​If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Someone in America dies by suicide every 11 minutes. It’s that common. But not normal.

Humans have evolved over centuries to survive. So when people try to kill themselves, something has gone wrong. Typically, the assumption is that something happened in the person’s mind — a mental illness.

But in recent decades, there’s been a growing movement to ask a different question: What went wrong in the world around that person?

For Chris Pawelski, it was a torrent of factors. His dad — one of his best friends, whom he worked with daily for decades — was diagnosed with renal cancer and died six months later. Pawelski was left as the primary caregiver for his mom, who had dementia.

His family’s multigenerational onion farm in New York’s Orange County — where he first worked as a 5-year-old, collecting onions that fell out of crates — was hemorrhaging money. Pawelski said he was growing roughly $200,000 worth of crops some years but took home only about $20,000, unable to negotiate higher prices with wholesale buyers that dominated the market.

Debt to suppliers and equipment vendors piled up, and the burden strained his marriage. He had little time for friends, working sunup to sundown seven days a week, desperately trying to preserve his family’s legacy.

“It’s all stuff collapsing down upon you,” he said. “It’s weeks, months, years of dealing with all sorts of pressures that you can’t alleviate.”

Pawelski started wondering what it would be like to get hit by a truck on the busy road in front of his house. “You think you’re already on your way out, so why wait?” he said.

  (Jeffrey Basinger for KFF Health News)

After his father died, Pawelski became his mother’s primary caregiver. Meanwhile he was struggling to preserve his farm — his family’s legacy. “It’s all stuff collapsing down upon you,” he says. (Jeffrey Basinger for KFF Health News)

Millions of Americans have serious thoughts of killing themselves, and tens of thousands die by suicide annually. Suicide repeatedly ranks among the top 10 leading causes of death — making the U.S. an outlier among developed nations.

Prevention efforts have typically focused on connecting individuals in crisis with treatment — despite therapy and medication being notoriously expensive, the healthcare system struggling to meet demand, and a consensus that suicide is caused by a host of factors, including but not limited to mental illness.

Now, many people working to prevent suicide, including some who have tried to harm themselves or lost a loved one to it, are calling for a broader approach. Some were galvanized by the covid pandemic, when rates of anxiety and depression spiked — not because everyone’s brain chemistry suddenly changed but because the world changed.