If your ‘suicide prevention’ isn’t talking about the mental health system, you’re missing the point.

As both a suicide attempt and loss survivor, I need to climb up onto my soapbox for a minute.

Suicide attempts, from a “preventative” standpoint, are rarely, if ever, as easily prevented as calling a hotline or a loved one. “Reaching out” — while incredibly important — is not the be-all-end-all of preventative strategies.

Especially considering the fact that many of us have a history of asking for help, and not getting the care that we needed.

I understand the impulse to ask, “Didn’t they know they could call me?” I asked myself that many times when I lost one of my best friends earlier this year. But this shows a very big misunderstanding of the emotional experience that many suicide attempt survivors have described.

Speaking from my own experience, when you are in a very acute amount of emotional distress, your thought process is not as linear or composed as you might assume.

The pain in that moment can eclipse everything else — past, present, future. It’s a sort of tunnel vision in which the pain becomes too great; in those moments, I’m cognitively incapable of stepping back to get the kind of perspective I might otherwise have.

This is why I always try to remind folks that suicide attempts don’t necessarily reflect a person’s overall state, as much as it does their level of pain in that particular moment.

To put it as a metaphor, suicide attempts remind me quite a bit of heart attacks, in the emotional sense.

After a certain point, the body’s resources can no longer fend off a very acute and painful event. It is so pronounced that your brain’s reaction is to scramble and do whatever is necessary to combat that pain, as immediately as possible.

We have some autonomy when we’re in that kind of pain. But so many of our actions are ultimately driven by the visceral agony we’re in. Our systems are flooded and overwhelmed, made worse by the adrenaline, the stress hormones, and for many of us, whatever substances we might be abusing — like alcohol — in a misguided attempt to cope.

But more often than not, unlike a heart attack, it’s also a pain that’s been building for weeks, months, or even years.

When we talk about “suicide prevention,” we focus too much on trying to understand the actual attempt, and not enough on accessibility of care.

We don’t do much to ensure that the pain doesn’t become that acute in the first place. We don’t focus enough on quality of life afterward. And most importantly, we rarely interrogate the systems in place that have failed to support them long before they reached this place.

It’s as though we’ve seen someone having a heart attack, but we start asking what they had for dinner the night before, or kicking ourselves for not offering them aspirin that morning.

When we talk about addressing heart disease, we’re not just trying to intervene in the mere moments before they happen — we know that isn’t enough, which seems like common sense in this context.

We talk about the whole person, and all of the ways in which their wellbeing needs to be prioritized well before they reach a crisis point.

But suicidality is still not viewed this way. We treat suicide attempts as very deliberate choices, rather than complex reactions that we know are better addressed sooner, not just puzzled over later.

The problem is, our mental health system isn’t set up to intervene at the moment when it’s needed.

Therapists and psychiatrists are still wildly inaccessible. And if you can find one that has availability and is covered by your insurance (assuming you have insurance), it often takes weeks, even months before you can actually see them.

If that clinician isn’t competent or a good fit? That’s additional weeks, months, and even years until you find someone who meets your needs. Which doesn’t include the months it takes for those treatments to start yielding real results.

I recently wrote a reported piece about a veteran with PTSD, for whom the nearest mental health provider that took his insurance was a staggering four hours away by car. And if he hadn’t had access to a vehicle? I’m not sure he would still be alive right now.

And all this assumes that mental health care isn’t so stigmatized in your community that you feel empowered to get help sooner rather than later, which is simply not the culture we live in.

This bureaucratic nightmare, combined with stigma, is why many people with mental health struggles often don’t seek help for nearly a decade (or more) after their symptoms set in, if they seek help at all.

And that’s why I bristle at the questions I so often hear after a suicide attempt. “Why didn’t they ask for help?” is the wrong question to ask. “What were they thinking?” is the wrong question to ask.

“What did WE do to help them, as a society?” is the question here. And more specifically, what were WE thinking, when we set up our mental health system to be so inaccessible?

I want to challenge us to think about what we’re doing to change this on a substantive, systemic level. This isn’t about reaching out. This is a call-to-action.

My own suicide note years ago simply read, “I’m sorry. I just can’t do this anymore.”

Not, “I don’t want to do this.”

Not, “I don’t have any other options.”

Not, “I don’t care about my loved ones.”

I simply said, “I just can’t.” I had reached a point at which I truly believed that I could no longer physically withstand the pain that I was in.

This led me to the emergency room and, even there, I saw people desperately trying to harm themselves by any means they could, being stopped only because they were restrained by hospital staff.

And this was not because they didn’t have “help” or “options.” It wasn’t even because they weren’t asking for support. They were in the hospital — they were surrounded by people who, in theory anyway, wanted to help them.

But their pain was that unbearable, that all-consuming.

How do you bring someone back from that? And more importantly, how do you make sure they don’t return to that place?

Beyond preventing the act of attempting suicide, I want to know how we can assure them that the life they’re returning to is one in which they are truly supported.

No one should ever get to a point of experiencing that much pain. And if they do, there should be no question of what resources are in place to guide them through recovery. But our system isn’t built to intervene sooner rather than later. Our system isn’t built to create a reliable, consistent safety net afterward.

It’s certainly not interested in establishing any real quality of life, so much as it focuses on simply preventing death.

We have a “worst case scenario” mental health system, and it’s failing. Its efficacy is a game of luck at best, a roll of the dice.

If you have insurance; access to transportation; the right combination of clinicians, inpatient or outpatient programs, and/or medications; the time to commit to recovery; the persistence to keep following up with providers; the support system around you to help you when this becomes overwhelming; and the sheer energy to navigate the system that is already overburdened — maybe, just maybe you’ll survive.

No one’s livelihood or quality of life should be left to chance.

I’m not trying to paint a bleak picture. People can and do thrive, and I’m absolutely an example of that.

But not because our system is actually successful at what it does — it’s because I am one of the lucky ones that eventually, after many years, found my way through it.

I can tell you why I attempted suicide years ago, and it’s simple: the amount of time it took to “recover” exceeded the amount of resources I had to cope.

It took eight years to get the proper diagnoses for my mental health conditions from the time I started therapy at age 17.

Which means it took eight years to find the right medications to treat my OCD, PTSD, and ADHD. And it took eight years to find a therapist that specialized in those areas — a therapist that I had to pay out-of-pocket for, because my insurance wasn’t taken by any therapists in the area who had openings for new clients.

I’m less interested in preventing the act of suicide itself, and more interested in knowing why our system is doing such a terrible job of caring for people who are struggling before, during, and after.

When we know earlier and more compassionate interventions are so critical, and when we know quality of life is exceedingly more important than simply keeping someone alive, we need to start asking why our system is set up the way it is.

We need to start demanding that something change — because our lives depend on it.

Hey there, friend. Before you go, I want to share some resources with you.

If you’re suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386, or reach the Crisis Text Line by texting “START” to 741741.

• Don’t know what to say but want to ask for help? That’s amazing. I wrote an entire guide on how to reach out and what you could say.
• You can also go to the emergency room. If you’re not sure if you should or how to prepare for something like that, I’ve got an article for that, too.
• Looking for some immediate self-care resources? I’ve got some for you in this article.

This isn’t just a generic “here are some numbers” plug, I promise. This is a “I want you to stay, we need you here, please don’t go just yet” plea.

Are you a loved one that wants to reach out to someone you think is struggling? Incredible. You totally should.

I have a guide here for how you can offer support in concrete ways.

One more thing: I created this resource totally for free, but your donations help keep this labor of love going.

This blog is not sponsored by any fancy pants investors that are trying to sell you stuff.

It’s funded by readers like you via Patreon!

Every donation counts. Help keep resources like these accessible to everyone that needs them! And help buy me a cup of coffee, because I write a lot of these blogs after work, late at night, so I could definitely use the caffeine.

 

Some credits & gratitude go to… Photo by rawpixel on Unsplash. Artwork by Jessica Krcmarik.