This column discusses suicide. If you or someone you know may be struggling with suicidal thoughts, you can call 988 any time day or night, or chat online. Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.

In eastern Democratic Republic of Congo, I worked in a province of more than 6 million people served by a single public psychiatric hospital. More than 16% of that population had attempted suicide. When I describe this to American audiences, I get a sympathetic nod and a certain distance as they think, “That happens over there, not here.”

But the truth about the United States should unsettle us. About 137 million Americans live in a federally designated mental health professional shortage area, and nationally we are meeting only 27% of the need. And, as of 2019, the last national count, 70% of rural counties had no psychiatrist at all. 

We are not Congo. We have psychiatrists. We have simply built a country where they are not where people in crisis live.

Some things are working, like the national 988 hotline. Since launching in July 2022, it has taken more than 23 million contacts by call, text, chat and videophone. Roughly 8 million came in 2025 alone. That is a genuine achievement. 

But a crisis system needs three parts:

We........

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