09/11/2026
September means that every other post on my feed is talking about โending the stigmaโ.
And stigma is still real.
People are still judged for substance use, mental illness, setbacks, medication, treatment, incarceration, poverty, and asking for help, etc. etc.
But Iโm increasingly uncomfortable with acting like stigma is the biggest or even most important barrier we need to solve as a community.
Because sometimes people are ready to ask for helpโฆ
and they doโฆ
and then there isnโt any.
Thereโs a six-month waitlist.
The provider doesnโt take their insurance (if they even have insurance).
They donโt have transportation.
They canโt leave work to make the appt times available.
They donโt have childcare.
They donโt meet the right eligibility criteria.
Theyโre too โhigh functioningโ for one service and not โstable enoughโ for another.
So they get discharged too quickly, referred somewhere else, or just handed another phone number to call.
Or maybe, by some miracle, they get clinical treatment or fragment of support but then go right back to a life where they are isolated, lonely, financially underwater, disconnected from community, and surrounded by the same conditions that helped create the crisis in the first damn place.
We can tell people all day long that itโs okay to ask for help but if we actually want to make a difference we have to make sure help actually exists, is accessible, and is collaborative.
And I think we need to broaden what we mean by โhelp,โ too.
People may need clinical care, sure.
They also need somewhere to belong.
They need relationships.
Peer support.
Safe places to spend time.
Transportation.
Housing.
Meaningful things to do.
Opportunities.
People who notice when they start isolating or disappear for a while.
They need communities that see them before they are in crisis, not just systems that respond after everything falls apart.
Anti-stigma campaigns still matter, yes.
But even if we magically made all the stigma melt away today I donโt really believe that weโd have less lives lost.
Maybe the next phase of this work needs to push the conversation beyond stigma.
I think weโve gotten stuck there because itโs hard to measure whether weโve achieved our goal and thatโs comforting in some ways.
It allows us to keep talking about things without having to take any concrete action.
And it allows us to avoid any real accountability, conflict, or responsibility.
Maybe the next goal is making sure there is actually something and someone there when people do need support.
But more largely, if we want to stop people from ending their lives we have to do our part as a community to help make life at least bearable.
Personally, when Iโve struggled with my own ideation, the list of reasons I would have left behind would have included financial challenges, loneliness, trauma, mental overwhelm, physical and emotional pain, and lack of access to resources and healthcare.
Stigma would never have made the list.
-r
