The realities of rural living
are a ‘lethal triad’ says expert
By Sarah Baker
Clallam County’s climbing suicide rate, twice as high as King County’s, is not something the community is experiencing by itself. 20 percent of the US population lives in rural areas, and those places – the mountains, the farmlands, the farthest reaches in snowy Alaska – are dying too.
“There are more barriers to psychological treatment in rural areas than can easily be put into words,” said K. Bryant Smalley, PhD, PsyD, Center of Excellence for Rural and Minority Health Director at Georgia Southern University.
There has been at least one death by suicide almost every month this year in Clallam County, the majority occuring in the first half of the year with 10 deaths by June 1.
According to Clallam County’s Coroner Statistics, in the last ten years more 60-69 year-olds have died by suicide than any other age group, and individials over the age of 70 are at the highest risk, with six deaths so far this year. The statistics also display a spike in deaths for 40-49 year-olds with three deaths this year as of Nov. 1.
Of deaths by suicide from 2009 to 2019, 75 percent were men. Every year deaths by suicide are a problem overwhelmingly experienced by males in Clallam County. In 2018, seven females died by suicide while 24 males died by suicide. These numbers may be even higher, as some overdoses are self-inflicted, Prosecuting Attorney-Coroner Mike Haas relayed to the Peninsula Daily News.
Though men die of suicide more often, the rate for women is increasing nationwide.
“It’s a reminder to all of us that we need to be more attentive to the health of our community,” said Clallam County Prosecuting Attorney-Coroner Mark Nichols.
Nichols believes the increase in overall suicides demands a more attentive and deliberate approach in addressing mental health, as well as consistent recognition of conditions like depression, according to the Peninsula Daily News.
Wendy Sisk, CEO of Peninsula Behavioral Health reflected on 2018 as being the “tipping point,” where so many suicides occurred that the community had no choice but to address it. This is when the City of Port Angeles erected the chainlink barriers on the Eighth Street bridges, a project costing nearly $800,000. The community donated $124,000.
However, while the overall numbers are down, deaths by suicide are still occuring at a steady rate nearly every month, the most common methods remaining death by gunshot, followed by hanging.
According to Smalley, money should be invested in providing psychological treatment and outreach. “Increasing access by recruiting additional providers is a key component, but only one aspect of a large, systemic challenge with improving overall utilization of psychological treatment in rural areas,” said Smalley.
“In rural areas, there’s not only stigma against mental health and treatment-seeking, but against any external interferences,” said Jameson K. Hirsch, PhD, a member of the American Psychological Association’s Committee on Rural Health. “Members of rural areas may adhere to principles of honor and rugged individualism.” That is, the belief that problems should be handled on one’s own or within one’s own family.
This requires culturally-tailored interventions and programs that take into account the realities of rural living, according to Smalley. These realities include greater access to firearms, high rates of drug and alcohol abuse, and few healthcare providers and emergency medical facilities. “A lethal triad,” Julie Goldstien Grumet refers to it, director of practice and prevention at the Suicide Prevention Resource Center in Washington, D.C.
Hirsch adds that because there are fewer in rural areas, hospitals and all other public health centers must be utilized as important “catching sites” for identifying symptoms of someone struggling with suicidal ideation.
“About 50 percent or more of people who die by suicide contact their primary-care physicians in the month before the suicide,” said Hirsch, citing a 2002 study from the American Journal of Psychiatry. That number is even higher in rural areas, he notes.
But what can individuals do about this? How can we make a difference in the face of such a systemic problem?
First comes knowing your resources.
In Clallam County, you can contact Peninsula Behavioral Health at (360) 457-0431 for assistance in finding mental health professionals among other resources, 24 hours a day.
Other local crisis counselors can be contacted at (350) 452-4500.
The Veterans Crisis Line is 1-800-273-8255. After calling, press 1.
For Domestic Violence and Sexual Assault Assistance, call Healthy Families of Clallam County at (360) 452-3811.
The next step is being able to identify symptoms of suicidal ideation when you see them in someone you know. This includes sudden changes in personality or appearance, withdrawal, feeling hopeless and dangerous or self-harming behavior. It is important to familiarize yourself with what professionals have to say on the matter, so please visit one of the following websites for in-depth explanations of the warning signs and how to respond to someone who comes to you about their struggles; mentalhealth.gov, afsp.org or save.org.
“People in the suicide prevention world understand that you need to ask if someone contemplating suicide,” says Gromet, “but they need to know what to do next when someone says, ‘yes.’”
