes and rules addressing the topic; and
  • Recommendations for improvement.

988 Suicide and Crisis Lifeline 

At the federal level, the Federal Communications Commission adopted rules in July 2020 establishing “988.” This created a national three-digit phone number for Americans in crisis to contact the National Suicide Prevention Hotline to connect with suicide prevention and mental health crisis counselors.21 HR 4194/S 2661 (116th, Gardner) – known as the National Suicide Hotline Designation Act – was signed into law by the president in October 2020.22 The bill codified “988” as the phone number for the National Suicide Prevention Lifeline (NSPL).

After two years of preparation, the 988-crisis line went live nationwide on July 16, 2022. While the federal government mandates the hotline, states carry responsibility for most of the funding and implementation. However, the federal government has given out several technical assistance grants to states and tribal territories to supplement the necessary 988 spending.23 Preliminary data from the U.S. Health and Human Services Secretary showed that the first month of the 988 roll-out resulted in a 45 percent increase in overall volume, and a substantial improvement in answer rates and wait times compared to the same month of the previous year.24

988 in Texas

The Texas Health and Human Services Commission (HHSC) is responsible for the oversight of 988 and the integration of this service into existing crisis continuum services in Texas. HHSC contracts with four 988 centers to cover Texas 988 calls:

  • MHMR of Tarrant County (Fort Worth)
  • Emergence Health Network (El Paso)
  • The Harris Center (Houston)
  • Integral Care (Austin)

The Suicide and Crisis Center of North Texas also answers 988 calls, but HHSC does not have a formal contractual relationship with this agency.25

In April 2022, SAMHSA awarded HHSC the 988 State and Territory Cooperative Agreements Grant. Through this opportunity, Texas received approximately $8 million over two years to support workforce capacity building and unification of 988 responses statewide. Additionally, HHSC has committed over $18 million in Mental Health Block Grant (MHBG) funding through state fiscal year 2024 for workforce expansion and increased responsiveness to 988 contacts.26 The purpose of this funding is to improve state response to 988 contacts (including calls, chats, and texts) originating in Texas by:

  • Recruiting, hiring, and training behavioral health workforce to staff local 988 centers to respond, intervene, and provide follow-up to people experiencing a behavioral health crisis;
  • Engaging 988 centers to unify 988 responses across states and territories; and
  • Expanding the crisis center staffing and response structure needed for the successful implementation of 988.27

In May 2024, 84 percent of the 18,800 people who called the Texas 988 hotline connected with a counselor.28 While this is an improvement from 2023 when Texas left nearly a quarter of suicide hotline calls unanswered, several issues need to be addressed in order to provide an adequate crisis line to callers.29 In HHSC’s Report on the 988 Implementation Study, the agency stated that the current infrastructure of the NSPL will struggle to meet the increased demand with the 988 transition.30 The behavioral health workforce shortage across the nation negatively impacts the availability of workers to answer the crisis line, but also impacts the availability of follow-up services to those who may need them. Stakeholders agree that integrating peer support specialists and recovery coaches into this service can help address some of these workforce challenges and be a value-add to creating rapport with the caller.

In addition to staffing and follow-up issues, there is public distrust from some people in using the crisis line during a mental health emergency– particularly in communities of color.31 The potential involvement of law enforcement in 988 crisis response exacerbates existing distrust of police within certain communities. Further, some advocates and stakeholders fear that the potential use of geolocation services during 988 calls to locate the caller could harm callers who want to remain anonymous for their own safety or the safety of others with them.32 Overall, the 988 crisis line has shown encouraging results as a lifeline for people experiencing a crisis, however, further efforts are needed to make the line a more equitable and robust resource.

88th Texas Legislative Session and Suicide Prevention

During the legislative session, policies aimed at reducing these rising rates revolved around information provision on suicide prevention and mental health care to populations at a higher risk of suicide, such as veterans, students in higher education, and youth. However, legislation that would have followed recommendations from suicide prevention stakeholders were not ultimately passed.33

Passed

HB 671 (González, Mary/Eckhardt)

Relating to a veterans suicide prevention campaign.


Requires the Texas Veterans Commission to conduct a suicide prevention campaign to provide veterans with information regarding suicide prevention, and to create a dedicated website to provide information about safely storing firearms.

SB 63 (Zaffirini/Raymond)

Relating to an instruction guide for family members and caregivers of veterans who have mental health disorders.

Requires Health and Human Services Commission and Texas Veterans Commission to create an instruction guide for family members and caregivers of veterans with mental health conditions, which must be available on both agency’s websites.

Failed

HB 906/SB 633 (Moody/Menéndez)

Relating to the provision of information regarding mental health and suicide prevention services to entering students at public institutions of higher education.

Would have required institutions of higher education to provide information on mental health services and suicide prevention to all enrolling students.

HB 2898 (Garcia)

Relating to the definition of preventable death of a child.

Would have classified suicide as a preventable death for purposes relating to the review and investigation of child fatalities.

HB 3631 (Lalani)

Relating to a requirement that public institutions of higher education provide certain information regarding mental health services to entering students.

Would have required institutions of higher education to provide information on campus mental health resources and suicide prevention resources to all entering students, including part-time students.

*Amended onto SB 532 which did pass.

HB 4065/SB 2423 (Rose/Johnson)

Relating to required reporting by the Department of Family and Protective Services regarding youth in the managing conservatorship of the department who attempt suicide.

Would have required DFPS to report on suicide attempts in foster youth.

References

  1. Texas Health and Human Services Commission. (2022). Report on suicide and suicide prevention in Texas. https://www.hhs.texas.gov/sites/default/files/documents/leg-report-suicide-prevention-tx-nov-2022.pdf ↩︎
  2. Centers for Disease Control and Prevention. (2022). Suicide increases in 2021 after two years of decline.  https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220930.htm  ↩︎
  3. American Foundation for Suicide Prevention. (2024). Suicide statistics. https://afsp.org/suicide-statistics/ ↩︎
  4. Centers for Disease Control and Prevention. (2022). Suicide prevention resource for action: A compilation of the best available evidence. National Center for Injury Prevention and Control. https://www.cdc.gov/suicide/pdf/preventionresource.pdf ↩︎
  5. Rural Health. (2024). Suicide Prevention: Rural Policy Brief. Centers for Disease Control and Prevention.  https://www.cdc.gov/rural-health/php/policy-briefs/suicide-policy-brief.html ↩︎
  6. Nehme, E., Elerian, N., Oppenheimer, D., & Lakey, D. (2017). Suicide in Texas. The University of Texas System, Office of Health Affairs. https://www.utsystem.edu/sites/default/files/news/assets/Suicide in Texas.pdf ↩︎
  7. America’s Health Rankings. (2022). Suicide in Texas. https://www.americashealthrankings.org/explore/annual/measure/Suicide/state/TX ↩︎
  8. Ibid. ↩︎
  9. Ibid. ↩︎
  10. Statewide Behavioral Health Coordinating Council. (2023). Report on suicide and suicide prevention in Texas 2022 update. https://www.hhs.texas.gov/sites/default/files/documents/leg-report-suicide-prevention-tx-nov-2022.pdf ↩︎
  11. Rural Health. (2024). Suicide Prevention: Rural Policy Brief. Centers for Disease Control and Prevention.  https://www.cdc.gov/rural-health/php/policy-briefs/suicide-policy-brief.html ↩︎
  12. Benham, B., & JH Bloomberg School of Public Health. (2017). Higher rural suicide rates driven by use of guns.  https://www.jhsph.edu/news/news-releases/2017/higher-rural-suicide-rates-driven-by-use-of-guns.html ↩︎
  13. Dillard, C. (2017). East Texas counties have higher suicide rates than other areas of state.  Tyler Morning Telegraph. https://tylerpaper.com/lifestyle/health/east-texas-counties-have-higher-suicide-rates-than-other-areas/article_52412607-045d-5a36-bac8-9a8b87b14889.html ↩︎
  14. American Foundation for Suicide Prevention. (2024). Suicide data: Texas. https://www.datocms-assets.com/12810/1707241704-texas_2023_state_fact_sheet.jpg ↩︎
  15. Ivey-Stephenson, A.Z., Demissie, Z.; Crosby, A.E., Stone, D.M., Gaylor, E., Wilkins, N., Lowry, R. & Brown, M. (2019). Suicidal ideation and behaviors among high school students – Youth Risk Behavior Survey, United States, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/69/su/pdfs/su6901a6-H.pdf ↩︎
  16. Garing, J.H. (2022). Youth mental health in Texas: 2021 Youth Risk Behavior Survey updates. Texas Health and Human Services Commission. Update to the Children and Youth Behavioral Health Subcommittee of the Behavioral Health Advisory Committee. ↩︎
  17. The Trevor Projects. (2022). 2022 national survey on LGBTQ youth mental health, Texas. https://www.thetrevorproject.org/wp-content/uploads/2022/12/The-Trevor-Project-2022-National-Survey-on-LGBTQ-Youth-Mental-Health-by-State-Texas.pdf ↩︎
  18. Statewide Behavioral Health Coordinating Council. (2023). Report on suicide and suicide prevention in Texas 2022 update. https://www.hhs.texas.gov/sites/default/files/documents/leg-report-suicide-prevention-tx-nov-2022.pdf ↩︎
  19. Centers for Disease Control and Prevention. (2018). Vital signs: Suicide rising across the US. https://archive.cdc.gov/#/details?url=https://www.cdc.gov/vitalsigns/suicide/index.html ↩︎
  20. Statewide Behavioral Health Coordinating Council. (2023). Report on suicide and suicide prevention in Texas 2022 update. https://www.hhs.texas.gov/sites/default/files/documents/leg-report-suicide-prevention-tx-nov-2022.pdf ↩︎
  21. Federal Communications Commission. (2020, July 16). FCC designates ‘988’ as 3-digit number for national suicide prevention hotline [press release].  https://docs.fcc.gov/public/attachments/DOC-365563A1.pdf ↩︎
  22. Gardner, C. (2020). S.2661 – 116th Congress (2019-2020): National Suicide Hotline Designation Act of 2020. https://www.congress.gov/bill/116th-congress/senate-bill/2661 ↩︎
  23. U.S. Health and Human Services. (2022). HHS Secretary: 988 transition moves us closer to better serving the crisis care needs of people across America. https://www.hhs.gov/about/news/2022/09/09/hhs-secretary-988-transition-moves-us-closer-to-better-serving-the-crisis-care-needs-of-people-across-america.html?utm_source=substack&utm_medium=email ↩︎
  24. Ibid. ↩︎
  25. Behavioral Health Services Division. (2022). 988 suicide and crisis lifeline in Texas. Texas Health and Human Services. https://www.hhs.texas.gov/sites/default/files/documents/988-suicide-and-crisis-lifeline-in-texas.pdf ↩︎
  26. Ibid. ↩︎
  27. Ibid. ↩︎
  28. Goldman, M. & Jordan, J.R. (2024, June 21). Texas improves 988 hotline answers rate but still lags behind. Axios Houston. https://www.axios.com/local/houston/2024/06/21/988-mental-health-hotline-texas-answer-rate ↩︎
  29. Jordan, J.R. (2023, July 24). Texas leaves nearly a quarter of 988 calls unanswered. Axios Houston. https://www.axios.com/local/houston/2023/07/24/988-calls-unanswered-texas ↩︎
  30. Texas Health and Human Services. (2022). Report on the 988 implementation study. https://www.hhs.texas.gov/sites/default/files/documents/9-8-8-implementation-study-rider-58.pdf ↩︎
  31. Goldberg, M. (2022, July 21). Mistrust lingers in Black communities amid 988 launch. The Associated Press. 
    https://apnews.com/article/health-race-and-ethnicity-mississippi-jackson-mental-3e794332adc39785c11bf8c9a006e1ce ↩︎
  32. Kennedy Satcher Center for Mental Health Equity, Morehouse School of Medicine, & Beacon Health Options. (2022). Embedding equity in 988: Imagining a new normal for crisis response. https://kennedysatcher.org/wp-content/uploads/2022/06/988-Policy-Brief_Final.pdf ↩︎
  33. The Hogg Foundation for Mental Health. (2023). Summary of mental health and substance use-related legislation, Texas 88th legislative session, July 2023. https://hogg.utexas.edu/project/88th-legislative-summary ↩︎

Updated on December 13th, 2024



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