Suicide Prevention Requires Collective, Systemic Solutions

Person with dark skin sitting on the ground with their elbows on knees and hands on their face.

Suicide prevention and intervention programs and services are vital. Mental health services are essential to support individuals, families, and communities struggling with mental health, suicide, and after suicide loss. But we must also recognize that preventing suicide requires a larger collective, systemic response. 

Suicide deaths are rising steadily every year, with a record high of nearly 50,000 people who took their own lives in the U.S. in 2022. This urgent public health issue requires us to examine and address the social determinants of health of poor mental health. We must also zoom out to take a wider view of the social, economic, and political landscape that creates the conditions for depression, anxiety, and suicide.

Suicide is a collective, systemic issue
Person with dark skin sitting on the ground with their elbows on knees and hands on their face.

It’s time to reframe our traditional narrative of poor mental health – and suicide specifically – as an individual, problem. While there are individual and biological risk factors for poor mental health, we must also recognize that suicide is a collective, systemic issue. Poverty, racism and other systems of oppression, for example, increase the risk of poor mental health, but are often swept under the rug as causes of suicide.

Suicide crisis hotlines are essential for individual crises. More culturally inclusive, accessible, and affordable mental health providers are needed. But more mental health care providers and hotlines alone won’t solve our mental health crisis. 

Lack of social safety nets 

Tens of millions of Americans do not earn a living wage. With frayed social safety nets, an astounding 78% of Americans are living paycheck to paycheck (defined as not being able to save money). And for 29% of people in this category, income doesn’t even cover their basic expenses. This is collective trauma.

Financial insecurity, and working menial, often unsafe jobs for little pay causes chronic stress. Having to choose between buying food and medicine leads to chronic stress. Not being able to afford health care, even while working a full-time job, leads to chronic stress. This financial insecurity can contribute to depression, anxiety, and suicidal thoughts.

When one can’t find work, or loses a job, it’s often viewed as an individual problem. But that’s not the full story, as we don’t operate in a vacuum. What impacts one of us impacts us all. Ensuring jobs with a purpose and a livable wage is suicide prevention. Ensuring access to quality healthcare is suicide prevention. Having a strong sense of community, connectedness, and belonging are suicide prevention. 

The U.S. ranks at the bottom of nearly every category of social safety net support when compared to other industrially developed countries. Many countries have social safety nets that protect their residents when the country is hit with an economic crisis. There is government support to all as a collective effort. In the U.S. we’re more likely to go it alone.

Individualism can lead to isolation, a major risk factor for suicide 

It’s important to consider how the social world influences the individual, and the role that culture plays in suicidality. The deeply engrained American values of personal freedom and rugged individualism contribute to the idea that we don’t need external support, be it from friends, family, and community, or the government. Western philosophical thought encourages self-interest over the collective. This worldview creates a physical, emotional, and spiritual disconnection from others. Humans are social beings, and social isolation can be extremely painful. 

The idea that we must be independent and self-reliant at all costs creates a lack of belonging and is harming our collective mental health. Individualism has led to less participation in community-based organizations over the decades. This, coupled with the immense rise in social media and the skyrocketing numbers of people living alone, has led to less time socializing and more time alone. The lack of social support and connection can exacerbate isolation. In individualistic countries, such as the U.S., high collectivism has been associated with less suicidal ideation. Similarly, “pulling yourself up by the bootstraps” is the belief that success in life is determined by personal will and responsibility. When an individual experiences failure, the result can be soul crushing, as that guilt and shame is internalized. 

Oppression leads to depression

Another form of isolation is oppression. Oppression is a social injustice that contributes to poor mental health and suicidality, especially among people with marginalized identities. Oppression plays out in many ways, from racism, homophobia, sexism, poverty, and beyond. This systemic discrimination can lead to trauma, and increases symptoms of stress, depression, anxiety, and PTSD for groups who experience the brunt of oppression. An increase in emotional distress can occur in groups with multiple marginalized identities, as the the affects are multiplied. This is because groups with marginalized identities have less rights and access to resources than those in dominant groups. They also experience less political and economic power, contributing to hopelessness and worse mental health outcomes. Groups that experience oppression within the United States include marginalized racial and ethnic groups, women, LGBTQ people, people with disabilities, and low-income folks. Groups that benefit from oppression in the U.S. include white people, men, heterosexual people, able-bodied people, people with higher incomes and wealth, and dominant religious groups.  

white jigsaw puzzle pieces on brown marble tableMicroaggressions and mental health

Oppression can be overt and explicit when it comes in the form of discrimination, violence, harassment, and abuse of power. Oppression can also be more subtle and insidious. Microaggressions are the subtle, usually unintentional, words or behaviors that communicate that someone is less than because of their group membership. These daily stressors, in addition to not being able to bring one’s full self and all of one’s identities to all spaces, causes an increase in the stress hormone, cortisol. Over time, this hypervigilance coupled with the release of cortisol, can damage to the body. Hypervigilance can lead to anxiety, depression, and hopelessness, all risk factors for suicide and self-destructive behavior. 

What can we do? 

  • Create safe, compassionate communities where people have social support, feel connected to each other, and have a sense of purpose. 
  • Increase community integration by participation in community-based organizations, volunteer opportunities, and local activism.
  • Listen to and uplift the voices of people with lived experience and psychiatric survivors.
  • Share these links with people in need of mental health counseling or health care: and LGBTQ+ Healthcare Directory
  • Share this resource with the transgender community: Trans Lifeline is a grassroots hotline and 501(c)(3) non-profit organization offering direct emotional and financial support to trans people in crisis – for the trans community, by the trans community. 
  • Create programs, policies, and services that center marginalized people and center racial equity. 
  • Conduct a Racial Equity Impact Assessment to reduce, eliminate and prevent racial discrimination and inequities. Use for new or existing programs, policies, or services.

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the 988 Lifeline network is available 24/7 across the United States. Call or text 988.

Alison T. Brill

Alison T. Brill (she/her), MPH, is a Training & Technical Assistance Specialist at ICF International, a global leader in strategic consulting and communications services for various industries and challenges. She delivers strategic, innovative consulting and DEI-informed strategies to advance health equity and well-being and support healthy, resilient communities. She also serves as the Co-chair of the APHA Medical Care Section’s Health Equity Committee, as well as a mentor. She holds a Master’s of Public Health from Boston University, and a BA in Social Work and Psychology from the University of Iowa. Views expressed are the author’s and do not necessarily reflect those of ICF.

Alison T. Brill

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