Over the last seven years, the suicide rate in the San Joaquin Valley has been significantly higher than the statewide rate, according to a review of state and federal data.
Across Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus and Tulare counties, the overall suicide rate in the region was 10.8 per 100,000 residents – a rate about 15% higher than the statewide suicide rate of 9.4 per 100,000 residents – from 2018 through 2024.
During that period, almost 3,300 Valley residents died by suicide.
“It’s a huge problem,” said Amanda Nugent Divine, CEO of Fresno-based nonprofit Kings View Behavioral Health, which operates the Central Valley Suicide Prevention Lifeline. “Obviously, it’s a very permanent solution to what is often a temporary problem or a transitional problem.”
How huge is the problem? Enough to rank suicide among the 15 leading causes of death over the seven-year period in each of the Valley’s eight counties – not as high as heart disease, cancer or accidental deaths, but in the same neighborhood as kidney disease, influenza and Parkinson disease.
Those who died by suicide represent a demographically diverse cross-section of the Valley’s population, according to data retrieved from a mortality database maintained by the U.S. Centers for Disease Control and Prevention.
They range from children under 14 to teenagers, young adults, middle-age and senior citizens. Almost three-quarters were white, and the balance included Black, Asian, Native American and other racial groups. About one-third were of Hispanic ethnicity. They include both men and women, with men outnumbering women by more than 4-to-1.
About 10% of the suicides in the eight-county region were former military servicemembers. At least 314 veterans took their own lives between 2018 and 2022, the latest year for which data is available from the California Department of Public Health, a suicide rate of almost 30 per 100,000 vets – nearly triple the rate of the general population.
More than 1,200 victims used a gun to take their life. About 1,000 others died by hanging or strangulation, and about 250 intentionally poisoned themselves through drug overdoses or other chemical exposure.
“We know that one of the biggest risk factors is when people lose hope, and they don’t feel that it would matter if they were gone,” Nugent Divine said. … “That seems to be sort of a common thread, where people will go ahead and take that step.”
Suicides are not only a concern in the Valley, but statewide and nationwide as well. Nationally, suicide was the 12th leading cause of death from 2018 through 2024, claiming more than 334,000 lives.
Fresno Survivors of Sucide Loss, a support program for people who have lost a loved one to suicide, reports that in 2022, about 13.2 million people in the U.S. seriously thought about committing suicide, about 3.8 million made a plan to commit suicide, and 1.6 million people attempted suicide. That year, more than 49,000 people died by suicide.
A wide range of factors can play a hand in triggering suicidal thoughts or intentions in a person, and they don’t necessarily have their roots in a chronic mental health issue, said Nugent Divine, who is also a psychologist in addition to her CEO duties at Kings View.
“Not everyone who commits suicide necessarily has a mental illness,” she said. “They may be suffering from a depression that is situational” rather than a longer-term diagnosed condition. “It may be completely circumstantial, obviously the loss of a job, loss of marriage. … We see it in older folks who have just gotten a (medical) diagnosis they feel they cannot manage, or maybe they’re alone, or there’s fear.”
She also said drug and alcohol use can be contributing factors.
“We know that alcohol amplifies emotions,” she said. “We know that a number of other drugs amplify emotions.
Alcohol and drugs not only impair judgment, she said, but also lower inhibitions that might ordinarily override a person’s desire to take his or her own life.
“There are people who survived their attempt, and they’ve shared that they used (drugs or alcohol) to be able to do it,” she added. “They shared that they would not have been able to do it if they had not used that substance.”
Still, societal perceptions about suicide – and an awkwardness about openly discussing the issue – can serve to dissuade people from seeking help because of the stigma associated with mental illness.
“You know, even talking about that is scary. I know some people are like, ‘Let’s not talk about that, because I don’t want to make people feel like it’s a good solution,’” Nugent Divine said. “Of course it’s not a good solution.”
“We firmly believe that the more we talk about it, the better we’ll get at preventing it,” she added. “Not talking about it does not keep people safe. It doesn’t work that way.”
That’s the idea behind the 988 nationwide suicide prevention lifeline system and crisis call centers across the U.S. The Central Valley Suicide Prevention Hotline is one of 12 such centers in California. The counselors who field calls for the Valley hotline undergo 160 hours of training to prepare them for providing an empathetic and analytical ear for callers in crisis, said Karla Luna, who worked the phones at the Fresno call center for about six years before becoming the director of the crisis line about a year and a half ago.
Reaching out to be heard
The 988 system enables people to quickly call or text for help using the three-digit number. People can also chat with a counselor online at chat.988lifeline.org. The call centers and text and chat systems are available 24 hours a day, seven days a week, every day of the year. The service is free of charge and confidential for callers.
“A lot of it is just providing a listening ear,” Luna said. “A lot of the time that’s really all people need. They just need someone to talk to at the time. They maybe don’t have that support system at home, or maybe it’s a situation where they just don’t feel comfortable talking to the people around them of what they’re going through and what’s going on, and it’s a little bit easier to talk to a counselor.”
When a caller dials 988, they have an option to speak to someone in English or Spanish. There are also options for military veterans and for LGBTQ callers – segments of the population that have been shown to be at higher risk for suicide.
Once connected, a counselor will explore with the caller what led them to reach out for help, Luna said. Counselors then go through a suicide assessment and talk the caller through a safety plan.
Sometimes, the caller is a person who is concerned that a friend or loved one may be considering suicide, and counselors provide guidance or resources. In some instances, if the caller agrees to it, the counselor will reach out to see if the subject of concern is willing to talk about their situation.
More than numbers
People who have taken their own lives are more than mere numbers in a government database. They were troubled individuals who are survived by anguished families and friends who in many cases are left wondering: why?
Those are the people who feel “profound guilt, that there was something they missed, that they could have done more and it’s their fault,” Nugent Divine said. “Survivor guilt is overwhelming.”
The suicide of a family member, she added, “changes their lives forever. It’s never the same again.”
Family members and friends often relate that while a victim may have been experiencing depression for several years, “more often than not it’s the family that says they were doing so well … that for the last six months they’d been thriving,” Nugent Divine said. (See “Suicide warning signs” near the end of this article.)
That in itself can be a red flag, she added, because “people that suffered from a severe depression, when they decided to take their own life and had a plan, sometimes their mood lifted because they felt it was going to be over, that this was about to get better, … that all that pain was going to be over.”
Mental health stigma is a roadblock
One of the big challenges to getting people considering suicide to reach out for help is the societal stigma associated with mental illness, Nugent Divine said.
“When the body breaks down, maybe you have to take insulin shots, or you get cancer and you have to get treatment for that, and nobody blames you, you’re not at fault,” she said. “But with the brain, just because of the nature of it, we seem to believe that if the person just tried harder, or maybe they weren’t a ‘difficult’ person, they wouldn’t have this.”
Many people manage to function well in society despite being treated for severe mental illnesses, she said. “And then there are people, like most of the rest of the world, who maybe have suffered from one depression in their lifetime, and it was hell, but they emerged on the other side and never had another one.”
Nugent Divine said the stigma is powerful enough that some people who seek clinical help ask to be diagnosed with post-traumatic stress disorder because they think that makes their situation or experience less shameful.
”Because it implies that you did something worthwhile and you became a victim of something,” she said. “We’ll have people that have a mental health diagnosis, but do not want to be given that. They want the label of PTSD because people treat them differently.”
Social stigma extends in particular to the LGBTQ+ community – a demographic acknowledged to be at greater risk for depression and suicide, Nugent Divine said.
LGBTQ+ youth especially at risk
A nationwide survey of youth risk behaviors conducted by the Centers for Disease Control in 2023 – and since disavowed by the Trump administration – revealed that 65% of high school students who identified as gay, lesbian, bisexual, trangender or queer had experienced persistent feelings of sadness or hopelessness in the prior year. That’s more than double the percentage of their heterosexual or cisgender peers, and the highest percentage of any gender, orientation, race or ethnic demographic.
More than 40% of LGBTQ+ students responding to the survey reported they had seriously considered attempting suicide over the previous year; 32% had made a suicide plan; and 20% had attempted suicide. Each of those percentages was higher than those of any other group.
But in a statement atop the survey results web page, the Trump administration denounced the survey results related to gender identity as “extremely inaccurate and disconnected from the immutable biological reality that there are two sexes, male and female.”
“The Trump Administration rejects gender ideology and condemns the harm it causes to children, …” the statement continues. “This page does not reflect biological reality and therefore the Administration and this (Health and Human Services) Department rejects it.”
The web page was disabled shortly after President Donald Trump took office in January in accordance with one of his executive orders, but the statement adds that a court order required the Trump administration and HHS to restore the website.
But Trump’s views of gender and sexual orientation continue to be reflected in budget legislation moving through Congress that would discontinue suicide prevention efforts geared specifically toward the LGBTQ+ community. KFF.org, a health news services, reports that the administration’s budget request for 2025-26 would maintain overall funding levels for the 988 suicide prevention lifeline system, “but eliminates dedicated funding for the LGBTQ+ service.”
The administration also took steps in February to remove any promotional materials for the 988 LGBTQ+ line from the website of the Substance Abuse and Mental HealthServices Administration, an agency within the federal Department of Health and Human Services.
Such moves are not without potential consequences for would-be callers to the 988 hotline.
“The people that are most compassionate about those who are struggling are the people that have struggled with it, that’s the people that get it,” Nugent Divine said. “We have to increase our ability … to actually look and imagine what it may be like for someone.”
Luna, the Valley hotline director, expressed a similar concern.
“We do find that a lot of the times when we do get individuals, maybe in a particular group, whether it’s LGBTQ or Spanish speakers or veterans, a lot of the times they feel more comfortable talking to someone who can relate to their situation,” Luna said. “That’s very important… when you’re building rapport and when you’re connecting with someone.”
“To me, it’s like we’re making this progress (and then) having these lines shut down,” she added. “It almost seems like we’re going a little backwards.”
Suicide warning signs
The National Institute of Mental Health details some indicators that a person may be thinking about suicide.
- Talking about: Wanting to die, great guilt or shame, or being a burden to others.
- Feeling: Empty, hopeless, trapped or having no reason to live; extreme sadness, more anxious, agitated, or full of rage; unbearable emotional or physical pain.
- Changing behavior, such as: Making a plan or researching ways to die; withdrawing from friends, saying goodbye, giving away important items, or making a will; taking dangerous risks such as driving extremely fast; displaying extreme mood swings; eating or sleeping less; or using drugs or alcohol more often.
Getting crisis help
If you or someone you know exhibit some of the warning signs of suicidal thoughts or behavior, the National Institute of Mental Health urges seeking help “as soon as possible.
The Central Valley Suicide Precention Hotline offers a range of information and resources at its website, centralvalleysuicideprecentionhotline.org. The hotline and website are a program of Fresno-based Kings View Behavioral Health. Persons in crisis can reach out any time, 24 hours a day, seven days a week, every day of the year, including holidays:
- Call 988 to speak with a suicide crisis counselor.
- Text 988 for a text chat with suicide crisis counselor.
- Visit chat.988lifeline.org for an online chat with a suicide crisis counselor.
In Kern County, the 988 hotline connects with Kern County Behavioral Health Services.
Tim Sheehan is the Health Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. CVJC student research assistant Lauren Aiello contributed to this report. Contact Sheehan at tim@cvlocaljournalism.org.