Published September 17th, 2021 at 12:01 PM
HAYS, Kansas — Kyle Carlin understands first-hand how hard a mental health crisis can hit in rural Kansas.
He dealt with depression starting as a teenager. It eventually led him to attempt suicide.
But he didn’t think about seeking counseling until he was preparing to leave the Army Reserve in Hays roughly 12 years ago. Even then, asking for help wasn’t easy.
“Stigma is such a big issue around mental health,” Carlin said, “especially in western Kansas.”
His story illustrates a growing trend stressing rural communities across Kansas and the nation.
While suicide rates have increased by nearly 45% statewide over the past two decades, rates have risen most sharply in the most sparsely populated parts of Kansas.
A new Kansas Health Institute analysis of state data shows that suicide rates climbed in rural and frontier counties by roughly 55% and 60% respectively from 2000 to 2019, significantly outpacing the increases in mid-sized cities and urban areas.
For frontier counties — the least populated parts of the state — the KHI analysis also revealed a troubling rise in the rate of suicides that used firearms, which was notably higher than the rate in rural areas with more residents. (The institute and the Kansas News Service both receive significant funding from the Kansas Health Foundation.)
And a variety of factors — from scarce resources to cultural stigmas to economic hardships — continue to put rural Kansans at risk.
That’s why Carlin volunteers with the local chapter of the American Foundation for Suicide Prevention to put on a suicide prevention walk happening this month in Hays: He hopes it can make it easier for others to reach out for help like he did years ago.
“The difference for me was recognizing that you can’t just muscle through it,” Carlin said. “There are times when you need support outside of yourself.”
Bradley Dirks, a behavioral health specialist with K-State Research and Extension, said that the geographic isolation that generally accompanies rural life is often compounded by a culture that rewards toughness, grit and self-sufficiency.
“We don’t want to look weak, particularly as a male, particularly in a rural agriculture setting,” Dirks said. “So to go to someone and say, ‘Look, I’m at the end of my rope, I need help,’ is really difficult.”
That mindset, plus the limited number of counseling options nearby and the challenge of finding anonymity in a small town, fuels the stigma that often keeps people from getting the help they need.
“If someone goes to a local therapist, and everybody sees the pickup out in front,” he said, “There’s that stigma: ‘Oh, what’s wrong with so and so?’”
Meanwhile, Dirks said the COVID-19 pandemic has multiplied the layers of stress piling onto rural Kansans as people have lost jobs, scrambled to find child care when schools closed and felt heightened tensions within the community as everyday discussions became politicized.
“It’d be abnormal,” he said, “if you were to come to me and say, ‘Hey, no, everything’s cool, everything’s good’ in today’s climate.”
The growing risk of suicide in rural Kansas mirrors national trends over the past two decades, with suicides occurring at much higher rates in rural parts of the U.S. compared to urban areas. (National suicide rates actually dropped 6% last year during the pandemic.)
It’s an issue that’s especially pressing in many of the neighboring Great Plains states that share some cultural and economic similarities with western Kansas. Colorado, Oklahoma, Wyoming and South Dakota all rank among the nation’s highest per capita suicide rates. Kansas currently ranks 16th nationally.
Suicide is now the ninth-leading cause of death in the state and the second leading cause of death for Kansans aged 15 to 34.
Wyatt Beckman, an analyst who worked on the Kansas Health Institute report, said the mental health challenges rural Kansans face demand different approaches than what works in Kansas City or Wichita.
“Rural communities aren’t simply smaller versions of cities,” Beckman said. “Suicide prevention efforts that we design and implement and evaluate in an urban context … can’t always be copied into rural communities.”
What’s more, Beckman said that even across western Kansas, significant differences exist from one county to the next — such as whether residents live in a town of 15,000 or 150 people and whether the nearest mental health clinic is 10 or 100 miles away.
For the KHI report, sparsely populated counties were categorized either as rural, with between six and 20 people per square mile, or frontier, with fewer than six people per square mile. Combined, they account for more than half of Kansas counties and comprise nearly all of the western half of the state.
Beckman grew up in Ness County, one of the many frontier counties in western Kansas with fewer than 3,000 residents. He said that makes the challenges people face in Ness County very different from those in neighboringEllis County — Hays is the county seat — which has more than 20,000 residents.
If national and state initiatives don’t customize their approaches to understand those nuances between rural communities, people will continue to fall through the cracks.
For example, the per capita number of people dying by suicide with a gun in rural counties is similar to the statewide average. But the suicide-by-firearm rate in frontier counties is more than 1.5 times higher than rural counties.
That could call for new suicide prevention strategies specifically designed for gun owners in those frontier communities.
Beckman pointed to a Vermont initiative that partners with gun shops and firing ranges to promote suicide awareness with materials written by gun owners and a Colorado coalition that provides a statewide network of temporary, voluntary gun storage locations for gun owners in crisis.
“It could be easy to lump all of (the rural counties) together and say they’re all the same,” he said. “But the data show that they’re facing different rates of suicide by firearm, and underneath that, there are likely different challenges and different needs for suicide prevention.”
For rural Kansans who want to reach out for help, there are resources available.
For example, the state department of agriculture partnered with farming organizations to set up an initiative called Kansas Ag Stress that offers support designed for farmers, ranchers and their families. A 2017 University of Iowa study found that the average suicide rate among American farmers and ranchers was 3.5 times that of the general public.
Businesses, churches or other community organizations in Kansas can contact their local Kansas State University extension office to have an agent offer training on mental health first aid and suicide prevention to their group. The training can be customized for the audience and range from 15 minutes to a few hours.
Kansas also has a network of community mental health centers that offer care at locations spread throughout the state, including Garden City, Liberal, Greensburg and Hays.
But for people living in frontier counties, it might still be a challenge to reach them. The Hays-based center, High Plains Mental Health Center, serves 17 counties spanning more than 15,000 square miles.
Dirks, the K-State extension agent, grew up in a farm family in Iowa and has worked in rural mental health settings for much of his 40-year career. He said that it’s key for mental health providers in rural areas to understand the ways that people in those communities tend to downplay mental and emotional struggles and learn how to spot the subtle signs of distress before they lead to crisis.
“In cultures where you can’t admit that you are struggling,” he said, “when someone does mention something, it is probably the tip of the iceberg.”
But nearly all rural counties in Kansas have a shortage of mental health providers, and it can be challenging for centers in less populated areas to attract and retain specialists.
Still, Dirks said he’s starting to see rural attitudes toward mental health slowly change.
“We think it’s weakness,” Dirks said. “I turn that upside down and say I think it’s a sign of strength … for someone to say, ‘Look, I need help.’”
David Condos covers western Kansas for High Plains Public Radio and the Kansas News Service, where this story first appeared. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.