People in rural areas do not necessarily experience more behavioral health problems than those in other areas – what is different is that the availability of mental health services is often more limited. As many as 60 percent of rural residents live in federally- designated mental health professional shortage areas. This designation means that there are not enough mental health professionals in a particular county or community to provide a sufficient level of care. As a result many rural residents who need mental health care either will not receive it, or must rely on unspecialized care from primary care providers, faith-based providers, or others. Often, rural residents do not receive the help they need until symptoms are more severe.
However, it is also true that rural culture offers many strengths. People may be more familiar with one another and better able to notice problems early. They are more likely to pitch in and help one another in a crisis. And many people have more than one role in the community, making networking and getting information out easier. This is why it is important that friends, family, service providers, and other community members – know the signs of suicide and are prepared to find the words to talk frankly about suicide with someone they are concerned about.
Fortunately, if you are concerned about the problem of suicide in your community, or if you are concerned about someone, there are several things you can do to help:
- Call a Crisis Line – The Suicide Prevention Lifeline (1-800-273-8255) is a free, confidential 24/7 service that will connect you to an accredited suicide prevention crisis center where you can talk to a trained counselor about your concerns. In California there are currently nine crisis centers around the state that are members of the Lifeline. These life-saving services are available around the clock to all Californians, including those in remote areas. Share this number with the person you are concerned about and urge them to call. You can also call to discuss your concerns about a friend or family member.
- Attend a Training – There are a wealth of trainings available that educate natural helpers such as providers and clergy, friends, and family members about the signs of suicide and about various ways to intervene. They include “gatekeeper” trainings such as Applied Suicide Intervention Skills Training (ASIST) (http://www.livingworks.net) and Question, Persuade, Refer (QPR) (www.qprinstitute.com). You can also check with your county behavioral health department to see if there are trainings scheduled in your area. Training is also available for professionals, such as Assessing and Managing Suicide Risk (http://www.sprc.org/training-institute). Although these trainings are not always expensive and may even be available at no cost, attending an in-person training may still not be an option for some. There are several web sites that also offer useful information; start by visiting www.SuicideisPreventable.org.
- Provide Support for the Bereaved – The tragedy of a suicide death in a small community can be devastating. People who have lost someone to suicide often have trouble reaching out, and often those around them are unsure how to help or what to say. Grief after a loss by suicide can be complicated by feelings of shame, self-blame, and mixed feelings of loss and anger toward the person who died. People who’ve recently lost someone through suicide are at increased risk for thinking about, planning, or attempting suicide themselves. The most important thing you can do is to be there for the person – and to listen, without judgment. Providing support to those bereaved by a suicide death – often known as “survivors” – from others who have been through this pain can be enormously helpful. Find out if there is a suicide bereavement support group available locally or regionally by visiting the web site for the American Foundation for Suicide Prevention (http://www.afsp.org), or consider starting one in your community. Visit Sacramento-based Friends for Survival’s web site (http://www.friendsforsurvival.org) for more information about starting a group.
- Reduce Access to Lethal Means – In California, firearm-related suicides accounted for nearly half of all suicide deaths that occurred in 2009. One reason for the high rate of firearm suicides is the lethality of this means. Having a firearm in the home is associated with an increased risk of suicide. Many rural households own at least one firearm, making them very accessible to people who may be in crisis. Strategies such as removing firearms from the home for safekeeping, applying a gun lock, and locking ammunition separately from the firearm can all put potentially life-saving minutes between an impulse for self-harm and the means to do so. Talk to your local law enforcement agency for more information about safe storage. Similarly, safe storage of medications and limiting the amount of medication kept in the home at any given time can reduce the risk of suicide by overdose.
Many rural communities in California are working hard to prevent suicide in their communities – more than ever before.
Find out more by visiting www.SuicideisPreventable.org and www.yourvoicecounts.org. Know the signs. Find the words. Reach out.