On the Front Lines of Suicide Prevention Stand Family and Friends

New Jersey’s suicide prevention hotline clinician says knowing the warning signs and what to say could save lives

The Centers for Disease Control and Prevention reported that suicide was the 11th leading cause of death overall in the United States, with more than 48,000 lives lost to suicide in 2021.

While national rates declined in 2018 through 2020 from a previous 18-year high of 14.2 deaths per 100,000 citizens, suicide was the second-leading cause of death among people ages 10 to 14, 15 to 24, 25 to 34 and 35 and 44. The total number of suicides, 48,000, nearly returned to their peak in 2021. 

New Jersey now has the lowest suicide rate in the nation, with about 7.1 suicides per 100,000 people, in part because of the resources available for individuals in crisis. 

“A transformation in our nation’s crisis continuum is unfolding” said William Zimmermann, director of crisis services at the National Call Center at Rutgers University Behavioral Health Care. “Our collective goal remains the same: Zero deaths by suicide. A single life lost is too many.”

During National Suicide Prevention Awareness Month, Zimmermann discusses how people and communities can continue to aid in suicide prevention.

How has the new 988 line for suicide prevention helped to improve access to services?

Zimmermann: 988 is a three-digit dialing code for anyone in the United States, territories and tribal regions who is in a suicidal, mental health or substance-abuse crisis. It went live in July 2022 as the result of the National Suicide Hotline Designation Act of 2020, is funded by a grant from the Substance Abuse and Mental Health Services Administration and administered by Vibrant Emotional Health. Federal funding has increased the number of trained counselors available to provide support, assistance and linkage for callers in crisis.

In the first two years, 988 answered over 10 million texts, calls and chats after the Biden-Harris Administration invested over 1.5 billion in the nation’s crisis continuum. There are now multiple national subnetworks available. Callers can press 1 to speak to someone from the Veteran’s Crisis Line, press 2 to connect to someone in Spanish, and press 3 to connect to the LGBTQI+ youth subnetwork. In addition, videophone contact via American Sign Language (ASL) is available (for more details, visit the 988 Suicide and Crisis Lifeline).

Since 2023, texts to 988 increased by over 51%, and calls increased by 34%, while chat volume decreased by 21%. 988 will not only provide better access to crisis care for underserved populations such as those in rural areas and communities of color, it will also direct the current mental health crisis response away from law enforcement to trained mental health professionals. As part of the 988 crisis continuum transformation, the New Jersey Division of Mental Health and Addictions Services is preparing for the launch of both mobile crisis teams and crisis receiving and stabilization centers, increasing the level of support for those in crisis whose needs exceed what a phone call can provide, but do not require an emergency response. More details are available here. Those in need of support or information can text directly to 988 or initiate a web chat via Vibrant’s landing page here.

Who is often the first line of defense in suicide prevention?

Zimmermann: Everyone can participate in suicide prevention. Family, friends and acquaintances should be alert for signs an individual is contemplating suicide and take action. Be prepared before a crisis occurs by taking a few minutes to visit Vibrant Emotional Health’s site bethe1to.com. There is a wealth of information to help support someone in suicidal crisis.

A misperception is that suicides happen without warning. While this can and does occur, often the person suffering has attempted to communicate his or her distress or plans to someone else. It may not be clearly stated, so asking direct questions about suicide can start the conversation and help-seeking process.

What are some signs that someone is suicidal?

Zimmermann: Increased substance abuse, anxiety, agitation, difficulty sleeping or dramatic mood changes can indicate someone is at risk. A feeling of hopelessness and being trapped or having no sense of purpose can be warning signs. Social withdrawal, uncontrolled anger and reckless behavior also are causes for concern.

Most importantly, if people talk about wanting to hurt or kill themselves, threaten to hurt or kill themselves or indicate they are attempting to find a method to kill themselves, seek immediate help or guidance by contacting a mental health professional or 988, where specialists will listen to your concern and, together with you, develop a plan to get your friend or family member the help they need.

If you notice signs that someone is suicidal, what should you do?

Zimmermann: If you do encounter someone you suspect is in crisis, express concern and ask them directly if they are thinking about suicide. You can say, “I care about you. Some of the things you’ve said or done have made me wonder. Are you having thoughts about suicide?” It’s that simple. 

If they say they are considering suicide, don’t judge, don’t deny and don’t dare. Telling them, “Don’t say that” or “You shouldn’t feel like that” will likely send the message that you aren’t interested in continuing this important conversation. Don’t promise to keep it a secret. Get support for yourself and for the person talking about suicide. Reach out to 988 for further direction or guidance. Help and support is available 24 hours a day, every day of the year.

What are some public misperceptions about suicide?

Zimmermann: A common myth about suicide is that it only affects those with a mental health condition. Not all who die by or attempt suicide have a mental illness, and many who do struggle with a mental health issue do not experience suicidal thoughts or behavior.

Another myth is that asking directly about suicide will “put the idea in a person’s head.” Opening the topic for discussion gives an opportunity to share something painful that had previously been borne alone. It also provides an opportunity to provide support and intervene.

How can society reduce the stigma surrounding a person who seeks help for a mental health condition?

Zimmermann: Education and open discussion are critical. The statistics show that each year, over one in five Americans will experience a mental health illness. In 2021, nearly twice as many people died by suicide than by homicide in the United States, and for each death by suicide there are 25 attempts. That’s over one million attempts a year.

Oftentimes there are signs and opportunities to intervene well before a crisis develops. We hope that increased attention, education and resources will help reduce both the stigma associated with mental illness and the suffering of those affected.