The U.S. suicide rate is climbing alarmingly at a time when rates are falling in other modern democracies. What is going wrong with our society? Other than these three paragraphs, this long article is about some examples of practical steps psychologists can take to prevent suicide.

Over the last two decades, suicide has slowly and then very suddenly announced itself as a full-blown national emergency. Its victims accompany factory closings and the cutting of government assistance. They haunt post-9/11 military bases and hollow the promise of Silicon Valley high schools. Just about everywhere, psychiatric units and crisis hotlines are maxed out. According to the most recent figures from the Centers for Disease Control and Prevention, there are now more than twice as many suicides in the U.S. (45,000) as homicides; they are the 10th leading cause of death. You have to go all the way back to the dawn of the Great Depression to find a similar increase in the suicide rate. Meanwhile, in many other industrialized Western countries, suicides have been flat or steadily decreasing.

What makes these numbers so scary is that they can’t be explained away by any sort of demographic logic. Black women, white men, teenagers, 60-somethings, Hispanics, Native Americans, the rich, the poor—they are all struggling. Suicide rates have spiked in every state but one (Nevada) since 1999. Kate Spade’s and Anthony Bourdain’s deaths were shocking to everybody but the epidemiologists who track the data.

And these are just the reported cases. None of the numbers above account for the thousands of drug overdose deaths that are just suicides by another name. If you widen the lens a bit to include those contemplating suicide, the problem starts to take on the contours of an epidemic. In 2014, the federal government estimated that 9.4 million American adults had seriously considered the idea.