Washington, DC - The rate of suicide among teens and young adults in the United States has increased over the last decade. Suicide is now the second leading cause of death in these groups. Studies have revealed geographic differences in youth suicide rates. Youth living in rural areas are at greater risk of suicide than those living in urban areas. Suicide rates are also growing at a faster pace among rural youth.

Access to mental health care is an important factor in reducing suicide rates. Studies have found that youth in rural counties have access to fewer mental health services than those in urban and suburban counties. But previous studies haven’t examined the availability of suicide prevention services in rural areas. They’ve also lacked a sophisticated way to classify how rural or urban an area is. 

A study led by Janessa Graves of Washington State University examined the nationwide distribution of mental health facilities that serve youth and offer suicide prevention services. The study was funded in part by NIH’s National Institute on Minority Health and Health Disparities (NIMHD). Results were published on October 22, 2020, in JAMA Network Open.

The researchers identified about 9,500 mental health facilities and determined whether they offered suicide prevention services. These included suicide screenings, treatment for suicidal thoughts, and referrals for follow-up care.

The team then used each facility’s zip code to classify its location as metropolitan, micropolitan (a smaller urban community), small town, or rural. Location was also rated on a scale of 1 (most urban) to 9 (most rural), based on county. Using these data, the team analyzed where youth had access to mental health facilities, particularly those that offer suicide prevention services.

They found that highly rural areas had fewer mental health facilities serving youths—and fewer suicide prevention services—than more urban areas. Only 3% of rural areas had a mental health facility that offered suicide prevention services for youths. This is compared to 8% of metropolitan areas, 9% of micropolitan areas, and 12% of small towns.  

About 64% of all U.S. counties had at least one mental health facility serving young people. However, only about 30% of highly rural counties had such facilities. Suicide prevention services were also much less likely to be offered in rural counties.

“Given the higher rates of suicide deaths among rural youth, our findings highlight how critical it is to improve access to mental health services in rural communities,” Graves says. “These efforts, in addition to increasing awareness, decreasing stigma, and reducing access to lethal means of suicide, will be key to addressing rural-urban disparities in youth suicide.”