As youth suicides continue to climb nationwide, a growing body of research shows that the deaths are happening at higher rates in rural communities.
Courtesy Dr. Kriechman
In 2017, suicides reached their highest point since 2000, a trend driven by a sharp rise in male suicides and in youth aged 15-19 years, according to an analysis published recently in JAMA (2019 Jun 18. doi: 10.1001/jama.2019.5054). Among youth aged 15-19 years, the suicide rate was 12 per 100,000 in 2017 (18 per 100,000 in males and 5 per 100,000 in females), compared with 8 per 100,000 in 2000, the study found. Across all age groups, the highest suicide rates and greatest rate increases are in rural counties, according to data from the Centers for Disease Control and Prevention (CDC).
Now, a unique initiative in New Mexico is working to combat those alarming trends through an alliance of community leaders that strives to strengthen resilience and build peer support for at-risk youth.
The Alliance-Building for Suicide Prevention & Youth Resilience (ASPYR) program, created by the University of New Mexico (UNM), Albuquerque, focuses on training professionals and advocates within New Mexico communities in a strength-based, youth-directed, collaborative approach for the assessment and treatment of suicidality. A diversity of community members undergo the training, including health and behavioral health care providers, peer support and community support workers, youth and community advocates, educators, and first responders. The initiative also supports and facilitates the development of a communitywide crisis intervention plan that promotes youth safety and resilience.
“ASPYR is unique, in that we actively involve youth to guide our program, versus an adult-only led program,” says Laura Rombach, program manager for ASPYR and a senior program therapist in the department of psychiatry and behavioral sciences at UNM. “Youth offer feedback about our training and ideas about how to best prevent suicide in their schools and communities. New Mexico is underresourced, and individuals living in rural/frontier areas do not always have access to licensed behavioral health providers, so our training is developed for licensed providers as well as peers and paraprofessionals to increase the knowledge of care for individuals experiencing a suicidal crisis.”
Rural populations present challenges
The many rural pockets of New Mexico pose numerous obstacles for antisuicide advocates.
Of the 33 counties in New Mexico, six are identified by the Census Bureau as completely “rural,” and an additional six are defined as mostly rural, according to the University of New Mexico Bureau of Business & Economic Research. Even among counties considered “urban” however, a considerable amount of the population lives in rural areas, according to the bureau. San Juan County, for example, which is considered urban by the Census Bureau, had an estimated 34% of residents living in rural areas in 2010.
Poverty adds to the difficulty. In 2017, nearly one in five New Mexicans (20%) lived below the poverty line, and the state had the second-highest rate of children under 18 years living in poverty in the country, according to a report by the New Mexico Department of Workforce Solutions.
“New Mexico is an impoverished state with limited capacity, especially in regards to behavioral health services,” said Avi Kriechman, MD, principal investigator for ASPYR at UNM and a child, adolescent, and family psychiatrist at the university. “It is also challenging to create a truly statewide effort where there is limited public transportation, problematic Internet connection, and other barriers to involving those who live and work in rural and frontier New Mexico.”
Dr. Mary Roessel
Addressing suicide among the many native and Indigenous people in rural New Mexico presents another unique set of challenges, said Mary Roessel, MD, a Santa Fe, N.M.–based psychiatrist who specializes in cultural psychiatry. Native and Indigenous residents often have a general mistrust of outsiders and a stigma against mental illnesses, Dr. Roessel said in an interview.
“One of the problems is being able to identify when a person has attempted suicide in some of these small, private, Pueblo communities because they are very closed,” she said. “At times, we don’t get the information to go in and help them. They’re trying to address or deal with the problem themselves.”
To address the many barriers of rural New Mexico, ASPYR works hard to recognize, identify, and support preexisting community resources that are often neglected in needs assessment and stakeholder identification, Dr. Kriechman said. This can include food banks, church care committees, youth advocacy groups, local caregiving, and spiritual traditions, among others. Frequently, many community caregivers and agencies have not connected or communicated with one another and often are unaware of all they have to offer, he said.
“We try to build capacity through community trainings, which include a widely diverse group of providers, advocates, and supports,” he continued. “Our trainings involve highlighting and building upon local and cultural practices and traditions of healing, caregiving, and support. A significant part of our onsite training involves assembling a representative group of local providers in health care, behavioral health care, peer & community support and advocacy, education, first responders to community crises, and government and nonprofit agencies, then facilitating a community conversation between the panel and training attendees about how best to move forward in a synergistic and systemic manner to support youth safety and resilience.”