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.

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.

June is Men's Mental Health Month and advocates in Ohio and elsewhere are working to eliminate the shame or judgment guys often face when they struggle with mental illness.

Studies show the prevalence of mental health problems is growing among children and adults but men are less likely to seek care.

Javon Howard, manager of engaging men initiatives for the Ohio Alliance to End Sexual Violence, said men need to understand it is OK to have experienced trauma and they need to find ways to better connect to their emotions.

"It's important to bring awareness to this month and bring awareness to men's mental health, because we want to encourage men to seek help," Howard explained. "We want to encourage men to feel like they are able to identify for themselves when they do need help, and to understand how to use the tools that are around them."

Studies show women have a significantly higher frequency of depression and anxiety in adulthood, while men have a higher prevalence of substance use disorders and anti-social behaviors. However, four times as many men die by suicide than women and both categories are on the increase, according to the Centers for Disease Control and Prevention.

Howard noted men often believe they will be perceived as weak if they seek mental health care. He observed the culture often tells men to "just get over it," to "man up" or "quit being a sissy." He added the fact large parts of Ohio are rural rather than urban brings a special set of problems for men seeking help.

"With Ohio being a rural state, the reality of folks having access to services can be difficult," Howard emphasized. "If you live in a community where everyone knows each other, it's harder to keep things closer to what's going on with you."

Howard added Men's Mental Health Month highlights the growing number of men across the country dealing with stress, anxiety and depression. His organization hopes to change attitudes about men seeking help to overcome their problems.

It's been about a year since the official end of the COVID public health emergency - which has led to a significant drop in Medicaid enrollments and a rise in uninsured individuals in Colorado.

This poses challenges for community mental health centers, like the Jefferson Center for Mental Health, where the rate of Medicaid enrollee decline has surpassed earlier predictions. It has remained below pre-pandemic levels since January.

Dr. Kiara Kuenzler, president and CEO of the Jefferson Center for Mental Health, said it's now facing a daunting $6 million shortfall.

"The people that we're serving are just in extreme stress, struggling to deal with regaining health-care benefits. That impacts not only their access to behavioral health care, but all of their health-care needs," she said.

The nonprofit KFF recognizes the need for behavioral health at an all-time high in its 2023 Colorado fact sheet - identifying more people than ever reporting mental health and substance use challenges.

Kara Johnson-Hufford, Colorado Behavioral Health Care Council CEO, emphasized the urgent need for support for these clinics. She noted a projected shortfall of $24 million to $29 million for these centers overall could mean a risk of reduced services, longer wait times and compromised care.

She added many individuals who have lost Medicaid coverage and now have private insurance are also seeking treatment less frequently - or discontinuing it altogether - due to co-pays and deductibles.

"More people than ever are now going without insurance. No longer qualifying for Medicaid, but cannot afford private insurance - or they may be giving up on Medicaid altogether because of the emotional toll of the enrollment process just being too great," she continued.

Johnson-Hufford predicted if reimbursement mechanisms don't keep pace with the need, programs will close. Despite efforts to address the issue, such as helplines and complaint processes, she said the gap in funding remains a critical concern.