When it comes to reporting on mental health in Utah, there’s a lot of smoke—but figuring out what caused the fire can be tricky. Fortunately, it’s a mission that a number of groups, experts and elected officials care about immensely and are working to address. The most recent data we have shows that Utah has a higher prevalence of adult mental illness than any other state. Utah also has the highest rate of suicidal ideation among adults, with a suicide rate that has been consistently higher than the national rate for more than a decade, and suicide was the leading cause of death for Utahns ages 10-17 and 18-24.
Supporting research into the underlying causes of and contributing factors to mental illness and substance abuse disorders is just part of the mission of the Huntsman Mental Health Institute (HMHI) at the University of Utah. Dr. Mark H. Rapaport, M.D. is the CEO of HMHI and has been with the institute since its founding in early 2021. He’s also the Chairman of the Department of Psychiatry and serves as the second William H. and Edna D. Stimson Presidential Endowed Chair of the University of Utah School of Medicine.
“We have a higher rate of certain mental health disorders than other places in the country, but we’re doing something about it—and researching it,” says Dr. Rapaport. One area of research is looking at the relationship between altitude and suicidal thoughts. Rapaport references the work of Dr. Perry F. Renshaw, M.D., Ph.D., M.B.A., who has studied extensively the impact altitude can have on the brain. His research has shown that hypobaric hypoxia (the reduced oxygen we experience at high altitude) can also lead to an increase in depression and poor air quality is linked to suicide risk.
While the air and altitude likely contribute to the comparatively high prevalence of suicidality and depression in Utah, genetics play a role as well as culture. “Utah has a tradition of rugged individualism,” explains Dr. Rapaport. “It has created an environment that, at times, has put pressure on people to perform and be strong and independent, rather than acknowledging that they’re talking about a brain disorder.” There is also a strong emphasis on being of service to others here. “Individuals in this community might feel ‘I can’t let others down’ and ‘I have to contribute’ or ‘be a good member,’” he says. “That comes with a lot of strings and puts pressure on people, especially younger individuals, and that may be a factor as well.”
Another contributing factor to a higher prevalence of mental illness, unique to Utah, could be the two-year mission undertaken by many young members of the Church of Jesus Christ of Latter-day Saints. “We’re a community where so many young people of ages 18–22, go away to foreign places, leaving home, for years. This process is very stressful on young people,” he says. “Going to a country where you don’t know the language or culture for an extended time creates a very stressful environment. To my knowledge, the LDS Church is aware of this and is taking steps proactively to deal with it.”
When it comes to improving the outcomes for people with mental illness and substance abuse disorders, Dr. Rapaport says HMHI is campaigning to eliminate the surrounding stigma. There’s self-stigma, often characterized by feeling shame and guilt for having an illness or disorder. People might think “if I were just tougher or if I just prayed more, I could handle this.” “Self-stigma isolates people and prevents them from seeking out resources because they believe they’re somehow defective,” says Rapaport.
There’s also institutional stigma. For instance, “mental health services and substance abuse services are often carved out and don’t get the same amount of support as physical health,” he says. “We also criminalize substance abuse disorders.” Societal stigma manifests as a tremendous bias in giving community support. As an example, if one child in a neighborhood is diagnosed with a brain tumor, their family is going to receive an outpouring of support from neighbors, but a child diagnosed with a brain disorder might not garner the same.
“One of the things we need to do, we’re already doing—a thoughtful, concerted and long-term effort to eliminate prejudice and stigma,” says Rapaport. “We also need to increase funding for this kind of work. If we funded this appropriately, the cost savings for the state would be astronomical. It’s one of the reasons all of the institute’s projects also involve examining the economic and social impacts.”
That said, Dr. Rapaport appreciates the work the Utah State Legislature has done to support mental health resources in recent years. “Our state legislature has been more pro mental health than any other. Over the last five-plus years, we’ve passed more positive-impact mental health legislation than any state in the nation.” Resources for those in a mental health crisis, including the state’s Crisis Line and Mobile Outreach Teams and the SafeUT app for students, are all coordinated under one roof. It put Utah in a unique position to be set up for the integration and implementation of 9-8-8, the new three-digit calling code for the National Suicide Prevention Lifeline mandated by U.S. Congress. Says Rapaport, “We already had the foundation together.”
SafeUT is a 24/7 crisis chat and tip line that provides real-time crisis intervention for students, connecting them to licensed counselors with the push of a button. It was created by legislation and rolled out in 2016. It’s also free to use and staffed by counselors at Huntsman Mental Health Institute.
“The app promotes school safety, prevents violence and helps prevent kids from becoming alienated and disenfranchised. The anti-bullying aspect of the app is a wonderful example of a tool that can proactively be used to prevent kids from acting out against others,” says Dr. Rapaport. The app also allows students to confidentially report tips related to bullying, threats of violence at school and other emergencies.
“What we have here is a true resource that other places in the nation are interested in learning more about,” says Dr. Rapaport. “We’re setting what will become the standard.”
Crisis and Prevention Hotlines
Child Abuse/Neglect: 1-855-323-DCFS (3237)
Crisis Line & Mobile Outreach Team: 1-801-587-3000
National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or 9-8-8
Sexual Violence Crisis Line: 1-888-421-1100
Utah Domestic Violence: 1-800-897-LINK (5465)