The Price of Survival: Inside the emotional labor of suicide prevention

The Checklist

When Elise brought her teenager home from the hospital after a suicidal crisis, they did not return to the house they left. Ordinary objects now carried the weight of what they might become: a kitchen meant for nourishment became an inventory of potential weapons; a familiar pile of shoes by the door became a tangle of nooses.

At home, suicide prevention often begins with vigilance. Discharge instructions from Seattle Children’s Hospital tell families to “secure and lock up” medications, cleaning products, knives and razors, belts and cords, plastic bags, sheets, firearms — anything that could poison, cut, or suffocate. School counselors, therapists, emergency rooms, and social workers hand out similar safety plans to people experiencing suicidal ideation, the clinical term for thinking about, considering, or planning suicide.

For Elise, a mother of three, the checklist was only the beginning. Her middle child, now 17, spent years cycling through severe depression, repeated hospitalizations, self-harm, and suicide attempts. Elise requested that only her first name be used to protect her family’s privacy.

“I remember getting the safety-plan forms — hide the sharps, the cords, the medications — all of it,” Elise said. “It was overwhelming: How are we supposed to live like this? But I was willing to do anything to keep my child safe.”

Limited Access to Mental Health Care

More than 122 million people in the U.S. live in federally designated Mental Health Professional Shortage Areas. By 2037, federal projections show the country will be short roughly 114,000 addiction counselors, 88,000 mental-health counselors, 79,000 psychologists, and more than 43,000 adult psychiatrists.

At the same time, suicide rates are increasing. Health analysts say there is no single cause; rather, the rise reflects a complex mix of social, economic, demographic, and health-care system factors. A 2025 analysis of more than 300,000 U.S. suicide cases found that social isolation and loneliness strongly contribute to suicide risk.

Brenda, the mother of a college student in Washington state, spent five years supporting her son through self-harm and two suicide attempts. She asked to remain anonymous to protect his identity. The hospitals they visited were equipped to address immediate harm but often had limited access to behavioral health support.

“I walked in on him cutting and there was blood everywhere,” Brenda said. “There wasn’t a limb that wasn’t bleeding. I took him to Seattle Children’s and wanted him to see a psychologist or psychiatrist while they were stitching him up in the ER, but there were so many kids in crisis it would have taken seven hours to wait,” said Brenda.

Shortages in Veteran Mental Health Services

In 2025, VA facilities nationwide reported 4,434 staff shortages. More than 90 percent of VA medical centers identified shortages in medical-officer positions, with psychology and mental-health clinicians among the most frequently cited.

“Mental health crises outweigh the number of providers that can actually respond,” said Dave Konkler, a U.S. Army veteran and program manager at Nine Line Veteran Services. “We're funded by the VA and refer to VA behavioral health, but because of funding cuts we're seeing an increase in wait times.”

When care is unavailable, veterans often face crisis alone or rely on family and friends who lack training or support. “There’s something to be said about the people in close relationships with folks dealing with these struggles — it weighs on them as well,” Konkler said. “They don’t always understand the PTSD or trauma the veteran is experiencing… and they don’t know how to respond.”

What We Ask of Love

As access to mental health care narrows, families do what they can. “You become the caregiver, nurse, and protector,” said Jennifer Lovely, a Washington-based mental health therapist. “You want to be a parent — suddenly you’re the doctor.”

Over time, she said, hypervigilance erodes boundaries, relationships, finances, and mental health, leaving families exhausted long after the immediate danger has passed.

For Elise, helping her child survive meant constant oversight. “For years, all I had were a few butter knives,” she said. “Everything else was locked away. I didn’t sleep. I felt I had to be alert 100 percent of the time.”

As her child struggled to attend school, Elise said she stayed present through repeated hospitalizations while waiting for inpatient beds. She missed work and eventually lost her job. Differences in opinion about how to maintain a safe home strained her marriage, she said. After divorcing, she relied on food stamps and Medicaid to get through years of hospital visits, therapy appointments, and outpatient programs.

Brenda hoped to solve her son’s crisis through research and vigilance. “I just immediately thought, OK — we have to figure this out,” she said. Left without guidance for the long, relational work of supporting someone in pain, she researched different therapies and behavioral health education. Carrying that responsibility affected her own well-being. “I never wanted to leave him alone. I was just in constant crisis mode.”

Beyond Survival

“Caregiver support is one of the most important elements for someone with mental illness,” said Mary Traxler, board treasurer for the National Alliance on Mental Illness in Thurston–Mason County, WA. “After hospitalizations, there’s often no follow-up.”

Traxler supported a close family member through multiple suicide attempts. After five hospital stays, she was left with no more than a safety plan. “Clinicians tell you what you’re supposed to do,” Traxler said. “But they don’t tell you how.”

“I was just in absolute personal crisis,” she said. “I could barely function at work.” She eventually received a brochure for NAMI from a counselor. “Caregivers need free resources. NAMI offers programs at no cost, but only because of donations and volunteers.”

“When I called the local NAMI number, the volunteer immediately told me her own story. That perspective was so helpful,” said Traxler. NAMI’s free training helped her gain practical tools to support her family through mental health challenges and connected her with other caregivers. “The best part of NAMI for me is the peer support of other family members and building on those relationships,” she said.

“There isn’t enough support for caregivers,” said Vanessa Cameron, a Marine veteran and wellness coach from Freeland, Washington. Cameron spent years supporting her husband through suicidal ideation and PTSD symptoms while also addressing her own mental health.

Cameron’s husband eventually found relief through Veterans to Farmers, a program that helps veterans rebuild purpose and connection through agricultural work. “Now he copes through gardening, building, working with his hands,” Cameron said. “Working with other vets was deeply therapeutic. Community was the true turning point — shared understanding did more than talk therapy alone.”

At South Whidbey High School, students partner with the University of Washington’s Forefront Suicide Prevention program to deliver peer-led education. “Students reach students,” said senior peer educator Raegan Labadens. “After presentations, we collect anonymous notes from students who are concerned about a classmate. If someone’s at risk, counselors intervene.”

Forefront has partnered with more than 60 high schools, training educators, students, and families in prevention and crisis response. Since 2020, the program has reached nearly 25,000 students and adults. They address immediate danger by distributing safe storage devices to students — creating time and distance during moments of crisis. Their programs also use social methods that help reduce suicide rates by teaching students how to speak to their peers with validating language.  

Moving beyond the heavy responsibility of preventing death helped Elise find a better way to support her child. “When I was triggered by fear, I was afraid to upset my child, thinking that might save them,” Elise said. “But that only hurt us both.” Learning to listen — “to simply say, ‘I’m sorry’” — transformed their relationship.

Letting go of the belief that she had to fix everything “gave power back to my child,” Elise said. Today, both are healing. “That first time my child told me they didn’t feel suicidal — it was beautiful.”

By Brandy Stone,  Whidbey Island, WA , Harvard Extension School, Assignment 4, News Reporting and Writing, Matthew Hay Brown MS, Fall 2025