If you, or anyone you know is struggling with suicidal thoughts or actions, please reach out to the national suicide hotline at 800–273–8255. There is always help. We need you around.

The International Association of Fire Chiefs’ (IAFC) Volunteer and Combination Officers Section (VCOS) released the 2021 Yellow Ribbon Report Update: Best Practices in Behavioral Wellness for Emergency Responders. In the email that accompanied the report to my inbox, the IAFC stated, “more firefighters die from suicide each year than in the line of duty, according to the Firefighter Behavioral Health Alliance, and many suicides are likely unreported.”

Firefighters are not the only ones being struck at an alarming rate by suicide. Police officers are showing similar trends. According to the National Law Enforcement Officers Memorial Fund, Covid-19 was the top killer of cops in the United States in 2020, followed by shootings and car crashes. But those are numbers for on-the-job deaths. Buried in the statistics are suicide numbers, which, according to the Ruderman Family Foundation, outpace on-the-job deaths.

During the January 6, 2021, riot at the United States Capitol, a number of police officers suffered serious and life-threatening injuries. Two officers who were there subsequently died by suicide. Depending on who you ask, their deaths are or are not counted in the casualty count of that day. Yes, even deaths by suicide are now political. But I digress.

As a subset of the entire population, the United States military has a higher rate of death by suicide than the general population, according to the Uniformed Services University. The most common method of death is by firearm, and it usually happens after a particularly tough or long deployment. That risk of suicide is carried into service members’ lives after deployment, with suicides among veterans also at an alarmingly high rate.

You may have guessed why these three professions would have suicide rates that are higher than the general population. Men make up most of these professions. Most of the people working in these professions see some horrible things, and they are subjected to high levels of emotional stress. Most of the people working in these professions are young, with brains that haven’t fully developed yet. And, at least in two of these professions, firearms are part of the gear of their day-to-day work.

Of course, there are more factors to be considered in the mechanics of how people who devote their lives to service can be in such despair that they decide to end their lives. There are the issues around substance use disorders that develop from trying to self-medicate to deal with the stresses of the job. There is the lack of access to services. There is the low pay, high expectations, and so on, and so forth.

If you want to attack suicide in these groups, you have to really take a highly coordinated approach that is aimed at all (or most) of those factors at the same time. Because one factor alone can be enough to turn any kind of intervention on its head. For example, even if a person has access to mental health, one triggering event can lead them to make an impulsive decision with their firearm. Or, even if they are doing well financially, a culture of “toughness” combined with a lack of resilience can lead them to not seek mental health care.

That is why suicide in general, and among first responders and service members in particular, is such a unique and difficult threat to public health. It leaves communities without some of their most important pillars. It can make a fire station be understaffed during an emergency. It may lead people away from serving, threatening public safety and national defense. And so on, and so forth.

Unfortunately, at this moment in history in the United States, public health interventions that are based on sound science and best practices have been questioned and politicized. Laws requiring a person who is exhibiting suicidal behavior to turn over their firearms until they can be assessed and receive care are seen as an assault on the Second Amendment to the United States Constitution. (The argument is that the big, bad government will then accuse non-suicidal people of being suicidal in order to take away their guns… Never mind that these laws require judicial review — i.e., a judge’s order — to carry out the temporary seizure of firearms.)

The taboo nature of mental health problems also makes it difficult to address this public health problem. For example, look at the case of Kenneth Santiago, who took his life on the steps of the Lincoln Memorial in November 2021. According to The Washington Post, “Santiago had a high-level security clearance in his new role as an Air Force flight attendant for the nation’s biggest VIPs, stationed at Joint Base Andrews, where he was president of a base council and mentor to many.” That security clearance and other aspects of his profession would have been in jeopardy had he revealed his mental health struggles by seeking care.

As the Covid-19 pandemic continues, the resources of public health agencies the world over are being stretched to the limit. Even in wealthy parts of the planet, where money is not an issue when it comes to public health funding, public health workers are exhausted and in short supply. But the issues around mental health at a population level are not going to be fixed by public health workers alone. We will need mental health experts and care providers, and they are in short supply as well.

While the vast majority of people are resilient and will get through these hard times without any issues, a significant proportion of men and women working in very important positions in our society are dealing with mental health issues that are costing them their lives. While there are science- and evidence-based ways to treat them, things like our culture and politics get in the way of an honest discussion and a meaningful response. Only by putting aside the things that are withholding proper care of those who need it can we address this situation and help those we care about stay with us — in more ways than one — for the long run.