Of course, money is only one possibility. Suicidal thoughts can be triggered by any number of things, such as a traumatic event, loneliness or feeling powerless. Thoughts like, "Can't stop the pain, can't think clearly, can't make decisions, can't see any way out," according to the National Suicide Prevention Lifeline.
Emily said some of those were running through her head both times she considered killing herself — once with pills; the other by driving off a bridge.
The latter, ironically, is what led her to a new life with her husband. She went to a friend's house where she met James, who was empathetic since he'd considered it, too.
"If you're thinking about (suicide), pretty much all you're dealing with is negative stuff," he said. "It's hopelessness. You need to reach out."
That's sometimes difficult, McNeany said, because there's often a stigma associated with depression. "But it truly is a mental health issue," she said. "There's a chemical imbalance that takes place and multiple stressors can bring that on. It's not shameful to be depressed."
Both Marshalls were lucky to have a strong support system: each other, doctors, friends and family. After Emily's hospital hold, "one grandma threatened to take me over her knee if I ever did it (thought about suicide) again," she said, jokingly.
Whether or not you think the person is likely to actually commit suicide, it's important to take them seriously, James said. Speak openly about how they're feeling, offer alternatives and encourage them to get help.
At the Community Health Center, a behavioral health team offers psycho-educational programs and counseling for individuals, families, couples and groups, many of which are geared toward building coping skills.
"It's all about mixing primary care with behavioral care," Malone said, "because that's one of the best safety nets, when you put the two together."