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As we focus attention on mental health and suicide during National Suicide Prevention Week, Sept. 7 – 13, a new national survey about mental health and suicide provides some insight on Americans’ understanding and perceptions.

According to the survey, U.S. adults recognize the importance of mental health care to overall health, but don’t feel the current health care system matches that need. The overwhelming majority of adults (89 percent) feel that mental health and physical health are equally important and feel that health services that address mental health, such as treatment for depression and suicide prevention, should be part of any basic health care plan (92 percent). However, less than one-third (28 percent) feel that mental and physical health are treated equally in our current health care system.

The online survey was conducted in August for the Anxiety and Depression Associations of America, the American Foundation for Suicide Prevention and the National Alliance for Suicide Prevention.

Suicide has touched the lives of most adults — more than half (55 percent) of adults say they know someone who has talked about/attempted/died by suicide. Nearly three quarters of adults (74 percent) feel that most people who die by suicide show some signs before, and more than 40 percent feel it can be prevented always/often. Yet only a quarter (26 percent) think they could tell if someone is suicidal.

Americans are savvier than ever about the need for access to mental health care and its pivotal role in preventing suicide. As important is the fact that addressing mental health problems also improves outcomes for physical conditions as people become better able to take care of themselves.”Maria Oquendo, M.D., APA President-elect

Stigma of mental illness and suicide still plays a big role in people not seeking treatment. When it comes to seeking treatment, the survey found age made a difference. Younger adults ages 18-34 are more likely to consider it a sign of strength to see a mental health professional, compared with older adults, and also more likely to believe that suicide can always or often be prevented. Adults ages 54 and younger are more likely to have received treatment for a mental health condition than those 55 and older.

The survey also addressed peoples’ understanding of potential risk factors for suicide. The top two categories, each identified by 86 percent of adults, were mental health conditions (including depression PTSD and bipolar disorder) and life situations (including feeling hopeless, being bullied, financial problems, relationship problems, losing a job and going through a divorce). Drug and alcohol use and chronic condition/pain were each identified by about two-thirds of adults while less than half (47 percent) identified anxiety/panic disorder as a risk factor for suicide.

Despite many efforts and much progress, suicide continues to be a major issue across the country. Both the total number and the rate of suicides increased every year from 2005 to 2013, according to the Centers for Disease Control and Prevention. On average, a person dies by suicide every 15 minutes in the United States.

Some recent research shows promise in helping to prevent the tragedy of suicide and reversing this upward trend. The Veterans Health Administration (VHA) is using electronic health records data to help identify people at high risk of suicide. Researchers used the large volume of data available through the VHA to develop a predictive model of suicide risk. The research, involving data on more than 3,000 suicides and more than a million control patients, is the result of a collaboration between the Department of Veterans Affairs (VA) and the National Institute of Mental Health. Because this analysis uses the kinds of data common to large health systems, this research and knowledge holds promise for helping to prevent suicides in other areas beyond the VA.

Suicidal behavior is preventable and controlling the psychiatric conditions associated with it, whether with medication or psychotherapy is key,” noted APA President-elect Maria Oquendo, M.D. “We also now have interventions that target the suicidal behavior itself and patients can develop coping strategies to deal with suicidal thoughts or impulses.”

New research from Johns Hopkins University (1) found that state laws making it harder to get handguns were associated with a reduction in suicide deaths. Moreover, it is now evident that suicidal behavior runs in families, and appears inherited independently from psychiatric disorders. (2) That is, it is not simply that psychiatric illness is familial and increases risk for suicide. For example, some families with depression have suicidal behavior amongst its members, while other families with depression do not.

Clearly public perception and lingering stigma of mental illness and suicide play a role and talking about suicidal behavior openly in affected families can help individuals and their relatives identify suicidal thoughts or urges as requiring medical intervention. Interestingly, a recent public survey asked American adults what they thought would help reduce the number of suicides.

A growing movement is using the semicolon, and in particular a semicolon tattoo, as a symbol of hope for people with mental illness. The Project Semicolon website describes the meaning behind the symbol:

A semicolon represents a sentence the author could have ended, but chose not to. The sentence is your life and the author is you.”

It represents a choice to live on especially for those who may have considered ending their lives.

The project has inspired many people to tattoo or draw the symbol in creative ways to symbolize their own struggles or to honor or support loved ones who have struggled. The project encourages people to use social media to promote the message and continue the conversation, sharing pictures and stories of hope and strength to help end the stigma of mental illness and encourage those who are struggling feel safe and comfortable enough to reach out for help.

Project Semicolon was founded Amy Bleuel, a Green Bay, Wisc., artist. She lost her father to suicide and initiated the project as a way to honor her father. “I wanted to tell my story to inspire others to tell their story. I wanted to start a conversation that can’t be stopped, a conversation about mental illness and suicide so we can address it,” Bleuel told USA TODAY Network in a recent interview.

While this initiative is one of many aimed at raising awareness, fostering hope and fighting the stigma of mental illness, its simple and powerful message and symbol seem to be resonating with many. The project’s Facebook page has more than 100,000 likes and it has nearly 20,000 followers on Instagram.

In 2014, 9.4 million adults aged 18 or older reported they had thought seriously about trying to kill themselves at any time during the past 12 months and more than one million attempted suicide, according to new data from the Substance Abuse and Mental Health Services Administration (SAMHSA).

A new resource is available to help people who have attempted suicide take their first steps toward healing and recovery. A Journey Toward Health and Hope: Your Handbook for Recovery after a Suicide Attempt was developed by SAMHSA and features firsthand experiences of individuals who have survived a suicide attempt and their supporters.

We often focus more on treating illnesses, both physical and mental, than on staying healthy. But the absence of mental illness does not necessarily mean good mental health.

What is mental health? According to the World Health Organization, mental health is “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.” As we observe Mental Illness Awareness Week this week it is a good opportunity for self-assessment with a brief mental health checkup.

A Brief Mental Health Checkup

While not exhaustive, this list provides a starting point to examine how you’re doing emotionally and mentally. If any of these items raise a concern, talk with your health care provider.

Concentration

Are you able to focus on the task at hand and get it done in a timely manner? Or, do you find yourself overrun with missed deadlines and undone chores? Poor concentration is a hallmark of ADHD, but it can also be a symptom of depression or anxiety.

Tuning In

One characteristic important to good mental health is knowing yourself (being self-aware). How “in touch” do you feel with yourself? Do you feel like you’re experiencing emotions and don’t know why? It’s not uncommon to get so busy that you don’t have time to process what is happening on an emotional level. However, taking time to process events and emotions by writing in a journal or talking with a friend can be important to good emotional health.

Avoidance

Do you feel like you’re avoiding yourself? It may seem like a funny question, but if you find yourself trying to keep from being alone, there could be something you are avoiding emotionally. Many people find feelings of anxiety or worry are intensified when they are alone, and so find ways to stay busy.

Mood

Do your moods feel pretty stable, or are you experiencing significant mood swings (highs or lows)? Are you crying more than usual? Feeling persistently depressed for two weeks or more could indicate clinical depression. Talk to your health care provider.

Energy

Do you feel that you have the energy to do the things you need and want to do? Fatigue can be a sign of depression, anxiety and other mental illnesses, but it can also be a symptom of many physical illnesses. If you find that you are feeling unusually fatigued, contact your doctor.

Sleep

How are you sleeping well at night? Do you wake rested? Poor sleep can often be a sign that there is something troubling you emotionally. When under stress or dealing with a more serious mental illness, many people have trouble falling asleep or wake frequently during the night.

Tension, Anxiety

Are you feeling tense and anxious all the time? Is it hard to unwind at the end of the day? We live in a fast-paced society that is frequently stressful. However, if you’re unable to take mental breaks and relax for a few moments, then your stress could be approaching dangerous levels. Relaxation is a skill that many of us have to learn and practice. There are many ways to help you relax such as meditation, yoga and progressive muscle relaxation.

Balance

Is there an appropriate balance between your home life and your work life? Are you getting in some “me-time,” including physical exercise and spiritual pursuits? Achieving perfect balance is probably not possible, but it’s worth striving for!

Adapted from a previous series of posts from by Gina Duncan, M.D.

Recent federal laws have expanded health insurance coverage of mental health and substance use disorders, but accessing that coverage can be difficult and complicated. Many barriers still exist and challenges can vary from state to state. To enforce the law, federal and state agencies need to hear from you about possible violations. A number of new resources are available to help you understand your rights to coverage under the law and to get access to the coverage you deserve.

If you’ve been denied coverage, had limits set on behavioral health services, or are being charged more for behavioral health services than general medical services, that may be a violation of the law. But how do you know if it’s a violation and what can you do about it?

“How to File a Complaint” and Poster on the Law

The American Psychiatric Association has developed a poster, Fair Insurance Coverage: It’s the Law (available in English and Spanish) that outlines the patient rights under federal law.

APA has also developed step-by-step guidance and template letters to help you file a complaint. Depending on the type of insurance you have, you will need to file a complaint with the U.S. Department of Health and Human Services, the U.S. Department of Labor, or your state insurance commissioner. See instructions on how to file a complaint.

Download the Mental Health Parity Poster

Parity Tracking Website

A new website, Parity Track, can also help you understand your rights under federal and state law. It provides simple explanations of common parity violations, such as “I have limits on how many times I can see a behavioral health provider” and “I am being charged more for prescription medication for behavioral health treatment than I am for prescription medication for other treatments.”

The site includes federal and state-by-state breakdown of parity legislation, regulations and litigation (see map below). It also has stories from across the country and highlights of some promising state initiatives. For example, new legislation in Missouri specifies how insurance plans should cover eating disorder treatment. New legislation in Maryland requires coverage of partial hospitalization for behavioral health treatment at the same terms as for other medical treatment.

Parity Resource Guide

A recently updated resource guide can help. The Parity Implementation Coalition* in conjunction with The Kennedy Forum recently published an updated version of the Parity Resource Guide for Addiction & Mental Health Consumers, Providers and Advocates, Simplifying the Appeals Process: Strategies for Winning Disputes with Your Health Plan.

The guide provides information for patients and families on the steps they can take to ensure they receive the same type of insurance coverage for mental health and substance use treatment as they receive for physical illnesses. It breaks down and simplifies the process and terminology, such as what a parity violation looks like and how an individual should initiate an appeal. It also explains medical necessity in regards to mental illness and the appeals process.

Parity Implementation: Legislation, Regulatory Action, Litigation from Parity Track