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As a teenager, Rei Scott spent several weeks living out of a car with four family members and their dog. Each day, Scott worried about where they would spend the following night.

One day at school, Scott snuck away to the bathroom and called the national suicide hotline.

Scott, who is transgender and nonbinary, explained to the hotline counselor that the family had struggled with poverty for years. They had lived in crumbling homes with water leaks, or a family member’s basement with no privacy. Sometimes the family worried about having enough food. The stress and anxiety were constant, and Scott had been suicidal many times.

The counselor seemed shocked into silence, Scott said. Eventually, the person provided reassurance and kindness.

But what Scott really needed that day a decade ago and many times since was a fix for the economic difficulties that had become an unbearable weight.

“It can definitely help to have someone who can listen, but when you’re struggling to eat and you don’t have a roof to be under, I honestly don’t think words can go as far as you need them to,” said Scott, who now studies social work at Capital University in Columbus, Ohio.

Over the years, Scott has been directed to hospitals and therapists. But those generally don’t address core problems, such as a broken-down car or an eviction notice.

“There’s so many times in my life where I’ve thought if I had $5,000, I wouldn’t even be suicidal right now,” Scott said.

People don’t typically think of suicide as an issue of economics, but it often is.

Decades of research shows that , , , , and make people more likely to kill themselves. Conversely, things that bring down people’s cost of living — such as , , , and — are linked to lower suicide rates.

It makes sense. If someone can cover their basic needs, their life will feel better.

Other countries have been incorporating this understanding into their efforts for some time. But because suicide prevention in the U.S. has historically been seen as a medical issue — the responsibility of clinicians who can provide medication or therapy — economic solutions are frequently left out of the equation.

Some advocates and people with suicidal experiences, like Scott, are trying to change that. They say traditional approaches to suicide prevention haven’t succeeded. For decades, the U.S. has had among high-income countries.

To move the needle, “we all need to be challenged to broaden our aperture, to broaden the lens of what is mental health,” said , a national expert in mental health policy and an adjunct professor at the Stanford University School of Medicine.

The highest-impact interventions may not be adding crisis lines or screening more people in emergency rooms, Miller said, though those can be helpful. If he had to pick one strategy, it would be alleviating poverty.

That “allows us to reconcile and solve for these conditions that put people in places of despair,” he said. “I don’t know what stronger intervention one could possibly have.”

To be sure, suicides also occur among wealthy people. It’s a complex issue and almost never boils down to one reason. For most people, the decision to hurt themselves results from an intricate interplay of biological factors, relationship concerns, finances, trauma or abuse, and access to lethal means. That means suicide prevention requires a variety of approaches.

The argument for including economic policy as one of those approaches, many advocates and researchers say, is that policies affect entire populations. So even a small effect can save a significant number of lives.

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‘Economic Uncertainty’ Builds

However, the push for an economic lens on suicide prevention is encountering gale-force headwinds from Trump administration policies.

and the have contributed to economic pressures. Meanwhile, the administration has increased hurdles for safety net programs such as the , often called food stamps, and , the state-federal health insurance program for low-income people. Experts estimate will over the coming years.

The administration has also , saying people who are homeless to receive support. The president’s 2027 budget request, which signals his priorities, that helps low-income people pay for heat and air conditioning.

Research suggests increase people’s risk for suicide.

“Anytime there is economic uncertainty, people will fear for their future and livelihood,” Miller said, and “this last few months have been terrifying.”

Notably, the administration’s actions directly contradict strategies that the promotes as having “the best available evidence to reduce suicide.” No. 1 on the page is “Strengthen economic supports.” It lists SNAP benefits and housing-first policies as examples.

, director of the CDC’s injury center, said the agency doesn’t work on economic policy directly but encourages state and local governments to look at the relationship between health and economics.

The Department of Health and Human Services supports suicide prevention through the 988 national crisis hotline, investments in treatment, and the Rural Health Transformation Program, which states can use to expand mental health care in rural areas, HHS spokesperson Emily Hilliard said.

Alec Varsamis, a spokesperson for the Agriculture Department, said the agency is providing states guidance on SNAP changes and “remains deeply committed to supporting the health and mental well‑being of all Americans.”

It’s too soon to tell how recent actions may affect suicide rates. And given the unique combination of factors at play in each death, it’s challenging to draw direct causal links.

The most recent data available shows nearly 49,000 people died by suicide in 2024 — a slight dip from previous years but still among the highest tolls since the late 1990s.

The concept of suicide prevention writ large has historically drawn bipartisan support, said , a New York University researcher who last year highlighting public policies shown to reduce suicide.

The details are where things get murky. For example, strong evidence suggests that increasing the minimum wage reduces suicides. (The is $7.25 per hour, with higher rates in certain states.) But such increases are often a hard sell for lawmakers facing the realities of balancing a budget and small-business owners struggling to stay afloat.

Closely tying suicide prevention initiatives to such politically charged and complicated issues could undermine their chances, Purtle said, adding, “We’ll see suicide get polarized.”

That’s why the focus often stays on areas of agreement, such as funding crisis hotlines.

View From a Crisis Line

is the chief clinical officer at Samaritans, a Boston-based nonprofit that has operated a suicide crisis hotline for more than 50 years and fields upward of 10,000 calls a month, including local calls to 988.

Although people might assume every call is an imminent crisis, Maitland said, many callers are struggling with everyday needs — financial problems, housing concerns, or unemployment.

“Whatever is going on in the world, we absolutely hear about that in real time,” Maitland said.

In November, when during a government shutdown, people affected called Samaritans.

“That in and of itself was a hit to suicide prevention,” Maitland said. “If people don’t have access to eat, to feed their children, to be alive, quite frankly, how are they able to move further through anything else?”

Samaritans volunteers are trained to listen with compassion and make callers feel less alone in what they’re going through. That validation and caring are powerful, Maitland said.

But she often wants to do more, to “dig in and fix” the root issue.

Research supports her instincts. found that increasing the number of people who receive SNAP benefits by 5% could have prevented nearly 32,000 suicides over 15 years. And a $1 increase in minimum wage roughly 8,000 fewer suicide deaths over a decade.

Although Maitland can’t change federal welfare policies, she and her co-workers are applying this approach locally. They recently started an initiative to provide blankets, socks, and water to people living on the streets of Boston.

“Suicide prevention doesn’t always look like a crisis helpline,” she said. “That’s what we imagine it as.” But “having your basic needs is also a form of suicide prevention.”

Continuing To Live

In the years since calling the suicide hotline in high school, Scott has turned to a number of resources to help overcome recurring thoughts of suicide. Crisis lines, hospitalization, medication, and therapy have all played a role.

But, Scott said, the biggest impact came from programs that helped fulfill daily needs — for example, a housing program for LGBTQ+ youths and another for former foster care children attending college.

Scott, who now lives close to campus because of the foster care program, said the ability not to “worry about ‘Where am I going to sleep tomorrow night?’” has provided a significant mental health boost.

Although some programs like those are under threat from the Trump administration, Scott is hopeful they will persist and rebuild.

Surviving difficult times has given Scott confidence to persist through more potential challenges ahead.

Despite “the policies and legislation that harm us, we continue to live, and I think that’s really important,” Scott said. “It gives me a lot of hope that things can be different.”