Week 7: The influence of public sector institutions and policies on suicide prevention among first responders

Health is central to human physical and mental well-being and happiness. Healthy people live longer, and are more productive, which makes population health essential to nations’ economies. Public health makes an important contribution to economic progress. Health status and a country’s ability to provide quality health services for its people are affected by many factors (World Health Organization, 2020). Healthy People 2020 names five broad categories of determinants of health that influence health status: policymaking, social factors, health services, individual behavior, and biology and genetics. It also identifies some of the barriers to health services including high cost of care, inadequate or no insurance coverage, lack of availability of services, and lack of culturally competent care. Barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services, financial burdens, and preventable hospitalizations (Healthy People 2020, 2020). Public health interventions can operate at the local, state, and federal levels affecting individual and population health and health inequalities. The main purpose of health policy is to enhance health or facilitate its pursuit by supporting people in their quest for health (Longest, B., 2014).     

Over the last couple of decades, in spite of increased awareness, suicide has become a serious public health problem in the U.S. and around the world. In the U.S., suicide is one of the leading causes of death among young people. It is the third leading cause of death among 15-24 year olds and the second leading cause of death among 25-34 year olds. Suicide rates among first responders are 20 percent higher than general public (Ruderman Family Foundation, 2018). Continuous exposure to “critical incidents” of human pain, trauma, and death leads to high rates of anxiety, depression, PTSD, and substance abuse among first responders which often remain untreated. According to the study, PTSD and depression rates among firefighters and police officers are 5 times higher than the rates within the civilian population, which causes these first responders to commit suicide at a considerably higher rate (firefighters: 18/100,000; police officers: 17/100,000; general population 13/100,000) (Ruderman Family Foundation, 2018). Stigma surrounding mental health, shortage of mental health providers, inadequate mental health insurance coverage are just some of the reasons why first responders fail to get the help they need.   (191 words)Just a few years ago, individual and small group health insurance plans were not required to cover mental health and substance use disorders. Over the years, numerous efforts were made to improve private insurance benefits. The Mental Health Parity Act (MHPA) of 1996 required group health plans with fifty or more employees that offered mental health coverage to apply the same lifetime and annual dollar limits to mental health coverage as those applied to coverage for medical/surgical benefits. Unfortunately, the health plans were able to circumvent the law by tightening restrictions on the number of hospital days and outpatient mental health services, and by greater “cost-sharing” with patients and families. In spite of its limited scope, the 1996 MHPA brought to light the parity issue, and with the encouragement of mental health advocacy groups, prompted state legislators to consider more comprehensive parity laws (Barry, 2010).

In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed. The objective of MHPAEA was to eliminate historical disparities between insurance coverage for behavioral health treatment and coverage for medical treatment.  It was a federal law that prevented group health plans and health insurance issuers from imposing less favorable benefit limitations on mental health or substance use disorder benefits than on medical/surgical benefits. It was originally applied to group health plans and group health insurance coverage and was amended by the Patient Protection and Affordable Care Act. In 2010, it was amended further by the Health Care and Education Reconciliation Act to also apply to individual health insurance coverage (Centers for Medicare and Medicaid Services, 2016).   

The current requirement that health plans cover mental health and substance use disorders at the same level as other health conditions remains critical as we seek to better address mental health needs and lower the estimated $300 billion annual economic cost of mental illness. By ensuring equitable mental health coverage, individuals with mental health disorders would be able to get the help they need before they lose all hope and decide to end their life. Jay Ruderman, President of the Ruderman Family Foundation said, “First responders are heroes who run towards danger every day in order to save the lives of others. They are also human beings, and their work exerts a toll on their mental health. It is our obligation to support them in every way possible – to make sure that they feel welcome and able to access life-saving mental health care”. 

Centers for Medicare and Medicaid Services (2016). The Mental Health Parity and Addiction Equity Act (MHPAEA). Retrieved from https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet

Barry,C., Huskamp, H., & Goldman, H. (2010). A Political History of Federal Mental Health and Addiction Insurance Parity

Healthy People 2020 (2020). Determinants of health. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

Longest, B. (2014). Health policymaking in the United States (5th ed.). AUPHA. Arlington, VA.

Ruderman Family Foundation (2018). The Ruderman White Paper on Mental Health and Suicide of First Responders. Retrieved from https://rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty/

World Health Organization (2020). Health and development. Retrieved from https://www.who.int/hdp/en/