When they realized their son was struggling, Jordana Ash and Oliver Lignell dropped everything to fly from Colorado to Seattle, where they helped him connect with a psychiatrist and asked the hard questions.
Everyone had taken the right steps, including their son , when he asked for help. After 26 years of observing their son, Ash knew his mannerisms, and is sure he wasn’t lying when he told the psychiatrist he didn’t have a plan to die by suicide.
And yet, less than 24 hours before he was scheduled for an evaluation and six days after a Mother’s Day call where he didn’t seem quite himself, their “goofy,” compassionate, outdoorsy and endlessly curious Maddy was gone.
“Neither he nor we knew he was in a fight for his life,” Oliver Lignell said.
Since Maddy’s death in 2021, his parents have made it their mission to raise awareness of what some in the field are calling — a state characterized by feeling trapped and hopeless, while also withdrawing from people and being jittery or sleepless. The term can apply to people with a long-term mental illness who are at a crisis point, or those like Maddy without an apparent psychiatric history.
“We understood the tragedy of suicide to be the result of a long-term mental illness,” said Ash, a Boulder resident who works in the mental health field.
But Maddy had never shown previous signs of mental health problems, and while he was adjusting to a new job following a mid-pandemic move, he hadn’t gone through an obvious crisis, such as unemployment or a bitter breakup.
In 2024, the couple worked with the nonprofit Healthier Colorado to to learn about suicidal crises in people without a preexisting mental illness.
Since then, Lignell has given a presentation alongside other bereaved fathers to the American Psychiatric Association, and Ash is collaborating with a researcher to develop additional screening questions to assess suicide risk. The current questions about thoughts of suicide, planning and access to lethal means are important, but may not flag risk in people without long-term ideation, she said.
Suicide deaths in Colorado gradually trended up from 2004 to 2021, rising from 792 to 1,370 deaths a year. Since then, they’ve been relatively stable, fluctuating around 1,300 per year.
The death rate also rose nationwide, and experts have proposed a variety of possible causes, including precarious economic conditions since the Great Recession, increases in depression diagnoses among youth and the rise of social media.
Colorado typically has one of the nation’s highest suicide rates, particularly among young people. From 2021 to 2023, the most recent years with detailed data, Colorado had the seventh-highest suicide rate among people between 15 and 19, . The death rate from suicide was more than three times as high in Colorado as the state with the lowest rate, New Jersey.
The most recent data on contributing factors, from 2024, found 66% of people who died by suicide in Colorado had some sort of crisis in the two weeks before killing themselves. More than half had a diagnosed mental health problem, and a similar share had a known history of suicidal thoughts.
Dr. Megan Rogers, an assistant professor of psychology at Texas State University, is testing whether a new screening tool could catch more people at risk. Research has found that people do before a suicide attempt in an average of six hours, creating a tight timeframe to intervene if others haven’t spotted the signs before.
The majority of suicide decedents who sought medical care before their deaths said they weren’t thinking about killing themselves. Conversely, only about 14% of those who said they had serious suicidal thoughts in the past year made an attempt, .
“For some, they may be concealing (suicidal thoughts). For others, they had a more rapid onset,” Rogers said.
A 2016 study found that roughly four out of five people who died by suicide displayed at least one warning sign, though not always to those who were in the best position to intervene, said Mandy Doria, an associate professor of psychiatry at University of Colorado’s Anschutz Medical Campus. And, of course, people may not recognize something like a change in sleeping patterns or an unexplained mood improvement in someone with longstanding depression as red flags, she said.
“It’s more of a rapid change in behavior that you want to look for, rather than just feeling worse,” she said.
The human body is hard-wired to prioritize survival, and a person needs to be in an intense state of despair and agitation to knock that instinct offline, Rogers said. Fortunately, emotions that powerful don’t last long, so if something prevents people from completing an attempt, most ultimately don’t die by suicide, she said.
Dr. Chase Anderson, an assistant professor of child and adolescent psychiatry at University of California San Francisco, said people become suicidal when a situation feels unbearable and they can’t see a way out of it. A mental health provider’s role is to keep the person safe in the moment, then help them get to a place where they see their problems as something they can either fix or cope with, they said.
One of the things Anderson does with youth experiencing suicidal thoughts is to normalize them as a thing some people live with, and not a sign that someone is broken or should die, they said. Then they start working backward to identify what might have triggered the thought, and possible coping skills to use if it happens again.
“There are people living with it, and they can get help,” Anderson said.
Attempting to identify people at risk of suicide and get them into treatment is important, but it can’t be the only form of prevention, because no form of screening will ever be perfect, Rogers said.
“It’s similar to a heart attack. We know risk factors,” she said. “We still can’t predict who (will have one) and when it’s going to happen.”
Colorado is investing in a continuum of suicide prevention, with a focus on groups known to be at higher risk, such as youth and veterans, said Dr. Ned Calonge, the state’s chief medical officer. Some of the efforts include encouraging schools to teach students about resilience; supporting peer networks for groups such as farmers and ranchers; educating the public about how to respond if someone might be in crisis; and working with hospitals on “postvention” programs for people who survived an attempt.
Ideally, the state could do more to ease life’s blows through economic support, but with limited funding for suicide prevention, they have to put more focus on people at increased risk, Calonge said. People in more precarious economic circumstances have a higher risk of suicide, and , such as raising the minimum wage and expanding health insurance coverage.
“One of the problems with upstream prevention efforts is they have to be provided broadly, across the entire population,” he said.
Medical providers and the general public will always have an important role in looking for warning signs, but they can’t be the only line of defense, Rogers said.
“It’s not just, ‘How can we keep people from dying?'” Rogers said. “It’s, ‘How can we work upstream to make life worth living?'”
