Beyond Awareness: Moving Suicide Prevention Upstream

By

Cassie Sexton, CMCP

911 Training Institute

Reader Caution: this article is about struggle with suicide. If you have been personally touched by suicide, have yet to heal, or know you are easily triggered, please stay attuned to how you are impacted and seek professional support as needed. Call the 988 Lifeline by dialing 9-8-8 or text "BLUE" to the Crisis Text Line at 741741.

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September is Suicide Prevention Month.

And this year, those words feel heavier to me.

Maybe it's because every day seems to bring another post. Another family. Another agency. Another life lost. Maybe increased awareness and social media mean we hear about these losses more than we once did. But awareness doesn't change the reality that suicide remains a significant public health crisis.

In 2024, there were 48,824 people in the United States who died by suicide. Millions more seriously considered it, made a plan, or attempted to take their own lives.

For me, those aren't abstract numbers.

I come from a family deeply impacted by suicide. I have lost multiple family members, friends, and colleagues to suicide, well into the double digits now. And beyond those losses are the many others I know who have attempted suicide.

I am also a suicide attempt survivor.

Then I stepped into a career where, eventually, wellness and prevention became a significant part of my work. And when I say prevention, I don't mean waiting at the bottom of the river to pull people out after they've fallen in.

I mean asking a much harder question: What are we doing upstream to keep people from falling into the river in the first place?

Let's Have an Honest Conversation.

Over the last nine months, I have sat in conference sessions, participated in conversations, and watched discussions unfold across social media about first-responder wellness. If I’m being honest, I’ve been part of these conversations for much longer than that. But lately, it feels like the claws have come out. Conversations that should be centered around helping people have started to feel more territorial.

Are we doing enough? Is "wellness" becoming a buzzword? Where are the resources? Who is actually doing this work?

I've also watched organizations and individuals occasionally take jabs at one another, each suggesting that nobody else is doing enough or that they are the only ones doing something meaningful.

Here's the hard truth: This isn't a new fight. And none of us are fighting it alone. There are so many people doing incredibly good work in first-responder wellness every single day.

There are culturally competent clinicians who understand public-safety. There are inpatient and outpatient treatment programs, peer support teams, chaplains, nonprofits, training organizations, retreats, wellness conferences, and support groups. There are resources for trauma, grief, substance use, critical incidents, resilience, and families. There are Alcoholics Anonymous and Narcotics Anonymous programs, technology platforms, therapy dogs, equine therapy, and evidence-based treatment modalities like Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, Cognitive Behavioral Therapy (CBT), and Dialectical Behavioral Therapy (DBT). There are grants available to help agencies build and strengthen wellness programs.

The list goes on, and that’s exactly the point. And that barely scratches the surface.

Professional associations in the 9-1-1 industry are doing this work, too. The National Emergency Number Association (NENA) and the Association of Public-Safety Communications Officials (APCO) maintain wellness resources specifically for the 9-1-1 community, while the International Association of Chiefs of Police (IACP) and the Fraternal Order of Police (FOP) offer extensive officer safety and wellness resources for law enforcement. The International Association of Fire Fighters (IAFF) has also invested heavily in behavioral health and wellness resources for firefighters. Across these associations, you can find everything from education and peer support to technology, treatment programs, clinical resources, and connections to additional services.

Resources exist.

Are there still gaps? Absolutely.

Do rural communities face different challenges? Yes.

Does insurance, cost, staffing, geography, confidentiality, stigma, leadership support, and cultural competency complicate access? Of course.

Do we need more research, funding, programs, and options? Always.

But "we need more" and "there is nothing available" are two very different statements. And that distinction matters.

Eight Years Ago, I Raised My Hand.

Eight years ago this month, I asked for help.

I was told, essentially, there wasn’t anything specifically for someone like me. We had the standard Employee Assistance Programs (EAP). Cool, thanks. Beyond that, I would have to figure it out. So, I did.

And do you know what I eventually discovered? There was a first-responder treatment center in the very city where I worked. There were support groups in the very city where I worked.

Help existed!

The problem wasn’t that there was nothing available. The people I trusted to point me toward help simply didn’t know where to point me.

I don’t share that to blame them. Eight years ago, the public-safety industry was having a very different conversation about mental health than it is today. And to its credit, it has come a long way since then. What exists today are entirely different programs than what existed when I raised my hand eight years ago. I share because eight years later, we know better.

And when we know better, we have an opportunity and, I would argue, a responsibility to do better.

Some agencies have been doing wellness well for years. Others are just beginning to build their programs, and some are still trying to understand what meaningful wellness even looks like. We are not all starting from the same place, and that’s okay. What matters is that we keep moving forward.

You Don't Have to Know Everything. You Need to Know Where to Look.

Nobody expects a supervisor, dispatcher, officer, firefighter, EMT, peer supporter, trainer or coworker to memorize every mental health resource available.

You don't need to know every treatment modality; you don't need to become a clinician; you don't need to have all the answers. But if someone walks into your office, sits beside you at a console, calls you after shift, or finally works up the courage to say, "I need help."... your answer should never be, "There isn't anything. Sorry."

If you don't know, then say, "I don't know, but I know who we can ask, and we'll find out."

Build the List Before You Need the List.

Know your local resources. Know your peer-support contacts. Know which clinicians understand first-responders and public-safety. Know your association resources. Know what your EAP actually covers, not just the phone number hanging on the bulletin board. Know your treatment options. Know your chaplains. Know your nonprofits. Know what is available regionally when the local option isn't enough.

And leaders: don't wait until somebody is already in crisis to figure this out.

That is Suicide Prevention.

It is not only a hotline number posted during September.

It is creating connection before crisis. It is educating people before they need help. It is reducing barriers before someone encounters them. It is building a culture where asking for help doesn't cost someone their identity, reputation, career, or sense of belonging. It is knowing what resources exist and making sure the people around us know they exist, too.

There Is Room for All of Us.

Maybe that's the other conversation we need to have during Suicide Prevention Month.

This work is too important for competition. We don't need to tear down one resource to elevate another. We don't need to pretend we're the only organization doing the work. We don't need to compete over who cares the most.

Because somewhere tonight, someone doesn't care whose logo is on the resource. They just need it to work.

There is room for clinicians, peer support, chaplaincy, nonprofits, treatment centers, technology companies, trainers, associations, retreats, researchers, wellness coordinators, therapy animals, support groups and every other CREDIBLE resource willing to help.

In fact, we need all of them. No single resource will work for every person. The goal shouldn't be to prove that our resource is the answer. The goal should be to make sure the person asking for help finds their answer.

So, this Suicide Prevention Month, Let's Move the Conversation Upstream.

Let's stop waiting at the bottom of the river. Learn what exists and build relationships with the people doing the work. Share resources instead of guarding them. Ask questions; collaborate; and if you don't know where to send someone, then find someone who does.

Because eight years ago, someone told me there wasn't anything.

There was.

Let's make sure the next person who raises their hand knows that, too.

About the Author:

Originating from Southern California and now residing in North Carolina, Cassie Sexton, CMCP, possesses an extensive background in law enforcement, with the majority of her career dedicated to serving in the 9-1-1 center. In her current role as Director of Client Relations at 911 Training Institute, she focuses on proactive wellness initiatives, providing resources, education, and consulting to first-responders. She currently serves as the National NENA (National Emergency Numbers Association) Wellness Co-Chair, and as North Carolina NENA's 1st Vice President.