Saving Lives in Our Rural Communities

Each year, more than 41,000 people die by suicide.

Even more disturbing, this number is growing. The CDC reports an alarming 20 percent increase in the suicide rate since 2000. Suicide is now at the highest rate in 30 years and its taking its largest toll on our rural communities, who are experiencing higher percentages of suicides than urban areas. In a recent study published in the American Journal of Public Health, rural areas of Maryland were found to have suicide rates 35 percent higher than in urban settings.

As we talk about all these devastating statistics, what often gets lost in the numbers is the tremendous pain our family and friends experience. I know this personally, having lost a college roommate to suicide. During school, she struggled with major depression. I had no experience with mental illness at that point and I didn’t understand it. The reality was that I didn’t know what kind of help she needed. Her death by suicide a few years later was devastating for me and her other friends.

Now I know more. We, as a society know more and we need to do more, especially for our rural communities who are hit hardest by suicide.

The growing disparity in suicide rates between rural and urban communities may well have multiple causes, but one clear issue is a lack of access to mental health care. While there is an overall shortage of mental health providers nationwide, this is particularly true for rural counties. More than half of rural counties have no licensed behavioral practitioners. It is hard to imagine any other area of health where this level of unmet need would continue.

What is the answer to this shortage? Primary care must be on the front lines, particularly when it comes to suicide prevention in our rural communities.

It is crucial that primary care practices are equipped with the tools and knowledge to identify and treat mental illness. Research shows that most who die by suicide had a mental health or substance use condition, and, startlingly, 45 percent of individuals who die by suicide visited their primary care doctor within one month of death.

If primary care practices were better equipped to screen and treat mental health conditions, could an office visit have made a difference? Sad and deeply frustrating as this may be, it suggests we have the potential to lower the suicide rate by helping train local doctors and nurses in rural areas, who are already on the front lines, to better address mental health issues before they lead to tragedy.

We are making some progress in discovering solutions. Recent hopeful strides include the Suicide Prevention Resource Center’s free Suicide Prevention Toolkit for Rural Primary Care, and the Emergency Department Safety Assessment and Follow-up Evaluation five-year research study, funded by the National Institute of Mental Health, which shows how hospital emergency departments can effectively intervene in preventing suicide with screening, safety planning and follow up phone check-ins. Hospitals could implement these simple steps, which have been shown to reduce suicide attempts by as much as 30 percent.

But we still have a very long way to go in addressing this national crisis and we must stay focused. The fact is that three out of four counties (77 percent) in the U.S. face severe shortages of mental health professionals, with rural counties facing the greatest strains. Fully 96 percent of counties have shortages of psychiatrists. This is, quite frankly, a public health emergency.

We need more and better-paid mental health professionals trained in effective mental health interventions—and we need to train nurses to provide mental health care. It is also vital to press the Centers for Medicare and Medicaid Services (CMS) to provide incentives for primary health care providers to adopt screening and brief interventions for mental health conditions and to integrate mental health specialists into their primary care practices, including through tele-mental health care, to serve their rural patients.

Arming primary care providers with the skills, knowledge and tools to provide help to people in crisis, and potentially save lives, is the humane step we must take for America’s rural communities—and for countless individuals and families who could be spared the heartbreak of a death by suicide and wondering what more could have been done.

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