Beyond crisis lines: How broader suicide prevention helps people in need

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Someone in America dies by suicide every 11 minutes. It’s that common. But not normal.

Humans have evolved over centuries to survive. So when people try to kill themselves, something has gone wrong. Typically, the assumption is that something happened in the person’s mind — a mental illness.

But in recent decades, there’s been a growing movement to ask a different question: What went wrong in the world around that person?

For Chris Pawelski, it was a torrent of factors. His dad — one of his best friends, whom he worked with daily for decades — was diagnosed with renal cancer and died six months later. Pawelski was left as the primary caregiver for his mom, who had dementia.

His family’s multigenerational onion farm in New York’s Orange County — where he first worked as a 5-year-old, collecting onions that fell out of crates — was hemorrhaging money. Pawelski said he was growing roughly $200,000 worth of crops some years but took home only about $20,000, unable to negotiate higher prices with wholesale buyers that dominated the market.

Debt to suppliers and equipment vendors piled up, and the burden strained his marriage. He had little time for friends, working sunup to sundown seven days a week, desperately trying to preserve his family’s legacy.

“It’s all stuff collapsing down upon you,” he said. “It’s weeks, months, years of dealing with all sorts of pressures that you can’t alleviate.”

Pawelski started wondering what it would be like to get hit by a truck on the busy road in front of his house. “You think you’re already on your way out, so why wait?” he said.

Millions of Americans have serious thoughts of killing themselves, and tens of thousands die by suicide annually. Suicide repeatedly ranks among the top 10 leading causes of death — making the U.S. an outlier among developed nations.

Prevention efforts have typically focused on connecting individuals in crisis with treatment — despite therapy and medication being notoriously expensive, the health care system struggling to meet demand, and a consensus that suicide is caused by a host of factors, including but not limited to mental illness.

Now, many people working to prevent suicide, including some who have tried to harm themselves or lost a loved one to it, are calling for a broader approach. Some were galvanized by the covid pandemic, when rates of anxiety and depression spiked — not because everyone’s brain chemistry suddenly changed but because the world changed. That led many to believe that, while treatments and crisis care are vital, the goal of suicide prevention needs to expand beyond stopping people from dying to also giving them reasons to live.

“It’s not rocket science,” said Sally Spencer-Thomas, a psychologist and internationally recognized suicide prevention researcher who lost her brother to suicide. If “you have happier, healthier people, they live longer, happier lives.”

That means suicide prevention shouldn’t be limited to answering hotlines or treating patients in psychiatric wards, she said. It should also involve running food banks to ensure families don’t go hungry or hosting weekly book clubs for homebound seniors to make friends. It can take the form of school programs that build resilience in children or housing policies that prevent evictions.

Decades of research shows these types of initiatives — even if they don’t have the words “mental health” or “suicide” in the title — can reduce the number of people who kill themselves. They often lower rates of crime, addiction, and poverty, too.

The U.S. has lagged other countries in adopting this approach, Spencer-Thomas said, perhaps because it’s easier — and more politically palatable — to tell someone to go to therapy than it is to enact sweeping policy changes, such as an increased minimum wage.

“As long as we have that convenient narrative that it’s just a bunch of broken people needing medicine and treatment, then we’re never accountable for fixing the broken things in our communities,” Spencer-Thomas said.

Overhauling suicide prevention efforts to focus on broad social and economic policies might seem overwhelming and unrealistic — especially right now. This approach requires large upfront investments that lack across-the-board support, either because of budgeting realities or ideological bents.

President Trump and his appointees have said little about suicide directly, but many of their policies do the opposite of what research shows prevents suicide.

Millions of Americans have serious thoughts of killing themselves, and tens of thousands die by suicide annually. Suicide repeatedly ranks among the top 10 leading causes of death — making the U.S. an outlier among developed nations.

The administration has championed cuts to Medicaid and the Supplemental Nutrition Assistance Program that are projected to leave millions of people without health insurance and food stamps in coming years. It has injected uncertainty into the economy through the war with Iran, seesawing tariff policy, and mass layoffs of federal employees. It has canceled $1 billion in grants for school-based mental health initiatives, gutted federal programs that focus on at-risk blue collar workers, and cut gun violence research. (Suicides are the most common type of gun death in America.)

“All of these changes are creating a firestorm,” said Hannah Wesolowski, the chief advocacy officer for the National Alliance on Mental Illness. They can cause “extreme stress and anxiety” in people’s lives, she added, and “when people feel desperate, that’s when crises can emerge.”

Federal health officials insist that suicide prevention remains a priority.

Allison Arwady, director of the Centers for Disease Control and Prevention’s injury center, said the agency is focused on creating systems that can support people “no matter what may be happening” in the world around them. “There’s always going to be turmoil in people’s lives,” she added.

Arwady and Brandon Johnson, who leads suicide prevention work at the Substance Abuse and Mental Health Services Administration, said several of the Trump administration’s priorities align with an upstream approach.

For example, they said, its focus on youth physical and mental well-being could help address the increasing suicide risk among adolescents, since exercise is proven to improve mental health. Similarly, people who are homeless have higher rates of suicide, and the administration has been pushing them into treatment. Federal officials have also encouraged partnerships with religious organizations, and research shows members of faith communities are less likely to attempt suicide.