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A new study published on the JAMA Network looked at the association of rurality with the availability of youth mental health facilities with suicide prevention services in the United States. 

“The study is about the availability of mental health services in rural communities,” lead author Janessa M. Graves told us. “The incidence of suicide deaths among adolescents is higher in rural areas than in urban areas, suggesting that rural areas have high needs for services. We were interested in seeing whether there was any variation in the number of mental health facilities by geographic location, specifically those that treat children and offer suicide prevention services.”

Suicide is when someone tries to harm themselves with the intent to die. Suicidal ideation means that someone is considering or planning suicide. According to the Centers for Disease Control and Prevention, suicide was the tenth leading cause of death of US adults in 2018. Forty-eight thousand people died by suicide in 2018 in the US. 

“The previous literature (and our experience) suggested that there are fewer health care resources in general in rural areas compared to urban areas, so we suspected that rural communities may have fewer mental health facilities as well,” Graves told us. “Several of the coauthors, including myself, are from rural areas and care deeply about improving access to care for rural residents. We are aware of the increasing trend in youth suicides in rural communities and seek to learn more about how access to services can be improved.”

Suicide is the second leading cause of death for children, youths and adults between the ages of 10 and 34 in the US. Suicide is the fourth leading cause of death among US adults between the ages of 35 and 54. The suicide rate for males was 3.7 times higher than that of females. In 2018, the suicide rates was highest for men over the age of 75 and in women it was between the ages of 45 and 64. In 2018, there were more than two and half times as many suicides as homicides in the US. From 1999 to 2018, the rate of suicide in the US increased by 35 per cent.

“We obtained directory information for all mental health facilities in the US from the Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator,” Graves told us. “Using this, we were able to identify services offered and classify the level of rurality of each facility. We used two methods to classify rurality – one by zip code and another by county.”

Results showed that across both rurality classification schemes, very rural areas had fewer youth-serving mental health facilities with suicide prevention services than urban areas.

“We were not surprised to see that rural areas had fewer services. It was interesting to see that the moderately rural counties and zip codes (e.g., small towns) had slightly more youth-service mental health facilities with suicide prevention services than metropolitan areas,” Graves told us. “We need to think about how to best serve rural communities, how to get mental health care to youth who are in need. Perhaps this doesn’t mean building more facilities, but perhaps working with schools to have more mental health therapists (schools may be a more efficient way to reach youth).”

There were some limitations to the study. Researchers did not survey the facilities themselves, they used available data that was reported to SAMHSA. There may be other facilities or other mental health services that were not captured by the study (in rural and urban areas). They also did not examine use of services. Finally, they did not examine the association between service availability and the rates of suicide deaths. This is a cross-sectional study and therefore causality cannot be explored.