Florida's rural counties are seeing suicide rates for youth almost double that of the state's large cities. And experts say isolation, poverty, access to firearms and a lack of mental health resources are to blame.
Wauchula, population 5,000, is one such town. It's more than an hour southeast of the closest major city: Tampa. To get there, you'll drive through three counties on the interstate and along several back roads before reaching the center of town, named Main Street of course.
There are churches on just about every corner in Wauchula, but not one mental health clinic.
"One of the big problems in a rural area is lack of resources,” said Peggy Saddler, a guidance counselor at Hardee High School, the only high school in the county of almost 28,000 residents.
The closest mental health clinic is Peace River Center and it takes more than 30 minutes to drive there. It’s in Bartow in Polk County.
"For the average person, generally getting services, if you're not going to Peace River Center, it means you have to travel and that's limiting for some people,” Saddler said.
That's a serious concern , as the teen suicide rate in Florida's small towns has doubled in the past 20 years.
From 2012 through 2014, almost 8,000 youth younger than 21 killed themselves in Florida. Of those, 520 come from rural communities - a significant number given their populations.
Also, experts say the number of teen suicides could be much higher, in part because medical examiners and law enforcement don't have an objective set of criteria to decide whether to label a death as suicide.
And, suicide prevention advocates say, the statistics don't address the number of suicide attempts.
Saddler - the Hardee County High counselor - said there isn't a place in Wauchula where youth can be treated for anxiety, depression, or even suicidal thoughts. That's high on her wish list of resources she would bring to her small town for teens and other vulnerable groups, such as gay and lesbian youth.
"It's kind of interesting because I think even some of the larger counties around here, Highlands (County) or whatever, I think in some ways they have the same dearth or programs,” she said.
Compared to Wauchula, the towns in Highlands County are considerably more urban. Sebring, with 10,000 residents, and Avon Park with more than 8,000, are more than double the population of Wauchula.
"I think you have to get into a truly urban area before you have some of those specialized that service different groups of kids,” Saddler said.
But agricultural communities such as Wauchula aren't the only places in Florida where isolation and a lack of resources increase suicide risk. For example, the Florida Keys is best known as a tourist destination. Monroe County stretches from Florida's southeastern tip - about 15 miles south of Miami - all the way to the uninhabited Dry Tortugas.
But this home to sandy beaches and quirky towns has the highest suicide rate in all of Florida.
Mary Lou Hoover, a volunteer for the Key West branch of the American Foundation for Suicide Prevention, said there were more than 10 suicides just in Key West this summer.
That's one death for every 2,500 residents.
The first was a 15-year-old boy, Hoover said. Most of the others, she said, were younger than 40.
"They were young people, vibrant — shining stars," she said.
To Hoover, the Keys has a "perfect storm" of people who are vulnerable to suicide attempts: military, veterans, gay, lesbian. bisexual and transgender people and people with addiction issues.
And while some mental health resources are available in its largest city, Key West, she said the rest of the island chain has little to offer people who are at risk.
That geographic challenge magnifies the risk in a community seen by the rest of the country as being the laid-back and carefree " Margaritaville."
"We know there's an aspect to living here that eventually you have to grow up and be part of the community and it's not always fun and games and partying 'til 2 in the morning,” Hoover said.
The isolation people in rural communities feel is no different than the loneliness felt by people in towns of all sizes, advocates say. They point to resources such as smart phones as a key lifeline.
The National Suicide Prevention Lifeline and other groups offer free apps that use text, Skype or instant messages to connect teens or anyone else to counselors who are on call 24-hours a day.
Saddler said that kind of access could help small town residents who tend to have a "pull yourself up by your bootstraps" mentality. They can be especially helpful in a place where it's a constant battle to get parents to realize that sometimes their child isn’t just being a stereotypical teen.
"I think they don't really see the signs of depression or anxiety or any other issues," she said. "If an adult exhibited the same things you'd say, 'oh, he has problems' because 'oh, you're a kid. You'll get over it. You're resilient.’ "
But, Saddler says in this small town, they don't always "get over it."
Daylina Miller is a reporter with WUSF in Tampa. WUSF is a partner with Health News Florida, which receives support from the Corporation for Public Broadcasting.
