Most People Who Die by Suicide See a Doctor First. Most Parents of Suicidal Teens Have No Idea. The Reasons Go Beyond Stigma.
By Courtney Turrin · September 1, 2026 · 7 min read read
Category: Health & Wellness
This September, Channel RVA explores suicidal ideation and support. Learn why people hesitate to speak out and how to help loved ones. Dial 988 for free, confidential support.
September is Suicide Prevention Awareness Month. This is the first of four pieces Channel RVA will run through the month of September covering topics designed to bring awareness and offer avenues for support. Each of these articles discusses suicidal ideation. If you are struggling, dial 988 to reach the national Suicide and Crisis Lifeline. It's available by call or text, 24 hours a day, for free and confidential support.
The four pieces cover why many people experiencing suicidal thoughts don't tell anyone, why isolation and loneliness are increasing in America, the impacts of people turning to chatbots for emotional support, and how to help when your child, loved one, or friend is experiencing suicidal thoughts. Why people don't tell anyone is where I have firsthand experience. In a doctoral program a decade ago, I spent over a year experiencing suicidal thoughts. I talked about it with my therapist and my partner at the time. My family only found out during a crisis.
Most of what keeps people silent about their struggle with suicidal ideation is worry about what will happen the moment the words are out. For nearly everyone, what they think will happen is wrong.
The Disclosure Gap Exists at Every Age
Jones and colleagues published the numbers in Pediatrics in 2019, drawing on 5,137 parent-adolescent pairs interviewed separately about the same questions. About half of parents whose child had suicidal thoughts didn't know it. About half of teenagers denied thoughts their parents had reported. The youngest kids in the sample were the hardest for parents to identify as needing support (Figure 1).
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The gap doesn't close with age. Luoma, Martin, and Pearson's 2002 review in the American Journal of Psychiatry found that three of four people who died by suicide had seen a primary care provider within the year before death. A later study of 5,894 people, published by Ahmedani and colleagues in the Journal of General Internal Medicine in 2014, found nearly half had made a health care visit within four weeks of death, most without any prior mental health diagnosis on record (Figure 2).
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These weren't people avoiding care. They were sitting across from a doctor. What didn't happen was disclosure, or recognition, or both.
Shame Keeps People Quiet and Struggling Alone
Suicidal thoughts carry a stigma distinct from mental illness generally: weakness, selfishness, a moral failure. People absorb that from the culture around them and arrive at a private verdict, often something like: having this thought means something is wrong with me.
Fulginiti and Frey, publishing in Families in Society in 2018, interviewed 26 U.S. suicide attempt survivors about their family relationships. Forty-six percent believed their family held stigmatizing attitudes toward survivors of suicide attempts. Twenty-nine percent had never told a single family member. Maclean and colleagues, publishing in the International Journal of Environmental Research and Public Health in 2023, tested a validated stigma measure against people's stated willingness to seek help from four sources: a doctor, family, friends, or no one. More than anything else measured, higher stigma scores predicted an intention to tell no one (Figure 3).
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But shame isn't the whole story. Someone who has moved past feeling ashamed is often running a second calculation, not about how they'll be seen, but about what happens once the words are out. Someone gets called. You get taken somewhere. You lose the ability to leave. None of that is what usually happens.
The Prediction Is Usually Wrong
Most Americans believe disclosing suicidal thoughts triggers an automatic 72-hour hold. Virginia law doesn't work that way. A magistrate can issue an Emergency Custody Order, capped at eight hours, while a certified prescreener looks specifically for the least restrictive option available. Only if a prescreener and magistrate separately agree that the person will, in the near future, cause serious physical harm to themselves or others does a Temporary Detention Order, or 72-hour hold, follow (Figure 4).
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The fear extends to help lines. Pew's 2023 survey found 41% of people worried that calling 988 would bring police, 40% worried they'd be forced into a hospital, 37% worried the call wouldn't stay private. Vibrant Emotional Health, which runs the Lifeline, reported that emergency services were dispatched in roughly 2% of calls, involuntary rescue in about 1%. Concern was highest among those with a mental health condition and LGBTQ+ respondents on every measure Pew asked about (Figure 5).
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The fear isn't always misplaced. Nearly 40% of physicians surveyed said they'd avoid mental health treatment specifically because it could jeopardize their medical license. Emergency physician Lorna Breen died by suicide in 2020 after telling people that seeking treatment would end her career. The federal act passed in her name pushes licensing boards to ask about current impairment instead of treatment history; 44 state medical boards have changed their questions as of mid 2026 (Figure 6). That's a different problem than the 72-hour myth. A misconception can be corrected with information. A real professional consequence needs a policy fix.
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For people whose disclosure does end in an emergency room, the wait is mostly about bed availability, not psychiatric care. Nolan and colleagues, publishing in the Journal of Emergency Nursing in 2015, found psychiatric patients board in emergency departments (EDs) at twice the rate of other patients. A ten-hospital Massachusetts study found that the actual medical evaluation only accounted for a tenth of total time in the department. The rest was waiting, and the waiting period was longer still for patients on Medicaid or without insurance (Figure 7).
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I spent part of a night in one of those rooms about ten years ago, after disclosing suicidal thoughts in a text message to my sister, who is an emergency physician. What I remember about that night is a closed door, long hours in an empty room, and a few brief visits from doctors. It didn't function well as care. It was also the moment my family first understood what I'd been dealing with for months. I don't regret that. I just wish it hadn't taken an emergency room visit to get there. My sister's background likely shaped how quickly I was seen, so I don't know that my experience reflects what most people go through.
The real danger isn't the evaluation. It's what happens after. A 2017 JAMA Psychiatry analysis of 100 studies found the suicide rate in the first three months after psychiatric discharge is more than double the overall post-discharge rate, and highest among people admitted for suicidal thoughts specifically. A separate 2021 qualitative study of young people who'd been involuntarily hospitalized found three-quarters described lasting damage to their trust in providers, including new reluctance to disclose. That's an argument for better follow-up care and for how holds are handled, not for staying silent going in.
Not every suicidal thought is a plan. Virginia's legal standard reflects the difference: an Emergency Custody Order requires a substantial likelihood of serious harm, not just the presence of a thought. The culture hasn't caught up to the statute. Most people have absorbed a binary: you're having suicidal thoughts and a process starts, or you're not. There's no category in between for a thought that arrives, gets noticed, and passes without ever becoming a plan.
Asking Does Not Plant the Idea
Many would-be supporters don't ask their loved ones if they’re having suicidal thoughts because they believe raising the subject will plant the idea or make things worse. It won't. Dazzi and colleagues reviewed the research in Psychological Medicine in 2014; DeCou and Schumann reached the same conclusion in a 2018 meta-analysis in Suicide and Life-Threatening Behavior. Neither study found a significant increase in suicidal ideation among people who were asked about it, at any timeframe, even among people with a prior history (Figure 8).
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Some people who are struggling stay quiet out of shame. Others stay quiet because of a prediction about what a system will do, and that prediction is usually wrong. For a documented few, the prediction is right, and the fix is policy, not conversation.
Still, someone has to go first. For most people reading this, it's safer than they think.
If you or someone you know needs support, dial 988 to reach the Suicide and Crisis Lifeline by call or text, 24 hours a day. In the Richmond region, the Richmond Behavioral Health Authority also operates a crisis line at 804-819-4100.