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Mental Health

Mending a Broken Heartland is such a compelling title, how could anyone resist the temptation to pick up this publication? Written in the 1980s by Joyce Barrett, it details how rural communities find ways to survive through the farm crisis. However, even with all the concern, it is well documented that rural America still lags behind its urban counterparts in mental health care, with little difference between the prevalence of clinically defined mental health problems in urban America versus rural.

Rural America continues to suffer from an economic crisis; besides farming, there are other struggling industries related to natural resources - such as mining and logging - experiencing a net loss in economic strength. Jobs are scarce in rural America, local businesses and services are closing, and young people are moving to the urban areas leaving the elderly back home. It is no wonder that suicide is the second leading cause of death in states with primarily rural populations, especially states in the rural mountain west and Alaska. The need for outreach and community-based mental health services is as critical in rural communities as it is in urban regions but the health care just isn't there to do the mending.


If you or someone you know is contemplating suicide, call 800.SUICIDE (800.784.2433) or 800.273.TALK (800.273.8255)

For more information about suicide prevention

Contact your local Mental Health Association

There are more organizations related to Mental Health in the organizations section.

Frequently Asked Questions

What resources are available for suicide prevention efforts?

The Department of Health and Human Services (HHS) considers suicide a significant public health problem and is involved in prevention activities. Several Federal agencies collaborate and direct necessary prevention resources, services and programs that are both public and private. Federal collaborators include the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the National Institutes of Health, the Office of the Surgeon General, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the private collaborators include advocates, clinicians, researchers and suicide survivors. The Suicide Prevention Resource Center, with federal funding from SAMHSA, provides prevention support, training, and resources to assist organizations and individuals to develop suicide prevention programs, interventions and policies.

The following organizations may be able to provide additional information:

What are some of the challenges to accessing and providing mental health services in rural areas?

Nearly half of the American population is affected by a mental disorder at some time in their lives and yet the misconceptions, myths, and cultural taboos associated with mental illness may be the most significant barriers that keep persons with mental disorders from seeking and receiving treatment in rural areas. Inadequate knowledge about mental illness, even in the medical profession; fear of and prejudice toward those with mental illness; and hesitancy on the part of people with mental illness to get treatment instill an atmosphere of disgrace and shame in some rural communities. This stigma combined with other challenges can prevent people with mental illness from seeking help.

Because of their small size and close-knit society, rural communities are known for knowing everybody and everybody's business. Often news gets back into a community before the newsmaker. Cars parked outside of a mental health clinic are recognizable and patients in passing will recognize each other. Familiarity such as this will cause the mental health care seeker to feel insecure in regards to confidentiality and privacy which may suppress their seeking professional care.

Another challenge comes from the lack of mental health care providers and services in rural areas. According to rural health researchers at Texas A&M University's Southwest Rural Health Research Center, 20 percent of nonmetropolitan counties are without mental health services; and in 1999, 87 percent of the 1,669 federally designated Mental Health Professional Shortage Areas in the nation were in nonmetropolitan counties. Because of the scarcity of mental health care providers, primary care doctors, who may not be adequately prepared in mental health care, provide the majority of mental health services in rural areas.

Although small communities display characteristics that stifle mental health services they do rally around their residents and provide community support in times of need. This strong external support group can help facilitate a person's success in treatment and also help support the family's efforts in attending to the care seeker.

What can a community do to minimize these challenges?

The most significant challenge regarding mental health care in rural America is the lack of health care providers and services. In recent years, health policy experts and health care providers have begun to encourage closer integration of mental, or rather, behavioral health and primary care services, for rural areas. It is assumed that integration will increase access to mental health care services and increase quality of care through enhanced coordination of services. In rural areas, where behavioral health workers and primary care givers are in short supply, integration is vitally important. Integration of these services is an effective strategy for maximizing the use of scarce rural health care resources and improving the quality of care for both behavioral health and primary care patients.

This same method of integrating behavioral health with primary care services can also help to reduce or eliminate the powerful social stigma associated with mental illness in rural areas. The social stigma prevents many rural citizens from obtaining needed services but is less a deterrent to accessing care when behavioral health professionals see patients in their regular primary care settings. This integration of behavioral health and primary care services also applies to the challenges regarding confidentiality and privacy. Rural patients may be reluctant to be seen in settings where their privacy might be compromised but more willing to seek mental health care from the more common and accepted primary care clinic.

Where can I find mental health statistics?

SAMHSA provides a variety of both national and state-level data at the SAMHSA Data, Outcomes, and Quality website. Statistics specific to Mental Health by state can be found in SAMHSA’s Uniform Reporting System (URS) Output Tables: 2007-2012.

In addition, you may find it useful to contact:

How can our community take action to prevent suicides?

There are a number of ways for your community to be involved in suicide prevention:

  • Find out what your state is doing to prevent suicide by visiting the SPRC States and Communities web pages. These pages include state suicide prevention plans, state data, and how to contact people involved in suicide prevention in your state.
  • Form a local coalition to address the problem of suicide in your community. For more information about building coalitions, see the SPRC Building and Maintaining Coalitions toolkit.
  • Work with local media representatives to raise awareness about the problem of suicide in your community and to share resources on how to seek help. See the SPAN USA/SPRC Guide to Engaging Media in Suicide Prevention for more information.
  • Contact the Suicide Prevention Resource Center. SPRC can connect you with people, organizations, and resources in your community, state and nationally and provide technical assistance and training on suicide prevention.

How can our school take action to prevent suicides?

There are several actions schools can take to prevent suicides:
  • Become involved with your state or community’s suicide prevention coalition and learn how to coordinate your school’s efforts with state or community efforts.
  • Visit SPRC’s Customized Information pages for Teachers and School Mental Health Providers to learn more about how to respond to students and staff at risk for suicide.
  • Implement a school-based suicide prevention program, which includes a comprehensive set of interventions, such as:
    • Gatekeeper training
    • Screening for mental health
    • Health education curriculum that includes suicide prevention and/or mental health
    • Peer mentoring
    • School-based mental health services
    • Crisis response
    • Postvention

For more information on any of the items listed above, please visit the SPRC Online Library or contact one of the SPRC Prevention Specialist. To review guidelines for school-based suicide prevention programs, please refer to the University of South Florida’s Youth Suicide Prevention School-Based Guide.