https://goo.gl/599ata"It's an epidemic in our community," says Skyler, now 27 and active in local suicide-prevention efforts. "There are so many different factors. We have a heavy prevalence of alcohol, heroin, and meth. We have miners working underground 24 hours a day with no sunlight. There's a lack of resources, and there's a stigma about discussing your issues. It's that old cowboy thing: Buck up and move on."
Nevada ranks last in the country in overall mental
health, according to the nonprofit group Mental Health America, which rates the prevalence of mental illness and substance abuse in relation to access to care. A report earlier this year from the University of Nevada, Reno, found that 16 of the state's 17 counties have a severe shortage of mental health professionals. Fourteen are without a single psychiatrist, and a smattering of psychologists and social workers are spread over tens of thousands of square miles. In 2015, the state had the 11th highest suicide rate in the country. From 1981 to 2013, it was number two in suicide by self-inflicted gunshot wound—second only to Wyoming.
In many ways, Nevada typifies the broader state of mental health in rural America. Since 1999, premature death rates have risen sharply among rural whites; analyses point to marked increases in suicide, drug overdoses, and liver disease, presumably related to
alcohol abuse, which collectively were designated "deaths of despair" in a 2015 paper by Princeton economists Anne Case and Angus Deaton. Last year, the Centers for Disease Control reported that both suicide rates and drug overdose rates in rural areas have surpassed those in metropolitan areas. And rural areas everywhere are faced with a chronic lack of access to care.
In 1948, Cornell University psychiatrist Alexander Leighton and his colleagues traveled Canada's maritime province of Nova Scotia to initiate what would become known as the Stirling County Study, a longitudinal study that continues to this day. Parts of the region were in the midst of economic decline, and the researchers found that psychiatricdisorders were higher in communities with "broken homes, few and weak associations, inadequate leadership, few recreational activities, hostility and inadequate communication, as well as poverty, secularization, and cultural confusion."
The Stirling County Study is a landmark from the early days of psychiatric epidemiology, when scientists began to look at social determinants of mental health. Many subsequent studies have echoed and elaborated on its key findings. "It's clear from data across the decades that there's a connection between the health of the economy, the health of communities, and the development of mental health problems," says psychologist Peter Keller, a researcher and past president of the National Association for Rural Mental Health.
Keller cautions against painting rural settings with a broad brush. Some are thriving, he says, some are chugging along, and some have creatively reinvented themselves after their former economic base disintegrated. Financial distress also isn't the sole source of psychiatric troubles. But many rural areas that have experienced years of systematic job loss, especially those that were built on manufacturing, have seen a cascade of human damage that can be traced in large part to the economy. In vast swaths of the country, young people face a future without financial stability, let alone upward mobility. Those who are middle-aged are not even treading water. The stressors add up, fostering conditions with grave outcomes.