New Jersey’s suicide prevention hotline clinician says knowing the warning signs and what to say could save lives

In 2020, the Centers for Disease Control and Prevention reported that suicide was the 12th leading cause of death overall in the United States, with more than 45,900 lives lost.

While national rates declined in 2019 and 2020 from a previous 20-year high of 14.2 deaths per 100,000 citizens, suicide was the second-leading cause of death among people ages 10 to 14 and 25 to 34, the third-leading cause of death among those between 15 and 24 and the fourth-leading cause of death for people between 35 and 44. The total number of suicides (45,979) in the U.S. in 2020 was nearly twice the number of homicides (24,576). 

Although New Jersey has the second-lowest suicide rate in the nation, one New Jerseyan dies by suicide about every 13 hours.

“While significant progress has been made, now is the time to redouble our efforts at suicide prevention,” said William Zimmermann, program manager for the New Jersey Suicide Prevention Hopeline (855-654-6735) and the recently opened national 988 backup center at Rutgers University Behavioral Health Care. “Ask someone who has lost a loved one to suicide: A single life lost to suicide is too many. Our goal as a state and nation is zero suicide.”

During National Suicide Prevention Awareness Month, Zimmermann discusses how people and communities can continue to aid in suicide prevention.

How will the new 988 line for suicide prevention help improve access to services?

Zimmermann: 988 is a three-digit dialing code for anyone in the United States, territories and tribal regions who is in a suicidal, mental health or substance-abuse crisis. It went live in July as the result of the National Suicide Hotline Designation Act of 2020, is funded by a grant from the Substance Abuse and Mental Health Services Administration and administered by Vibrant Emotional Health. Federal funding will increase the number of trained counselors available to provide support, assistance and linkage for callers in crisis. We also anticipate shorter wait times and improved answer rates, thus helping more people in need.

The 988 line will not only provide better access to crisis care for underserved populations such as those in rural areas and communities of color, it will also transform the current crisis response away from law enforcement to trained mental health professionals.

The Rutgers University Behavioral Health Care National Call Center has been selected to serve as one of the national backup centers that will triage overflow calls made to 988.

Who is often the first line of defense in suicide prevention?

Zimmermann: Everyone can participate in suicide prevention. Family, friends and acquaintances should be alert for signs an individual is contemplating suicide and take action. Be prepared before a crisis occurs by taking a few minutes to visit the New Jersey Suicide Prevention Hopeline’s website or Vibrant Emotional Health’s site Both sites have a wealth of information to help support someone in suicidal crisis.

A misperception is that suicides happen without warning. While this does occur, most of the time the person suffering has attempted to communicate his or her distress or plans to someone else. It may not be clearly stated, so asking direct questions about suicide can start the conversation and help-seeking process.

What are some signs that someone is suicidal?

Zimmermann: Increased substance abuse, anxiety, agitation, difficulty sleeping or dramatic mood changes can indicate someone is at risk. A feeling of hopelessness and being trapped or having no sense of purpose can be warning signs. Social withdrawal, uncontrolled anger and reckless behavior also are causes for concern. Most importantly, if people talk about wanting to hurt or kill themselves, threaten to hurt or kill themselves or indicate they are attempting to find a method to kill themselves, seek immediate help or guidance by contacting a mental health professional, the New Jersey Suicide Prevention Hopeline or 988, where specialists will listen to your concern and, together with you, develop a plan to get your friend or family member the help they need.

If you notice signs that someone is suicidal, what should you do?

Zimmermann: If you do encounter someone you suspect is in crisis, express concern and ask them directly if they are thinking about suicide. You can say, “I care about you. Some of the things you’ve said or done have made me wonder. Are you having thoughts about suicide?” It’s that simple.

If they say they are considering suicide, don’t judge, don’t deny and don’t dare. Telling them “Don’t say that” or “You shouldn’t feel like that” will likely send the message that you aren’t interested in continuing this important conversation. Don’t promise to keep it a secret. Get support for yourself and for the person talking about suicide. Reach out to either the New Jersey Suicide Prevention Hopeline or 988 for further direction or guidance. Both are available 24 hours a day, every day of the year.

What are some public misperceptions about suicide?

Zimmermann: Callers sometimes express fear that asking directly about suicide will “put the idea in a person’s head.” This is a myth. Opening the topic for discussion gives an opportunity to share something painful that had previously been borne alone. It also provides an opportunity to intervene.

Also, viewing suicide as an act of aggression or revenge bears some clarification. Most people who die by suicide feel disconnected or that they are a burden to those closest to them. Their thinking gets distorted to the extent that they come to believe their death will somehow benefit those around them.

How can society reduce the stigma surrounding a person who seeks help for a mental health condition?

Zimmermann: Education and open discussion are paramount. The statistics show that each year, over one in five Americans will experience a mental health illness. In 202, over twice as many people died by suicide than by homicide in the United States, and for each death by suicide there are 25 attempts. That’s over one million attempts a year. Oftentimes there are signs and opportunities to intervene well before a crisis develops. We hope that increased attention, education and resources will help reduce both the stigma associated with mental illness and the suffering of those affected.