In this deeply reported piece at the Huffington Post Highline, Jason Cherkis looks at how suicide rates in the United States are at an all-time high — leaving no gender or demographic unaffected — while those of other Western or industrialized countries “have been flat or steadily decreasing.” In examining a complicated, underfunded healthcare system in the US that’s ill-equipped to serve those struggling, Cherkis finds some hope in therapist Ursula Whitehead, who uses a therapy pioneered by Jerome Motto to help suicidal people. Through short letters and texts specially crafted to reinforce positive personality traits and avoid judgement of any kind, both Motto and Whitehead have found that they’ve been able to connect with those in despair.

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.

Ursula Whiteside is, above all else, a bad pun and cat-based humor kind of person. She seems never to have met a GIF of a penguin, or of Beyoncé, she didn’t like. And her therapeutic practice draws heavily on these cornball ways. One of her clients had trouble getting out of bed in the morning, so Whiteside regularly texted her things like: “Here comes the magical wake up goat to make this day less baaahhh.” And the next morning: “The rabbit needs feeding! Only you can make this happen by hopping out of bed.” When that same client went on vacation last year, Whiteside sent a text urging her to feel “FREEEEEEEE!” accompanied by a cartoon of a dog sticking his head out the window. (These texts, like all others in the piece, were provided not by Whiteside, but by the patients.)

While her messages don’t mimic Motto’s plainspoken voice, they fully capture the spirit of his work. Whiteside started sending them when she went into private practice four years ago and immediately discovered how powerful they were. So many of her patients struggled between sessions. They bristled at the artificial boundary of a 50-minute conversation. The texts acted like evidence of a relationship, tokens her patients could hold on to as proof someone cared about them. It’s hard to overstate how different this is from the correspondence patients usually receive from the medical establishment. Whiteside has a therapist friend who calls the typical automated notices people get when they miss an appointment “I Hate You Letters.”

Still, Whiteside sets rules for her patients: They must agree to receive the texts. They don’t have to text back. If they do, they need to understand that they might not receive a response for at least an hour. She might be in a session with another client, or on her way to lunch. She also wants her patients to give her clear feedback on what they like and don’t like. One person said she hated the penguin memes and would prefer to receive pictures of nature instead. “You’re always paying attention to what they find funny, to what they are saying when they cry,” Whiteside said.

She sets rules for herself, as well: Typos are OK. Being a little annoying is OK. Each text should take no more than 90 seconds to write, because anything longer might read like it’s been workshopped too much, not enough like a message between friends. She also makes sure to time her texts so they don’t arrive only when patients are in crisis. Mostly, they should appear for no particular reason. She had been thinking about them, that’s all.

“I think people die when they feel completely alone,” Whiteside explained.

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