ARUN RATH, HOST:
Young people in rural communities face a suicide rate nearly double that of their counterparts in cities. That's according to a report out this week from the Journal of the American Medical Association Pediatrics. Dr. Sandra Micken is a psychologist in the small ranching town of Dillon, Mont. It's home to a little more than 4,000 people.
SANDRA MICKEN: We're isolated from one another. Some of the people that I see need to travel at least a mile to get to their nearest neighbor. And they're often traveling up to 60 miles to come and see me.
RATH: But Dr. Micken says isolation isn't the only thing that takes a toll on the mental health of people in places like Dillon.
MICKEN: More people in rural areas are living in poverty than in urban areas. And poverty is a risk factor to all sorts of health problems, including depression and then suicide. There's also this very stoic, pull yourself up by your own bootstraps culture that's here in the West. And that means that people often suffer in silence. Independence is paramount out here, and asking for help goes against the grain. Instead, people think they should solve their own problems. And if they're depressed, suicide might seem like a good way to do that.
RATH: So do I understand correctly that you're the only practicing psychologist in the area?
MICKEN: I am the only psychologist that provides therapy. Yes. The closest one is about 100 miles from here.
RATH: So how is that - serving a community of 4,000 people? I mean, are you - are you enough?
MICKEN: Well, it depends on how you define enough. Certainly, we have a huge problem with depression and suicide in Dillon, as do most rural towns in the United States. However, there's also a pretty big stigma against getting mental health care, so I don't work full-time. So I've got time available to see more people, but those people aren't always finding their way to me.
RATH: The Journal of the American Medical Association Pediatrics study also reported that suicide by firearms was three times more likely in rural areas. How do you approach a topic with your patients?
MICKEN: Well, I start out by assuming that the patient probably does have access to firearms. And, you know, most of the time, that's just fine, but when somebody is depressed and suicidal, firearms can be lethal. Two-thirds of our suicides in Montana are completed using a gun. And this is really important because we know that suicidal impulses almost always pass, and people later are glad to be alive. But when the suicide is committed with a gun, there's no time to change your mind.
RATH: Over that span of time, those 18 years that you've been - you've been working there, how has the situation with suicide changed? Has it changed?
MICKEN: The rates have remained steady. And actually, as we've seen for the whole nation, they go up in times of economic stress and strains. It's a huge problem, and it affects everyone in the community. Almost everybody here has known someone - sometimes several members of their family - that have died by suicide.
RATH: Is the stigma any less intense after 18 years?
MICKEN: You know, what I really notice is that the kids don't seem to be concerned about having people know that they see me. I've had kids come up to me in public and introduce me to their friends. So the younger people - I think perhaps that stigma is starting to fade away. I certainly hope so.
RATH: Dr. Sandra Micken is a psychologist in the small town of Dillon, Mont. Dr. Micken, thanks very much.
MICKEN: You're welcome. It was my pleasure. Transcript provided by NPR, Copyright NPR.