When “Reach Out” Isn’t Enough

Every September, timelines fill with reminders to “reach out” if you’re struggling: Reach out. Hold on. You are not alone. Hotlines are promoted, hashtags circulate, and for a moment, the conversation about suicide prevention surfaces. Awareness campaigns spike for a month and then fade from view. But suicide does not happen only once a year, and awareness cannot be seasonal. The truth is, reaching out often isn’t enough—especially when what waits on the other side is rejection, waitlists, unaffordable care, or even outright harm. Suicide prevention cannot be reduced to hashtags and hotlines once a year. Prevention has to be built into the fabric of our everyday lives, because the need does not begin and end with a campaign.

I know this because I’ve lived it. I’ve been in intensive mental health treatment for over a year now, in large part due to chronic suicidality.  I didn’t get there quickly. After one of my earliest suicide attempts, I couldn’t find a single treatment program willing to take me. I learned that “asking for help” doesn’t guarantee help will come. After that,  I hesitated to seek treatment for chronic suicidality for years. When I finally reached out, I was met with rejection after rejection. Treatment centers told me I was “too complex,” “too risky,” or “too much” because of my chronic illness. Over and over, I was denied care—not because I didn’t ask, but because the systems I turned to were not equipped to hold me. Each closed door sent the same message: we care, but not enough to make space for you.

This is not just my story. Disabled people, chronically ill people, queer and trans people, and people of color are too often pushed aside by systems built not for care, but for convenience, liability, and profit. The uncomfortable truth is that reaching out is not enough when what’s waiting on the other side is silence, dismissal, or violence. Suicide prevention campaigns that focus only on hotlines miss this reality: what happens after someone reaches out determines whether survival is truly possible.

Primary Prevention: Where Real Change Begins

Suicide prevention is usually framed as crisis intervention: hotlines, emergency rooms, and involuntary hospitalizations. These tools have a place—but they are tertiary prevention, the last stop in a crumbling system.

Real prevention has to start earlier. In public health, this is called primary prevention:

• Primary prevention: addressing root causes before crisis

• Meeting basic needs like food, housing, and healthcare.

• Creating accessible education around mental health from a young age.

• Building communities where belonging and safety are the norm, not the exception.

• Reducing access to lethal means.

• Secondary prevention: intervening early when struggles begin

• reducing stigma

• fostering belonging

• treating mental illness as real illness deserving real care

• affordable, stigma-free therapy

• culturally competent providers

• Early intervention

• Tertiary prevention: crisis response

• Hotlines

• hospitalizations 

• ER visits.

Without the first two layers, hotlines are left trying to hold up a collapsing structure. In our cultural conversation, the first two layers are almost always skipped. We are told to wait until someone is on the edge, then offer them a hotline. But without strong foundations in primary and secondary prevention, those hotlines are forced to hold up a collapsing structure. Real prevention starts long before someone is in crisis. Without primary prevention, all the “reach out” messages in the world are like telling people to swim harder while refusing to build a lifeboat.

The Reality of “Care”

The promise is simple: if you’re struggling, ask for help. But the reality is much harsher.

For me, it meant calling ten providers in a week and begging to be taken seriously. It meant being turned away from inpatient, outpatient, and intensive outpatient care alike. It meant being told, in so many words: “We care, but not enough to actually help you.”

Even now, after piecing together over a year of treatment, I know how fragile it is. One closed program, one denied claim, one change in policy—and it could all vanish. For many, it does. Even for those who fight through barriers to reach treatment, care is fragile and inconsistent. According to the National Council of Mental Wellbeing, wait times for behavioral health average six weeks. For someone in acute crisis, six weeks can feel like an eternity. And for people who need providers with specific training or identities — such as people of color, queer and trans people, and disabled folks — that wait can stretch into months, if care is accessible at all. What this means is that the people most at risk are often the ones left waiting the longest, or turned away entirely. In 2020, one-fifth of “medically necessary” claims for behavioral health services were deniedaccording to the Association of American Medical Colleges. Behind every one of those denials is a person — often someone desperate enough to risk reaching out — being told that their needs do not count as “necessary” enough to warrant care, that their survival didn’t qualify.

Disabled people, among many others,  have always had to fight for recognition in medicine—our symptoms dismissed as exaggerations, our needs treated as too expensive, too complicated, or too inconvenient. This is not new; it’s systemic.

Queerness and transness were once—and sometimes still are—treated as pathologies. Without reckoning with that history, mental health care risks reinforcing stigma instead of dismantling it.

On paper, these systems are meant to protect. But in practice, they can be terrifying, even life-threatening—especially for those at the intersections of race, disability, and gender. What is presented as “care” too often becomes coercion, surveillance, or violence.

And when systems fail, crisis responses often default to coercion: involuntary hospitalization, wellness checks, or police involvement. For many, these measures don’t bring safety—they bring trauma. The danger is especially clear when police are involved. Police violence disproportionately harms Black, brown, Indigenous, disabled, queer, and trans people. Thee NIH found that one in five fatal police shootings involves someone experiencing a mental health crisis. These are not isolated tragedies—they are patterns baked into policing itself. 

Even when things don’t end violently, the threat itself lingers. Knowing that honesty with a provider could lead to handcuffs, a locked ward, or a police officer at the door forces many people to hold back their truth. Instead of opening up, they censor themselves, soften their words, or avoid care entirely. What is meant to be a lifeline becomes a muzzle, a place where survival is weighed against the risk of being punished for needing help.

Even outside of police encounters, care often strips away dignity: providers who don’t listen, systems that prioritize control, inaccessible costs, or interventions that retraumatize. Instead of trauma-informed, person-centered care, many of us encounter dismissal, disbelief, or punishment for needing help.

This is what “reach out” often means in practice: running headfirst into locked doors.

The Missing Care

Even when violence isn’t present, what’s offered, often isn’t care. Too many of us encounter treatment that strips away dignity and autonomy: providers who won’t listen, systems that prioritize control, interventions that retraumatize instead of heal.

This is where trauma-informed, person-centered care is supposed to make the difference.

• Trauma-informed care means recognizing how trauma shapes a person’s life and working to create safety, trust, empowerment, and cultural responsiveness. It avoids practices that re-open wounds.
  
  

• Person-centered care means seeing someone as more than a diagnosis or crisis. It means respecting their autonomy, honoring their values, and offering care that flexes with their needs instead of forcing them into rigid systems.
  
  

And yet—most of the time, these approaches are missing.

• Instead of safety, police show up with weapons.

• Instead of trust, people are dismissed or disbelieved.

• Instead of collaboration, decisions are made for people, not with them.

• Instead of empowerment, autonomy is stripped away. 

• Instead of cultural responsiveness, racism, ableism, and transphobia are allowed to fester in care settings.

• Instead of accessibility, care is priced out of reach or buried under waitlists. 

When the very systems we’re told to lean on become another site of harm, the message to “just reach out” rings hollow.

Who Is Left Out

These failures don’t fall equally.These failures hit hardest at the intersections.

 People with complex chronic illnesses and disabilities—who already face heightened risk of suicidality—are routinely dismissed, disbelieved, or denied appropriate care. 

Queer and trans people face additional barriers. Many of us fear that our gender identity or sexuality will be pathologized or policed, especially in the current political climate and administration. This fear is not unfounded: homosexuality was historically classified as a mental illness, and even now, gender dysphoria remains in both the DSM and ICD. The system as it is now necessitates the pathologization of trans identities to gain insurance coverage of, and in some cases even just access to, gender affirming care. These histories and classifications shape how care is delivered—and too often, they reinforce stigma, gatekeeping, or outright harm instead of healing.

People of color are routinely dismissed and minimized at best and put in danger at worst. 

This isn’t just about individual bias. It’s about structures built on eugenics, on pathologizing difference, on prioritizing white, cisgender, able-bodied lives over others. Those legacies show up every time care is withheld, denied, or weaponized.

The result: those carrying the heaviest burdens face the highest walls just to survive.

Beyond “Reach Out”

If we want to prevent suicide, we must build something stronger than seasonal slogans, we need more than once-a-year reminders to call a hotline.. Survival should not depend on privilege, persistence, or the ability to hide the parts of yourself systems deem inconvenient. It should be supported by structures that make life livable in the first place.

• Accessible, affordable, long-term care.

• Trauma-informed, person-centered providers.

• Peer-led supports rooted in lived experience.

• Crisis responses that don’t rely on police.

• Communities that meet basic needs before crisis takes hold.
  
  

This is not hypothetical. Disability justice movements, queer and trans communities, and grassroots mutual aid networks have already modeled what real care can look like. The blueprint is here—we just need the will to scale it.

Closing

Reaching out is important. But what matters just as much is what meets us on the other side. Survival should not depend on luck, privilege,the right diagnosis, or whether you can fight hardest for care.

“Reach out” is not enough when what waits is dismissal, silence, or violence. Suicide prevention requires more than crisis hotlines. It requires year-round investment in primary prevention—systems that meet basic needs, dismantle barriers, and create conditions where life itself feels possible. If we want to reduce suicide, we must stop treating prevention as a one-month slogan and start building it into the bones of our society. Care cannot be seasonal. Survival cannot wait until next September.

Until then, the responsibility for survival continues to fall on those already carrying the weight of staying alive. And that is not prevention. That is abandonment dressed up as awareness.