Helping the Rural US Overcome Its Rising Suicide Rates

Helping the Rural US Overcome Its Rising Suicide Rates

States lawmakers are boosting funding for 988 and crisis response teams to address limited mental health care and transportation options.

Telehealth services could help overcome the lack of counseling and psychiatric care in rural areas. Recent Montana legislation includes audio-only conversations under the definition of telemedicine, and requires telehealth services to be covered under public employee and student health plans. (Ivan-balvan/Getty Images)

Americans who live in rural areas die by suicide at twice the rate of those living in urban areas. 

Brett Harris, a senior research scientist at the University of Chicago, says people in rural communities face unique struggles that make them more likely to take their own lives, including historically low funding for mental health resources. That funding tends to be based on total numbers of deaths, rather than rates. 

"The rate is much higher in rural areas, but you're looking at a number-and the number is much lower," Harris told a session of NCSL Base Camp 2025. "Historically, we haven't been putting as much of our focus on rural areas in terms of funding and resources because it's impacting fewer people." 

She says that 20 people out of 100,000 die by suicide in rural communities, compared with 13.2 out of 100,000 in metro areas. Suicide rates increased by 46% in nonmetro areas from 2000 to 2020, while the rate grew by 27% in metro areas, according to the Centers for Disease Control and Prevention. White non-Hispanic people have the highest suicide rates in urban areas, while non-Hispanic American Indian and Alaska Native people have the highest rates in rural areas. 

Issues Impacting Rural Areas

Harris says because of the prevalent hunting culture in rural areas, use of firearms is the most common suicide method It can be challenging to have conversations with people who are mentally struggling about temporarily removing firearms from their home or keeping weapons in a locked gun safe.

Other challenges to rural mental health: lack of counseling and psychiatric services, which results in longer travel distances for care, and limited transportation options to get to that care, she says. Many rural areas also lack reliable internet service and the technological capacity to support telehealth, which increases wait times at physical care locations. 

Harris also lists a lack of support systems, such as accessible child care, to assist those who may need to travel out of town to receive care but can't leave their families behind. 

"Social isolation also has a significant impact on mental health," Harris says. "We talk about the distance, so there is isolation, and we have limited resources, but it creates a lack of connection, so people feel socially isolated."

Harris says this isolation is especially prominent in groups such as older adults, veterans and caregivers. 

In addition to loneliness, other contributing factors to poor rural mental health include lack of mental health education and positive coping mechanisms, difficulty finding work, poverty, poor housing and generational issues, Harris says. 

Although rural areas and small towns may be known for close-knit communities where most people know one another, Harris says this closeness can also heighten stigmas around seeking mental health services or speaking up about being in a difficult place emotionally. 

"Having the community be like that-everyone's in everyone else's business-if there's a suicide attempt or some sort of self-mutilation, it's hard to keep on the down-low," she says. "You just feel like everyone knows, and you are being judged based off your past." 

Legislative Solutions

Harris says there are several areas legislators can examine to allocate funding or resources to address poor rural mental health care. She recommends expanded suicide prevention education, non-clinic peer support, sustaining the workforce and targeted, community-specific approaches from the state and county levels. 

Molly Widoff, an NCSL health policy analyst, adds that Montana had great success after passing a law in 2021 that removed site restrictions for telehealth within the state. 

"It allows care to be provided without a prior patient-provider relationship, and it includes additional technologies such as audio-only conversations under the definition of telemedicine, and requires telehealth services to be covered under public employee and student health plans," she says. 

Washington has also made strides toward addressing rural mental health needs by passing a bill (HB 134, 2023) to strengthen the state's 988 suicide and crisis hotline.

"States are integrating 988 with mobile crisis response teams to ensure on-the-ground support, and dedicating sustainable state funding streams so that rural areas are not left behind as demand for crisis services grows," Widoff says. "Some states are also working to improve coordination between 988 and 911, ensuring that people in crisis are connected to mental health professionals." 

Grace Olson is an Iowa-based freelance writer.