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Letter to the Editor: From Darkness to Hope: Suicide Prevention Efforts and Recognizing Those at Risk

September is recognized as Suicide Prevention Month. During this time, we turn our attention to the ongoing fight against mental illness and the causes that may lead someone to take their own life.  Suicide is most often the result of psychological, environmental, and social factors. Mental health conditions can elevate the risk.  Still, it is important to understand that not all individuals with mental health conditions will experience suicidal thoughts or engage in self-harm.  The feelings of isolation and emotional pain that often follow these, however, can contribute to the vulnerability of those considering suicide.  As such, understanding and reducing the rates of suicide becomes a difficult challenge.
In Tennessee, the suicide rate is increasing. According to the Tennessee Department of Health’s 2021 Suicide Prevention Report, the total number of deaths by suicide increased by approximately 13 percent from 2015 to 2019.  Likewise, the rate of death by suicide per 100,000 population also increased by 11 percent during this same time frame.  Based on available data, the suicide rate for Tennessee males is 3.6 times higher than that of females.  Additionally, the Upper Cumberland region of Tennessee held the highest suicide rate for 2015 to 2019.  Therefore, we must take a closer look at the variables at play when considering suicide and identify the communities with increased risk. We must also look at the warning signs and approaches to suicide prevention.
When discussing suicide prevention, it is crucial to recognize groups within our communities that may be more vulnerable to experiencing thoughts of self-harm.  While it is important to note that everyone may have thoughts of self-harm and suicide, there are communities of people with circumstances that increase the risk.  These experiences result from unique stressors, societal factors, and individual challenges.  Targeted interventions and support are often the result of understanding vulnerable groups and identifying them.
• Adolescents and young adults:  Adolescence and young adulthood can be a period of emotional hardship, identity formation, and intense social pressures.  Bullying, academic stressors, peer pressure, and relationship issues may all lead to increased vulnerability.
• LGBTQ+ individuals:  Members of the LGBTQ+ community may face numerous rejections, discrimination, and social stigma.  These factors may contribute to increased feelings of isolation and depression, thus contributing to increased risks of suicidal thoughts.
• Veterans and active-duty military personnel:  Those who have served in the military may experience post-traumatic stress, traumatic brain injuries, or other mental health challenges.  There is, therefore, a potential for elevated risk of suicide due to these unique stressors associated with military service.
• Indigenous and Native communities:  Cultural discrimination, limited access to mental health resources, and historical trauma are all important factors, which contribute to increased suicide rates for Indigenous and Native communities.
• Individuals with mental health disorders:  People living with mental and behavioral health disorders are at an increased risk of suicide due to the potential severity of these illnesses.
• Those experiencing substance use disorders:  Substance use disorders can lead to greater feelings of hopelessness, isolation, and despair, contributing factors leading to increased vulnerability of suicidal thoughts and behaviors.
• Older adults:  Isolation, loneliness, physical health issues, and the loss of loved ones may contribute to a higher risk of suicide among older adults.
• People with chronic illness:  Chronic pain, limited mobility, and the challenges of managing chronic illnesses may lead to feelings of hopelessness and despair.
• Individuals with a history of trauma:  Survivors of trauma, including childhood trauma or sexual assault, may face long-standing emotional scars and pain, thereby increasing vulnerability to suicidal thoughts and ideation.
• Those in correctional facilities:  Individuals in incarceration face numerous unique challenges, which may include isolation, lack of access to mental health care, and a higher incidence of mental health disorders.  All of these factors may increase their risk of suicide.
• Refugees and immigrants:  Displacement and the challenges of adapting and adjusting to a new environment and culture may contribute to increased vulnerability among refugees and immigrants.
Being aware of potential warning signs is vital in offering timely support for someone in crisis.  While there may be multiple and often changing signs displayed when someone is considering suicide, the National Institute of Health identified the following as the most common:
• Expressing suicidal thoughts, feelings of shame, or claims of burdening others
• Social withdrawal
• Sudden changes in mood, including intensified feelings of hopelessness, despair, or even rage
• Increased risky behaviors, such as substance abuse or reckless driving
• Isolation from regular activities
• Drastic changes in appearance, such as neglecting personal hygiene
While the mental health field has grown in recent years to meet the increasing need for mental health and substance use services, preventing suicide is not the sole responsibility of healthcare providers or organizations.  That duty lays at the hands of everyone.  Building and nurturing a strong community involves individuals, families, schools, workplaces, and government agencies alike.  There are many ways we all can contribute to decrease suicide, including engaging in open conversations, promoting available resources, and creating supportive environments.  It is incredibly important for each of us to educate ourselves on not only the signs and risk factors associated with suicide but also the resources and services available to us and our loved ones.
Openly speaking with someone we feel may be contemplating suicide is often the first step in getting the assistance needed; if you suspect someone is struggling, directly ask if they are having thoughts of self-harm or suicide.  Following this, stay engaged by regularly checking on those with whom you have concerns and encourage them to seek professional help.  If harm or suicide are introduced into your conversations, it may be necessary to create a safety plan.  You may work with them to develop a plan for when they are having overwhelming thoughts or feelings. Take their safety into consideration and reduce access to items that could be used for harm.
In these scenarios, supporting those in crisis is crucial to their recovery and survival.  Remain calm around them while listening and confirming what they are thinking and saying. Allow them to express their feelings without judgment.  Remind them they are important and needed to those around them while refraining from debates of the seriousness of their thoughts and actions.  Ultimately, seek professional help to assist those in crisis situations, as again, the burden to assist those in need to foster a healthy life is not a sole responsibility.  It is a continuation of supportive care from many different people and agencies.
Suicide prevention requires a community effort with understanding, compassion, and active engagement.  By familiarizing ourselves with warning signs, having open conversations about mental health, and offering meaningful support, we can save lives, remembering that your presence, empathy, and willingness to listen can make a profound difference in someone’s journey from darkness to hope.

If you or someone you know is experiencing a mental health crisis, call or text the Mental Health and Suicide hotline at 988 or call 800-704-2651 to reach the Crisis Team at Volunteer Behavioral Health.

Other statewide and national suicide resources include:
Tennessee Statewide Crisis Hotline 1-855-CRISIS-1 or 1-855 (274-7471)
National Suicide Prevention Hotline 1-800-273-TALK or 1-800 (273-8255)
Learn about more ways Volunteer Behavioral Health can help by visiting their website at