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Suicide rates show largest increase in rural counties

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There are not enough resources in southeast Oklahoma to accommodate all the needs, and recent cuts to the mental health care budget have taken a toll, one expert says. [Thinkstock image]
There are not enough resources in southeast Oklahoma to accommodate all the needs, and recent cuts to the mental health care budget have taken a toll, one expert says. [Thinkstock image]

By 3 p.m. Wednesday, T. Nichole Spies had already logged 55 miles in her vehicle transporting clients to and from her office in Hugo near the state's southeast corner.

But her day wasn't over.

Spies, a nationally certified counselor and licensed marriage and family therapist candidate who works at Cornerstone Counseling Service, used to practice in Muskogee. She hardly stepped out of her office then. But working in rural Oklahoma, especially in southeastern Oklahoma, is different, Spies said.

Less than a week into the month of June, she had already driven 350 miles to see clients. She had plans to pick up a couple more people that afternoon.

"Everything is contingent upon the life of the client in that moment," Spies said. "I may spend 90 percent of my time out in the field going from house to house to help individuals who need help."

Spies said there are not enough resources in southeast Oklahoma to accommodate all the needs, and recent cuts to the mental health care budget have taken a toll.

This at a time when suicide rates in many of Oklahoma's rural counties are on the rise, according to a recent study conducted by researchers with the Centers for Disease Control and Prevention.

Nationwide, rural counties had the highest rates and saw the largest increases during a recent 10-year period, according to the same report.

In Oklahoma, many of the counties with the highest suicide rates were concentrated in the state's southeastern corner, although some counties with high suicide rates also were scattered in other parts of the state.

The report, published in the American Journal of Preventive Medicine, examined changes in county-level suicide rates from 2005 through 2015. During that time, model-based suicide rates increased by more than 10 percent for 99 percent of counties in the United States, the report states, but more rural areas had larger increases than more urban areas.

Nearly half of the most rural counties saw estimated suicide rate increases of more than 30 percent, the report states. Meanwhile, about 10 percent of the most urban counties had a similar rate of increase.

Rural states and rural communities have been disproportionately impacted by suicides for many years, said Jessica Hawkins, director of prevention services for the Oklahoma Department of Mental Health and Substance Abuse Services. She pointed to several factors that might contribute to higher suicide rates in rural communities, including challenges with access to high-quality mental health care.

"The number of mental health providers equipped and ready and resourced to provide care in rural communities is very low," Hawkins said. " … When people need help the most and are not able to find it, that is definitely a risk factor."

Having effective and timely access to mental health care is essential, she said. Suicide is a progressive problem in that thoughts of suicide and suicide behaviors and co-occurring mental health problems develop over time, Hawkins said. There are many opportunities to intervene and to identify treatment, but communities that don't have access to those services or that have sporadic or irregular access to services suffer, she said.

Issues of trauma and exposure to traumatic and adverse experiences can be disproportionately higher in rural communities, Hawkins said. Reluctance to seek treatment and access to lethal means like firearms or prescription medications are also factors.

For the report published in the American Journal of Preventive Medicine, researchers used "small area estimation" methods to produce estimates of suicide rates at the county level. They used dozens of data sources to help produce stable estimates that would allow them to examine geographic patterns and urban-rural differences.

Attempts to estimate county-level suicide rates have traditionally been limited because many counties report fewer than 20 suicides a year and direct estimates based on small numbers can be "unstable and highly variable," which makes it difficult to detect trends, researchers noted in the report.

Being able to identify and examine county-level patterns and trends can shed light on where suicide rates have increased more rapidly and can help lead to more targeted prevention efforts at the local level, researchers noted.

Hawkins said county-level suicide data has been provided for many years in Oklahoma through the state Health Department and has been a "vital planning tool" for her agency. Those working in the field look at a variety of data, including suicide rates, number of deaths, and suicide attempts that require hospitalization, to better understand the scope of the problem in Oklahoma, to identify potential gaps and to know where to direct resources.

Nationwide, clusters of counties with high suicide rates span across much of the western United States, according to the report by CDC researchers. There are some exceptions within that area of the country, including in southern California, Hawaii and spots in the Pacific Northwest. Another area of the country with a high concentration of counties with high suicide rates starts in Oklahoma and extends eastward through the Appalachian region.

Maps produced as part of the report illustrate changes in Oklahoma during the 10-year period examined.

In 2005, many counties in Oklahoma were shaded green, indicating they had suicide rates that fell on the lower end of the spectrum. But by 2015, a growing number of counties in the state were colored hues of orange, indicating their suicide rates were on the higher end of the spectrum.

About 90 percent of people who die by suicide have a mental disorder at the time of their deaths, according to the American Foundation for Suicide Prevention.

Mental health service providers who work in southeastern Oklahoma discussed a variety of challenges facing residents in their communities that could contribute to high suicide rates, including substance use issues and the stigma surrounding mental health.

"I think one of the main ones is just the socio-economic disparity between here in the rural communities and in the bigger cities," said Teresa Kennison, a licensed professional counselor in Atoka who works with Southeastern Oklahoma Family Services. "Our population is impoverished, and they're always in fear of having their services cut."

In rural communities, employment opportunities and opportunities for people to better their situations are more limited, Kennison said, which can lead to feelings of hopelessness and helplessness.

Sometimes people don't receive the services they need when things like depression or anxiety are an issue.

"I think that's a big reason why we have such a higher suicide rate in these areas than we do in the more industrialized places," Kennison said.

Resources that are more readily available to people living in urbanized areas like Oklahoma City can be more difficult to access for people in rural communities. People might have to travel a long distance to access the services they need. If they're living under the poverty level, they might not be able to afford to travel, Kennison said.

The Oklahoma Department of Mental Health and Substance Abuse Services is involved with a variety of suicide prevention efforts and training efforts. The agency also works with professionals in general health care settings, such as family doctors and emergency departments, to make sure they are equipped to identify suicide risk and they know how to intervene effectively, Hawkins said.

She encouraged people to reach out to loved ones who are struggling.

"The first thing that we tell people is to not be afraid to have the conversation," Hawkins said. "To have a compassionate, non-judgmental conversation with their loved one about, 'Are you thinking of harming yourself?' 'Are you thinking of killing yourself?' Having that conversation and opening up that line of communication is incredibly important. It reduces stigma. It creates a pathway to helping that person find help and reassuring them that there's hope."

How to get help

The National Suicide Prevention Lifeline offers free, confidential support 24 hours a day, seven days a week. If you or someone you know is struggling, call 1-800-273-8255 to speak to someone.

 

Warning signs

There is no single cause for suicide. Most often, suicide happens when stressors and health issues converge and create an experience of hopelessness and despair, according to the American Foundation for Suicide Prevention. Here are some warning signs: 

• If a person talks about killing himself or herself, feeling hopeless, having no reason to live, being a burden to others or feeling trapped or in unbearable pain.

• If a person exhibits certain behaviors, including increased use of drugs or alcohol, looking for a way to end one's life, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, aggression and fatigue.

• If a person displays one or more of the following moods: Depression, anxiety, irritability, humiliation, agitation and rage. 

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Darla Slipke

Darla Slipke is an enterprise reporter for The Oklahoman. She is a native of Bristol, Conn., and a graduate of the University of Kansas. Slipke worked for newspapers in Kansas, Connecticut,... Read more ›

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