Staff photo by Erin O. Smith / Stephen Kavalkovich, the host and creator of the Rescue the Rescuer radio show, gives the keynote during the Southeast Saving Those Who Save Conference at Hixson United Methodist Church Friday, September 6, 2019 in Hixson, Tennessee. The event was held by the Tennessee Suicide Prevention Network.

To get help

The National Suicide Prevention Lifeline is 1-800-273-TALK (8255).

A phone conversation with our 15-year-old granddaughter reminded me of how far we have come in our awareness of suicide. She is part of a team at her high school that is raising awareness and prevention of self-harm during September, which is National Suicide Prevention Awareness Month.

I first became aware of suicide soon after graduation from high school when a classmate fatally shot himself. He had always appeared cheerful and concerned with the welfare of others. During college, a graduate student acquaintance jumped to his death from a chapel tower. In medical school the suicide of a resident physician briefly shocked us. A female classmate killed herself soon after graduation while in the early months of her internship. During a shared rotation in pathology, I had noted white scars on both of her wrists. If we had only known how to reach out.

A revered role-model died from a self-inflicted gunshot wound during my early years of clinical practice.

The topic of suicide or our own mental health was never raised during our medical training. At a time when several of us were grieving the loss of a young patient, a junior faculty member told us, "If you can't stand the heat, get out of the kitchen." As students and trainees, we felt that acknowledging depression or even suicidal thoughts would be viewed as a sign of weakness that would disqualify us from medical careers. I suspect the same attitude prevailed in many other educational and vocational arenas.

Fortunately, this attitude has changed. Counseling is widely available. Seeking help is not stigmatized.

(Read more: First responders are dying by suicide. A local conference confronts the stigma about getting help.)

According to data analyzed by the Centers for Disease Control and Prevention and the National Institute of Mental Health, the age-adjusted rate of suicide has increased by 31% from 2001 (10.7 per 100,000 persons) to 2017 (14.0). I believe the upswing represents increased stress in all our endeavors along with a growing sense for many individuals of loneliness.

Across the age span, suicide is the 10th leading cause of death in the US. Suicide is the second leading cause of death, behind accidental injuries, for age groups 10 to 14 years, 15 to 24 years, and 25 to 34 years.

In 2017, more than 47,000 Americans died from suicide, more than twice the number of homicides that year (19,510).

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Clif Cleaveland

Firearms account for almost half of deaths by suicide, followed by suffocation (27%) and poisoning (14%).

In 2017, an estimated 1.4 million Americans made suicide attempts. Almost 11 million entertained serious thoughts about suicide during that year.

Groups at increased risk of suicide include members of the Armed Forces andveterans and persons suffering from mental illness, substance use disorders, and chronic illness, especially if associated with severe pain. Advanced age is a risk factor for men (31 per 100,000).

Factors that may increase suicide risk include family history of self-harm, access to firearms, repeated exposure to violence, bullying, and acute loss or rejection.

In light of this data, what can you and I do if we find ourselves despondent or considering ending our lives? Seek help without delay. Reach out to a close friend or family member. Contact, without delay, a counseling center or mental health professional. It there is a delay before you can be evaluated, go to an urgent care center or call the prevention lifeline.

What if we sense that a loved one, friend, or business associate is depressed? A shared walk or a chat over a cup of coffee is a starting point, a reminder that one is not alone. The key is being alert to the needs of others.

If we have influence or authority in our schools or workplaces, we should make every effort to create a warm, supportive environment. Behavior that demeans or threatens another person cannot be tolerated. A toxic workenvironment represents another call for assessment and counseling.

Timely, professional contact, assessment and therapy, along with emotional support of family and friends, will reverse the upward trend in self-harm.

Contact Clif Cleaveland at