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PTSD: National Center for PTSD

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Suicide Risk Management


Rural Provider PTSD Toolkit

Suicide Risk Management

What creates additional risk?

In general, suicide risk is greater in rural compared to urban areas.38-40 Evidence also suggests that suicide rates are increasing more rapidly in rural settings. Importantly, Veterans are at higher risk for death by suicide than the general population, regardless of location.38 These trends highlight the critical importance of suicide risk management among rural Veterans, who are at increased risk of death by suicide relative to non-Veteran rural residents and their urban Veteran counterparts.9
Veteran sitting on bench with rolling hills in the background
The high rates of suicide among rural Veterans may be linked to an interaction between attitudinal barriers to care (e.g., stigma) and structural barriers (e.g., geographic isolation, transportation) with a health care system that has fewer resources and training to effectively identify, treat, and manage suicidal patients.

Click any barrier to learn more:
Attitudinal barriers Structural barriers
Attitudinal barriers
These barriers include stigma, lack of perceived need, and desire to handle problems by oneself. Attitudinal barriers that impede access to mental health treatment may be higher in rural areas.41 Greater stigma towards suicide, mental illness, and help seeking; increased geographic and social isolation; greater access to firearms; and economic and social fragmentation have all been cited as risk factors for suicide associated with rurality.39
Structural barriers
These barriers include financial means, transportation, and availability. An abundance of literature demonstrates that rural communities have fewer mental health resources and less knowledge and training for suicide prevention and treatment among health care professionals.42 Rural Veterans are less likely than urban Veterans to access mental health services, yet VA-enrolled Veterans living in rural areas report lower mental health-related quality of life than their urban and suburban counterparts.3,43,44 Rural Veterans with a mental health diagnosis experienced greater disease burden and health care costs than their urban counterparts.45

Steps in Suicide Risk Management

Suicide risk management must take into account the multiple intersecting risks presented by rurality--in particular, cultural attitudes around help seeking, access to firearms and cultural norms regarding firearm ownership and use, barriers to treatment (such as transportation), and the availability of care professionals with expertise in the treatment and management of suicidality.

Click to reveal more information about the process of suicide risk management.
1. Effective suicide risk management strategies start with a comprehensive assessment of a Veteran's level of suicide risk.
2. Additional warning signs must be considered.
3. Information is then integrated to determine Veteran's level of risk.46,47 Risk management efforts focus on helping the Veteran cope with factors elevating risk and enhancing factors that reduce risk.
4. Risk management strategies are tailored to the individual Veteran.
Working with Veterans at risk for suicide can feel stressful and overwhelming at times. There are resources to support providers who see Veterans, both within and outside VA.

PTSD Information Voice Mail: (802) 296-6300
Also see: VA Mental Health