- Over the past two decades, suicide rates in the U.S. have been steadily rising.

There are more than twice as many suicides as homicides, according to the most recent numbers.

The issue has emerged as a major public health crisis, and yet despite the decades of research not enough is known about how to prevent people from taking their own lives.

- One remarkably simple intervention is now showing promise, sending short, caring messages to those at risk, but it's a method that's been tried before.

It was first tested half a century ago in an unconventional experiment that had been filed away and seemingly forgotten.

(gentle music) - In 2014, I woke up restrained to a gurney naked.

I had an IV in my arm, so that hurt.

I was wondering where my clothes were.

I was wondering where I was.

I was wretchedly embarrassed, felt ashamed.

At that point, I was still very much suicidal.

And I was like, oh my God, what have you done?

I was a alcoholic, military, sexual trauma, PTSD soldier.

And the world gets really small, because all you can see is your pain.

I felt like I had tried as hard as I could and that I was just never gonna get it right, and that I was just destined to be tortured forever until I died.

- [Woman] October 18th, 1973, this is just a note to let you know we are interested in how you are coming along.

April 24th, 1974, we continue to be interested in how you are doing.

We want you to know that our interest in you continues.

We hope that life is going well for you at this time.

- [Narrator] In the late 1960's, a San Francisco psychiatrist named Jerome Motto began an unusual experiment.

He wanted to understand how to help people driven to suicide, and he recruited researcher Chrisula Asimos.

- To me, the whole idea of working with suicidal people was really new.

I do recall thinking, oh my gosh, I'm gonna talk to a lot of depressed and suicidal people all the time.

Am I ready for this?

- [Man] Contrary to popular belief, people who threaten suicide do kill themself.

- [Narrator] At the time, suicidal people were so misunderstood that the developing field created training videos to teach doctors and first responders what not to do.

- Listen to bad lady, wanna succeed, you better cut deeper next time.

- You could take almost any medical book you want, and you'd be lucky if you could find the word suicide in it.

- She hurt very bad?

- Nah, she's looking for sympathy, wants a little attention.

- Don't we all?

- There really was a judgemental stance that they took.

It's like what you've done is manipulative and it's not legitimate, and I really don't buy in to your pain.

- [Narrator] Motto embarked on his study with a team of researchers that included his wife Pat.

- Let's see what we have here.

This is from the project, and this one was mine.

- [Narrator] They fanned out across San Francisco to talk with over 3,000 patients hospitalized for depression or suicidal thoughts.

- [Pat] This is number 2,859.

- We each established a relationship with a patient in the hospital.

Here's somebody who you're sharing the deepest pain and experience with.

And then that person left, and we thought, who knows what's gonna happen after they leave.

And so we're gonna send a letter saying we just care, that's it.

- Jerry was in World War Two, and he always had letters from home.

They brought back that sense that this will be over.

War is hell, but there's somebody out there that cares.

- We wanted it brief.

I think it was just a couple of sentences.

You know, no expectations, and let's see if it works.

- [Narrator] Motto and the researchers decided to focus their study on patients who had declined follow up treatment, and to send them letters at regular intervals over the next several years.

- The key thing was doing something for nothing.

Doing something 'cause you cared.

And I said, I don't know how you're gonna get that across in a letter?

I really didn't.

I wasn't overly enthusiastic.

I guess I said, is that all your gonna do?

- [Narrator] Before long though, they began hearing back.

- "Please call me, I'm really down.

"Don't know what to do, I can't talk to anyone."

- [Narrator] And they were able to help some of the patients get back into treatment.

But they hoped the letters might be doing something more.

- Every year we'd go up to Sacramento to the Vital Statistics Records.

We wanted to look and see what the death records were like.

That was very anxiety provoking, you know?

Looking at 'em and going oh don't, please don't have the names that I know on this.

- [Narrator] After Motto and the researchers scoured the records, they discovered something remarkable.

The group of patients that had received the letters had about half the suicide rate as the group that had not in the first two years after leaving the hospital.

- The letters seemed to matter.

It was pretty exciting.

Yeah, it really was exciting.

He was such a salesman about that, you know?

That the ties that bind are really what makes life.

It's the essence of life itself.

- [Narrator] Motto published the results in 1976 and spread the word about caring letters at conferences afterwards.

But the years passed, and then decades.

- We still, over the years, couldn't believe that nobody picked this up and did this.

Why doesn't anybody do this?

- All I remember is conversation about it just dwindled away.

- [Narrator] By the mid-2000's a suicide crisis was emerging among American service members and veterans.

David Luxton, a U.S. Air Force veteran and clinical psychologist, was hired by The Department of Defense to help find a solution.

As he searched for ideas, he came across Motto.

- I will admit, when I was first reading the literature on this, reading Motto's work, I was a little skeptical.

There's something kind of intangible about this caring connection.

- [Narrator] For a field that had grown reliant on prescription drugs and finite 50 minute therapy sessions, the notion of sending letters to patients over time didn't quite fit.

- That's not what people are looking for.

What they're looking for is the pill that'll do the same thing.

To a hammer everything's a nail.

To them, everything is medication and treatment.

- [Narrator] And yet, as suicide rates continued to climb, it was clear to Luxton that they needed more tools.

He kept returning to Motto's original study and a more detailed follow up paper Motto and a colleague published in 2001.

- These caring letters actually reduced the rate of people dying by suicide.

And that's been something that few other studies have been able to show have been effective at doing with any kind of intervention.

And so, that requires some attention.

- [Narrator] Luxton and other researchers have been testing Motto's technique.

But with a modern twist, using text messages and emails instead of letters.

James Wooley took part in one study.

- The first one that I really remember was a couple months after I got out of the hospital.

"Hey James, how you doing?

"What's going on?"

And it was no big deal at the time.

I was just like, oh yeah, they're sending me that email.

Great, don't need that.

- [Narrator] Wooley had spent 10 months on the inpatient unit in intensive therapy, and he was now sober.

But as he moved from the VA hospital to a homeless shelter, to a room he now rents in San Jose, he hit a rough patch.

- I was scared, lonely.

I was working a new job, living in a new city with strangers.

I was just coming back here to not much.

They sent me one around the holidays when I was particularly low.

I opened up the email and I read it.

It made me feel better, you know?

I just knew that if I was in crisis again that I had a place to go, that there were people that cared about me and it was okay.

That I wasn't burdening anyone by asking for help.

- [Narrator] While more study is needed, researchers say that repeated followup contact show promising results in reducing suicidal behavior in the short term.

- It can overlay whatever else is happening with that person, whatever their treatment may be.

So when a person is in crisis, they can reply back, and we can then actively intervene and help get them into care.

- [Narrator] And with high suicide rates across the country, new attention is being paid to nontraditional approaches, including Motto's, more than 50 years after he mailed his first letter.

- He clearly wanted to see that happen, and I'm sorry he didn't see that in his lifetime.

- A letter's approach is treating a person as an individual not as a number, and not treating them like a cog in a machine.

That's where the real power is.