Susan Tolle knows too much about the pain associated with suicide. Her daughter has attempted to take her life three times and on December 20, her 13 year-old granddaughter also attempted suicide.

Both are in treatment, but these painful experiences have led Tolle to become a passionate crusader for the American Foundation for Suicide Prevention to save lives and bring hope to those affected by this national epidemic.

“When risk factors and warning signs appear together, that is a perfect storm for suicide,” Tolle told attendees at the “Talk Saves Lives” program at Williamson Chapel United Methodist Church in Mooresville on Tuesday night.


The scope of the problem is enormous. Worldwide, a reported 800,000 people died by suicide (1 every 40 seconds) in 2017, but Tolle pointed out the actual number most likely exceeds 1 million because of poor reporting in undeveloped countries and the stigma associated with death by suicide.

Even more concerning is the fact that for every death by suicide, another 25 people attempted to end their lives, meaning worldwide some 20 million people attempted suicide.

Suicide is the 10th leading cause of death in the United States, claiming 47,126 people in 2017, according to the U.S. Centers for Disease Control. That number is higher than the number of lives claimed by homicide, war, and natural disasters combined.

In 2018 in North Carolina, suicidal ideation claimed 1,498 lives, a rate of four per day. That number is three times more than those killed in alcohol-related accidents in the state.

However, that figure represents a 1.5 percent decrease from the previous year, so education and better resources are starting to have an impact, added Tolle.

In Iredell County, one life is lost to suicide every 9.1 days.

Specific groups are also at a higher risk of succumbing to suicide. Last year, 258 American police officers died by suicide, more than the number who died in the line of duty.

One in five who die by suicide are veterans, an average of 22 veterans per day. Female veterans are 220 percent more likely to take their lives than female non-veterans and have increased their suicide rate by 46.7 percent in the past year.

Tolle also mentioned a recent “Washington Post” article that cited a 56.7 percent increase in suicide deaths among 13-year-old girls.

In addition to the emotional impacts on those left behind, the economic impact of these lost lives on communities is a stunning $69 billion annually.


Combatting the stigma of mental illness is an important factor in preventing suicide. Tolle recounted a childhood memory of passing a home each day while walking home from school with her sister. When she asked why the attic light was always on, Tolle’s sister informed her that Margaret, a bipolar family member, lived there.

Instead of hiding of it, mental illness must instead be brought into the open as the public health issue that it is, just like heart disease, diabetes, or other ailments.

Tolle asked attendees to take care when speaking about suicide, avoiding the phrase “committing suicide” and instead saying “died by suicide,” “ended life,” or “killed self.” “You don’t ‘commit’ diabetes,” added Tolle.

Also, referring to a suicide attempt as “failed” or “unsuccessful” is unhelpful phrasing since death by suicide should not imply “success.”


Tolle said that multiple intersecting factors result in the decision to take one’s life. Nine out of ten people who die by suicide have some type of mental condition. On the other hand, the good news is that one in four Americans have a mental health condition, but most do not attempt suicide.

Research has indicated that the brains of those exhibiting suicidal ideation differ in structure and function from healthy brains. These people are more impulsive and feel their failures and disappointments more keenly. Suicidal thoughts will not enter a healthy brain, according to Tolle.

When the impulse to attempt suicide hits, Tolle said intervention should happen within 60 seconds. Getting in between the suicidal person and any means of hurting themselves and stalling for time until the impulse passes is important to the person’s safety.

“You should never leave them alone, even for a second,” said Tolle.

Suicidal people are in crisis and desperate to escape their pain as well as the pain they feel they are causing others. Their thinking becomes limited because they believe death is the only solution to their problems.



If people talk about killing themselves, express hopelessness, say they no reason to live or feel like a burden to others, express feelings of being trapped, or profess feeling unbearable pain, these are verbal signs of suicidal ideations.


Behaviors that may signal risk, especially if related to a painful event, loss or change, include increased use of alcohol or drugs, looking for a way to end their lives (searching online for methods), or withdrawing from normal activities.

Isolation from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, displays of aggression, or extreme fatigue are other signs to watch for.


People who are considering suicide often display one or more of the unusual moods, including
depression, anxiety, loss of interest in activities or friends, irritability, humiliation, shame, agitation, or anger. Another danger sign is a sudden relief or an improvement of behavior after displaying these other signs because the decision to attempt suicide has been made.


Some people are more likely to have suicidal thoughts because of certain health, environmental, or historical situations.

Health factors include mental health conditions, depression, substance use problems, bipolar disorder, schizophrenia, personality traits of aggression, mood changes, and poor relationships.

Conduct disorder, anxiety disorders, serious physical health conditions that cause pain, and traumatic brain injury are other health factors.

Environmental factors include access to lethal means of self-harm (including firearms and drugs) and prolonged stress, such as harassment, bullying, relationship problems, or unemployment. Stressful life events, like rejection, divorce, financial crisis, or other life transitions or loss can also lead to suicidal thoughts.

Exposure to another person’s suicide or to graphic or sensationalized accounts of suicide is also a danger. Tolle noted significant upticks in suicide rates after the well-publicized deaths of Kate Spade, Anthony Bourdain, and Robin Williams at their own hands.

Historical factors include previous suicide attempts, a family history of suicide, and childhood abuse, neglect or trauma.


Tolle said suicide research includes looking at biomarkers in the blood, exploring the most effective interventions and psychotherapies, and developing the best medications to address depression and other mental illnesses.

Communities are also implementing protective factors such as more access to mental health care, family and community support, teaching problem-solving skills, coping mechanisms, and resiliency, and reaching out to those in crisis through religious and cultural groups.

Carbon monoxide sensors in cars, barriers on bridges, promoting the securing of firearms and prescription drugs, and moving to blister packaging for medications (delaying tactic) are all ways that society is trying to limit access to means to self-harm.

Making mental health care readily available is essential because only two out of every five people with mental illness will get treatment. “We need a culture where everyone knows to be smart about mental health,” said Tolle.

Tolle asked attendees to be proactive, urging them to help anyone in possible crisis to seek evaluation by medical and mental health professionals and learn about the treatment options that work best for each individual situation.

Depression, linked to a chemical imbalance of serotonin transporters in the brain, is a medical illness that can be treated with medication and counseling to learn coping strategies.

Self-care is also important. Exercise, a healthy diet, proper amounts of sleep, and stress management are important to a healthy mind and body. Poor self-care, especially poor hygiene, is an indicator of depression and possible suicidal tendencies.

Tolle just finished training all 2,700 employees of the Iredell-Statesville Schools system in suicide prevention strategies. She stressed that teaching kids to talk to a trusted adult if they or their friends feel depressed, anxious, or suicidal is essential to address rising suicide rates among young people.


Tolle urges folks to trust their gut.

“Assume you’re the only one who’s going to reach out. Assume they are serious and don’t walk away.”

People must not be afraid to have a conversation about suicide with a person they are concerned about. Talk to them in private, listen to their story, and express concern without judgment or unsolicited advice.

“We need to create a culture that’s smart about mental health and suicide prevention.”


The National Suicide Prevention Lifeline is 800-273-TALK (8255).

For more information about suicide prevention, visit the American Society for Suicide Prevention online at

For information about helping resources available in your area, dial 211 to reach the United Way of North Carolina’s help line or visit online at

Another local resource for help is at the National Alliance on Mental Illness (NAMI) of Lake Norman/Iredell at or call (704) 236-2264.

For more information on local ASPF activities or to arrange for a presentation for a civic, community, or church group, contact Tolle at