More households, workplaces, and schools are struggling with mental health crises, and a new report by the mental health advocacy group Inseparable highlights how West Virginia is handling 988 crisis hotline calls and responses.

Congress passed legislation in 2020 establishing 988 as a nationwide three digit number to access mental health crisis resources, and the number went live in 2022.

Christina Mullins, deputy secretary of mental health and substance use disorders with the West Virginia Department of Human Services, said West Virginia's call center response rate is 90%, noting the state could make policy changes to continue strengthening its crisis infrastructure.

"We actually did some investments early on to help prepare a crisis line be ready for the 988, transition. And you can see from that 90% answer rate, that those investments are paying off and that our residents are getting their phone calls answered here in the state of West Virginia," she explained.

According to reporting by the healthcare organization KFF, West Virginia's age-adjusted suicide rate was higher than the national level in 2021. Suicide deaths have increased fastest among people of color, younger individuals, and people who live in rural areas.

Angela Kimball, chief advocacy officer with Inseparable, said states can build strong crisis response systems, but will need to look beyond Medicaid for funding. She said state legislators can take steps to bolster services, noting the consequences of not addressing the issue will result in people going without help, landing in jail and E.R.s, being hospitalized or worse.

"One in five fatal police shootings involve someone with mental illness. So too often we see really a tragic outcome when people don't get the right help at a less severe level, we see a lot of people who end up in crowded emergency departments," she said.

The report says additional funding opportunities could come from a 988 telecoms surcharge to support crisis lines, which has already been implemented in a handful of states, and, utilizing a federal program under the American Rescue Plan that allows states to receive extra funding for mobile response services for three years.

Some 125,000 children in Michigan struggle with major depression, which can hinder learning, behavior and relationships, according to a recent survey. Research shows the benefits of school-based services to connect them with the care they need.

Together with parents, school mental health resources can help keep kids safe.

Scott Hutchins, who manages the behavioral health unit for the Michigan Department of Education, stresses the importance of these services, especially in light of the pandemic and school shootings.

"Those needs have only been exacerbated since COVID and those other violent tragedies," he said. "So, what mental-health services do is, they allow us to break down the barriers that students need to get the care that they need."

However, the state needs more of these professionals. Michigan has one school psychologist per almost 2,200 students. The recommended ratio is one for every 500 students. The state also requires school districts to include suicide-prevention hotline contact information on IDs for students in grades 7 through 12.

Statistics show youths receiving school-based mental-health services are six times more likely to complete treatment than those receiving community-based services.

Angela Kimball, chief advocacy officer for the nonprofit mental health advocacy group Inseparable, noted that funding is one key challenge in expanding the school mental-health workforce.

"In order to become a licensed professional," she said, "you not only have to pay for schooling, but there's also periods of supervision - where people are essentially working for free and having to pay for supervision as they work towards their credentials."

Kimball said groups like hers are pushing for policies to improve staff ratios and encourage people to consider mental-health careers. In the meantime, if you or someone you know is in crisis, call 988 to be connected with a trained counselor, available 24/7.

About half of youths experiencing depression in Illinois are not receiving treatment. While the state ranks fairly well nationwide when it comes to youth mental health, officials say there is room for improvement.

Andrea Durbin, CEO, Illinois Collaboration on Youth, said anxiety and depression are at an all-time high, especially with LGBTQ youths and those in immigrant families.

"This is a time for us to be compassionate and empathetic and to embrace folks who are feeling this way and to be supportive, and understand where this is coming from and what our responsibility as adults is to protect them," she said.

The state's Children's Behavioral Healthcare Transformation Initiative passed in 2022. It emphasizes the importance of proactive mental-health screening in schools, similar to vision and hearing tests. Now, a new state law requires yearly mental-health screenings for seventh through 12th grade students.

Despite this progress, barriers to community-based mental-health services for youths still exist and include cost, transportation, insurance issues and stigma.

Angela Kimball, chief advocacy officer with Inseparable, said school-based services that provide different levels of support are one of the most effective tools for supporting student mental health and improving access to care.

"We are starting to see some improvements in student mental health, and that's very encouraging, but the need is still very, very high," she explained. "So we can't let our foot off the pedal now. We really need to do everything we can to build the workforce and to make sure students are supported."

She said youth who get school-based services are six times more likely to complete treatment and have improved long-term education and work outcomes. Yet currently, most state schools don't have the recommended ratio of mental-health staff to students. State-funded programs such as the Behavioral Health Workforce Center are working to address the provider shortage. Kimball added that state policies and initiatives that continue to provide solutions to any roadblocks to mental-health services are crucial to providing youths the care they need.

More than 3 million New Yorkers have a diagnosed mental illness but only around one in three can get the care they need to treat it.

The barriers stem from many factors, like so-called "fail first" policies, which require people to try an insurer-preferred medication first, before covering the original prescription.

Matthew Shapiro, senior director of government and cultural affairs for the New York State Chapter of the National Alliance on Mental Illness, said another issue is what are known as "ghost networks."

"In some cases, up to 75% of providers that the insurance company gives to their client don't actually exist," Shapiro pointed out. "They're no longer practicing in the area. We call that 'ghost coverage,' where they're telling you coverage is there and it's not."

A 2023 New York State Attorney General report found 86% of providers listed on health plan networks are not valid listings. The report recommended state regulators crack down on insurers to maintain consistent and accessible levels of care for all. Another barrier is low mental health care reimbursement rates for providers.

As mental health issues rise nationally, insurance coverage needs to meet the moment. Federal laws like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act ensure behavioral health coverage is on par with other health care.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said loopholes in the laws still have to be closed.

"What mental health advocates across the country and in states are pushing for is to make sure when a doctor is recommending treatment, the health plan has to cover those services when they're consistent with what the standards of care are," Lloyd explained.

The biggest challenge to closing loopholes is lawmakers finding the political will to do so. Lloyd added the overall goal is to align providers' and insurers' standards of care, so patients get the treatment they need.