Is this what a month of awareness is for — so society can peer into lives that never asked for the scrutiny?
So more judgment gets placed on people who certainly didn’t ask for their diagnosis?
Sadly, I don’t think much has changed over the years as far as stigma goes. It’s easy to fund a cause that makes a problem less public facing.
It’s harder to admit that doesn’t make the problem go away. It just conceals it.
We mourn the tragic lives of movie stars and rock stars when they succumb to their own hand. We barely recognize the neighbor, the classmate, the cousin, the sibling who simply couldn’t battle alone any longer.
Maybe they asked for help in the only way they knew how, and it got brushed off. Or maybe it was just years of silence around the subject creating an invisible barrier for communication.
South Dakota gives that stigma plenty of company. The state recorded 198 suicide deaths in 2024, up 10% from 180 the year before, and its age-adjusted rate — 22 per 100,000 — ranks among the five highest in the nation, roughly 61% above the national rate.
Suicide is the leading cause of death for South Dakotans age 20 to 39. Among American Indian residents age 20 to 29, the rate climbs to 126.1 per 100,000 — more than five times the statewide average.
Fifty-nine percent of the state’s suicides involve a firearm. Those figures come from the state Department of Health’s own annual surveillance report. A document almost nobody outside public health circles ever opens.
I know the other numbers too, the ones that don’t show up in any report. I know what it sounds like when a person tries to say the quiet part out loud and gets handed a shrug instead.
Good luck with that.
Oh, I hope someone shows up for you.
You don’t look sick.
Can you do this for me — I haven’t seen you in a few days.
Never are you okay. Never how can I help you. Sometimes, if you’re lucky, are you sick — asked the way you’d ask about a cold.
Even the people paid to be someone’s support system fail at this, and not because they don’t care.
Pennington County has roughly one mental health provider for every several hundred residents. Sixty-four percent of South Dakota’s counties are federally designated mental health shortage areas.
Nationally, turnover at community behavioral health centers runs 30 to 50 percent a year — which means the case manager who finally got the full picture, who finally earned the trust it takes to say the hard thing out loud, is gone within twelve months, and the story has to be told again to a stranger.
After enough years of new case managers and new therapists, the effort of re-explaining a life gets very old. That’s not a personal failing. That’s a staffing crisis wearing a clipboard.
I lost someone to suicide. What I’ll say is that the ending had help getting there: a drink that filled space nobody else would, a couple of years of isolation the pandemic made permanent for a lot of people who never fully came back from it, a family history that taught silence instead of asking, and long enough being told — one way or another — that he didn’t look sick. None of that is an excuse. All of it is a pattern, and the pattern is bigger than one person.
The breaking of a mind happens a little at a time — a slight here, a piece of it ignored there, often undetected until a new fissure opens from another small aggression, or the world’s ordinary complicity in looking away. By the time people realize the cry for help was real, the person making it has usually stopped believing anyone was listening.
I don’t say any of this for sympathy. I say it because a “month of awareness” that stays inside a press release doesn’t fix a single one of the numbers above.
Ribbons and walks are fine as a front door. They’re not a system. A system means enough providers that someone in crisis isn’t waiting weeks for an intake appointment. It means paying behavioral health staff enough, and supporting them enough, that they stay long enough for a relationship to mean something.
It means the people around a struggling person practicing the boring, unglamorous work of actually asking — and staying in the room for the answer, even when it’s not the answer they wanted.
There’s a particular cruelty stigma produces that doesn’t get said out loud enough. The feeling of having to make plans so your life no longer complicates the world is real. The field has a name for this: perceived burdensomeness.
It shows up again and again in people who die by suicide — not just pain, but the specific belief that they’ve become a weight worth setting down. It is very often false. It is very rarely challenged out loud before it’s too late.
If you’re the one white-knuckling it right now: you don’t have to look sick for it to be real, and you don’t have to wait until it’s an emergency to say something. The 988 Suicide & Crisis Lifeline takes calls and texts, 24 hours a day, and you can reach it whether you’re in crisis tonight or just tired of carrying something alone.
If you’re the one who might get the call: don’t ask if they’re okay as a formality you already expect them to wave off. Ask like you’re prepared to hear “no.”
Sourcing
South Dakota Department of Health, 2024 suicide surveillance data; Violence Policy Center state-ranking analysis of CDC data; Pennington County Behavioral Health Continuum of Care assessment (provider-ratio figure dated 2019, the most recent county-level estimate available); HRSA Mental Health Health Professional Shortage Area designations; National Council for Mental Wellbeing and HRSA workforce turnover reporting, 2026.
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