Utah’s mental health crisis demands a response from its next governor, that much the candidates agree on, but what is the role of the state government in reducing the stigma on asking for help, or pushing insurance companies to improve benefits, or increasing the number of counselors who work in rural areas?

There remains some debate in those areas among the four Republicans and one Democrat seeking the state’s top elected office.

But just getting to this starting point feels like a win for state Rep. Steve Eliason, R-Sandy, who has made mental health the focus on his legislative service.

“It may be the first gubernatorial race in the state’s history where several candidates are having that as part of their platform,” Eliason said. “It’s quite refreshing, if you ask me.”

Times of crisis

Fewer than half the adults with a mental illness in Utah are getting treatment or counseling, and suicide is the leading cause of death for the state’s youths. Last year, Utah landed at the bottom in a national mental health ranking because of its high rates of mental illness and suicidal thinking and significant unmet needs.

On average, about 620 Utahns have died by suicide annually over the past five years, and the state’s age-adjusted suicide rates were the fifth-highest in the nation, according to state data.

And that was before the coronavirus and its economic consequences straining government resources and deepening anxiety and depression.

The man who emerges victorious in November will likely have to meet a growing disparity between the state’s mental health needs and its ability to meet them.

The five candidates — including the four Republicans, Lt. Gov. Spencer Cox; former Gov. Jon Huntsman; former state GOP Chairman Thomas Wright; and former House Speaker Greg Hughes, along with Democrat Chris Peterson, a University of Utah professor — acknowledge the state’s significant mental health needs. And despite recent investments, Utah’s safety net has holes, advocates and candidates say.

On his campaign website, Wright says mental illness in the state is “at unprecedented levels.” Huntsman also says on his website that Utah is experiencing a crisis on mental health issues and has had a “collective failure” on the issue.

Huntsman said the governor is in “perhaps the most powerful position” aside from individual parents to lead a conversation about mental health.

“Which is what I want to do by declaring war on mental illness as soon as I get elected,” he said.

Cox has spoken openly about his own suicidal thoughts when he was a child, dealing with bullies at school and battling the feeling that the world might be better off without him.

He first shared the story a few years ago, hoping to open up the conversation on suicide and mental health issues. Since then, he estimates he’s repeated it dozens of times in schools and to groups of young people.

A report last year by University of Utah’s Kem C. Gardner Policy Institute identified stigma as one of the primary barriers to seeking mental health treatment, and all the gubernatorial hopefuls agree the state’s next top executive must use the office’s platform to help combat these attitudes.

Hughes said he once adhered to an “old-school mindset” that people dealing with depression or suicidal ideation should simply focus on the positive and fill their time with constructive activities. Hearing from experts and watching the statistics have changed his thinking, he said.

“I’ve seen enough now in terms of what kids are grappling with,” he said. “I’ve had that paradigm shift as a policymaker.”

Cox believes Gov. Gary Herbert’s youth suicide task force, which he and Eliason have co-chaired, and other initiatives have succeeded in removing some of the shame that can be attached to conversations about mental health. But he says there’s more to do.

Last week, Cox and Eliason announced the launch of Live On, a three-year campaign to prevent suicide by offering education and resources.

“We’re changing culture,” Cox said at the news conference. “We’re understanding that having mental health issues doesn’t mean you’re broken, doesn’t mean you’re flawed.”

Rural help

In recent years, a handful of mobile crisis teams have formed to help people through mental health emergencies. Brandon Hatch, CEO of Davis Behavioral Health, said the state now has five teams serving Weber, Davis, Salt Lake, Utah and Washington counties.

Made up of mental health professionals, the teams pull up in an unmarked van to assist someone in need, said Cox. It’s a preferable alternative, he said, to sending an ambulance and police officers who aren’t necessarily trained to deal with mental health emergencies and whose presence draws attention when a family might want privacy.

But because vast portions of the state are outside the reach of the mobile teams and crisis centers, advocates say too many people are still ending up in jails or emergency rooms.

Earlier this year, Eliason, who declined to say which gubernatorial candidate he supports, passed a bill that would fund several behavioral health “receiving centers,” or safe spaces where people can weather a crisis and receive care. The legislation would also create three new mobile teams to cover rural Utah, he said.

However, the roughly $11 million in annual state funding for those initiatives is now on the chopping block as lawmakers consider rolling back virtually all new spending to cope with the budgetary hit from the coronavirus outbreak.

Cox, Huntsman, Wright and Peterson contend that legislators should preserve funding for Eliason’s bill, predicting a surging need for mental health services in the pandemic’s wake. Hughes said he’s not so sure.

“You couldn’t answer that," he said, “without knowing the other areas of our state budget that are at risk of being defunded as well.”

Mental health workers

Wright says one of the most heartbreaking conversations he’s had on the campaign trail was with a mother who told him she called for professional help for her suicidal child. She was told an appointment wasn’t available for the next nine weeks.

“What do you do with a child that’s suicidal for nine weeks while you’re waiting for an appointment?” Wright said. “We need to change.”

Huntsman says the state hasn’t undertaken a comprehensive review of its current and future mental health needs and that he would launch such a project.

“We have never done a long-term study in the sense that we do a long-term study for water or power or education, for example,” he said. “We just don’t think about mental health in that same context, and I would submit that we need to begin seeing mental health in that same spirit.”

Cox said the state has mental health provider shortages at different points along the service spectrum, from crisis care to helping a college student who just needs to talk to someone. The SafeUT app has helped fill the gap, he said, and some institutions in the state are recruiting students who are interested in entering the mental health profession.

The idea is to pair these volunteers with other students who need a listening ear or are struggling with the transition to campus life but who don’t necessarily require professional help. If that works, Cox said, state officials can look at expanding that concept.

If elected, Wright said, he’d tackle this provider shortage by trying to deregulate the industry.

“I have talked to several mental health professionals who say that they spend so much time on paperwork, that they’re seeing patients less and less,” he said.

Wright also suggests the state should support vocational training in mental health fields for some people who lost jobs because of the current economic turmoil.

Insurance

A shortage of rural mental health care providers exacerbates the problems for residents in remote areas. Telehealth is one potential solution that has gained traction during the pandemic, said Nanci Klein, professional affairs director for the Utah Psychological Association.

The problem is that insurance companies typically reimburse mental health providers at lower rates for virtual appointments compared with in-person visits, she said. Insurance carriers have offered equal reimbursement during the coronavirus but are starting to return to normal, she added.

Huntsman and Peterson argue that part of making mental health care more accessible is pressing insurance providers to offer adequate coverage.

“The insurance companies are not being fair in terms of giving equity to both physical health and mental health, and until they do, we have a problem,” Huntsman said, adding that he wouldn’t be satisfied as governor until this parity exists.

Peterson agreed that insurance carriers don’t give equal weight to physical and mental health care.

“That’s a mistake," he said, “and I would proactively manage the Utah Insurance Department to make progress on that issue.”

Hughes said he liked the idea of making telehealth more feasible for mental health professionals but would be cautious about imposing new restrictions on insurance providers.

“The challenge when you begin to create more mandates with insurance," Hughes said, “is you can drive insurers out of your market.”

Editor’s notes •

• If you or people you know are at risk of self-harm, the National Suicide Prevention Lifeline provides 24-hour support at 1-800-273-8255.

• Jon Huntsman is a brother of Paul Huntsman, chairman of The Salt Lake Tribune’s nonprofit board of directors.