Rural Suicides Follow Medicaid Cuts

Dec. 5, 2011 -- Suicide is on the increase in rural America--nowhere so much as in western mountain states like Idaho, Wyoming and New Mexico. Mental health professionals attribute it in part to cutbacks in Medicaid funding, to the recession and to the culture of the rural West.

In Idaho, somebody kills himself every 35 hours, according to a 2009 report to Idaho's governor by the state's Council on Suicide Prevention. Their report calls suicide "a major public health issue" having a "devastating effect" on Idaho's families, churches, businesses and even schools: 65 students aged 10 and 18 killed themselves in a recent five-year period.

Last week a county sheriff in Bonneville told the Idaho Falls Post Register that his department was getting more suicide calls than in 2010—a year in which 290 Idahoans took their own lives. "We're in a spike right now," he says.

Historically the suicide rate in rural states has been higher than in urban ones. According to the most recent national data available, Alaska has the highest rate, at 24.6 suicides per 100,000 people. Next comes Wyoming (23.3), followed by New Mexico (21.1), Montana (21.0) and Nevada (20.2). Idaho ranks 6th, at 16.5. Suicide is the second-leading cause of death for Idahoans aged 15-34. Only accidents rank higher.

Kathie Garrett, co-chairman of the Idaho Council on Suicide Prevention, says the problem has gotten only worse since the recession. "The poor economy and unemployment—those put a lot of stress on people's lives," she explains. To save money, people skip doctor visits and cut back on taking prescribed medications. Cuts in Medicaid have reduced the services available to the mentally ill.

"I personally know people who lost Medicaid who've attempted suicide," says Garrett.

Reductions in funding have led to the closing of mental health offices, she says. Such closings mean more in Idaho than they would, say, in Manhattan, where a therapist can be found on every block. Before the cuts and closings, somebody in Idaho seeking therapy might have had to drive 160 miles to find it.

Kim Kane, executive director of Idaho's Suicide Prevention Action Network in Idaho says other factors explain the high rate of suicide in western mountain states. One is the greater prevalence of guns: In 2010, 63 percent of Idaho suicides involved a firearm, compared with the national average of 50 percent.

She and Garrett also say the West's pride in rugged individualism can prevent people from seeking help. Their feeling, says Kane, is that they ought to be able to pull themselves up by their mental bootstraps. Idaho is the only state not to have a suicide-prevention hotline.

Garret, who has served in the Idaho legislature, complains state policy-makers don't all view mental illness as an illness—one on a par, say, with glaucoma or pancreatitis. Their belief, she says, is that a person suffering depression ought to be able to get help from church or family, rather than from state-provided professionals. "I told them," she says of her fellow legislators, "that when I had cancer, what I needed was a doctor. My family gave me support. My church gave me faith. But I still needed a surgeon."

Dave Strong, an assessment and referral coordinator for the Eastern Idaho Regional Medical Center, says the people now most at risk, ironically, are not the most severely ill. "Schizophrenics, once they've been diagnosed and qualified by Medicaid, don't fall out of treatment," he says." They're always able to get services."

Rather, it's people suffering the first onset of their disease who have the hardest time getting treatment. With services reduced, the mildly depressed now have to wait until their condition has reached a crisis stage to before they can get medical attention.

"We wait too long now to get treatment to them," said Garrett. "It's like telling somebody with diabetes that he'll have to wait until he's in a coma." People with mental illness, she says, can and do recover. "There's a 60 to 80 percent chance they will. But it takes time. The meds are very tricky: it's not a case of one-size-fits-all." Given that seven years can pass between diagnosis and getting a successful treatment going, it's important, she says, to start early.

It's important, too, "to remind the people reading this that there is always hope. All that anybody feeling suicidal has to do to get help is call the national hotline number. Dial 800-273-TALK (8255)."