How available are suicide prevention services in rural areas?


Suicide is on the rise among children and teenagers. Access to mental health care isn’t always as accessible in rural areas as it is in urban centers. Are pediatric patients in these regions lacking much-needed suicide prevention services?

Over the past decade the incidence of suicide among children and adolescents has increased and the incidence is higher among those who live in rural areas than in urban areas. Additionally, the need for health care professionals in those rural areas continue to be high. A research letter in JAMA Network Open looked at the tie between rurality and the availability of suicide prevention services at mental health facilities.1

The researchers used the Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator to find mental health treatment facilities in the United States. The facilities included in the research included outpatient, inpatient, and residential treatment and were located in all states and the District of Columbia. The rurality of the facilities was determined using the rural-urban commuting area codes according to ZIP Code Tabulation Areas and by county using the rural-urban continuum codes.

Across the 41,083 ZIP Code Tabulation Areas, 5637 of them had at least 1 mental health facility that provided care to children and teenagers. Among those that had such facilities, 2968 metropolitan areas had a facility; 666 micropolitan areas had a facility; 615 small town areas had a facility; and 265 rural areas had a facility that offered care for pediatric patients (nonparametric test for trend, P < .001). A similar trend was seen with facilities providing suicide prevention services. In this regard, 1936 metropolitan areas had such services; 535 micropolitan areas had them; 472 small town areas had suicide prevention services; and just 202 rural areas had such services (nonparametric test for trend, P < .001). Using the other determining factor that looked at counties, the researchers found that among 3223 counties, 2053 counties had at least 1 mental health facility that served children and adolescents. A smaller ratio of highly rural counties had at least one mental health facility that offered pediatric services than urban counties. Additionally, there were more mental health facilities offering suicide prevention services in counties that were in the middle of the rural-urban continuum than counties that were more urban or rural.

The researchers concluded that overall areas that were highly rural had fewer mental health facilities and suicide prevention services than other areas. They did note limitations such as the research didn’t look at service use and relied on the facility’s self-report. They emphasized that greater availability of such services are needed in rural areas to help combat the higher suicide rates found there.

For additional information, see this article from our sister publication, Contemporary OB /GYN.


1. Graves J, Abshire D, Mackelprang J, Amiri S, Beck A. Association of Rurality with availability of youth mental health facilities with suicide prevention services in the US. JAMA Netw Open. 2020;3(10):e2021471. doi:10.1001/jamanetworkopen.2020.21471

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