Suicide Is a Major Problem in Rural America. How Can Philanthropy Step Up for Prevention?

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Suicide is one of the leading causes of the death in the U.S. According to the Centers for Disease Control, suicide rates increased by 36% over the past two decades. The number of suicides reached a record high of 49,449 in 2022, up 3% from the previous year. About 1.6 million people attempted suicide in 2022 alone. 

In rural America, suicide is an even bigger problem, with the suicide rate almost twice that of urban or metropolitan areas. Between 2000 and 2020, suicide rates in rural areas increased by 46% compared to 27.3% in urban areas. There are many reasons for this discrepancy, including difficulties accessing mental healthcare, funding challenges and the geographic and social isolation that is common in rural communities. 

In recent years, the U.S. government has taken several steps to address suicide, including launching the 988 national suicide and crisis lifeline, enhancing community-based prevention efforts, providing communities with technical support and supporting at-risk populations — including rural Americans. Philanthropy, however, has fallen short when it comes to funding not just rural suicide prevention, but suicide prevention as a whole.

Keeping in mind the scope of the issue, there are several things philanthropic funders can do — and a few are already doing — across many issue areas to make a dent in the problem. 

“It's a funding issue across the board”

By far the biggest challenge facing rural suicide prevention efforts is an overall lack of funding. While there is some support available, particularly from the public sector, rural organizations find it difficult to secure that funding.

"It's a funding issue across the board," said Brett R. Harris, who authored a recent report from NORC at the University of Chicago detailing the results of a study on rural mental health, along with Katie C. Gallant and Abby Mariani. "A lot of times… whoever's providing the funding, they want to see a bang for their buck. So they're all very competitive."

Whether it’s philanthropic funding or government grants, monetary support often follows population density, which means that the communities with the smallest populations receive the least money despite the high levels of need that may exist there. We’ve often pointed to this dynamic when it comes to the rural philanthropy gap at large: Funders fund what they know, and most big philanthropies are based in urban places, not rural America.

Another major issue is that funding for suicide prevention is neither cost-effective nor sustainable. Government funding is usually allocated for two to three years, which doesn't allow for enough time to make a lasting impact on a community, the report said. When the funding runs out, organizations either have to find and apply for new streams of funding or are forced to discontinue their services. Applying for the grants, however, isn't easy.

"When you're talking about an application process, it's also hard for them to apply given [the] limited resources. They don't have grant writers. They don't have a lot of people that work in local government, which in rural areas are part-time or very part-time, and they have other jobs. So there are a lot of challenges," Harris said. 

NORC's report also noted that a lot of funding does not take into consideration the unique needs of rural communities and instead mandates a "one-size-fits-all" approach that doesn't work when it comes to rural communities, as each has different needs and challenges. 

Philanthropic funders are few and far between

Philanthropic grantmakers largely haven’t stepped up to the plate when it comes to suicide prevention writ large, as IP recently covered. As is often the case, the philanthropic situation seems even more dismal when we’re talking about rural funding specifically. But that doesn't mean that there aren't any philanthropic funders working in this space. The following are a few bright spots in an otherwise underwhelming landscape.

The Arthur M. Blank Family Foundation, for example, cites mental health and wellbeing as one of its main areas of giving. Since 2022, it has awarded $16 million in this area, including support for the Rural Behavioral Health Institute, whose mission is to reduce suicide among rural youth by building a school-based mental health system. The Rural Behavioral Health Institute also receives support from the Otto Bremer Trust, Montana Healthcare Foundation, Dennis and Phyllis Washington Foundation and M.J. Murdock Charitable Trust. 

Another rural funder to note, the Hogg Foundation for Mental Health, is focused on supporting the mental health and wellbeing of Texans. One of its initiatives is its Collaborative Approaches to Well-Being in Rural Communities, which provides grants to create or build on existing community collaboratives to support resilience and mental health. One of its grantees, the BHOLD Project, seeks to address the root causes of poor mental health at a community level, including youth suicide prevention.

The Wisconsin-based Charles E. Kubly Foundation, meanwhile, provides funding for mental health projects that seek to reduce suicide and stigma associated with depression. It has awarded grants to Catholic Charities of Madison to provide suicide prevention services to middle and high school students in rural schools in Marshall, Wisconsin, and to the Wisconsin Women's Health Foundation to purchase radio spots that address women over the age of 25, including women in rural communities.

The Seattle-based Washington Women's Foundation awarded a $100,000 grant to Forefront: Innovations in Suicide Prevention, an initiative of the University of Washington's School of Social Work, to support suicide prevention in six underserved rural communities. 

Finally, as we've written before, the Helmsley Charitable Trust has invested in programs to increase access to mental healthcare in rural areas across eight states — North Dakota, South Dakota, Nebraska, Wyoming, Minnesota, Iowa, Montana and Nevada. 

In addition, Helmsley has provided funding for the Helmsley Center at Avera Behavioral Health in South Dakota, which offers 24/7 behavioral health urgent care, observation care, youth addiction care services and partial hospitalization for youths. Helmsley has also funded Pivot Point, a crisis stabilization unit in Pennington County, South Dakota, which provides access to behavioral healthcare and trained professionals. 

What funders can do

Speaking generally, what are some of the ways philanthropic funders can help support rural suicide prevention? For one, donors can fund direct services, like many of the initiatives mentioned above. Funding for behavioral health facilities, incentives, and support for providers are all options. That backing is desperately needed: In an article published in the Journal of Rural Mental Health, the NORC report’s authors, Harris and Gallant, wrote that as many as 65% of rural counties across the U.S. lack access to psychiatrists, and more than 60% of rural residents live in what are considered to be mental health provider shortage areas.

But beyond direct services support, philanthropists can also make a big impact by offering technical assistance so that rural communities can apply for state and federal funding. "If you're asking small communities to be writing these applications, they don't have the resources to do it, so they'll never be able to access the funding… They're not even in the running," Harris said. "I think there's an opportunity to provide… technical assistance to help them if they have questions, or any kind of support to help them write the proposals would be really helpful." 

Funders can also engage in and support advocacy work to reshape the policies that govern how mental health and suicide prevention funding is allocated at the state and federal levels. In addition, funders can support mental health and suicide prevention education, as well as efforts to increase residents’ awareness of the services available to them.

In that vein, funders can back nonprofit organizations like Rural Minds, which works to empower rural residents with the information and resources they need to make a difference in their communities and in their own lives. Rural Minds is the only national nonprofit dedicated exclusively to rural mental health. It was founded in 2021, after founder Jeff Winton's nephew, Brooks Winton, died by suicide. Brooks was 28 years old and the father to three-year old twins. As a new organization, Rural Minds has yet to receive support from foundations.

Another big place where philanthropy can make a difference is by helping to expand broadband access and transportation in rural areas. Rural residents often have to travel long distances to access care — which in itself can be difficult, given that many rural communities have no or very limited public transportation — and have to contend with long wait times. And while telemedicine is an option for some, many rural Americans lack broadband access. According to the FCC, 22.3% of rural Americans and 27.7% of Americans in tribal lands lack access to high-speed broadband.

The VA, for example, has existing telehealth programs to aid veterans with suicide prevention, but they're not always accessible due to a lack of internet access. As one professional explained in NORC's report, "There are good programs out here, like the VA with their telehealth, but you can't bring telehealth to someone who doesn't have regular cellphone service." 

Funders can also provide support to address the root causes of suicide, including poverty, unemployment, housing and domestic violence. Addressing the “upstream determinants” of public health problems is already a popular strategy among major U.S. health philanthropies — most of them based in and gravitating toward cities — but there’s an argument that less-direct approaches to suicide prevention make a lot of sense in rural America, where the culture of self-determination is a big part of life.

"Part of the problem that people are facing that may lead them to that dark place is the fact that they feel they can't talk about [it]. No one's talking about suicide. No one's talking about mental illness, and that stigma makes people feel very isolated and alone,” said Chuck Strand, executive director of Rural Minds.

Helmsley Charitable Trust trustee Walter Panzirer voiced something similar. “This crisis cuts across every socioeconomic strata, yet when you talk about mental health in rural communities, it’s still a very taboo topic.”

The prevalence of gun ownership in rural America is another big contributor to rural suicide. Firearms, Harris noted, are the most lethal form of suicide, and rural areas have very high gun ownership rates. As with criminal justice reform writ large, gun violence is a difficult area for philanthropic funders to get at because so much rides on government policy and action, including on the state and local levels.

Leaning into strengths

That gets at a big challenge for rural philanthropy: the far-flung and highly local nature of rural problems. But that supposed weakness can also be a strength. As we've previously reported at Inside Philanthropy, one of the most effective means of supporting rural communities is through place-based funding. Regional funders have a better understanding of their communities and what their needs are. 

It's also important to take into consideration the strengths of rural areas. While there are certainly downsides to living in small, close-knit communities, there are a lot of advantages, as well, including their collaborative nature and residents’ desire to help one another. Rural healthcare providers, for instance, often see their patients as family and are creative with the resources available to them. 

Leveraging the strengths and assets of rural communities can make a really big difference, Harris said, and it's something that community members appreciate.

"You really want to make sure that you're not an outsider coming in and just pointing out all the negatives, but that you build on what is there in the community,” Harris said, “and there's often a lot of great work being done [by] a lot of dedicated staff that have been there for their whole careers.”