Rethinking Suicide Prevention

This is the first installment in a three-part series. Links to Parts II and III—which feature practical strategies for suicide prevention—are available at the end of the story.

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I still remember the moment I realized my suicide prevention preparation as a psychologist had failed me.

It was the evening of December 7th, 2004. I was driving on a Colorado highway when my mother called me. “Pull over,” she said, her voice shaking. Then she told me that my brother Carson had killed himself.

I had all three of my boys with me. We’d been heading to a holiday party and were running late as always. The smell of cloves from the ham I’d brought and the sound of my sons singing “I Have a Little Dreidel” filled the car. I was wearing a ridiculous red-and-white Christmas sweater with snowman earrings, feeling lighter than I had in months. My brother had been in crisis all fall, and for one evening, I was trying to hold on to something normal.

When my mother told me to pull over, I knew what had happened. Something in me shattered as I rushed to get out of the car. I dropped the phone on the ground and screamed—a sound that didn’t feel human, coming from somewhere I didn’t know existed. I sat on the shoulder of the highway in the dark, my hands and knees covered in gravel.

A small voice from the backseat slammed me back into my body: “Did something happen to Uncle Carson?” Nicholas asked, his voice tiny and tender. “Mommy, I am crying for you.”

In that moment, I understood that I had to survive this—not just for me, but for the three children watching their mother fall apart. I found my phone and managed to drive to my mom’s house on the worst night of my life by focusing on something simple: red means stop, green means go.

The Revelation

Something haunted me in the weeks and months following my brother’s suicide: I had done everything I’d been trained to do.

But even as a graduate student in the 1990s, a decade before Carson’s death, I knew I was under-prepared to support people experiencing suicidal crises. It was obvious. Suicide barely showed up in my curriculum, and when it did, it felt like an afterthought. So, I sought out extra training and experiences. I attended conferences that focused on lots of theories and statistics, risk factors, and warning signs, but little of that felt like prevention in any meaningful sense. None of it felt like recovery or healing.

I dove into the research and studied police responses to civilian suicide, exploring the compassion fatigue and secondary trauma they experienced. I even sought out an extra externship in the ER, desperate to understand what we were doing to help. What I found there was sobering. I watched as people in acute suicidal crisis—terrified, dysregulated, at their most vulnerable—were interrogated with a 40-page risk assessment checklist while bound to a gurney. The process was sterile, procedural, and profoundly disconnected from anything that felt like care.

So, attempting to process what had happened with Carson, I tried to pull together what I knew through the lens of my training. I knew he’d been in trouble for months. I knew about the major manic episode that summer, and the crash that came after, when his accountant told him he was broke. I knew that he’d descended into a debilitating depression so severe he couldn’t eat or sleep, that his hands had trembled from agitation, and that he was filled with remorse and self-loathing.

Carson had told me that he’d thought about suicide but felt he couldn’t do it because he had a lot to live for. He’d agreed to seek help and went to see his psychiatrist regularly. My dad and I both contacted his provider about his crisis state and begged for help in keeping him safe. Our messages were never returned.

Carson had never attempted suicide before. He didn’t have access to a firearm or lethal medication. He was surrounded by people who loved him, who valued what he brought to the world. And yet, despite all of this, I believe Carson felt profoundly alone and was terrified he’d lose control if he let people know the truth about his mental health condition. So, he carried it alone.

Losing my brother to suicide profoundly fractured my identity, both as a sister and as a professional. The grief was immense. But underneath the grief was something that took me longer to understand: a deep, unsettling recognition that the field I’d devoted myself to was, in some fundamental ways, getting suicide prevention wrong.

In fact, when it comes to suicide, where had our foundational tenets gone? Somehow, we’ve drifted away from what we do best—deep, human, relational connection—and toward something that looked more like risk management than healing.

My mission has been to name that drift, understand where it comes from, and point us back toward what works—because I believe we can do better.

An Unacknowledged Hazard

Encountering suicidal intensity and losing a client or colleague to suicide is one of the most common occupational hazards in mental health work. Studies suggest that many mental health professionals will lose at least one client or loved one to suicide over the course of their careers. Some will experience suicide more than once, either directly or indirectly through supervisees or colleagues. And yet almost nothing in our training prepares us for it.

We learn assessment and documentation protocols. We learn to list off risk factors and protective factors. But very few training programs spend meaningful time on the relational dimensions of working with someone in suicidal crisis—how to stay present when every instinct tells you to panic, how to hold someone’s pain without drowning in it yourself, how to slow down when the system is screaming at you to do something.

And when the worst happens—when we lose someone to suicide—the response from our professional community often, heartbreakingly, makes it worse. Research on clinicians who’ve experienced a client’s suicide shows that these losses profoundly affect their emotional wellbeing, confidence, risk tolerance, and clinical practice, manifesting in strong feelings of responsibility, guilt, blame, shock, anger, and grief. Without support, fear and grief don’t resolve—they calcify and show up as defensive practice, overcontrol, risk aversion, and avoidance of suicidal clients.

Unfortunately, rather than wrapping clinicians in the same compassion we ask them to extend to their clients, the field too often responds with scrutiny, blame, and a kind of professional shunning. The message, spoken or unspoken, is If you’d done it right, this wouldn’t have happened.

The Coalition of Clinician Survivors—a community built specifically to support mental health professionals who’ve lost clients, loved ones, or colleagues to suicide—puts it plainly: the stigma around both suicide and professional vulnerability means there are very few places clinicians can even acknowledge this loss, let alone process it.

But this spiral isn’t inevitable. Organizations that respond to clinician suicide loss with genuine support—not just paperwork and risk management, but real acknowledgment of grief, peer support, time away, and access to their own therapy—interrupt this cascade. When clinicians are held by their organizations rather than blamed, when their trauma is named and treated as seriously as any client’s, they recover their capacity for relational work. And crucially, they move away from the defensive postures that paradoxically increase risk.

The path back to genuine suicide prevention begins with creating the conditions for clinicians to grieve, to process fear without shame, and to rebuild trust in their own clinical judgment. A clinician who’s been held through their own devastation is far more likely to hold their clients with genuine presence.

In addition, a clinician who’s no longer drowning in unprocessed fear can learn and implement evidence-based therapies thoughtfully, collaborate on safety planning without white-knuckling the outcome, and teach regulation and self-support skills from a place of centered composure rather than desperate control.

We’re Inside the Risk

Mental health professionals are often positioned as experts and gatekeepers, the ones who assess and refer “them,” the people in crisis. But that split between us and them can be dangerous. It can make it harder for clinicians to recognize their own suicidal thoughts as serious, to seek help early, or to admit distress without fearing professional consequences.

Psychologists, psychiatrists, social workers, and counselors face suicide risk shaped by occupational hazards unique to our work: vicarious trauma, client suicide, burnout, access to lethal medications, and the expectation that we should know how to handle our own pain. Research shows that depression, anxiety, trauma, and family history predict greater suicidality among mental health professionals. At the same time, we often face formidable barriers to help-seeking: internal and professional stigma, confidentiality concerns, fears about reputation, and the real worry that disclosure could threaten our license or practice.

If we’re going to ask clients to tell the truth about suicide, we need a professional culture where clinicians can tell the truth too.

When Caring Feels Like Betrayal

In rethinking our approach to suicide risks and prevention, we also need to consider a particular kind of anguish that comes from knowing the right care and being unable to give it: moral injury.

Moral injury isn’t burnout or PTSD. It’s the wound that occurs when we’re forced to act against our deepest commitments, witness preventable harm, or feel betrayed by systems we trusted to help us do good. For therapists working with suicidal clients, it often sounds like this:

I came into this field to sit with people in pain, but now I’m being asked to manage them like risk objects. I believe in autonomy and dignity, but coercion is the only option available. I know this person needs connection and skilled care, but all I can offer is an emergency referral, a locked unit, a waitlist.

This gap between our values and our actual options can become corrosive. And veterans, healthcare workers, and first responders who’ve experienced a moral injury are three times likelier to experience suicidal ideation and six times likelier to attempt suicide—even after accounting for PTSD and depression.

That should give us serious pause

Moral injury isn’t healed by yoga or better time management. It requires truth-telling, communal recognition, moral repair, and systems that stop asking clinicians to betray their own commitment to healing and then calling the resulting anguish “burnout.”

This is another reason connection must be the center of suicide care—not only for clients, but for clinicians. We need professional spaces where therapists can say, “This felt wrong,” “I felt helpless,” or “I don’t know how to keep doing this,” and be met with support rather than suspicion. If we want clinicians to offer courageous compassion to suicidal clients, we must build professional cultures that offer courageous compassion to clinicians too.

Read part II of this series: What Doesn’t Work in Suicide Prevention: Three Common Practices to Avoid 

Read Part III of this series: What Actually Works in Suicide Prevention: Reclaiming the Essential Skills We’ve Forgotten