As I sat listening to Cary Brus, Vice President of NERD Gas Company and the keynote speaker at the National Alliance of Healthcare Purchaser Coalition’s Mental Health Summit, share how he lost his boss, mentor and friend to suicide, I wondered what it was about his story that struck such a personal chord with me. Both in my personal life and through my work as a mental health advocate, I’ve listened to many firsthand accounts of suicide, but there was something about the rural western community Cary hails from that felt deeply familiar.
Cary is from Wyoming, as was his boss, Mick McMurry, a beloved figure not only in their town but throughout the entire state for his philanthropic and business contributions. In Wyoming, “when things get tough we don’t talk much,” Cary said, and as he described how the “cowboy culture” played a role in his friend’s death, I realized I too knew that culture. Though I lived most of my life in New York -- where it seems that there is a psychiatrist or psychologist on every corner, and people openly talk about being in therapy -- for the past thirty years, I’ve traveled frequently to Steamboat Springs, Colorado, where my sister and mother live. There, I’ve experienced some of the “tough it out” “hush hush” ethos that Cary spoke about during his talk, and which, historically, has been a powerful force keeping topics like mental health in the dark in smaller, rural communities. This culture of silence is part of the reason why my sister, living in a picturesque, seemingly idyllic small town, knows more people who have died from suicide than I do.
It’s not just that mental health and suicide aren’t talked about in these communities; as Cary shared and research indicates, there are key factors that actually put residents of rural communities at higher risk. Both Wyoming and Colorado are part of the “suicide belt,” a region comprising most of the western United States where the suicide rate is higher than the national average. The sociologist who coined that term in the early 2000s found that, in addition to having many of the same economic conditions that are believed to be linked to higher suicide rates, these states possess a certain set of characteristics that seem to lead to even greater risk: large populations of aging, single, unemployed men, and higher than average rates of gun ownership. If we add to that the barriers to care like shortages of mental health specialists and long driving distances to medical centers, we have a very dangerous combination.
Because treatment is not readily available in these communities, people either don’t seek help, or they go elsewhere. In Steamboat, for instance, I have known families who have had to drive four hours to Denver for their children’s psychiatry appointments to manage something as commonplace as ADD. You don’t see psychiatry practices or treatment centers, so mental health goes undiscussed, and remains a foreign concept.
In reflecting back on his boss’s death, Cary shared some of the lessons he learned, which he now promotes both in the Wyoming business community and to broader audiences: do not avoid the difficult conversations, tackle them head on. This is at the heart of prevention. We still need to address access to care, and make it easier for individuals living in these areas to get treatment -- whether through bringing additional mental health professionals to these areas, building more treatment facilities, or finding alternative ways to connect patients to providers. But the simple step of opening up the dialogue can have an outsized impact.
I say simple, but that doesn’t mean easy. It’s not easy to change culture. We need to start in the schools, educating kids not only about mental health, but giving them the tools and vocabulary in emotional intelligence to be able to recognize if they or a friend is out of balance and to confidently seek help.
As we enter National Suicide Awareness Month, it’s an opportune time to assess how we are doing on prevention, particularly in those communities where risk is high and education and awareness are underemphasized. We need to understand communities’ unique characteristics and needs, as well as collective attitudes and beliefs related to mental health and suicide, so we can build prevention programs that respond effectively. With this public health crisis at an all-time high it's important for us all to become more aware, educate ourselves, and become activists for this cause that is truly a matter of life and death.
For suicide resources visit the National Suicide Prevention Lifeline or call 1-800-273-8255.