Why does suicide continue to be a reasonable option for a growing number of American adults?
Over the past several years, federal, state, and local governments have made a substantial effort to increase access to mental health services. Through grant funding, mental health initiatives, crisis response and peer support programs accessible to the public, veterans, law enforcement, first responders, Native Americans, and rural communities, the government has invested billions of dollars to improve the availability and accessibility of mental health resources and care.
On the surface, it looks like things are improving. But once you look beneath the surface, you begin to see something very different. The deeper you look, the more outrageous it becomes. Despite increased accessibility to resources, the number of American people thinking about ending their lives and attempting to do so is either increasing, remaining stagnant, or going down by only the tiniest percentage.
It becomes hard to ignore that something is fundamentally wrong.
Take 2024, for example. In 2024, the number of adults in the U.S. was approximately 266 million.
Let’s not forget that these numbers tell us only what has been reported. They tell us nothing about those who suffer in silence. They tell us nothing about the people who never enter the mental healthcare system, never respond to surveys, never disclose their thoughts, and never ask for help. How many people are we not counting? Perhaps another 50% of this population?
Can you see what I see?
Clearly, something ain’t working.
So again, the question is: Why, despite the increase in mental health initiatives and resources, has the number of adults who have thoughts of taking their own lives increased, remained stagnant, or gone down by only the tiniest percentage?
In order to better understand this question, we need to look at mental health through the lens of a system. The United States is built on systems. We have a criminal justice system, an educational system, a highway system, a political system, etc. Each of these systems has different governmental agencies and subagencies associated with it that work together to achieve the same goal: the goal of the system. Each system comes with an internal process and a flowchart that explains how the system operates, how its different parts interact, how agencies share resources, and which agencies are responsible for what.
When it comes to mental health, I believe that it falls under the umbrella of both the healthcare system and the public health system and their respective agencies.
However, I struggle to see any coherent interaction between these agencies and subagencies that produces sustainable mental health improvement outcomes. I struggle to see any reasonable level of structure, collaboration, data sharing, oversight, and continuity of purpose.
Instead, what I see is a mess.
What I see is a collection of independent agencies and mental health organizations, confused and free-spirited mental health professionals, pharmaceutical playgrounds, ambiguous policies and regulations, and helpless people.
I see individuals with serious mental illnesses running around like chickens with their heads cut off, causing hardships to others. I see streets, parks, schools, and social gatherings filled with people with anxiety, depression, PTSD, substance abuse problems, and psychosis. I see an increase in violent offenses, domestic violence, homicides, and suicide attempts. I see people with serious mental health problems, including child predators, rapists, and individuals with schizophrenia, being released from the criminal justice system back into society after just a few days of so-called psychiatric stabilization, only to commit the same crimes over and over and over again. I see people pretending to be well in order to maintain an image when, in fact, they all are messed up and in crisis.
It looks like the majority of the mental health initiatives that we spend so much money on are struggling to achieve their intended purpose, which ultimately is to secure and protect the health and well-being of the American people.
It looks like the mental health system is in more of a crisis than the American people themselves.
In recent years, I began paying closer attention to the broader spectrum of society, public health, and the functionality of the governmental agencies that are delegated to oversee mental health regulations and initiatives. I was hoping that perhaps somewhere within those social and regulatory dynamics lies a clue that can help explain why more people entertain the idea of ending their existence and why, despite all of these mental health initiatives, mental health crises continue to get worse.
To try to explain this, I turned to a simple problem-solving tool known as the Five Whys. The Five Whys method was originally created by Toyota’s engineering team to troubleshoot equipment failures and identify issues on the assembly line. The Five Whys method was designed to improve the system, not to point fingers at the system operators.
In order to find the root cause of the system failure, the engineers repeatedly asked the question, “Why?” until they got to the bottom of the problem. The goal was not only to find the problem but to use countermeasures to prevent the problem from occurring again.
Using the Toyota Five Whys approach, our problem would look like that:
Question #1: Why do 14.3 million-plus American adults in our wonderful and democratic society want to end their existence by taking their own lives?
Answer: One possible explanation could be that these 14.3 million adults are not able to sufficiently cope with the stressors of life.
Question #2: Why are people not able to sufficiently cope with the stressors of life?
Answer: They are not adequately prepared.
Question #3: Why are they not adequately prepared? This question is more complex and may have multiple possible answers. Let’s evaluate these five answers using the process of elimination.
Answer #1 could be: There are no available resources to prepare people.
Well, let’s talk about that. Wherever we look, the government announces new mental health initiatives, awareness campaigns, peer support and employee assistance programs, etc. In other words, mental health resources are available. Many departments receive substantial funding that is intended to be allocated toward mental health programs and services. Notwithstanding these efforts, rates of people having suicidal thoughts keep rising. Thus, this answer could easily be eliminated.
Answer #2 could be: People do not know about the resources.
It is fair to speculate that perhaps people simply do not know these resources exist. However, we can largely eliminate that argument by looking at public awareness campaigns, advocacy groups, community events, suicide prevention walks, and countless other efforts designed to make people aware that mental health resources are available. So, if there is anyone out there who does not know about the available resources, perhaps they just have never considered using them.
Answer #3 could be: People know about the resources but, for whatever reason, do not take advantage of them.
So, let’s presume that people know about the resources but do not take advantage of them for a variety of personal reasons. This is a fair and reasonable argument, taking stigma into account.
Yes, The stigma is a bitch.
People may be afraid to seek help because they fear being judged, labeled, or treated differently. They are afraid of losing their jobs, careers, and reputations. But on the flip side, if you think about it, if anyone is afraid to access a resource, does that suggest that there is something about the resource itself that people are afraid of?
That is the question worth exploring. Let’s keep this point for another article.
Answer #4 could be: People are not eligible to access the resources.
This answer is equally reasonable and fair to entertain. Some people do not have adequate insurance coverage or cannot afford counseling or specialized treatment. That is a valid point. However, we must also recognize that many nonprofit organizations provide mental health services at no cost. There are crisis lines that anyone can call at any time without charge and without judgment. And if people are not accessing them, maybe, again, that suggests there is something about the resource itself that people are afraid of.
Answer #5 could be: The resources are out there, but they do not work.
This brings us to the final possibility that deserves careful evaluation: People can and do access the available resources, but the resources do not produce the outcomes they were intended to produce.
If that is true, this begs the nest question:
Why don’t the resources work?
What exactly is happening? If things are getting worse despite unprecedented investments in mental health resources, then we should question whether the resources are achieving the results we expect. What is it about the resources that prevents them from producing the expected outcomes?
This does not mean that counseling sessions are ineffective, that public mental health campaigns have no value, or that conversations with peer support specialists are useless. Many of these interventions have a meaningful impact. But a single encounter with a peer support specialist, one 20-minute mental health video, one 45-minute psychologist appointment, or a two-week awareness campaign is unlikely to produce lasting results for our mental health crisis if those efforts are disconnected from one another and are not part of a coordinated, continuous system of care.
The same principle applies to medication management. Inappropriate prescribing or a lack of ongoing oversight for people taking psychiatric medications hinders the entire mental health system and undermines the idea of securing and protecting the health and well-being of the American people.
A brief intervention may be an important first step, but by itself, it will never be sufficient to address the complex, long-term mental health struggles of the people and the society.
Mental health is a long game.
The goal is not simply to intervene when someone is suicidal, homicidal, or exhibits behaviors that are detrimental to our social values. The goal is to build generations of people who are able to cope with the stressors of life without thinking of killing themselves or those with whom they disagree by shooting up schools, churches, or Fourth of July parades.
The goal is to build a generation of people who possess the skills necessary to navigate the stressors of life and life’s adversities without becoming discombobulated to the point of having either suicidal or homicidal ideations.
We must stop waiting for people to become suicidal or homicidal before doing anything about it. Informing people how many other people are depressed, anxious, suicidal, and homicidal is not a solution. This is not solving the problem.
What will solves the problem is the use of a countermeasure. Something that will significantly decrease the number of American people entertaining the idea of ending their existence.
We need immediate action and sustainable mental health reform that will meaningfully reduce the number of people living with untreated or inadequately treated mental health conditions. Doing so has the potential to reduce many of the other problems affecting society, including violent crimes, homicides, carjackings, domestic violence, substance abuse, homelessness, drug overdoses, the opioid epidemic, shortcomings within the criminal justice system, inappropriate overuse or underuse of psychiatric medications, insurance fraud, criminal offenses, family breakdowns, divorces, and many other social challenges.
Mental health is not just another social problem among many others; it is one of the foundational factors that influences everything else. It is deeply connected to many of the other most pressing challenges facing our society today.
Yet much of our attention is directed toward reforming the consequences of our mental health system failures. We will remain focused primarily on managing the outcomes rather than preventing many of the conditions that contribute to them in the first place.
We are throwing mental health resources against the wall to see what sticks.
Unfortunately, thus far, nothing ain't sticking.
What we need is mental health reform before our house burns completely to the ground and our next generation has no idea what to do with themselves.
It’s about time for a fundamental change.
I can’t wait to share more.