What Suicide Prevention Should Really Look Like

With World Suicide Prevention Day on September 10th, there is a ton of content online about reaching out for help if you’re struggling, or reaching out to a friend if you think they are struggling. This is important — it helps highlight resources for people who are in crisis and brings awareness to services that exist to provide immediate intervention for people who need it. But that’s what it is: it’s intervention, not prevention. By that point, it’s too late. When we think of suicide prevention, there are a million things we can consider before it’s at a crisis point. Crisis lines are an emergency intervention that are often way over capacity, leading to high wait times.

We always say help is available to those struggling, but we don’t spend enough time highlighting how those services may not be enough. Encountering a wait time when in a crisis or when you’re in desperate need of support can be extremely detrimental and further feelings of hopelessness.

The second consideration is that even if you make it through the wait time, a crisis line cannot provide ongoing, consistent support for people dealing with suicidal ideation. Unfortunately, there is a misconception that suicidal ideation is a one-time thing, and as soon as that crisis is averted, everything is OK. But suicidal ideation can be chronic, and it can’t be resolved with one crisis chat. I’m not saying crisis lines are bad — they are vital tools for saving lives and deserve as much funding as possible, but to think of them as the only answer for suicide prevention overburdens them unfairly.

So let’s start with the absolute basics of suicide prevention. Suicide prevention looks a lot like trying to fulfill the most basic levels of Maslow’s hierarchy of needs. Adequate housing, a secure enough basic income, access to food, water and other basic necessities are all absolutely necessary parts of suicide prevention. These are parts of the lowest levels of Maslow’s hierarchy: physiological and safety needs. Why don’t we think of these as suicide prevention though? Why don’t we make the obvious connection that having your basic needs met can make you feel more secure or safe and less suicidal? What about access to a stable job that is accommodating and understanding of mental health needs?

Now say we get beyond fulfilling those basic needs, but a person is still dealing with suicidal ideation (which is completely normal and possible — many people can still struggle with suicidal ideation or mental illness and have all of their most basic needs met). What about the next level of Maslow’s hierarchy of Love and Belonging?

There are numerous studies that indicate minority stress, being higher baseline levels of stress due to being part of a minority, can lead to more negative health outcomes. There are reasons why trans folks, Black people and Indigenous people have some of the highest rates of suicidal ideation and suicide attempts. It’s because our society excludes certain groups and doesn’t make them feel like they belong. We can’t talk about suicide prevention without talking about how more marginalized groups are at more significant disadvantages and are at a much higher risk of suicide. Anti-racism, anti-oppression, acceptance of the LGBTQ+ community and conversations around intersectionality have to be included in discussions of suicide prevention.

Furthermore, we often don’t make it safe for people who deal with thoughts of suicide to talk to their friends and loved ones about it. We make it so easy to talk about a broken arm or a flu we’re dealing with, yet it’s much harder to get support when our mind isn’t feeling OK vs. our body. This further alienates people dealing with suicidal ideation, breeds shame and loneliness, and increases feelings of not belonging or being loved.

And even if we address all those needs: physiological, safety, belonging etc, we still need to address the issue of access to help. When we say help is available to those struggling, we don’t think enough about if that help is truly accessible.

Some people may need medication like anti-depressants, but without a good insurance plan, that can cost a lot of money and cause financial strain. For many people, ongoing therapy is a critical part of dealing with suicidal ideation, but can cost more than $200 a session. Free programs often have long waiting lists, and you can’t just put your suicidal ideation on the back burner until a spot opens up. If you’re lucky enough to get a spot in a free program, it’s often group-based and not individualized, and support only lasts a certain number of weeks. If you’re still struggling beyond the end of the program, you have to find additional supports. People trying to get help often run into roadblock after roadblock trying to navigate complex, overburdened, underfunded and expensive mental health systems. Creating accessible systems with the type of support people need when they need it is a vital part of suicide prevention.

Suicide prevention is so much more than a number to call when a person is already in such a state they need a crisis intervention, and it’s time we start looking at suicide prevention along a significant timeline vs. a single moment in time. If we focus on ensuring people have access to proper help and their basic needs met, with the customized support they need, we may have a better chance of handling the suicide epidemic we are currently facing. Suicide prevention must evolve to be more holistic and all encompassing so we can prevent folks from getting to a point where suicide is even an option on the table.