Suicide Prevention In America : Why Isn't More Done To Prevent It?
Publish Date: November 19, 2025
Author: Dr. Jeffrey A. Lieberman
Source: Shrink Speak substack
Few human deeds carry the shock, sorrow, and mystery of suicide. It is the most final expression of the tragic culmination of mental illness, emotional pain, and anger or frustration at circumstances that have become unbearable to the decedent. While it is a solitary act, suicide begets many victims, as it leaves torrents of grief, guilt, and numerous unanswerable questions in its wake for families, communities, and the professionals whose lives are dedicated to preventing it.
For those of us who have not encountered suicide in our own immediate circles, the abrupt finality and sobering reality of these unanticipated tragedies materializes when well-known, successful, and beloved public figures take their own lives despite their apparently enviable circumstances – the suicides of Anthony Bourdain, Alexander McQueen, Robin Williams, and numerous others have shocked and saddened the public in recent decades. Just weeks ago, news of the death of a scientific luminary shocked the psychiatric community when we learned that on October 8, 2025, Dr. Nolan Ryan Williams took his own life. In doing so, he left behind a wife, two children, and a retinue of faculty at Stanford University, where he was a Professor of Psychiatry, and colleagues in the psychiatric community.
Williams, already a highly acclaimed scientist at the age of 43 and a rising star in the world of psychiatry, would seem to have been suicide’s least likely candidate. His act, in spite of his manifestly successful and abundant life, attests to the fact that suicide is not an event that can be reduced to a single, observable incident. Rather, it is the accrual of numerous factors, some of which may be discovered in time, and some which may never be fully understood.
In the words of author and journalist Gabriel García Márquez, “All human beings have three lives: public, private, and secret.” It is this third, “secret” life, the life of the mind, that continues to thwart us as we try to comprehend the phenomenon of suicide. Yet it would be a mistake to suggest that we do not possess the knowledge necessary to greatly reduce the rate of suicide, preventing tragedy for innumerable families and communities across the United States.
For more than a century, science has advanced our understanding of suicide. We know the conditions most likely to lead to it — mood disorders, particularly depression and bipolar disorder, schizophrenia, substance abuse, trauma, and social alienation. We’ve dispelled old myths that suicide is random or inevitable. We’ve learned that it is almost always the product of treatable illness and identifiable risk.
And yet, despite our grasp of this lethal problem, suicide rates in the United States have remained stubbornly stable for almost a century and, more recently, have actually risen.
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Over the past two decades, while heart disease, cancer, and even homicide rates have declined, suicide deaths have increased. Adolescents, middle-aged men, and elderly adults now represent growing high-risk groups. Moreover, official statistics are likely undercounts, since stigma still drives families and institutions to label suicides as “accidents.”
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To add fuel to the fire, modern culture has changed faster than our coping mechanisms have allowed. Adolescence now stretches into the late twenties. Social media has transformed how we connect, build relationships, and compare ourselves to our peers, often amplifying loneliness and despair. Political polarization, economic insecurity, and the decline of community institutions have left many people feeling more isolated than ever. Among older adults, chronic illness, pain, and cognitive decline strip away independence and meaning.
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Since the first suicide prevention center opened in Los Angeles in 1958, our awareness has expanded dramatically. The first hotline began in 1962; the first national prevention center followed in 1966. Congress formally recognized suicide as a national problem in the 1990s. The National Institute of Mental Health launched its National Strategy for Suicide Prevention in 2001 and reaffirmed its goal of reducing suicide deaths by 20% by 2025.
But awareness alone hasn’t moved the needle. Suicide hotlines now answer millions of calls. We post crisis numbers on billboards, television, and social media. And still, the rates rise – because awareness is meaningless without the access, coordination, and care that must be rooted in a functioning mental health system.
The U.S. mental health system, in fact, is not really a system at all – rather, it is a collection of silos. A person in crisis might enter into care through an emergency room, a jail, a primary care clinic, or a school counselor, but most suicidal individuals never reach a psychiatrist or therapist. Their care ends at the point of crisis, and the root of their suicidality is never confronted.
We don’t need to rediscover the causes of suicide. We have the science, the tools, and the knowledge to make a difference. What we lack is the urgency and will.
Primary care doctors – the first contact for most people with depression or anxiety – are rarely trained in behavioral health. Even when they identify patients at risk, the referral pathways are broken, and escalation is convoluted. Wait times for treatment can stretch for months. Insurance coverage is inconsistent, fragmented across public and private systems, and fails to support continuity of care.
We know what works: continuous, team-based, multidisciplinary, evidence-based care. Programs that embed mental health in primary care, ensure follow-up after suicide attempts, and link crisis services with long-term care reduce deaths. But these are obscure, scattered, and underfunded.
We don’t need to rediscover the causes of suicide. We need to implement what we already know:
- Train primary care clinicians to recognize and manage depression and suicidality.
- Expand the behavioral health workforce nationwide, especially in rural and underserved communities.
- Build systems that ensure every person who experiences a suicidal crisis receives follow-up care — not a single phone call, but ongoing support.
- Demand accountability from government, insurers, and health systems to treat suicide prevention as a measurable performance goal, not a moral afterthought.
The tragedy of suicide may never be entirely eliminated. But its current toll is intolerable and indefensible. We have the science, the tools, and the knowledge to make a difference. What we lack is the urgency and will.
We must move from awareness to action – and from compassion to commitment.