Suicide Prevention or Overdose Prevention?

I review an article by Cal Matters’ Ana B. Ibarra on suicide rates among older adults in rural counties. In their integrated plans, nine of nineteen rural counties chose to focus on overdose rather than suicide. Two chose both and four chose suicide. The remaining four counties chose to focus on other goals such as engagement in work and the care experience. I take a look at the rates of overdose and suicide along with the funding sources cited by the counties that chose suicide and/or overdose. Does the data suggest that the changes in use of Behavioral Health Services Act (BHSA) dollars to provide care for substance use disorders has had an impact in rural counties? The numbers are small but suggestive.

In December, 2025, Cal Matter’s reporter Ana B. Ibarra reported on gun-related suicides in rural California counties in her piece titled Remembering Papa. Ibarra discussed the high rate of gun-related suicides among older rural residents, describing it as an epidemic. I wondered if this problem would be reflected in the Statewide data reported in the BHSA Integrated Plans each county was required to prepare for FY 26 through 29. If it was, I was curious whether counties would identify suicide as their supplemental goal for their Integrated Plan and how they proposed to fund efforts to reduce suicides. Each county was required, as part of their Integrated Plan, to specify a supplemental goal for their county in addition to a set of goals established by the State. What I found didn’t really surprise me: Most rural California counties appear to be grappling with a drug problem that overshadows suicides.

I reviewed the Integrated Plans for nineteen rural counties. Two counties didn’t have their integrated plans available for view online. Of those nineteen, fourteen had overdose rates that exceeded the State average. Five were below. Suicide rates are tricky to determine in small counties. That’s because the actual numbers are often so small that it’s impossible to establish a sound statistical rate. For example, in a small enough county, even one suicide death could increase the rate dramatically if you only had two or three suicides a year. It also poses the problem of inadvertently revealing the identity of the victim and their family. So, nine counties had no official rate of suicides. Of those that did, two were below the State average and the rest were above. Also reported was the rate of non-fatal self-harm ER visits. One county had too few to reliably report and three were below the State average. Fourteen were above the State average. The fact that every county had enough overdose deaths to produce a reliable rate demonstrates the severity of the overdose problem in rural California.

Funding for efforts to address these issues often included a broad array of resources including Re-Alignment dollars and Substance Use Block Grant money. They also included BHSA dollars and opioid settlement funds. Among the six counties choosing suicide as a supplemental goal, funding always included a plan to use BHSA dollars. Of the nine counties that chose overdose prevention as their only supplemental goal, four counties reported planning to use BHSA dollars to fund efforts to reduce overdoses without spending opioid settlement funds. This is meaningful because these efforts might not have been funded under the Mental Health Services Act or MHSA rules. Two counties chose both overdose and suicide as supplemental goals. Mariposa County said they would use BHSA dollars but not opioid settlement funds and the other, Del Norte, said they would use both BHSA and opioid settlement funds.

It was clear that opioid settlement funds continue to make a big difference when it comes to overdose prevention efforts throughout the State. Five counties reported planning to use those dollars for overdose prevention without using BHSA dollars. One county reported only planning to use clinical services and federal financial participation dollars to fund their overdose prevention efforts.

Based on this overview of supplemental goals and reported funding plans, many rural counties see overdose prevention as a greater need than suicide prevention. The flexibility to use BHSA funds for substance use programs appears to have borne fruit among rural counties.

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