Suicides are on the rise nationwide, and have been for some time. But no other part of America feels that increase quite as much as rural America.

A recent study published by the Centers for Disease Control and Prevention examined suicide rates throughout the United States between 1999 and 2015. While suicide rates increased nationally during this time period and reached their highest overall rate in 2015, smaller communities and rural areas saw the acceleration beginning in 2007-2008.

Rural areas have long had higher suicide rates than urban areas, and that trend has only gotten worse in the last decade. In order to protect the lives of people at risk of dying by suicide, we need to understand the risk factors that contribute to suicide rates in rural areas.

Lack of access to care, limited resources put rural residents at risk

Nationwide, we have an under-funded and under-equipped mental health system that fails to adequately care for people at risk of suicide. In rural areas, where the healthcare system is stretched thin to begin with, competent psychiatrists and mental health professionals are almost non-existent.

Politico recently reported on this lack of service with an account from an emergency room doctor in a small, rural community in Georgia, who often needs to care for patients at risk of suicide while also attending to those with acute medical issues. Because psychiatric hospitals rarely have beds available, these patients are left to board at the ER for days or weeks on end, receiving little if any treatment from medical professionals who are undoubtedly well-intentioned, but not trained or equipped to adequately care for individuals in crisis.  Good intentions don’t count; solid training in suicide prevention does.

And even when care is available, many people in rural communities find that it is inadequate to meet their needs. For example, many rural residents are still without health insurance and are unable to afford medications or follow-up care. Time and distance can also be prohibitive, as even if the patient can get an appointment, the nearest specialist may be hours away.

Telecommunications is part of the answer

In the day of telecommunications, it is troubling that lack of access to care is a problem for the mental health industry. Imagine you or your loved one is suicidal somewhere in rural America.  You are taken by paramedics or police to the nearest ER, where you are told that there are no mental health providers around. But luckily, the ER has videoconferencing equipment connecting it to psychiatry departments based in larger hospitals in other cities. These mental health providers are then able to screen for suicide and recommend proper interventions, all from a distance. In this way, telecommunication technology in healthcare or “telemedicine” could play a key role in saving the life of someone who needs to be protected from suicide, but is too far away from mental health specialists to physically reach this needed critical care.

How about proper training for emergency department physicians?

Telecommunications may not even be needed if the rural emergency room physician is properly trained in screening for suicide; they should be. If they are not they should demand the training from their medical schools.  What part of “emergency” do the medical schools not understand? The Suicide Prevention Resource Center has made training easy for the emergency physician. There is a “Consensus Guide for Emergency Departments” which trains the emergency doctor on what to do when a patient at risk for suicide presents at the emergency department.  Google it!

A comprehensive approach is needed to help prevent rural suicides

Other factors not directly related to medical care can also contribute to risk of suicide. Historically, rural residents have depended on friends and family for support; as families grow further apart, they may be left with increased stress and fewer options, especially in an economy that is increasingly unfavorable. There’s a strong stigma against seeking help with mental health issues in many rural areas that can be a further impediment to treatment, even when treatment is available. Moreover, there is a perception that inhabitants of rural communities are still acceptable targets for disrespect from city dwellers, which can add literal insult to injury in too many cases.

Because so many risk factors contribute to rural suicides, there is no single solution that can be identified to protect the lives of people at risk. Rather, a comprehensive strategy is needed to improve access to care, provide adequate training and resources for care providers, and encourage community engagement and social connectedness to help rural residents access the resources they need to mitigate the risk of dying by suicide.

In places where mental health resources are limited, friends and family members of people struggling with suicidal ideation need to be the first line of defense. They need to understand the warning signs, be vigilant, and advocate for their loved ones – and understand that there is no shame in seeking help.

An awesome place for gate-keeper training is the QPR institute. See http://www.qprinstitute.com. The QPR training will give you and your loved ones a great chance to live until professional help arrives, like CPR. By “professional help” I mean professional trained in suicide prevention; those who know how to properly assess for suicide and take the correct interventions to protect life.