If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”
In the United States, about one person dies by suicide every 11 minutes. It’s a common tragedy, but not an inevitability. For decades suicide has been framed mainly as an individual problem—a consequence of mental illness needing psychiatric care. Increasingly, researchers and people with lived experience are asking a broader question: what about a person’s circumstances pushed them to that point?
For Chris Pawelski, a fourth-generation onion farmer in Orange County, New York, the answer was layers of pressure. His father—his close friend and day-to-day farming partner—was diagnosed with kidney cancer and died six months later. Chris became the primary caregiver for his mother, who has dementia. At the same time the farm was losing money: imported onions drove down prices, wholesale buyers held the advantage, and years of thin margins left him deeply in debt to suppliers and equipment vendors. His marriage weakened, and he worked from dawn to dusk seven days a week trying to keep the family operation alive.
“All that stuff collapsing down on you,” he said—weeks, months and years of pressures you can’t easily fix. He began imagining being struck by a truck as a way out.
Millions of Americans experience serious suicidal thoughts, and tens of thousands die by suicide each year. Suicide has consistently ranked among the top 10 causes of death in the U.S., making the country an outlier among wealthy nations. Prevention efforts have often concentrated on finding people in crisis and connecting them with clinical care—therapy, medication, hotlines. Those services are essential, but they can be costly, the behavioral health workforce is stretched, and research shows suicide risk is shaped by many nonclinical forces.
A growing movement argues prevention must go upstream—addressing the social and economic conditions that give people reasons to keep living. That means supporting food security, offering social activities for isolated older adults, investing in school programs that build resilience, and adopting housing policies that reduce evictions. Decades of research show upstream programs—even when they aren’t labeled mental-health interventions—can lower suicide rates and also cut crime, addiction, and poverty.
Sally Spencer-Thomas, a psychologist and researcher who lost a brother to suicide, puts it simply: healthier, more connected communities produce longer, happier lives. She says prevention shouldn’t be confined to hotlines or hospital wards; it should include social programs and policies that create stable networks. In her view, the United States has been slow to adopt this approach partly because it’s easier to promote therapy than to pursue broad policy changes—raising wages, strengthening social safety nets—that require political will. If society frames suicide solely as individual brokenness, she argues, it avoids responsibility for fixing broken community conditions.
Moving prevention upstream is hard. It often requires substantial public investment and long-term commitments that don’t deliver quick wins politicians can point to. Still, some public health leaders say the approach is gaining ground. Allison Arwady at the Centers for Disease Control and Prevention has emphasized building systems that support people through life’s inevitable turmoil. Brandon Johnson at the Substance Abuse and Mental Health Services Administration highlights programs that promote youth well-being and partnerships with community and faith groups as practical ways to reduce risk.
The COVID-19 pandemic sharpened awareness of how environments affect mental health: anxiety and depression rose as people’s lives and supports were disrupted. The launch of the 988 crisis line in July 2021 improved access to crisis response, directing funding and attention to call centers and mobile teams. Federal leaders involved with 988 say the boost to crisis infrastructure mattered, but they caution that a system built only around crisis response will never be sufficient.
Policy choices also shape risk. Cuts to health coverage, food assistance, and community supports can create stress that pushes people toward crisis. Advocates note that some policy moves—promoting youth physical activity, connecting people experiencing homelessness to services—do align with upstream prevention goals. Yet budget reductions and staffing cuts at public health agencies raise questions about sustaining these efforts.
Historically, U.S. suicide-prevention strategies have emphasized medical and crisis care. In the late 1990s, as youth suicide rates rose, national plans focused on identifying people in crisis and expanding clinical treatment. Those measures remain crucial, but many experts warn that treating individuals without addressing the life events that trigger or worsen distress—job loss, bereavement, childhood trauma, economic instability—misses much of the problem.
Pawelski’s experience shows how broader help can make a difference. By 2020, low onion prices left the farm facing large losses. He and his wife decided they could no longer afford to plant onions, and the thought of the family farm ending felt devastating. They reached out to NY FarmNet, a free Cornell University–based program that pairs farmers with two consultants: a financial analyst to help rework the business and a social worker to address emotional and family challenges.
The financial consultant helped Pawelski design a new model: move away from competing in volatile wholesale onion markets and toward small-scale vegetable production sold directly to consumers—greens, tomatoes, peppers, eggplants. They upgraded a truck with a cooler for deliveries and identified ways he could diversify income, including teaching and speaking using his communications master’s degree. The social worker helped him process grief and accept a new direction; Pawelski also began seeing a therapist. The combination of practical business guidance and emotional support produced a psychological shift he says mattered as much as the new business plan.
It took months, but the turnaround became visible. A neighbor commented on how much happier he seemed. Today his operation is more stable, he and his wife are chipping away at debt, and he advocates for programs that support farmers’ mental health and address structural pressures—fair pricing, debt relief, rural broadband access.
Pawelski still values crisis hotlines and affordable therapy, but he says those are not enough. “We need to think broader and longer-term than a helpline,” he argued. “That’s a band-aid on a gunshot wound.”
Most experts now say a comprehensive suicide-prevention strategy must include both strong crisis-response systems and upstream investments that reduce the conditions fostering despair. That means blending clinical care with policies and community programs that secure housing, food, work opportunities, social connection, and economic stability. Together, these measures can both save lives in moments of acute danger and address the underlying reasons people need saving.