As San Francisco's budget process gets underway in the coming months, many competing interests will be vying for funding. Mental health services are critical, yet often overlooked, particularly regarding suicide prevention. A report last week in the New York Times makes the need clear: suicide in the United States has surged to the highest levels in nearly 30 years, based on a federal data analysis. The paper reported that increases have been found in every age group except older adults and that the numbers have been substantial among middle-aged Americans, a group whose suicide rates had been stable or declining since the 1950s.
This news is no surprise to the LGBT community. For years, reports have examined suicide among LGBT Americans and have found that rates are higher than average, particularly among LGBT youth, and the transgender community. According to a 2014 report by the Williams Institute at UCLA School of Law, the prevalence of suicide attempts among respondents to the National Transgender Discrimination Survey, conducted by the National LGBTQ Task Force and the National Center for Transgender Equality, is 41 percent, which vastly exceeds the 4.6 percent of the overall U.S. population who report a lifetime suicide attempt, and is also higher than the 10-20 percent of lesbian, gay, and bisexual adults who report ever attempting suicide.
Now, the Times analysis shows that the overall suicide rate rose by 24 percent, from 10.5 to 13 per 100,000 population from 1999-2014, according to the National Center for Health Statistics, which released its study last week.
The Williams Institute report summarized that the most striking finding of its analysis was "the exceptionally high prevalence of lifetime suicide attempts reported by NTDS respondents across all demographics and experiences."
"Based on prior research and the findings of this report, we find that mental health factors and experiences of harassment, discrimination, violence, and rejection may interact to produce a marked vulnerability to suicidal behavior in transgender and gender non-conforming individuals," the report's executive summary stated, calling for additional research.
The NTDS survey had responses from 6,456 self-identified transgender and gender non-conforming adults over the age of 18. The Williams Institute report stated that the survey had its limitations, but it did provide lots of information about employment status, relationship status, education, and household income. Yet across all areas, there were still high percentages of suicide attempts.
San Francisco offers a range of behavioral health programs, including those designed for the LGBT community. Some are offered by nonprofits, like the UCSF Alliance Health Project, others operate through the health department's clinics and other programs. But funding is a constant struggle and the Board of Supervisors and Mayor Ed Lee must provide leadership, even though the mayor has asked all city departments to trim their budgets by 1.5 percent. This week, Lee, in an editorial board meeting with the Bay Area Reporter, discussed how passage of Proposition A, a $350 million bond measure to seismically retrofit Building 5 at San Francisco General Hospital, could increase mental health services because it would preserve access to the 24/7 psychiatric emergency services, with added capacity.
Not everyone with mental health issues is suicidal, of course. But it's sobering in the context of the increased suicide rate in the U.S. that mental health services often take a back seat to other health issues. Counseling costs money. Therapy costs money. Helping someone get their life on track is not always easy. External factors like having a job and stable home life are also important. San Francisco is known as a city where people help each other, and that's harder to do when there are constant budget cuts in social service programs or wait lists because there isn't enough funding. This is especially true for the LGBT community, which has never really recovered from the closure of its only dedicated mental health agency years ago. Other nonprofits did step in to fill the void left by the closure of New Leaf: Services for Our Community, but nothing can take the place of an agency solely dedicated to mental health for queer people.
We would urge the supervisors and mayor to increase spending for mental health, so that more people can get the treatment they need.