September is National Suicide Prevention Awareness Month, a time to shed light on what continues to be one of the toughest topics to discuss for many people and families.

Almost 1,500 people in Georgia took their own lives in 2020, according to the Centers for Disease Control and Prevention; nearly 14 people per 100,000 Georgia residents. And of course, every suicide affects friends and family members as well.

Kim H. Jones, executive director of the National Alliance on Mental Illness-Georgia, said they are working to prevent all suicides.

"NAMI Georgia's mission is to empower our affiliates to be able to support, educate and advocate for people with mental illnesses in their community," Jones explained. "Our goal for suicide is the 'zero suicide,' you know. That is just something that is unacceptable to us."

The theme of this year's awareness month is "Together for Mental Health," focusing on the need for more mental-health resources. Suicide is not just a growing issue in Georgia, but across the nation. The CDC reported in 2020 nearly 46,000 people took their own lives.

In July, the number 988 was rolled out as a new, shorter suicide-prevention hotline, and Jones pointed out it has already led to an increase in calls. Prior to 988, Georgia already had a toll-free number, the Georgia Crisis And Access Line, or "G-CAL." She noted anyone who calls the hotline today is routed directly to 988, where help and resources are available.

"The intention is that you get a live person who can direct you to a physician or clinician, whatever might be needed for you to help you process the situation that you're in," Jones emphasized. "That could be just not feeling well and being depressed, all the way up to suicide, up to crisis."

To prevent suicide, Jones stressed it is essential for people to pay more attention to warning signs and to take note if something seems different with a friend or loved one.

"Somebody who is seriously considering suicide maybe seems depressed for a while, and then all of a sudden, they'll have an uptick of happiness," Jones suggested. "That usually comes from that they have made a decision to act on their suicidal thoughts, and they become relieved and happy. They start giving away prized possessions."

According to the alliance, almost 5% of adults consider suicide at some point in life. Among high school students, the figure increases to almost 19%, and 45% for LGBTQ+ young people.

Most South Dakotans live in federally designated mental-health professional shortage areas, and a new report recommended steps Congress and other decision-makers can take to help states close gaps within the behavioral health workforce, amid a growing demand for mental-health services and a shortage of licensed providers.

Kendall Strong, senior policy analyst for the health project at the Bipartisan Policy Center, said one solution is to enhance the role of those with mental-health training who do not have the full credentials. She argued behavioral-health support specialists are certainly up to the task.

"These people are underutilized," Strong contended. "They have a lot to offer because part of the folks that we're talking about are folks like peer-support specialists, who have lived experiences and can really connect with folks who are struggling."

Others in the group are community health workers and paraprofessionals. The report recommends reducing barriers for them to take on bigger roles in behavioral health, including adopting a certification framework to promote flexibility but still protect patients.

Strong acknowledged a divided Congress might provide obstacles but added there is optimism with both parties recognizing the provider shortage.

The report advised pulling in more help can free up licensed providers who are dealing with patient backlogs. Strong added behavioral health support specialists are embedded in the community and can meet in a nonclinical setting. She suggested it can be especially helpful in rural areas where mental-health stigma still might exist.

"In areas where there is just less infrastructure visibility as compared to urban areas, it's really clear if you're going into a health care facility," Strong noted.

The report also called on federal officials to explore expanding Medicaid and Medicare coverage of services provided by behavioral-health support specialists.

The Kaiser Family Foundation said South Dakota has nearly 60 areas with provider shortage designations, which affects nearly 800,000 residents.

A recently proposed plan has been devised to better fund Virginia's mental-health programs.

The new Right Help, Right Now plan calls for $230 million in funding for upgrades to the state's mental-health system.

Some elements of the plan include expanding mental-health programs in schools, growing tele-behavioral health operations in high schools and college campuses, and creating more than 30 mobile crisis centers.

However, some feel the plan is a good start with more to be done.

Bruce Cruser - executive director of Mental Health America in Virginia - said in the past, more money has been put toward hospital care than community care. Although this plan changes that dynamic, he outlined what else needs to be addressed in the state's mental-health landscape.

"What we don't see there is funding for the Community Services Board's employees," said Cruser, "and they're really the front line of care in the community to help prevent people from having to go into the hospital. And so, what we'd really like to see is some additional funding to make up the ground for the Community Services Board, the direct care staff."

The plan finds 106 of Virginia's 133 counties are classified as having a mental-health professional shortage.

Cruser said the COVID-19 pandemic only exacerbated existing flaws in Virginia's mental-health system. This resulted in less people being able to get the help they needed.

While he said it's fortunate to see the attention this plan is creating, he noted that it's a shame it took years of crisis to reach this turning point.

Although the plan has great support, Cruser also noted that there will be challenges to implementing this plan. Specifically, he noted that the pay rate from insurance or Medicaid needs to be increased.

But, Cruser said he feels there are two elements of this plan which ensure people won't always end up in hospitals for behavioral-health issues.

"The mobile crisis and the crisis receiving centers would help build up that continuum of care in the community so that people don't have to end up going to the hospital," said Cruser, "They can get the care they need, they can get the crisis resolved, they can find the services that they need in the community with much better outcomes."

He added that this would boost the state's mental-health system a lot.

Over the Virginia General Assembly's next legislative session, Cruser said he is eager to see this proposed plan become a package of legislation that'll advance the state's mental-health system.

One in 11 Missouri children, and one in 13 nationally, will lose a parent or sibling by age 18.

Childhood grief that is not dealt with can have short and long-term negative effects, including school problems, mental health issues and even a shortened life span.

Becky Byrne, founder and executive director of Annie's Hope, The Center for Grieving Kids in Glendale, explained kids grieve differently than adults, so it is not always obvious when they are struggling. She emphasized anyone can help a grieving child if they can overcome their fear and discomfort.

"And if you can't figure out what to say, just simply say, 'I want to be able to help you, I do not know what to say.' You don't have to be a trained professional," Byrne explained. "All you have to be is human, and willing to open up yourself to hear somebody else's pain."

During eight-session family support groups, she noted Annie's Hope pairs children with their peers and adults with adults. Byrne pointed out death affects the whole family system, and adults can learn about ways to best help their children at home.

Cindy Izzo, school support and education coordinator for the organization who facilitates the six-week school-based program, said it is especially important for kids who are not attending a grief support group outside of school, and it provides additional training for school professionals.

"We are showing the kids in the school that they are not the only one who is grieving," Izzo stressed. "Really, our group of participants is just the tip of the iceberg. So then, we're also connecting the students to the adults in the school who will provide that ongoing support for them."

Byrne added peers who are experiencing the death of a loved one can be immensely helpful to each other.

"When you find somebody who's your contemporary -- who this makes total sense to, and they can validate you -- that makes it like, 'Oh well, if that person can do it, maybe I can do it.' You immediately get this head start if it's a peer," Byrne stated.

For grieving families unable to attend an in-person support group, Byrne suggested virtual groups can also be helpful.