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Maryland was among the 49 states that saw an increase in suicide rates from 1999 to 2016, according to a report released this week by the Centers for Disease Control and Prevention, but the state's rates did not rise as sharply as the national average.

On Friday morning, it was announced that world-renowned chef, author, and TV personality Anthony Bourdain took his own life in France.

But the hope in knowing that so numerous millions of Americans who struggle with mental health issues go on to recovery can seem hard to focus on amid tragedies such as this week's public deaths of designer Kate Spade and celebrity chef Anthony Bourdain, said office director Sarah Brummett.

In 2016, almost 45,000 Americans aged 10 and older died by suicide.

Middle-age adults had the highest increase in suicides. And CDC also discourages media from reporting on suicides, which risks lowering awareness and stigmatizing mental health. In 1999, then-Surgeon General David Satcher issued a report on the state of mental health in the country and called suicide "a significant public health problem".

K. Bryant Smalley, a professor of community medicine and psychiatry at the Mercer University School of Medicine, described the mental health care challenges experienced by patients in rural areas as the "three A's": availability, accessibility and acceptability of care. It provides free and confidential support 24 hours a day, seven days a week for people in suicidal crisis or distress.

"If they say something like 'I feel like my life is really empty, ' say 'we need to get help, '" Lieberman said.

"It used to be that we didn't even talk about mental health, and certainly not suicide".

The report found that firearms were the most common method of suicide for both those with and without mental illnesses.

If you are concerned a loved one is at risk of suicide, talk to them about it. Experts say you shouldn't be afraid to raise the issue. The Berks County Suicide Prevention Task Force also has resources available to people who may not be able to afford extended counseling. The highest increases were seen among teens ages 15 to 17 years old.

Rates of increase varied. From 1999 to 2015, suicide rates increased among all genders, all racial and ethnic groups and all urbanization levels.

Buhse said anyone anxious about a friend or loved one should check in on them and use a direct approach.

Between 2007 to 2012, there were dramatic cuts to mental health funding.

The National Suicide Prevention Hotline is available at 1-800-237-8255. The direct line to her crisis center is 516-679-1111.

Heather Brown is a suicide prevention expert with Maricopa County.

"Just to sit with someone when they're in a crisis and they know you get it".