More Than Three Numbers
September is Suicide Prevention Month, and I have 988 tattooed on my arm.
For me, it means more than three numbers. It’s a reminder of the people I met at some of the most vulnerable moments of their lives, and of the people who answered when someone called. It’s a reminder that when someone finally finds the courage to reach out for help, our systems owe them a response that’s ready.
Long before I worked in healthcare technology, I was a crisis clinician. I answered calls for what was then the National Suicide Prevention Lifeline, and for the Veterans Crisis Line. I worked on a mobile crisis team, which meant the work rarely happened neatly inside a clinic. I met people in their homes, in emergency departments, in homeless shelters, and under overpasses. More than once, I sat across from someone who had survived a suicide attempt just hours before.
Those years taught me a lot, but one lesson has stuck with me throughout my whole career: suicidal crisis doesn’t have a particular look, ZIP code, diagnosis, income level, or family story. I’ve watched friends and family struggle too. No family is immune, and the numbers back it up.
In 2024, 48,824 people in the United States died by suicide. An estimated 14.3 million adults seriously considered suicide; 4.6 million made a plan and 2.2 million attempted. Suicide remains among the ten leading causes of death nationally.
Given my years supporting Veterans, some numbers hit closer to home than others. The most recent VA report found that 6,398 Veterans died by suicide in 2023, an average of 17.5 a day. Maybe the most instructive detail for those of us thinking about systems of care: 61% of those Veterans had not received VA healthcare in the year of their death or the year before. Suicide prevention can’t belong to one clinic, one behavioral health organization, one emergency department, or one agency. It has to exist everywhere people show up.
988 Changed the Front Door
The launch of the 988 Suicide & Crisis Lifeline in July 2022 was one of the biggest steps forward in our national crisis infrastructure in decades. We finally gave people something simple to remember: call, text, or chat 988, available 24/7/365. Veterans can call and press 1 to reach the Veterans Crisis Line.
And people are using it. In 2025 alone, the 988 Lifeline received more than 8 million calls, texts, chats, and ASL videophone contacts from people seeking help. That’s extraordinary progress. But a better front door doesn’t finish the house. The next phase of our national strategy has to ask what happens before someone reaches crisis, while they’re receiving care, and after the immediate crisis has passed. That’s where healthcare technology has real opportunity.
Advancing Crisis Care: Innovations, Best Practices, and the Future of 988
Building a suicide-safer system of care requires more than answering the call. It demands connected workflows, effective change management, strong implementation governance, and technology that supports clinicians at every step of the care journey.
In this on-demand webinar, Danny Gladden and Wendy Martinez Farmer share practical insights on how healthcare organizations can strengthen crisis response, improve care coordination, and build sustainable systems that support individuals beyond 988.
Access the On-Demand Webinar
Technology Should Help Us See Risk Sooner and Act on It
Healthcare organizations already hold a tremendous amount of information that could help identify risk: screening results, prior attempts, ED visits, diagnoses, changes in utilization, medications, clinical documentation, missed appointments, safety plans, past risk assessments. Research has shown that structured EHR data can help identify people at elevated risk well before an attempt. But prediction alone isn’t prevention.
A risk score sitting silently in a database doesn’t save anyone. Neither does a positive screening with no next step, or a well-written safety plan buried in a PDF the next clinician can’t find. Technology creates value when it turns information into action, helping clinicians screen and assess consistently, prompting the right response when risk shows up, making safety plans usable instead of static, supporting follow-up, and giving teams visibility across their population so they know when someone at elevated risk has fallen out of care.
It also means staying appropriately cautious about AI. There’s real potential for analytics and AI-enabled tools to surface patterns a clinician might miss, but this isn’t an area for technology theater. SAMHSA’s 2026 Zero Suicide guidance specifically says digital tools and predictive systems used for suicide-risk identification need to be clinically validated, keep human oversight, and never simply replace crisis intervention. That distinction matters to me: technology should extend clinical judgment, not replace it. And sometimes its most important job isn’t glamorous at all. It’s just making sure the next person knows what the last person knew.
The Handoff May Be Where Technology Matters Most
Think about the journey of someone experiencing suicide risk. Within a matter of days, they might interact with an emergency department, an inpatient unit, an outpatient therapist, a primary care office, a crisis line, a mobile crisis team, and a community behavioral health provider, sometimes more than one of these at once.
I was the clinician on one of those stops, and what worried me then still worries me now: what happens at the next stop? Does the next clinician know what we learned? Can they see that a risk assessment was completed, or find the safety plan? Do they know what was discussed, whether follow-up happened, or whether the patient actually connected with the next provider? Or does all of that stay locked inside the organization where the crisis first occurred?
This is one reason I’m proud of Streamline Healthcare Solutions‘ partnership with SPiER. SPiER’s mission is ambitious but simple to state: make suicide-safer care the standard everywhere. Its work embeds validated suicide-prevention tools into the systems clinicians already use, making that care more structured, measurable, exchangeable, and scalable, following the work clinicians actually do through an eight-stage Suicide Safer Care Pathway:
- Identify possible risk
- Clarify risk
- Define the risk picture
- Document safety actions
- Coordinate handoffs
- Track follow-up
- Track risk over time
- Measure and share the data
That progression matters. Suicide prevention can’t end at “identify,” yet too often our technology has been built exactly that way: administer a screening instrument, calculate a score, document something, move on. The harder, and potentially life-saving, work happens downstream.
From Information to Infrastructure
Most of the tools clinicians need already exist. Validated screeners, risk-assessment frameworks, collaborative safety planning, evidence-based interventions, follow-up protocols: none of this needs to be invented. The problem is that too many of these tools still live as paper forms, PDFs, free-text notes, or guidelines sitting outside the workflow. Even when they technically live inside an EHR, the information often isn’t structured in a way another system can understand or act on.
SPiER is helping close that gap by translating suicide-safer care into interoperable, technology-enabled workflows, which matters a lot when you think about FHIR and Health Information Exchanges. An EHR stores information. An HIE can move it between organizations. But moving information isn’t enough if every system describes it differently, or if the receiving system has no idea what to do with it once it arrives.
The goal should be bigger than exchanging documents. We should be exchanging meaning. When suicide-risk information is captured in a standardized form, represented so another system can interpret it, and connected to an appropriate next action, something changes: the patient’s safety information can follow the patient. The safety plan doesn’t have to stay locked inside the chart where it was written. The risk assessment doesn’t have to disappear when someone leaves the ED. The next provider doesn’t have to start from zero. That’s the kind of interoperability that matters to me, not interoperability for its own sake, but interoperability in service of an actual person.
There Is Still a Person on the Other Side of the Technology
For all my enthusiasm about technology, some of the most important suicide-prevention work I’ve ever done required none of it. It required answering a phone. Showing up. Sitting down. Listening. Staying a little longer than felt convenient. Asking directly about suicide when it would have been easier not to. Helping someone imagine getting through the next hour when the next year felt impossible.
Technology will never replace that, and it shouldn’t. But it can make it more likely the right person notices the risk. It can help a clinician know what to do next, make sure a handoff actually happens, remind a team to follow up, and help an organization see who’s falling through the cracks. Increasingly, it can help critical safety information travel with someone instead of forcing them to tell their story over again every time they enter another part of the healthcare system. That’s not replacing human connection. It’s building infrastructure around it.
The Number on My Arm
I’m grateful that today I can tell someone simply: 988. Call it. Text it. Chat with it. I’m grateful that millions of people are doing exactly that.
But the number on my arm also reminds me that suicide prevention can’t be reduced to a phone number, or to one month on the calendar. September should remind us to talk about suicide. The other eleven months should remind us to keep building systems capable of responding when someone does.
We know more about suicide prevention than we ever have. We have validated tools, evidence-based practices, crisis infrastructure, increasingly powerful healthcare technology, and interoperability standards capable of moving information between systems. The question now is whether we’ll connect those pieces well enough that when someone needs us, the system recognizes the moment and responds.
Because somewhere tonight, a clinician will answer a phone, walk into an emergency department, enter a shelter, pull up outside someone’s home, or meet someone under an overpass. I remember being that clinician. I want every tool we build today to make it a little easier for that clinician, and that person, to find the next step toward tomorrow.
If you or someone you know is struggling or in crisis, call or text 988 or chat through the 988 Suicide & Crisis Lifeline. Support is available 24/7/365. Veterans, service members, and their loved ones can call 988 and press 1.
Danny Gladden, MBA, MSW, LCSW, is Chief Clinical Officer at Streamline Healthcare Solutions. A licensed clinical social worker and former community behavioral health executive, he focuses on the responsible integration of technology to strengthen clinical care, compliance, and access across the continuum.
