Suicide Prevention: Rural Policy Brief

Overview

Suicide is one of the top ten leading causes of death in the United States and was responsible for almost 45,000 deaths in 2016.1 More people are hospitalized as a result of trying to attempt suicide than they are fatally injured. An even greater number of people are either treated in emergency departments or not treated at all.12 Among adults aged 18 years and older, for each suicide there are about 30 adults who reported making a suicide attempt.

Risk Factors for Suicide in Rural Areas

Important risk factors for suicide in rural areas include:345

• Living in an isolated location, which may reduce one's sense of connectedness.
• Difficulty obtaining mental and behavioral health services due to high cost, lack of transportation, and other distance-related issues.
• Socioeconomic factors, such as unemployment and being in persistent poverty.
• Sociocultural factors that increase mental illness stigma and prevent help-seeking, including a culture of stoicism (particularly for males).

Prevention strategies

These are some policy and strategy options that can help reduce the risk of suicide in rural communities.

• Improving access and health insurance coverage for mental health and behavioral care.
• Increasing telehealth services.
• Reducing stigma around mental health.
• Increasing connectedness with peer norm programs to make protective factors more normal and common.
• Promoting safe storage of firearms, medicines, and other potentially dangerous household products.

Case Studies

Oregon: The Rural Telemental Health Program

In 2014, veterans accounted for 18% of all suicides among U.S. adults while only being 8.5% of the U.S. adult population, making them a high-risk population.6 Nearly half of veterans of the Iraq and Afghanistan Wars live in rural areas,7 and the suicide rates among veterans in four predominantly rural states (Montana, Utah, Nevada and New Mexico) was almost twice that of the national veteran suicide rate.8 Rural veterans may have difficulty obtaining mental health treatment, often because traveling long distances to obtain care can be difficult due to factors like poor public transportation infrastructure.910

The Rural Telemental Health (RTMH) program started at the Portland Veterans Administration (VA) Medical Center, and now reaches rural veterans in Idaho, Oregon, and Washington.10 The program helps veterans get a wide range of mental healthcare services outside of VA facilities. They can access telehealth care via VA outpatient clinics—or in their homes, if resources allow.11

New Mexico: Adolescent Suicide Prevention Program12

This Adolescent Suicide Prevention Program involved one tribe in New Mexico, and was created in 1990 by a collaboration between The Indian Health Service (IHS) and the tribal council and community. It has since been expanded. The program focused on adolescents, the group in this community at the highest risk of developing symptoms of suicidal behaviors. It was designed using community input regarding what might prevent or help its success, and it integrated a wide range of activities related to the tribe's specific risk factors for suicide in an unconventional but culturally-appropriate manner. For example, there was a strong focus on family history of trauma, which occurred among 95% of people showing suicidal behavior.

An evaluation of the program showed a significant reduction of suicidal gestures and attempts. There was also a 75% drop in the total number of self-destructive acts (some of which were not suicidal). While the number of suicide deaths did not fall, this was likely due to the aging population, which usually leads to a growing number of suicides. However, the number of deaths did not increase like they had in past years. The program was also noted for its longevity and growth, as prevention programs often end prematurely due to limited resources and waning interest.