It's devastating on any family or community and it's something that hits Native American reservations far too often.
The suicide rate is higher among Native Americans than any other group. C.J. Addison knows how it feels to lose a family member to suicide.
"I didn't believe that he was dead," Addison said. "I took my mom back to her house and I was out in my car and she came running out and was waving me in. So I went in and she said your brother's dead."
What he saw next is an image that’s still clear in his head.
"His room was all the way down the hallway," Addison said. "His door was open and I just looked down and I see him laid out on the floor. I just didn't believe it I didn't want to believe it. I just went in there and held him. But he was already ice cold."
Addison says he felt mad and angry but didn’t know what to do. He is one of many people living on a reservation in South Dakota who's been touched by suicide. His fiancé Tammy Clark is another.
"Within a year hearing that your cousin passed away and then a couple months later another cousin passes away and the next year another cousin passes away by hanging themselves or overdosing," Clark said.
The suicide rate among Native Americans is more than one and a half times the national average. If you look at 15 to 24-year-olds, it's three and a half times higher.
The factors are widespread.
"The economic conditions or the poverty or the lack of resources that somebody might have which might be funding or jobs or not having a home or safe environment," Vickie Claymore, with Indian Health Service, said.
Claymore works with behavior health for IHS. Her district spans the Dakotas, Nebraska and Iowa. In addition to economic conditions, she says health factors such as depression and traumatic events also play a part.
"For a lot of our Native American families, several of those will hit at once and so you end up with kind of that cumulative. It's not just one thing that's happening; it's several things at once," Claymore said.
When there's one death, more often follow. Clark can relate to that. She can count six suicides within her family. She even thought about it herself when she was in an abusive relationship.
"I just felt isolated," Clark said, "felt like there was no way out. Then when I was 17 I felt like I might as well give him what he wants and kill myself."
But she didn't complete the plan. Workers in health service at IHS and elsewhere are working to keep others from killing themselves too.
Claymore encourages family members and friends to help in the fight by looking for warning signs. Is someone isolating themselves, behaving differently than they normally would, maybe giving things away?
She also says building suicide prevention programs within communities is important and the direction IHS in headed in the fight. The most effective methods on Pine Ridge might differ a bit from Cheyenne River or Standing Rock.
"And I think as we put those in and with the tribes that they're building their programs, that is the most effective," Claymore said.
Most effective is what both Clark and Addison want.
"I think it's a problem," Addison said.
"Yeah I think it is a very big problem," Clark said.
"Seeing it go away soon? It could if people want to really try to do something about it," Addison said. "The main thing I think is parents. Patents need to stop drinking, spend some quality time with their kids."
The Indian Health Service area that includes the Dakotas has the second highest suicide rate in the country.