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

Nearly every Tuesday for a decade, Steve Siple attended a bar trivia night with friends in Birmingham, Alabama. After moving to North Carolina, he developed a new ritual — on Saturdays to pick up trash along the city’s light rail.

These are more than fun outings to Siple. They help keep him alive.

Siple has battled suicidal thoughts in the past. He lost his father to suicide, and one of his sons has struggled with thoughts of hurting himself.

That’s made Siple vigilant about protecting himself and his family. In addition to seeing a counselor regularly and speaking openly about mental health, he prioritizes social connection.

“Loneliness was, over my lifetime, one of the greatest risk factors” for suicide, said Siple, a for the American Foundation for Suicide Prevention.

To some, this concept may seem obvious. Yet in the overall approach to suicide prevention, it’s often overlooked. Treatment of a serious mental illness that can lead to suicide, such as major depressive disorder, often centers on medication and talk therapy with little or no consideration of factors such as social isolation or financial duress. Now, there’s a growing movement to address loneliness not just through personal choices but also through public policy.

The research is clear: Among the various complex issues that contribute to suicide, is a . It’s a for older adults, who have and for youths, for whom .

Humans are social animals. When we feel cut off from one another, our , our , and ultimately we’re (by suicide or ). An concluded that being socially disconnected is as harmful to one’s health as smoking up to 15 cigarettes a day.

And it’s getting worse.

Mental health researchers and clinicians say a variety of factors are in America, including the , such as smartphones and ; increased ; the since the covid pandemic; and .

With suicide rates remaining stubbornly high — often ranking among the in America — some advocates and people who have lost loved ones to suicide say increasing pathways to social connection could be a new frontier.

In this ongoing series, ºÚÁϳԹÏÍø News is examining new approaches to suicide prevention that shift the focus from stopping harm in moments of crisis to efforts that give people reasons to live well before they make fateful choices.

“If we want to reduce suicide rates in our country, which is absolutely essential, then a key part of that has to be fostering social connection,” said who served as surgeon general under Presidents Barack Obama and Joe Biden. “We have more than enough data to support this as being an important area of focus.”

In 2023, Murthy released the first on loneliness as a public health issue, with more than 300 supporting citations. He’s also on the topic and is touring the country discussing the value of social connection.

“To help someone else feel less alone, to help them feel seen and understood and valued,” he told ºÚÁϳԹÏÍø News, “that can be one of the most powerful interventions that we make.”

A Role for Elected Officials

Curing loneliness may seem like the responsibility of families and neighbors, people making one-to-one connections. But Murthy says elected officials have work to do, too.

They can use their bully pulpits to turn this into a mainstream issue, he said. They can create microgrants to support grassroots ideas from community entrepreneurs and invest in “social infrastructure,” he added.

That term refers to things in the community that support the development of social connection, from physical spaces, such as libraries and parks, to policies and programs, such as building public transportation and fostering volunteer groups.

“These all matter and impact whether people gather,” Murthy said.

However, investing in public institutions and infrastructure is a costly endeavor that can seem unreasonable when local officials are struggling to balance budgets without increasing tax burdens.

That’s where creativity can kick in.

A health system and a museum in Charlotte have teamed up to for people to attend art classes or live performances together. In Tennessee, the city of Chattanooga is funding community ideas to increase connection and time in nature, where people can speak with volunteer listeners. And across the country, have popped up as places where men can work on projects side by side and discuss their mental health.

Meal Deliveries and Valentines

Marcie O’Neal knew she wouldn’t have much money at her disposal. She was hired in 2024 to lead suicide prevention efforts in the rural of western Kentucky after local leaders saw a rise in suicides among the elderly. Her grant was about $280,000 — less than .

But she knew the nine-county area had other strengths, such as dedicated meal delivery programs and high school clubs.

Drivers who drop off prepared meals to homebound residents “can be the only person that an older adult sees in the week,” O’Neal said.

The state had already been training some of those drivers to recognize warning signs of suicide among older people and alert county agencies to follow up with them. O’Neal thought there could be another component.

She reached out to high school , which focus on fostering leadership skills and volunteerism, across the nine counties and asked them to write cards that could be distributed to older residents along with meals. The response was swift, O’Neal said.

About 1,200 cards were delivered last May. They repeated the gesture in February for Valentine’s Day and again this May.

O’Neal said one of the older residents told her, “I don’t remember the last time I got a Valentine’s card.”

The students also enjoyed feeling as if they made a difference, O’Neal said. She’s helping one school set up an ongoing pen pal program with a nearby retirement community.

Locals affectionately call O’Neal “the suicide lady” — a term she considers “a badge of honor.”

Suicide prevention “doesn’t have to be sweeping huge things,” she said. “It’s a little thing you can do that can kind of snowball into more things.”

‘The Secret Sauce’

Siple, who has prioritized social connection through the trivia nights and volunteer clean-ups, felt most alone when he transitioned from a job at a commercial bank to working at home.

He spent most of his day analyzing Excel sheets, drafting grant proposals, and compiling recommendations for clients. The work felt important, but it was isolating, Siple said.

“If my wife or kids were around during the evening, I was safe,” he said. Holding meetings at coffee shops helped, too.

But when it was just him at his desk, “that’s where I got the darkest lonely feelings,” he said, including thoughts of suicide.

Breaking out of that required seeking new connections.

Siple said church was a great anchor for him and his wife — not just on Sundays but throughout the week at Bible studies and potlucks. They also go to see a variety of live music, including bluegrass and alternative rock.

“Being with folks that are into the same type of music that we’re into for a concert feels like connection,” he said.

Research suggests sports can play a similar role in some instances. At least two studies have found are associated with . The authors posit it’s because people coming together to support their team or to enjoy the event creates a sense of belonging, which is protective.

That concept resonates with , who has worked on suicide prevention efforts at the state and and helps run Sources of Strength, an upstream prevention program. Fostering that sense of belonging has played a central role in each of those initiatives, she said.

“We can’t eliminate hard stuff in our lives,” said Brummett, who lost five friends to suicide, starting in middle school.

“Belonging is really the secret sauce,” she said, “for how we, as humans, can navigate really hard things.”

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

As a teenager, Rei Scott spent several weeks living out of a car with four family members and their dog. Each day, Scott worried about where they would spend the following night.

One day at school, Scott snuck away to the bathroom and called the national suicide hotline.

Scott, who is transgender and nonbinary, explained to the hotline counselor that the family had struggled with poverty for years. They had lived in crumbling homes with water leaks, or a family member’s basement with no privacy. Sometimes the family worried about having enough food. The stress and anxiety were constant, and Scott had been suicidal many times.

The counselor seemed shocked into silence, Scott said. Eventually, the person provided reassurance and kindness.

But what Scott really needed that day a decade ago and many times since was a fix for the economic difficulties that had become an unbearable weight.

“It can definitely help to have someone who can listen, but when you’re struggling to eat and you don’t have a roof to be under, I honestly don’t think words can go as far as you need them to,” said Scott, who now studies social work at Capital University in Columbus, Ohio.

Over the years, Scott has been directed to hospitals and therapists. But those generally don’t address core problems, such as a broken-down car or an eviction notice.

“There’s so many times in my life where I’ve thought if I had $5,000, I wouldn’t even be suicidal right now,” Scott said.

People don’t typically think of suicide as an issue of economics, but it often is.

Decades of research shows that , , , , and make people more likely to kill themselves. Conversely, things that bring down people’s cost of living — such as , , , and — are linked to lower suicide rates.

It makes sense. If someone can cover their basic needs, their life will feel better.

Other countries have been incorporating this understanding into their efforts for some time. But because suicide prevention in the U.S. has historically been seen as a medical issue — the responsibility of clinicians who can provide medication or therapy — economic solutions are frequently left out of the equation.

Some advocates and people with suicidal experiences, like Scott, are trying to change that. They say traditional approaches to suicide prevention haven’t succeeded. For decades, the U.S. has had among high-income countries.

To move the needle, “we all need to be challenged to broaden our aperture, to broaden the lens of what is mental health,” said , a national expert in mental health policy and an adjunct professor at the Stanford University School of Medicine.

The highest-impact interventions may not be adding crisis lines or screening more people in emergency rooms, Miller said, though those can be helpful. If he had to pick one strategy, it would be alleviating poverty.

That “allows us to reconcile and solve for these conditions that put people in places of despair,” he said. “I don’t know what stronger intervention one could possibly have.”

To be sure, suicides also occur among wealthy people. It’s a complex issue and almost never boils down to one reason. For most people, the decision to hurt themselves results from an intricate interplay of biological factors, relationship concerns, finances, trauma or abuse, and access to lethal means. That means suicide prevention requires a variety of approaches.

The argument for including economic policy as one of those approaches, many advocates and researchers say, is that policies affect entire populations. So even a small effect can save a significant number of lives.

‘Economic Uncertainty’ Builds

However, the push for an economic lens on suicide prevention is encountering gale-force headwinds from Trump administration policies.

and the have contributed to economic pressures. Meanwhile, the administration has increased hurdles for safety net programs such as the , often called food stamps, and , the state-federal health insurance program for low-income people. Experts estimate will over the coming years.

The administration has also , saying people who are homeless to receive support. The president’s 2027 budget request, which signals his priorities, that helps low-income people pay for heat and air conditioning.

Research suggests increase people’s risk for suicide.

“Anytime there is economic uncertainty, people will fear for their future and livelihood,” Miller said, and “this last few months have been terrifying.”

Notably, the administration’s actions directly contradict strategies that the promotes as having “the best available evidence to reduce suicide.” No. 1 on the page is “Strengthen economic supports.” It lists SNAP benefits and housing-first policies as examples.

, director of the CDC’s injury center, said the agency doesn’t work on economic policy directly but encourages state and local governments to look at the relationship between health and economics.

The Department of Health and Human Services supports suicide prevention through the 988 national crisis hotline, investments in treatment, and the Rural Health Transformation Program, which states can use to expand mental health care in rural areas, HHS spokesperson Emily Hilliard said.

Alec Varsamis, a spokesperson for the Agriculture Department, said the agency is providing states guidance on SNAP changes and “remains deeply committed to supporting the health and mental well‑being of all Americans.”

It’s too soon to tell how recent actions may affect suicide rates. And given the unique combination of factors at play in each death, it’s challenging to draw direct causal links.

The most recent data available shows nearly 49,000 people died by suicide in 2024 — a slight dip from previous years but still among the highest tolls since the late 1990s.

The concept of suicide prevention writ large has historically drawn bipartisan support, said , a New York University researcher who last year highlighting public policies shown to reduce suicide.

The details are where things get murky. For example, strong evidence suggests that increasing the minimum wage reduces suicides. (The is $7.25 per hour, with higher rates in certain states.) But such increases are often a hard sell for lawmakers facing the realities of balancing a budget and small-business owners struggling to stay afloat.

Closely tying suicide prevention initiatives to such politically charged and complicated issues could undermine their chances, Purtle said, adding, “We’ll see suicide get polarized.”

That’s why the focus often stays on areas of agreement, such as funding crisis hotlines.

View From a Crisis Line

is the chief clinical officer at Samaritans, a Boston-based nonprofit that has operated a suicide crisis hotline for more than 50 years and fields upward of 10,000 calls a month, including local calls to 988.

Although people might assume every call is an imminent crisis, Maitland said, many callers are struggling with everyday needs — financial problems, housing concerns, or unemployment.

“Whatever is going on in the world, we absolutely hear about that in real time,” Maitland said.

In November, when during a government shutdown, people affected called Samaritans.

“That in and of itself was a hit to suicide prevention,” Maitland said. “If people don’t have access to eat, to feed their children, to be alive, quite frankly, how are they able to move further through anything else?”

Samaritans volunteers are trained to listen with compassion and make callers feel less alone in what they’re going through. That validation and caring are powerful, Maitland said.

But she often wants to do more, to “dig in and fix” the root issue.

Research supports her instincts. found that increasing the number of people who receive SNAP benefits by 5% could have prevented nearly 32,000 suicides over 15 years. And a $1 increase in minimum wage roughly 8,000 fewer suicide deaths over a decade.

Although Maitland can’t change federal welfare policies, she and her co-workers are applying this approach locally. They recently started an initiative to provide blankets, socks, and water to people living on the streets of Boston.

“Suicide prevention doesn’t always look like a crisis helpline,” she said. “That’s what we imagine it as.” But “having your basic needs is also a form of suicide prevention.”

Continuing To Live

In the years since calling the suicide hotline in high school, Scott has turned to a number of resources to help overcome recurring thoughts of suicide. Crisis lines, hospitalization, medication, and therapy have all played a role.

But, Scott said, the biggest impact came from programs that helped fulfill daily needs — for example, a housing program for LGBTQ+ youths and another for former foster care children attending college.

Scott, who now lives close to campus because of the foster care program, said the ability not to “worry about ‘Where am I going to sleep tomorrow night?’” has provided a significant mental health boost.

Although some programs like those are under threat from the Trump administration, Scott is hopeful they will persist and rebuild.

Surviving difficult times has given Scott confidence to persist through more potential challenges ahead.

Despite “the policies and legislation that harm us, we continue to live, and I think that’s really important,” Scott said. “It gives me a lot of hope that things can be different.”

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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 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 , and tens of thousands . Suicide repeatedly ranks among the — making the U.S. an .

Prevention efforts have typically focused on connecting individuals in crisis with treatment — despite therapy and medication being , the healthcare system , and a consensus that suicide is caused by a , 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 — 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 , 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.

shows these — 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 .

“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.

The Trump Administration’s Approach

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

The administration has championed and the that are projected to leave and in coming years. It has injected uncertainty into the economy through , , and . It has for school-based mental health initiatives, gutted federal programs that focus on at-risk blue collar workers, and . (Suicides are the in America.)

“All of these changes are creating a firestorm,” said , 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.

, 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 , 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 could help address the , since exercise is proven . Similarly, people who are homeless have , and the administration has been . Federal officials have also encouraged , and research shows members of faith communities are .

However, the Trump administration has made at and and has for , leading to questions about whether or how this work will continue.

A History of Medical and Crisis Care

Suicide prevention reached the national stage in the late 1990s, said , who worked at the CDC for 15 years before joining the , a nonprofit focused on teen and young-adult mental health.

As suicide rates grew among young people, a group of government officials, clinicians, and advocates gathered in Reno, Nevada, in 1998 to discuss the pressing issue. Over the next few years, the surgeon general and the federal government published its .

These documents acknowledged the role of society and economics in suicide risk but focused heavily on identifying people in crisis and increasing access to medical treatment.

Those are critical steps to suicide prevention, many mental health researchers and clinicians say. They’re also politically favorable. For elected officials, who have a few years to demonstrate their achievements before the next campaign, it’s easier to count the number of people receiving therapy than the number of people who never developed suicidal thoughts because long-term economic and social investments helped them maintain steady jobs and strong friendships.

The push for individual treatment also comes from a pervasive misconception that suicide is always the result of an underlying mental illness, said , who is the senior director of population health at Mental Health America and contributed to a .

Although how many people who die by suicide — with estimates from to — the takeaway is that mental illness is not the sole cause, Reinert said. That means treating it can’t be the sole response.

Plus, mental illnesses can be by life circumstances. Treating depressive symptoms without looking at factors such as childhood trauma, the loss of a loved one, or being laid off from a job is an incomplete approach, many mental health researchers and clinicians say.

The covid pandemic, especially, made people in the field recognize “we really need to address all of these conditions that are creating stress, anxiety, and crises,” Stone said.

In July 2022, the federal government — a shorter number for the national suicide crisis line, meant to provide an alternative to 911 for mental health emergencies.

, who led federal work on 988, said the infusion of money and attention on the hotline helped states build better crisis response systems, from centers that answer calls to mobile crisis units.

But that’s not enough to solve America’s suicide problem, she said. “You’ll never be able to build a system based on crisis alone.”

Help for the Farm and the Farmer

Pawelski, the onion farmer in New York, hit his breaking point in 2020.

He had a decent crop that year, but Canadian exporters were into American markets, making it difficult for him to sell his product.

“I was having to beg people” to buy, he said. And when he managed to sell, prices were comparable to prices in the 1980s.

By the end of the season, he had incurred losses of a few hundred thousand dollars.

He said he and his wife decided, “We couldn’t afford to grow onions again.”

The idea that his family’s onion farm would end with him was “soul-crushing,” Pawelski said. He lost weight rapidly and thought about ending his life.

He and his wife called for help. Founded at Cornell University in 1986, the free program connects farmers with two consultants: a financial analyst specializing in farm planning and a social worker focused on emotional concerns and family dynamics.

The financial specialist helped Pawelski develop a new business plan. Instead of farming onions for wholesale, he could grow greens, tomatoes, peppers, and eggplants at a small scale to sell directly to consumers. He could upgrade an old truck with a cooler and deliver produce to people’s doors. He would supplement that income with teaching, speaking engagements, and other work that took advantage of his master’s degree in communications.

The social worker helped him accept that new reality — equally crucial, Pawelski said. “If you’re pissed off” about the change, “no matter what kind of proposal or idea they have, it’s not going to go anywhere.”

The adjustment took months. Pawelski also saw a therapist during that time.

Then one day a neighbor noted that Pawelski seemed much happier. That “caught me off guard,” Pawelski recalled. He didn’t realize his inner transformation was so apparent.

Today, Pawelski’s business has stabilized, and he and his wife are paying down debt. Pawelski advocates for programs to help farmers’ mental health and address their .

That can mean crisis hotlines and access to affordable therapy, Pawelski said. But what he really wants are policy changes that help farmers get fair prices for their produce, debt relief, and the installation of broadband internet in rural areas so farm families and employees can be connected.

“We need to think broader and longer-term than a helpline,” he said. That’s “a band-aid on a gunshot wound.”

This <a target="_blank" href="/mental-health/suicide-prevention-mental-health-upstream-solutions-eleven-minutes/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">