RICHMOND, Va. - Substance-use disorder can go hand in hand with mental-health issues, and folks in rural Virginia can take a mental-health first-aid training course to better tackle the problem.

The free two-day program takes place starting January 7 and will focus on a five-step action plan that helps folks recognize signs and symptoms.

Certified Mental Health First Aid trainer Jordan Laney is the program coordinator for the Virginia Rural Health Association, and is leading the course sponsored by the association.

She said the session is especially timely as the Appalachian region, and much of America, has been hit hard by a spike in drug overdoses during the pandemic.

"While we're working through COVID," said Laney, "I think that mental-health issues are intensified really by isolation and anxiety that the pandemic has brought into everyday life. And being able to support one another and talk about things that are often stigmatized is incredibly important."

She said folks will need Internet access to participate in the virtual training. For more information or if you need help accessing broadband, go to the Virginia Rural Health Association website at VRHA.org.

Katrina Broughman is the director of Recover Virginia/Recover Fest, which is co-sponsoring the training session. She said folks who live in rural areas have been hit hard even before the pandemic by substance-use disorder and mental and behavioral issues.

"We don't have as much access to mental-health services and programs as people who may be in a more urban area," said Broughman. "So I find it very important, and anything we can do to help people to make them feel like they're not being left behind and that their mental health and physical health matters."

More than 100,000 Americans died of overdoses during the pandemic's 12-month peak that ended in April, up almost 30% from the 78,000 deaths the previous year, according to data from the National Center for Health Statistics.

Nevada is among a handful of states to add a surcharge to all phone bills intended to help support the state's 988 mental health emergency hotline.

A new report by the mental health advocacy group Inseparable found if the surcharge were to increase from 35 cents to 98 cents, it would generate approximately $3 million annually for the Silver State.

Angela Kimball, chief advocacy officer for Inseparable, said the report is a tool to help policymakers and state leaders develop an equitable and sustainable crisis response system. They found Nevada's in-state answer rate sits at 68%, when it should be above 90%.

"We're still a long way from having the kind of system that everybody expects in every ZIP code, in every part of America," Kimball acknowledged.

Kimball pointed out with the implementation of 988, it also brought about changes in the way local jurisdictions respond to mental health crises. The report highlighted Nevada has convened a workgroup to build response processes for collaboration between 988 and 911. While it is a step in the right direction, the report showed Nevada could improve call center capacity, crisis response as well as system financing.

Nevada has the 39th highest suicide rate in the country and also ranks 50th in the nation for overall mental health, according to the Nevada Division of Public and Behavioral Health.

Kimball stressed the figures need to see improvement. She added not having an effective response system in place can make a difference between life and death for some.

"People going without help, being turned on to the streets, being in jail, being in emergency departments, being hospitalized -- voluntarily or involuntarily -- or, tragically, having their life end," Kimball noted.

Kimball added the report lays out policy examples for each of their policy recommendations which come from red and blue states moving the needle in the right direction. She hopes they can serve as inspiration for other states. If you or someone you know is experiencing a mental-health emergency, do not hesitate to call or text 988.

Florida is getting attention for its efforts to create a comprehensive crisis response system for mental health needs.

A new report by the mental health advocacy group Inseparable calls for policies to expand 988 call center capacity, increase the availability of mobile response units, create more crisis stabilization centers and establish stable funding mechanisms to sustain the services.

Melanie Brown-Woofter, president of the Florida Behavioral Health Association, said the Sunshine State is doing all that and more to provide care for anyone in crisis, including adding more clinics.

"And now the certified community behavioral health clinics, we are really building an entire system that allows an individual in crisis to seek care and be linked to the right level of care at the right time," Brown-Woofter explained. "And to have those resources available that they need."

She pointed out with Florida operating mobile response teams for over 30 years, it is well ahead of other states. She notes the increased state funding to expand services and to establish central receiving facilities, which are not yet available in every state.

The facilities provide what she described as a full continuum of care, from crisis intervention to residential treatment, detox services and child care, all in one location.

Angela Kimball, chief advocacy officer for Inseparable, said it features solutions designed to ensure everyone in a mental health crisis receives the right services at the right time and provides a detailed roadmap for lawmakers.

"Our real goal here is to help create a very visual, easy to understand tool that lets them understand how they can be that champion," Kimball emphasized. "That helps ensure that no one's worst day keeps them from living their best life."

Another objective for Kimball is to spark conversations about what is achievable. For instance, the report showcased Oklahoma's RideCare program, which offers non-law enforcement transportation to urgent recovery centers. Oklahoma also distributed nearly 30,000 iPads equipped with crisis de-escalation tools to first responders and others.

Georgia provides "Peer2Peer Warm Lines" offering 24-hour support from trained specialists to people facing challenges who may not require emergency response.

Wyoming ranked highest in the nation for suicide rates four consecutive years through 2021, according to the Centers for Disease Control and Prevention, and the state is funding more crisis response.

About 90% of calls to Wyoming's 988 crisis response line get an in-state answer, according to a new report. Calls used to be routed elsewhere, but the state has been working to localize responses.

Two Wyoming call centers opened in 2020 to offer 24/7 support and now average about 500 in-state calls per month, according to the Wyoming Department of Health.

Kim Deti, public information officer for the department, said the state is currently working to house the helpline's text and online chat options in-state too, and a local connection is important.

"We believe that people within Wyoming, whether they're calling, texting or chatting, they may feel more able to connect and relate to someone from their area," Deti explained.

A 2023 state law created a trust fund for the program but failed to add money to pay for it. This year, a proposed $40 million allocation was reduced to $10 million in the final state budget. Federal funds are also available through July 2025.

If you or someone you know is in crisis, help is available by calling or texting 988.

The nonprofit Inseparable published a report this month to improve crisis response systems. It encourages states to pursue policies to develop system infrastructure, accountability, workforce capacity and sustainable funding.

Angela Kimball, chief advocacy officer for the mental health advocacy organization Inseparable, said in terms of payment, response to mental health emergencies should look like the response to other emergencies.

"Police come. They don't ask whether or not there's an insurance card or a payer first. And the same is true for mental health, substance use, and suicidal crises," Kimball urged. "We want there to be a response regardless."

Kimball argued there should be funds for mental health crises beyond Medicaid.