David Grant, director of the California Health Interview Survey, is the author of a new study revealing that more than half a million adults in California seriously thought about committing suicide during the past year. In this interview, Grant elaborates on why sexual minorities are more than three times as likely as other adults to commit suicide, what the barriers are to receiving mental health treatment, and whether the full implementation of health care reform will make treatment more accessible.

Q: Sexual minorities were more than three times as likely as all adults to have suicidal thoughts. What types of suicide prevention efforts are tailored to this population and what more needs to be done?

​That sexual minorities are at higher suicide risk is not a new finding and there are some — not enough — efforts tailored to reach the LGBT population, especially youth. Teens and young adults are not frequent users of the health care system, so it can be a challenging population to engage through traditional interventions. A couple of good, alternative ways to reach at-risk teens and young adults include: The Trevor Project, which operates a crisis and suicide prevention hotline tailored to LGBT youth, and social media and Internet-based efforts such as the “It Gets Better” site started by Dan Savage. Efforts that attempt to reach youth through social media and online interventions may be more effective. Ultimately, higher rates of suicide among sexual minorities reflect ongoing social intolerance. The President’s support of same-sex marriage and more states recently legalizing same-sex marriage are hopeful signs of increasing tolerance and change.

Q: Among adults who need mental health treatment and who also reported having suicidal thoughts, the majority did not receive the treatment they needed. What are some of the barriers preventing more people from receiving these services?

​Suicide ideation as well as mental health problems are poorly recognized, making initiating treatment challenging. Most of those with needs do not get adequate care. It is difficult to say exactly why this is the case, but there are a lot of potential barriers to receiving mental health treatment, including social stigma, lack of insurance or cost, not knowing where to go or what resources are available, language barriers, a lack of available services in some geographic areas, and the desire to want to take care of a problem on one’s own. The specific obstacles vary across California’s diverse population and may be particularly vexing when there are multiple barriers.

Q: Will the upcoming, full implementation of health care reform bolster suicide prevention efforts?

​Let’s hope so. Health care reform is likely to extend coverage to hundreds of thousands of currently uninsured Californians. We recently published results from another 2009 California Health Interview Survey study showing that of 1.6 million adults in California with mental health needs, about one third lacked health insurance coverage. As our suicide ideation data show, adults with mental health needs are far more likely (18.5 percent) to have had serious suicidal thoughts in the past year than adults without mental health needs (1.1 percent). And while the extension of health insurance coverage will certainly help, it is only one part of the problem. Suicide is a complex phenomenon, particularly in a state as diverse as California, and requires equally complex approaches to prevention.