Suicide is one of the leading causes of death in the United States, but what may be more distressing than the rate of these preventable deaths -- roughly one per 11 minutes in 2020, according to the Centers for Disease Control -- are the close calls.

That same year, the Substance Abuse and Mental Health Services Administration says a staggering 12.2 million people say they had seriously considered ending their life.

This public crisis is wholly preventable, but it takes knowledge, empathy, and patience to save lives and build stronger communities from the ground up.

With several years of experience working in community mental health, private practice, college counseling centers, and health systems, Kelly Holder, PhD, knows firsthand the struggles that many suffering from mental illness face. The Warren Alpert Medical School’s first Chief Wellness Officer says the key to staying mindful of one’s own mental hygiene every day can go a long way in ensuring a lifetime of wellness.

Start by understanding what good days look and feel like, Holder says. By identifying the things in life that bring joy and peace it becomes easier to notice when things begin to slip. These can be any activities that “fuel the soul” as Holder puts it – from regular exercise to eating well to spending time with friends and family, to even just spending a few hours of time alone.

“If you skip it one day or two days, OK, but by the time you get to that third day you should say, ‘Oh this is really something that is good for me and that I need. How do I get that back in?’ she said. “Because it is in those things that we do that we can hold onto our own wellness and maintain our own best levels of mental health.”

She notes that if you are having thoughts of suicide, it's important to reach out for help right away.

When it becomes obvious that things are not going well, Holder believes it is crucial to slow down and take stock.

“I think slowing down is often a good start because oftentimes we are so quick to want to fix what’s happening that maybe we don’t really know, ‘what is the problem I really want to solve?’” she said.

This can mean taking time to write down or record a voice note to work through the thoughts and feelings, take a walk, or do an activity that keeps the mind engaged but also gives space to work through the emotion, like knitting or coloring.

Identifying the problem is the next step to practicing good mental health. Holder says that once someone has given themselves enough time to reflect on their inner self, it is then time to ask, “What is my major issue here?”

She notes that sometimes there are many things piling up in life that can contribute to feelings of depression, anxiety, or even suicide, but being able to narrow it down to one change that could make all the difference could do just that.

“A good question to ask yourself is, “If I made one change, what change might impact everything?” You can ask yourself, “what do I need most,” said Holder. “I like that question a lot because that helps kind of narrow through all the things and get down to the heart of what’s really going on.”

Once the problem or problems are identified, Holder said it is important to reach out to another for support. 

“If you have a mentor, maybe there is a counselor or therapist you’re working with, maybe you have a coach, maybe you have a really good friend that is good at listening to you. Reach out to someone and share that thing and then be willing to take their advice,” she said.

The fourth step in staying on top of mental health challenges ties right into the third – being willing and open to the advice you receive.

“Once you’ve reached out for help, follow the good advice that you get, the guidance that you get to move forward through whatever those challenges or struggles are,” said Holder.

Sometimes this advice can be to seek professional help from a counselor or therapist, which then means reaching out a second time. 

These acts of self-reflection and awareness are not easy and often require a great deal of fortitude to accomplish. Knowing this, Holder says that congratulating oneself throughout this process is just as vital as any other step.

“Congratulate yourself on every step. Congratulate yourself for taking the time to slow down. You’re worth the slowing down. Congratulate yourself. Say, ‘Thank you. I thank myself for taking this time to slow down.’ Congratulate yourself for identifying what’s going on. It’s a big deal to have self awareness and know what’s happening.

“Congratulate yourself for reaching out for help. That can be hard for a lot of us. So, you need to celebrate and support yourself in saying, ‘Ah I asked for help. Good job, good for me.’ Then definitely celebrate whatever small steps you make toward making your life more of what you’d like it to be,” she said.

In her new role, Holder is only just beginning her important work of ensuring the nation’s future physicians are not only taught about but also possess the foundations upon which mental health and wellness are constructed and maintained.

Physicians are among the groups of people who experience a higher rate of suicide than many others. She says that many factors go into making this true, including the culture of healthcare and medicine, the challenges of meeting high demands with taxed resources and personnel, and maintaining a work/life balance. 

These have the potential to lead to chronic workplace stress more commonly known as burnout. This type of chronic stress have catastrophic consequences and lead to worsening of depression and other mental health conditions.

For her, promoting good, positive changes within healthcare organizations and within academic medicine organizations to make it a healthier environment is one factor that is essential for the reduction of chronic workplace stress and burnout. Holder says some actions can include reducing the stigma surrounding mental illness, creating improved avenues for treatment and simply talking about suicide more often.

“Start at the level of understanding the organization and the system and how do we support our faculty physicians, how do we support our resident learners, how do we support our students?” she said.

Last year, Holder started with opt-in mental health and wellness checks for students and this year moved to opt-out. She says keeping an appointment is much easier than reaching out for one and the students are already responding well to “being able to have an opportunity to check in with someone around their mental health and wellness and get resources personally designed for them.”