{"id":12942,"date":"2026-04-29T09:00:00","date_gmt":"2026-04-29T09:00:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=12942"},"modified":"2026-04-29T09:00:00","modified_gmt":"2026-04-29T09:00:00","slug":"saving-lives-by-changing-lives-the-next-frontier-in-suicide-prevention","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=12942","title":{"rendered":"Saving Lives by Changing Lives: The Next Frontier in Suicide Prevention"},"content":{"rendered":"
\n

<\/em>If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting \u201c988.\u201d<\/em><\/p>\n

Someone in America dies by suicide every 11 minutes. It\u2019s that common. But not normal.<\/p>\n

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\u2019s mind \u2014 a mental illness.<\/p>\n

But in recent decades, there\u2019s been a growing movement to ask a different question: What went wrong in the world around that person?<\/p>\n

For Chris Pawelski, it was a torrent of factors. His dad \u2014 one of his best friends, whom he worked with daily for decades \u2014 was diagnosed with renal cancer and died six months later. Pawelski was left as the primary caregiver for his mom, who had dementia.<\/p>\n

His family\u2019s multigenerational onion farm<\/a> in New York\u2019s Orange County \u2014 where he first worked as a 5-year-old, collecting onions that fell out of crates \u2014 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.<\/p>\n

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\u2019s legacy.<\/p>\n

\u201cIt\u2019s all stuff collapsing down upon you,\u201d he said. \u201cIt\u2019s weeks, months, years of dealing with all sorts of pressures that you can\u2019t alleviate.\u201d<\/p>\n

Pawelski started wondering what it would be like to get hit by a truck on the busy road in front of his house. \u201cYou think you\u2019re already on your way out, so why wait?\u201d he said.<\/p>\n

\u00a0 (Jeffrey Basinger for KFF Health News)<\/p>\n

After his father died, Pawelski became his mother\u2019s primary caregiver. Meanwhile he was struggling to preserve his farm \u2014 his family\u2019s legacy. \u201cIt\u2019s all stuff collapsing down upon you,\u201d he says. (Jeffrey Basinger for KFF Health News)<\/p>\n

Millions of Americans have serious thoughts of killing themselves<\/a>, and tens of thousands die by suicide annually<\/a>. Suicide repeatedly ranks among the top 10 leading causes of death<\/a> \u2014 making the U.S. an outlier among developed nations<\/a>.<\/p>\n

Prevention efforts have typically focused on connecting individuals in crisis with treatment \u2014 despite therapy and medication being notoriously expensive<\/a>, the healthcare system struggling to meet demand<\/a>, and a consensus that suicide is caused by a host of factors<\/a>, including but not limited to mental illness.<\/p>\n

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<\/a> \u2014 not because everyone\u2019s 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.<\/p>\n

\u201cIt\u2019s not rocket science,\u201d said Sally Spencer-Thomas<\/a>, a psychologist and internationally recognized suicide prevention researcher who lost her brother to suicide. If \u201cyou have happier, healthier people, they live longer, happier lives.\u201d<\/p>\n

That means suicide prevention shouldn\u2019t be limited to answering hotlines or treating patients in psychiatric wards, she said. It should also involve running food banks to ensure families don\u2019t 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.<\/p>\n

Decades of research<\/a> shows these types of initiatives<\/a> \u2014 even if they don\u2019t have the words \u201cmental health\u201d or \u201csuicide\u201d in the title \u2014 can reduce the number of people who kill themselves. They often lower rates of crime, addiction, and poverty, too.<\/p>\n

The U.S. has lagged other countries in adopting this approach, Spencer-Thomas said, perhaps because it\u2019s easier \u2014 and more politically palatable \u2014 to tell someone to go to therapy than it is to enact sweeping policy changes, such as an increased minimum wage<\/a>.<\/p>\n

\u201cAs long as we have that convenient narrative that it\u2019s just a bunch of broken people needing medicine and treatment, then we\u2019re never accountable for fixing the broken things in our communities,\u201d Spencer-Thomas said.<\/p>\n

The Trump Administration\u2019s Approach<\/strong><\/p>\n

Overhauling suicide prevention efforts to focus on broad social and economic policies might seem overwhelming and unrealistic \u2014 especially right now. This approach requires large upfront investments that lack across-the-board support, either because of budgeting realities or ideological bents.<\/p>\n

President Donald Trump and his appointees have said little about suicide directly, but many of their policies do the opposite of what research<\/a> shows prevents suicide<\/a>.<\/p>\n

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

\u201cAll of these changes are creating a firestorm,\u201d said Hannah Wesolowski<\/a>, the chief advocacy officer for the National Alliance on Mental Illness. They can cause \u201cextreme stress and anxiety\u201d in people\u2019s lives, she added, and \u201cwhen people feel desperate, that\u2019s when crises can emerge.\u201d<\/p>\n

Sally Spencer-Thomas, a psychologist and researcher, says suicide prevention shouldn\u2019t be limited to hotlines or psychiatric wards. She says it should also involve programs that help improve people\u2019s lives and make them feel more connected to one another. (Sally Spencer-Thomas)<\/p>\n

Federal health officials insist that suicide prevention remains a priority.<\/p>\n

Allison Arwady<\/a>, director of the Centers for Disease Control and Prevention\u2019s injury center, said the agency is focused on creating systems that can support people \u201cno matter what may be happening\u201d in the world around them. \u201cThere\u2019s always going to be turmoil in people\u2019s lives,\u201d she added.<\/p>\n

Arwady and Brandon Johnson<\/a>, who leads suicide prevention work at the Substance Abuse and Mental Health Services Administration, said several of the Trump administration\u2019s priorities align with an upstream approach.<\/p>\n

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

However, the Trump administration has made steep staff cuts<\/a> at the CDC<\/a> and SAMHSA<\/a> and has repeatedly called<\/a> for decreasing their budgets<\/a>, leading to questions about whether or how this work will continue.<\/p>\n

A History of Medical and Crisis Care<\/strong><\/p>\n

Suicide prevention reached the national stage in the late 1990s, said Deb Stone<\/a>, who worked at the CDC for 15 years before joining the Jed Foundation<\/a>, a nonprofit focused on teen and young-adult mental health.<\/p>\n

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 issued a landmark call to action<\/a> and the federal government published its first national strategy for suicide prevention<\/a>.<\/p>\n

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.<\/p>\n

Those are critical steps to suicide prevention, many mental health researchers and clinicians say. They\u2019re also politically favorable. For elected officials, who have a few years to demonstrate their achievements before the next campaign, it\u2019s 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.<\/p>\n

The push for individual treatment also comes from a pervasive misconception that suicide is always the result of an underlying mental illness, said Maddy Reinert<\/a>, who is the senior director of population health at Mental Health America and contributed to a 2025 national report on upstream suicide prevention<\/a>.<\/p>\n

Although researchers debate<\/a> how many people who die by suicide had a mental health condition<\/a> \u2014 with estimates from less than half<\/a> to about 90%<\/a> \u2014 the takeaway is that mental illness is not the sole cause, Reinert said. That means treating it can\u2019t be the sole response.<\/p>\n

Plus, mental illnesses can be triggered and exacerbated<\/a> 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.<\/p>\n

The covid pandemic, especially, made people in the field recognize \u201cwe really need to address all of these conditions that are creating stress, anxiety, and crises,\u201d Stone said.<\/p>\n

In July 2022, the federal government launched 988<\/a> \u2014 a shorter number for the national suicide crisis line, meant to provide an alternative to 911 for mental health emergencies.<\/p>\n

Monica Johnson<\/a>, 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.<\/p>\n

But that\u2019s not enough to solve America\u2019s suicide problem, she said. \u201cYou\u2019ll never be able to build a system based on crisis alone.\u201d<\/p>\n

After big losses in 2020, Pawelski and his wife, Eve, decided they could no longer farm onions for wholesale buyers. They called NY FarmNet, which helped them develop a plan to change to small-scale farming and sell directly to consumers. (Jeffrey Basinger for KFF Health News)<\/p>\n

Help for the Farm and the Farmer<\/strong><\/p>\n

Pawelski, the onion farmer in New York, hit his breaking point in 2020.<\/p>\n

He had a decent crop that year, but Canadian exporters were dumping cheap onions<\/a> into American markets, making it difficult for him to sell his product.<\/p>\n

\u201cI was having to beg people\u201d to buy, he said. And when he managed to sell, prices were comparable to prices in the 1980s.<\/p>\n

By the end of the season, he had incurred losses of a few hundred thousand dollars.<\/p>\n

He said he and his wife decided, \u201cWe couldn\u2019t afford to grow onions again.\u201d<\/p>\n

The idea that his family\u2019s onion farm would end with him was \u201csoul-crushing,\u201d Pawelski said. He lost weight rapidly and thought about ending his life.<\/p>\n

He and his wife called NY FarmNet<\/a> 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.<\/p>\n

\n
\n

\t\t\t\t\t<\/p>\n

\t\t\t\t\t\t\tEve Pawelski encouraged her husband, Chris, to change the way their farm operates and go to therapy to improve his mental health.\t\t\t\t\t\t (Jeffrey Basinger for KFF Health News)<\/p>\n

\t\t\t\t\t<\/p>\n

\t\t\t\t\t\t\tTogether, they transitioned to small-scale farming, stabilized their business model, and are paying down debt.\t\t\t\t\t\t (Jeffrey Basinger for KFF Health News)<\/p><\/div>\n<\/div>\n

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\u2019s doors. He would supplement that income with teaching, speaking engagements, and other work that took advantage of his master\u2019s degree in communications.<\/p>\n

The social worker helped him accept that new reality \u2014 equally crucial, Pawelski said. \u201cIf you\u2019re pissed off\u201d about the change, \u201cno matter what kind of proposal or idea they have, it\u2019s not going to go anywhere.\u201d<\/p>\n

The adjustment took months. Pawelski also saw a therapist during that time.<\/p>\n

Then one day a neighbor noted that Pawelski seemed much happier. That \u201ccaught me off guard,\u201d Pawelski recalled. He didn\u2019t realize his inner transformation was so apparent.<\/p>\n

Today, Pawelski\u2019s business has stabilized, and he and his wife are paying down debt. Pawelski advocates for programs to help farmers\u2019 mental health and address their higher-than-average suicide rates<\/a>.<\/p>\n

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.<\/p>\n

\u201cWe need to think broader and longer-term than a helpline,\u201d he said. That\u2019s \u201ca band-aid on a gunshot wound.\u201d<\/p>\n

With his farm more financially stable, today Chris Pawelski advocates for programs to help farmers\u2019 mental health and address their higher-than-average suicide rates. (Jeffrey Basinger for KFF Health News)<\/p>\n<\/div>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n

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

<img id=”republication-tracker-tool-source” src=”https:\/\/kffhealthnews.org\/?republication-pixel=true&post=2230139&amp;ga4=G-J74WWTKFM0&quot<\/a>; style=”width:1px;height:1px;”><\/p>","protected":false},"excerpt":{"rendered":"

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting \u201c988.\u201d Someone in America dies by suicide every 11 minutes. It\u2019s that common. But not normal. Humans have evolved over centuries to survive. So when people try to kill themselves, something…<\/p>\n","protected":false},"author":0,"featured_media":12943,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-12942","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12942"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=12942"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12942\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/12943"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=12942"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=12942"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=12942"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}