LEWISTON — About 45,000 people in the U.S. die by suicide annually, according to the federal Centers for Disease Control and Prevention. That’s one death by suicide every 12 minutes. Alarmingly, more than half of all states have seen suicide rates increase by over 30 percent between 1999 and 2016, with a 27 percent increase in Maine over the same period.

Our attention to this national crisis grows with celebrity tragedies such as the suicide deaths of Anthony Bourdain and Robin Williams, but suicide also takes the lives of those who aren’t in the spotlight: It’s the third leading cause of death among young people, and about 20 veterans die by suicide each day.

The growing rate of suicide in the U.S. should be alarming for us as a nation. It is unlikely that our increased awareness of suicide is what has contributed to the higher reported rates. The CDC reports that the rates of suicide rose in men and women and across all age and ethnic groups, propelled by mental illness, substance use disorders, financial hardships and relationship problems.

Many intersecting factors affect suicide risk. Fifty-four percent of those who died by suicide had no identified mental health conditions – meaning, tragically, that they likely never were screened because they had no access to care. It is not surprising that many who feel despondent, isolated and withdrawn because of the stress and difficult life circumstances they face are ashamed to admit suicidal thoughts or needing help with depression.

When considering someone’s risk for suicide, it helps to ask whether the person has a plan and the means to follow it through. “In 2016, firearms were the most common method used in suicide deaths in the United States, accounting for almost half of all suicide deaths,” the CDC notes.

It is hard to predict suicide if someone wants to go undetected, making it critical for friends, families and professionals to take steps to minimize risks and focus on prevention for those most vulnerable. Risk factors include a history of suicide attempts, mental health diagnoses, including depression, and alcohol or drug use disorders. Lack of mental health care resources is a strong contributor. Much has been written about the opioid crisis in the U.S. in general, and Maine in particular, and the substance use disorder epidemic has also contributed to the increased suicide rate.

Those who live alone, who have experienced relationship losses or who face financial strain may be at particularly high risk. Maine is the oldest state by median age, and older age is itself a risk factor for suicide.

The good news is that mental health services effectively reduce the suffering for those with mental health issues, including mood disorders, such as major depression, anxiety disorders and many other diagnoses. While undiagnosed and untreated mental health disorders serve to fuel the increased suicide rate, the provision of these needed mental health services is truly protective. Likewise, the lives of many Mainers with substance use disorder have been saved using medication such as Suboxone, provided alongside psychosocial interventions.

Certain protective factors also reduce suicide risk. Connections with family, friends and community and religious groups provide critical protection.

A common – and life-threatening – misconception is that it is unsafe to ask if someone has thoughts to harm or kill themselves. On the contrary: Asking about and identifying suicidal thinking often provides their first chance for treatment. Access to care using crisis hotlines is also key, and the numbers of the Maine (888-568-1112) and national (800-273-8255) hotlines should be readily available.

The public should work with professionals to provide safety and to expedite treatment of any underlying diagnoses such as depression and substance use disorder. A safety plan may also include restricting access to lethal means during a crisis.

While we remain concerned about the increased rate of suicide, we can offer lifesaving treatment for those with mental health or substance abuse problems to offset these risk factors. We at Tri-County Mental Health Services remain committed to working together to identify and help improve the lives of those most in need during this period of elevated suicide rates.