2026年4月28日 / 美国东部时间早上5:00 / KFF健康新闻
如果您或您认识的人可能正处于心理健康危机中，请拨打或发送短信“988”联系988自杀与危机生命线。
美国每11分钟就有一人死于自杀。这种情况太过常见，但并不正常。
人类历经数个世纪进化而来的本能是生存。因此，当人们试图自杀时，一定是某个环节出了问题。通常人们会认为，问题出在当事人的精神层面——即精神疾病。
但近几十年来，越来越多的人开始提出一个不同的问题：这个人周围的世界出了什么问题？
对克里斯·帕维尔斯基来说，是一连串的因素压垮了他。他的父亲——他最好的朋友之一，也是他共事了数十年的搭档——被诊断出肾癌，并在六个月后去世。帕维尔斯基随后成为了患有痴呆症的母亲的主要照料者。
他家族在纽约奥兰治县经营的世代相传的洋葱农场——他从5岁起就在这里帮忙捡拾掉出箱子的洋葱——正在巨额亏损。帕维尔斯基表示，有些年份他种植的作物价值约20万美元，但最终自己只拿到约2万美元，因为无法与主导市场的批发商协商提高收购价格。
拖欠供应商和设备商的债务越积越多，这份负担也让他的婚姻濒临破裂。他几乎没有时间和朋友相处，每周从早到晚拼命工作，拼命想要保住家族的传承。
“所有事情都压在你身上，”他说。“数周、数月、数年里，你要应对各种根本无法缓解的压力。”
克里斯·帕维尔斯基是纽约奥兰治县的第四代农场主。杰弗里·贝辛格 摄 / KFF健康新闻
帕维尔斯基开始想象自己被家门前繁忙公路上的卡车撞了会是什么样子。“你觉得自己已经在走向死亡了，为什么还要等？”他说。
数百万美国人曾有过严重的自杀念头，每年有数万人死于自杀。自杀始终位列美国十大死亡原因之一——这让美国在发达国家中显得格格不入。
以往的自杀预防工作通常侧重于将处于危机中的个体与治疗资源联系起来——尽管治疗和药物治疗贵得离谱，医疗系统也难以满足需求，且学界已达成共识：自杀由多种因素导致，精神疾病只是其中之一，而非全部。
如今，许多致力于自杀预防的人士，包括一些有过自杀企图或失去过亲友死于自杀的人，呼吁采取更广泛的应对策略。新冠疫情加剧了这种呼吁，当时焦虑和抑郁发病率飙升——这并非因为所有人的大脑化学物质突然发生了变化，而是因为世界变了。这让许多人意识到，尽管治疗和危机护理至关重要，但自杀预防的目标不应仅限于阻止人们死亡，还应包括赋予他们活下去的理由。
“这并非什么高深学问，”萨莉·斯宾塞-托马斯说，她是一名心理学家，也是国际知名的自杀预防研究者，她的兄弟死于自杀。“如果你拥有更快乐、更健康的人群，他们就能更长寿、更幸福地生活。”
她说，这意味着自杀预防不应仅限于接听热线或在精神科病房治疗患者。它还应该包括运营食品银行，确保家庭不会挨饿；或是为居家的老年人举办每周读书俱乐部，帮助他们结交朋友。这可以是旨在培养儿童韧性的学校项目，也可以是防止驱逐的住房政策。
数十年的研究表明，这类举措——即使它们的名称中没有“心理健康”或“自杀”字样——也能减少自杀人数。它们通常还能降低犯罪、成瘾和贫困率。
斯宾塞-托马斯表示，美国在采用这种方法方面落后于其他国家，或许是因为告诉某人去接受治疗比推行全面的政策变革——比如提高最低工资——更容易，在政治上也更易被接受。
“只要我们抱着这种方便的说辞，认为自杀只是一群需要药物和治疗的精神病人的问题，那么我们就永远不会对修复社区中存在的问题负责，”斯宾塞-托马斯说。
特朗普政府的应对措施
将自杀预防工作全面转向关注广泛的社会和经济政策，似乎令人望而生畏且不切实际——尤其是在当下。这种方法需要大量的前期投入，且难以获得全方位的支持，原因要么是预算现实，要么是意识形态偏见。
特朗普总统及其任命的官员很少直接谈及自杀问题，但他们的多项政策与研究表明的自杀预防方向背道而驰。
本届政府主张削减医疗补助和补充营养援助计划资金，预计将在2027年1月1日起让数百万人失去医疗保险，并在未来几年削减食品救济券发放。它通过与伊朗的冲突、摇摆不定的关税政策以及大规模解雇联邦雇员，给经济带来了不确定性。政府还取消了10亿美元用于学校心理健康项目的拨款，削减了针对高危蓝领工人的联邦项目，并终止了枪支暴力研究。（自杀是美国最常见的枪支死亡原因。）
“所有这些变化都在引发一场风暴，”美国国家精神疾病联盟首席宣传官汉娜·韦索洛夫斯基说。这些政策会给人们的生活带来“极端的压力和焦虑”，她补充道，而“当人们感到绝望时，危机就可能爆发”。
联邦卫生官员坚称，自杀预防仍是一项优先工作。
美国疾病控制与预防中心伤害预防中心主任艾莉森·阿尔瓦迪表示，该机构正致力于建立能够支持人们的体系，“无论他们周围的世界发生了什么”。“人们的生活中总会有动荡，”她补充道。
阿尔瓦迪和美国药物滥用与心理健康服务管理局负责自杀预防工作的布兰登·约翰逊表示，特朗普政府的多项优先事项与上游预防策略是一致的。
例如，他们说，政府对青少年身心健康的关注有助于应对青少年自杀风险上升的问题，因为锻炼已被证明能改善心理健康。同样，无家可归者的自杀率更高，而政府一直在推动为他们提供治疗。联邦官员还鼓励与宗教组织合作，研究表明宗教社区成员的自杀企图率更低。
但特朗普政府大幅削减了疾控中心和药物滥用与心理健康服务管理局的工作人员编制，并多次呼吁削减它们的预算，这让人质疑这项工作能否继续推进，以及将如何推进。
医疗与危机护理的历史
曾在疾控中心工作15年，之后加入专注于青少年心理健康的非营利组织杰德基金会的黛布·斯通表示，自杀预防在20世纪90年代末进入全国视野。
随着青少年自杀率上升，1998年，一群政府官员、临床医生和倡导者在内华达州里诺市齐聚一堂，讨论这一紧迫问题。在接下来的几年里，美国卫生局局长发布了具有里程碑意义的行动呼吁，联邦政府也发布了首个全国性自杀预防战略。
这些文件承认了社会和经济因素在自杀风险中的作用，但重点仍放在识别危机中的人群和增加获得医疗治疗的机会上。
许多心理健康研究人员和临床医生表示，这些都是自杀预防的关键步骤。它们在政治上也更受欢迎。对于那些在下次竞选前只有几年时间展示政绩的民选官员来说，统计接受治疗的人数，比统计因为长期经济和社会投入帮助人们保住稳定工作、建立牢固友谊而从未产生自杀念头的人数要容易得多。
美国心理健康协会人口健康高级主任马迪·赖纳特表示，推动个人治疗也源于一种普遍的误解，即自杀总是潜在精神疾病的结果。赖纳特曾参与2025年一份关于上游自杀预防的全国性报告。
尽管研究人员对死于自杀的人中患有精神疾病的比例存在争议——估计范围从不到一半到约90%不等——但关键结论是，精神疾病并非唯一的诱因，赖纳特说。这意味着仅靠治疗无法解决问题。
此外，生活环境可能会触发并加重精神疾病。许多心理健康研究人员和临床医生表示，只治疗抑郁症状，却不考虑童年创伤、亲人离世或失业等因素，是一种不完整的应对方式。
新冠疫情尤其让该领域的人士意识到“我们真的需要解决所有这些带来压力、焦虑和危机的状况”，斯通说。
2021年7月，联邦政府推出了988热线——全国自杀危机热线的短号码，旨在为心理健康紧急情况提供不同于911的选择。
负责988热线联邦工作的莫妮卡·约翰逊表示，资金和关注度向热线的倾斜帮助各州建立了更好的危机响应系统，从接听电话的中心到移动危机小组。
但她说，这不足以解决美国的自杀问题。“你永远无法仅靠危机应对体系解决所有问题。”
对农场和农场主的帮助
纽约的洋葱农场主帕维尔斯基在2020年达到了崩溃的临界点。
那年他的收成不错，但加拿大出口商向美国市场倾销廉价洋葱，让他很难卖出自己的产品。
“我不得不求着别人买，”他说。即便成功卖出，价格也回到了20世纪80年代的水平。
到季末，他已经亏损了数十万美元。
他说他和妻子当时认定，“我们再也负担不起种植洋葱了”。
家族的洋葱农场将在他这一代终结的想法“令人灵魂破碎”，帕维尔斯基说。他体重迅速下降，甚至考虑过结束自己的生命。
他和妻子拨打了纽约农场救助热线寻求帮助。该项目于1986年在康奈尔大学成立，为免费服务，为农场主配备两名顾问：一位专注农场规划的财务分析师，以及一位关注情绪问题和家庭动态的社会工作者。
财务专家帮助帕维尔斯基制定了新的商业计划。不再为批发商种植洋葱，他可以小规模种植绿叶菜、番茄、辣椒和茄子，直接卖给消费者。他可以升级一辆旧卡车，加装冷藏箱，将农产品送货上门。他还可以利用自己的传播学硕士学位，通过教学、演讲和其他工作补充收入。
社会工作者帮助他接受了这一新的现实——帕维尔斯基说，这同样至关重要。“如果你对这种改变心怀不满，那么无论他们提出什么样的方案或想法，都无法推进。”
调整花了数月时间。在此期间，帕维尔斯基也接受了心理治疗。
后来有一天，一位邻居指出帕维尔斯基看起来开心多了。“这让我措手不及，”帕维尔斯基回忆道。他没有意识到自己内心的转变已经如此明显。
克里斯·帕维尔斯基和他的妻子伊芙联系了纽约农场救助热线，这是康奈尔大学推出的免费项目，为农场主配备财务分析师和社会工作者。两人共同制定了转型计划，转向小规模种植并直接面向消费者销售产品。杰弗里·贝辛格 摄 / KFF健康新闻
如今，帕维尔斯基的生意已经稳定下来，他和妻子正在偿还债务。帕维尔斯基倡导开展帮助农场主改善心理健康、解决他们高于平均水平的自杀率的项目。
他说，这可以包括危机热线和负担得起的治疗渠道。但他真正想要的是政策变革，帮助农场主为农产品争取公平价格、提供债务减免，并在农村地区安装宽带互联网，让农场家庭和员工能够联网。
“我们的思考需要比热线更广泛、更长远，”他说。热线“不过是枪伤上的创可贴”。
KFF健康新闻是一家制作健康问题深度报道的全国性新闻编辑部，也是KFF的核心运营项目之一——KFF是独立的健康政策研究、民意调查和新闻资讯来源。
A broad approach to suicide prevention helped a farmer in need. Here’s how it went beyond crisis hotlines
April 28, 2026 / 5:00 AM EDT / KFF Health News
If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”
Someone in America dies by suicide every 11 minutes. It’s that common. But not normal.
Humans have evolved over centuries to survive. So when people try to kill themselves, something has gone wrong. Typically, the assumption is that something happened in the person’s mind — a mental illness.
But in recent decades, there’s been a growing movement to ask a different question: What went wrong in the world around that person?
For Chris Pawelski, it was a torrent of factors. His dad — one of his best friends, whom he worked with daily for decades — was diagnosed with renal cancer and died six months later. Pawelski was left as the primary caregiver for his mom, who had dementia.
His family’s multigenerational onion farm in New York’s Orange County — where he first worked as a 5-year-old, collecting onions that fell out of crates — was hemorrhaging money. Pawelski said he was growing roughly $200,000 worth of crops some years but took home only about $20,000, unable to negotiate higher prices with wholesale buyers that dominated the market.
Debt to suppliers and equipment vendors piled up, and the burden strained his marriage. He had little time for friends, working sunup to sundown seven days a week, desperately trying to preserve his family’s legacy.
“It’s all stuff collapsing down upon you,” he said. “It’s weeks, months, years of dealing with all sorts of pressures that you can’t alleviate.”
Chris Pawelski is a fourth-generation farmer in New York’s Orange County. Jeffrey Basinger for KFF Health News
Pawelski started wondering what it would be like to get hit by a truck on the busy road in front of his house. “You think you’re already on your way out, so why wait?” he said.
Millions of Americans have serious thoughts of killing themselves, and tens of thousands die by suicide annually. Suicide repeatedly ranks among the top 10 leading causes of death — making the U.S. an outlier among developed nations.
Prevention efforts have typically focused on connecting individuals in crisis with treatment — despite therapy and medication being notoriously expensive, the health care system struggling to meet demand, and a consensus that suicide is caused by a host of factors, including but not limited to mental illness.
Now, many people working to prevent suicide, including some who have tried to harm themselves or lost a loved one to it, are calling for a broader approach. Some were galvanized by the covid pandemic, when rates of anxiety and depression spiked — not because everyone’s brain chemistry suddenly changed but because the world changed. That led many to believe that, while treatments and crisis care are vital, the goal of suicide prevention needs to expand beyond stopping people from dying to also giving them reasons to live.
“It’s not rocket science,” said Sally Spencer-Thomas, a psychologist and internationally recognized suicide prevention researcher who lost her brother to suicide. If “you have happier, healthier people, they live longer, happier lives.”
That means suicide prevention shouldn’t be limited to answering hotlines or treating patients in psychiatric wards, she said. It should also involve running food banks to ensure families don’t go hungry or hosting weekly book clubs for homebound seniors to make friends. It can take the form of school programs that build resilience in children or housing policies that prevent evictions.
Decades of research shows these types of initiatives — even if they don’t have the words “mental health” or “suicide” in the title — can reduce the number of people who kill themselves. They often lower rates of crime, addiction, and poverty, too.
The U.S. has lagged other countries in adopting this approach, Spencer-Thomas said, perhaps because it’s easier — and more politically palatable — to tell someone to go to therapy than it is to enact sweeping policy changes, such as an increased minimum wage.
“As long as we have that convenient narrative that it’s just a bunch of broken people needing medicine and treatment, then we’re never accountable for fixing the broken things in our communities,” Spencer-Thomas said.
The Trump administration’s approach
Overhauling suicide prevention efforts to focus on broad social and economic policies might seem overwhelming and unrealistic — especially right now. This approach requires large upfront investments that lack across-the-board support, either because of budgeting realities or ideological bents.
President Trump and his appointees have said little about suicide directly, but many of their policies do the opposite of what research shows prevents suicide.
The administration has championed cuts to Medicaid and the Supplemental Nutrition Assistance Program that are projected to leave millions of people without health insurance starting January 1, 2027. and food stamps in coming years. It has injected uncertainty into the economy through the war with Iran, seesawing tariff policy, and mass layoffs of federal employees. It has canceled $1 billion in grants for school-based mental health initiatives, gutted federal programs that focus on at-risk blue collar workers, and cut gun violence research. (Suicides are the most common type of gun death in America.)
“All of these changes are creating a firestorm,” said Hannah Wesolowski, the chief advocacy officer for the National Alliance on Mental Illness. They can cause “extreme stress and anxiety” in people’s lives, she added, and “when people feel desperate, that’s when crises can emerge.”
Federal health officials insist that suicide prevention remains a priority.
Allison Arwady, director of the Centers for Disease Control and Prevention’s injury center, said the agency is focused on creating systems that can support people “no matter what may be happening” in the world around them. “There’s always going to be turmoil in people’s lives,” she added.
Arwady and Brandon Johnson, who leads suicide prevention work at the Substance Abuse and Mental Health Services Administration, said several of the Trump administration’s priorities align with an upstream approach.
For example, they said, its focus on youth physical and mental well-being could help address the increasing suicide risk among adolescents, since exercise is proven to improve mental health. Similarly, people who are homeless have higher rates of suicide, and the administration has been pushing them into treatment. Federal officials have also encouraged partnerships with religious organizations, and research shows members of faith communities are less likely to attempt suicide.
However, the Trump administration has made steep staff cuts at the CDC and SAMHSA and has repeatedly called for decreasing their budgets, leading to questions about whether or how this work will continue.
A history of medical and crisis care
Suicide prevention reached the national stage in the late 1990s, said Deb Stone, who worked at the CDC for 15 years before joining the Jed Foundation, a nonprofit focused on teen and young-adult mental health.
As suicide rates grew among young people, a group of government officials, clinicians, and advocates gathered in Reno, Nevada, in 1998 to discuss the pressing issue. Over the next few years, the surgeon general issued a landmark call to action and the federal government published its first national strategy for suicide prevention.
These documents acknowledged the role of society and economics in suicide risk but focused heavily on identifying people in crisis and increasing access to medical treatment.
Those are critical steps to suicide prevention, many mental health researchers and clinicians say. They’re also politically favorable. For elected officials, who have a few years to demonstrate their achievements before the next campaign, it’s easier to count the number of people receiving therapy than the number of people who never developed suicidal thoughts because long-term economic and social investments helped them maintain steady jobs and strong friendships.
The push for individual treatment also comes from a pervasive misconception that suicide is always the result of an underlying mental illness, said Maddy Reinert, who is the senior director of population health at Mental Health America and contributed to a 2025 national report on upstream suicide prevention.
Although researchers debate how many people who die by suicide had a mental health condition — with estimates from less than half to about 90% — the takeaway is that mental illness is not the sole cause, Reinert said. That means treating it can’t be the sole response.
Plus, mental illnesses can be triggered and exacerbated by life circumstances. Treating depressive symptoms without looking at factors such as childhood trauma, the loss of a loved one, or being laid off from a job is an incomplete approach, many mental health researchers and clinicians say.
The covid pandemic, especially, made people in the field recognize “we really need to address all of these conditions that are creating stress, anxiety, and crises,” Stone said.
In July 2021, the federal government launched 988 — a shorter number for the national suicide crisis line, meant to provide an alternative to 911 for mental health emergencies.
Monica Johnson, who led federal work on 988, said the infusion of money and attention on the hotline helped states build better crisis response systems, from centers that answer calls to mobile crisis units.
But that’s not enough to solve America’s suicide problem, she said. “You’ll never be able to build a system based on crisis alone.”
Help for the farm and the farmer
Pawelski, the onion farmer in New York, hit his breaking point in 2020.
He had a decent crop that year, but Canadian exporters were dumping cheap onions into American markets, making it difficult for him to sell his product.
“I was having to beg people” to buy, he said. And when he managed to sell, prices were comparable to prices in the 1980s.
By the end of the season, he had incurred losses of a few hundred thousand dollars.
He said he and his wife decided, “We couldn’t afford to grow onions again.”
The idea that his family’s onion farm would end with him was “soul-crushing,” Pawelski said. He lost weight rapidly and thought about ending his life.
He and his wife called NY FarmNet for help. Founded at Cornell University in 1986, the free program connects farmers with two consultants: a financial analyst specializing in farm planning and a social worker focused on emotional concerns and family dynamics.
The financial specialist helped Pawelski develop a new business plan. Instead of farming onions for wholesale, he could grow greens, tomatoes, peppers, and eggplants at a small scale to sell directly to consumers. He could upgrade an old truck with a cooler and deliver produce to people’s doors. He would supplement that income with teaching, speaking engagements, and other work that took advantage of his master’s degree in communications.
The social worker helped him accept that new reality — equally crucial, Pawelski said. “If you’re pissed off” about the change, “no matter what kind of proposal or idea they have, it’s not going to go anywhere.”
The adjustment took months. Pawelski also saw a therapist during that time.
Then one day a neighbor noted that Pawelski seemed much happier. That “caught me off guard,” Pawelski recalled. He didn’t realize his inner transformation was so apparent.
Chris Pawelski and his wife, Eve, called NY FarmNet, a free program out of Cornell University that connects farmers with a financial analyst and a social worker. Together, they developed a plan to change to small-scale farming and sell directly to consumers. Jeffrey Basinger for KFF Health News
Today, Pawelski’s business has stabilized, and he and his wife are paying down debt. Pawelski advocates for programs to help farmers’ mental health and address their higher-than-average suicide rates.
That can mean crisis hotlines and access to affordable therapy, Pawelski said. But what he really wants are policy changes that help farmers get fair prices for their produce, debt relief, and the installation of broadband internet in rural areas so farm families and employees can be connected.
“We need to think broader and longer-term than a helpline,” he said. That’s “a band-aid on a gunshot wound.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.