Suicide in Rural Communities: Breaking Barriers to Behavioral Health Care

This year, the Centers for Disease Control and Prevention reported that over 49,000 people died by suicide in 2023, the latest year for which data was available. That’s one death by suicide every 11 minutes. While suicide does not discriminate — it is one of the top 10 leading causes of death in the country —  suicide rates have been consistently higher in rural areas than in urban ones, and the rates of suicide in rural communities are increasing faster than in urban and suburban areas. In fact, regardless of demographic factors, the fact is that those living in rural communities are experiencing higher rates of suicide and higher rates of increase in suicides than most communities in America.

The conditions surrounding the increase in the rates of rural suicides are, of course, complicated. Rural areas are more likely to experience economic hardship. People living in rural communities may find it difficult to access care for chronic conditions, which may lead to pain and an overall decline in quality of life. The isolating nature of rural life can lead to loneliness. And while firearms are the most often used method of suicide overall, the rate of suicide by firearms in rural communities is nearly double that of more urban communities.

Suicide in rural areas often has a cascading effect. A suicide can tear through a tightly knit community, including a health care workforce that may be the only source of emergency care in the area. After a suicide, those responders may carry with them not only the burden of losing a patient, but also of losing a friend, neighbor or family member. The loss is not kept behind hospital doors, but is carried home by the doctors, nurses and other providers who may ask themselves what could have been done before the patient died by suicide.

In response to this crisis, rural hospitals are stepping up in innovative ways. The Farmer Angel Network is dedicated to suicide prevention in Wisconsin’s farming communities. They rely on peer and community outreach and education specifically targeted to those often-stoic individuals facing the challenges of modern farming. In West Virginia, a program integrating physical and behavioral health is bringing early intervention to youth and adolescents in schools and through their primary care providers, who are on the front lines of spotting symptoms of depression or suicidal ideation. And in New Mexico, Presbyterian Espanola Hospital is working to meet those with substance use disorder and other possible comorbidities to suicide to get medication and care in innovative ways that address common barriers to care in rural communities: transportation, community support and the cost of medications.

Access to behavioral health care in rural communities has long been a priority of the AHA, and programs like these illustrate the strength and innovation found in rural hospitals all across the country. AHA continues to support hospitals and health systems as they integrate behavioral health with primary care, expand telehealth services and explore partnerships with community organizations whose reach extends far beyond the hospital doors. AHA also continues to support the health care workforce across the country with suicide prevention initiatives that reduce stigma, improve access to care and address the stressors that weigh on health care workers in all communities.

Suicide prevention in rural communities must focus on one thing: minimizing the distance that separates care from those who need it. We have the strategies and the strength to provide support while being aware of the challenges that people living in and providing care for rural communities face. Rural residents may live far from cities, and even far from one another. But they are not alone.