Maggie McKay (Host): Welcome to the Kirby Connections Health Podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Maggie McKay. On this episode, we'll talk about Suicide Prevention and Awareness Month with RN and Kirby Senior Life Solutions Program Director, Taylor Ferguson. Thank you so much for joining us today, Taylor.

Taylor Ferguson, MSN, RN: Thank you. I'm glad to be here.

Host: This is such an important topic to so many people, so let's dive right in. What are the unique challenges faced by people who live in rural areas that contribute to higher risks of suicide compared to, say, urban areas?

Taylor Ferguson, MSN, RN: Yeah, so some of those include things like access to mental health, stigma, substance abuse, access to lethal means, as well as their socioeconomic status and factors. So just to kind of briefly highlight those; access to mental health, that's a lot of times related to transportation. Sometimes they're in a pretty rural or remote area. They might not have the means to drive. There might not be the means of transportation and again, to point A to point B. So that continues to be a barrier, in relation to that.

Stigma. As many know, when you live in a rural area, you live in a rural community, you have the idea of everybody knows everybody. So when they feel like they need to start seeking services and having those challenges, they don't want others to know about it. So that can be a deterrent to get that services.

Substance abuse and access to lethal means go very well together, and they're very common in rural areas. You know, a lot of times people have some type of method for protection, hunting. There is easy access for substance abuse and having those substances, because sometimes people are utilizing it as a supplement for monetary needs and things along those lines. So, the downside of having that access and having those abilities is firearms have become one of the most common modalities to use for suicide. It was highly rated, in 2022.

And then lastly, when you look at your socioeconomic status and those factors, you know, a lot of rural areas, they're having some type of financial hardship, whether it's poverty, they have a low income, there's poor housing and poor quality, there are challenges with unemployment. And especially when you think about the farms, we have a lot of land out here. There's a lot of ups and downs when it comes to farmings because of the prices of the commodities, dealing with the weather and how much that's affecting their crops, which can then deter how much they're going to make based on that profit, based on that crop.

Host: Now, just to clarify, because I noticed the word senior was in your title. Do you mostly see seniors or all age groups?

Taylor Ferguson, MSN, RN: So specifically for the, my program, we see seniors. So we target those ideally 60 and older, 60, 65 and older.

Host: Never really thought of that age group as people who take their lives. So can you explain the latest statistics regarding the prevalence of suicide in rural communities in 2023 or 2024?

Taylor Ferguson, MSN, RN: Yeah, I would be happy to. Sadly, the most recent data out there is as of 2022. There hasn't been released any 2023, 2024 data yet, but as of 2022, suicide has become the leading cause of death in the United States as a whole. And it's been categorized as the 11th leading cause of death.

And when you look at all the medical comorbidities that are out there, it's kind of starting to push those down and become one of the higher ones doing that. Over 49,000 individuals in 2022 took their life by suicide with older adults being the highest percentage of that, 85 and older.

Host: And why do they think that is?

Taylor Ferguson, MSN, RN: A lot of it has to do with, that kind of goes back to, what we talked about prior, the stigma of receiving services, isolation, not having those means, not being able to do the things that they once did. So their life has drastically changed and the alternative for them is not wanting to go through those changes that they're going to go this way.

Host: What are the most effective preventive strategies specifically tailored for rural communities during Suicide Prevention and Awareness Month?

Taylor Ferguson, MSN, RN: I think the biggest thing is education. This will probably go into a question that will be asked later on, like, with the signs and symptoms. Like, the biggest thing out of this would be having education. You know, I spend, as well as other mental health individuals here, spend that month doing a lot of talks within our nursing homes, our assisted livings, with our patients, just to educate on the resources that are available and educating families as well. You know, our town has had some suicides. They were in younger age for the ones that have happened in town. So, the biggest thing is just education and trying to break down that stigma.

Host: What are some common signs of suicidal ideation that families and friends should be aware of in their loved ones?

Taylor Ferguson, MSN, RN: So there is a little difference between adults and youth. So I'm going to kind of talk about adults first and then I'm going to switch over to youth. So adults when you start seeing something new in their behaviors based on what we thought was normal for them, you know, they start talking about making plans.

They're acting more anxious. They're agitated. They're behaving has come a little bit more reckless. They're talking about being a burden to others. They're talking about feeling trapped, that the pain that they have is just unbearable. They have now turned to increasing amounts of alcohol and drug abuse. They are verbalizing those feelings of hopelessness, that there is no reason for them to be alive anymore. Their sleeping habits have changed, whether it's too little or it's way too much, and they're withdrawing and isolating themselves from their connections, from their social circles. They can show bouts of rage and talking about seeking revenge, as well as displaying extreme mood swings.

 So those are things we want to start looking for in adults, and it might not ideally mean that they're suicidal, but there is something happening that is now deterring where they're at from where they were.

With the youth, it is also very similar that, they're going to start talking about making plans. They're going to start expressing those feelings of hopelessness as well and having those severe and overwhelming back and forths in their moods. And they can start showing changes when it comes to withdrawing as well from their social connections, changes in their sleeps, being angry and hostile, as well as having, Increased amounts of anger and agitation.

Host: So you brought up a good point earlier about, smaller communities, everyone knows everyone's business. So I wonder how important community involvement and peer support is in suicide prevention efforts in a rural area.

Taylor Ferguson, MSN, RN: It can, I think, be the make or break of things. Because communities such as ours can be very influential and once you start getting people to open the mindset of it's okay to ask for help, it's okay to be supportive, that suicide and mental health are not as taboo topics as they might have been 10, 15 years ago.

Host: So I guess it goes back to education again, to get the word out that if you need help, ask for it. We're here for you.

Taylor Ferguson, MSN, RN: Right.

Host: What types of training programs are available for general practitioners to better equip them in recognizing and managing suicidal tendencies?

Taylor Ferguson, MSN, RN: A lot of it is just, you know, your knowledge base. Having that comfortability of having those conversations, you know, it is kind of hard when you might have to be the one to be like, are you suicidal? Are you wanting to take your life? Nobody wants to ask those questions because they don't want to know the answer to that question.

So I think a lot of it is a comfort level and just knowing that it's okay to ask the question, or reach out to somebody who can ask those questions. And some resources out there currently is like mental health first aid is a big thing. And that's, just like the introductory of being able to have these safe conversations and feeling comfortable utilizing the words, even such as suicide, saying depression, saying anxiety, because those can be scary words to individuals for them to even face.

So, making it not say common, but utilizing the words as they are. And then there are resources such as like mental health first aid, and then again, we're going to go back to the education and normalizations of mental health in general.

Host: So what are some common misconceptions, if there are any, about suicide risk in rural areas that need to be corrected?

Taylor Ferguson, MSN, RN: I don't think that it is really understood that rural areas are at a higher risk of suicidal rates in comparison to urban areas. So you compare us to like Chicago, St. Louis, Indianapolis, we're going to see higher percentages of those attempts being successful in comparison to those more urban metro areas.

And a lot of it can go back to the original question that we started with, the access to the care. When you're in those more metro areas, you're going to have some type of service within blocks of you. Whereas here, yes, we are a little bit more tight knit, but if you get into more rural areas, it could be a 30, 40, an hour long before you get to any type of service that you need.

Host: Wow. So what role can schools and local organizations play in suicide prevention efforts in rural communities during this Awareness Month?

Taylor Ferguson, MSN, RN: Education. The biggest thing that's going to come back to is education. You know, having whether it's us coming in and having those conversations, and again, we're working to break down that stigma, and we're working to say it's okay to ask for help. It's okay if you need help. It's okay if you are struggling. It doesn't mean you're any less of the individual you were prior. So just, again, being open to those conversations and being open to the educational platform that can be available during that time and even outside of that time frame.

Host: I wonder how you get the word out. Of course, schools are a good start, but like you're talking about seniors also. So if they live in a rural community, how do you get the word out to them? I mean, you don't go house to house, right?

Taylor Ferguson, MSN, RN: No, we don't, you know, we have used mailers on that. We have used mailers in connection with like, whether it's my services or services here available at Kirby, you know. At least in our area, we can say that the seniors that are in our area likely go and see a primary care provider within our system, so then I'm able to connect with them in that way and have those conversations.

And we work to try to mitigate those transportation concerns, whether it's I go to their house and I meet them and I talk to them, or we find alternative ways to have those conversations and see what we can do to either enroll them in our program or get them set up with some type of service.

Host: Well, Taylor, thank you so much for sharing this invaluable information. It really is invaluable and sharing your expertise on such a crucial topic.

Taylor Ferguson, MSN, RN: Yeah, thank you. No, thank you. I appreciate the time that you guys have taken to do this.

Host: Absolutely. Again, that's Taylor Ferguson, and if you'd like to find out more, please visit KirbyHealth.org/services/mental-behavioral-health/senior-lifesolutions. Again, that's KirbyHealth.org/services/mental-behavioral-health/senior-lifesolutions. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

Thanks for listening to Kirby Connections Health Podcast presented by Kirby Medical Center.