Trauma training, CISM/CISD, and mediation are needs in the Rocky Mountain states. We work with people who, due to a variety of reasons, have been traumatized. For example, being hospitalized itself is a trauma. Persons with mental illness often have multiple experiences of trauma and loss.

In terms of the larger community issues, for persons with mental illness, housing, food and subsistence level supports are ongoing issues. When persons have an exacerbation of illness, they may wind up in jails or other detention facilities after which their housing may be terminated. There is a reversal where an internal crisis (illness manifestation) creates the external crisis. Rural hospitals are getting an increasing number of individuals with mental illness. From the perspective of the hospital, they are holding them in the wrong setting for up to ten days until they go through all the processes in place and until state facilities can manage to arrive to transport them. This is the most critical state they are in and they are in a setting which is not conducive to meeting their needs.

In Australia, as in some states in the United States, suicide has become one of the highest recorded death rates. In rural Australia during 1991, for the first time, deaths from suicide were greater than deaths from motor vehicle accidents (Harrison, Moller & Bordeaux, 1997; King, 1994; Meldrum, 2004). The level of legitimate ownership of firearms in rural areas is similar in both countries and the Australian rate of self harm and death by firearms is also higher in rural and remote areas. This is despite the strength of the Australian national gun control laws. The suicide rate in rural areas (e.g. Big Horn Basin in Wyoming) is high and in hospital settings, a higher number of youth (ages 12-19) are admitted with severe emotional disorders. They are violent, self-destructive, and suicidal. There is a growing concern about school intervention programs. Are we catching these individuals and intervening before they spin out of control? Some clinical observations suggest that we are not.

Suicide, domestic violence, drugs and violent crimes do occur in rural areas. Why are there so many suicides in rural areas? The reasons suggested by the panel and delegates at the conference were many and varied. One suggestion involved isolation where people who are new to an area have great difficulty adjusting to the large distances and long travel times to maintain social contacts. There is often a lack of adequate support systems. In a changing rural environment, older support and social systems are disappearing. Schools, which traditionally have been a source of social contact in small rural communities, are closing down for various reasons. Friends die or move away. Isolation in some cases leads to phobias such as not wanting to leave one's house.

Wind was also mentioned as a contributing factor to depressed feelings and possible suicidal ideation. Together with isolation, poor social support systems, and hoplessness/helplessness, it provides, in some cases, the metaphor for obstacles that are perceived as being insurmountable and out ot the control of the individual.

Bars, however, seem to remain. Alcohol problems quite often develop as a method of denying problems and/or dulling the effects of isolation, economic difficulties or dulling pain. Suicide becomes a solution that becomes more inviting. In rural areas of the west, many Veterans of the Viet Nam War are still struggling with no jobs, hoplessness, post-traumatic stressors and other related problems. Since the end of the Viet Nam War an estimated 200,000 veterans have committed suicide. The discussion of how to deal effectively with various types of suicidal persons was quite varied, dependent upon the age, background and other factors involved. Two types of suicide were discussed: the impulsive type that occurs as the result of a momentary decision; and the premeditated type that occurs following a decision process and a definite plan. It was concluded that, in most cases, if an individual is really intent upon ending his/her life, he/she will eventually succeed. It was stated that families are the real victims of a suicide.

Some Suggestions

Some of the suggestions and goals resulting from the panel discussion included the following:

• Minimize all professional jargon. Speak in terms that all rural people can understand - on an equal level - do not patronize them.

• Create an atmosphere of trust and respect which may take an extensive amount of time and effort.

• Remember that changing old behaviors may be more challenging with rural people than expected.

• Understand that rural workers do not work on a timetable. They often work by seasonal requirements. Interrupting that process to "seek help" may not be an option.

• Professionals are often more accepted if they have some personal connection with rural life.

• Work to decrease suicide rates among all groups, with special emphasis on teens.

• Educate on prevention methods, recognition of warning signs, etc.

• Provide information and interventions to strengthen mental wellness strategies, measures, etc., including how to effectively identify and manage stress.

Decrease drug and alcohol abuse among the elderly and teens by educating about prevention measures and recognition of indicators.

• Continue to train law enforcement and EMS personnel in recognition of mental illness (those in acute crisis) and recognition of people who may be impaired by drugs and/or alcohol.

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REFERENCES

Above represents comments, papers presented and results of panel discussions at the recent CRISES IN RURAL AMERICA Conference held in Casper, WY - April 21-24, 2004. Presenters and abstracts are located at: http://www.rmrinstitute.org/presenters.html

Harrison, J., Moller, J. & Bordeaux, S. (1997). Youth Suicide and Self-Injury Australia. Australian Injury Prevention Bulletin, Issue 15. Printed from http://www.nisu.flinders.edu.au/pubs/bulletin15/bulletin15sup.html 28/5/04

King, R. (1994) Suicide prevention: dilemmas and some solutions, Rural Society 4(3/4) Printed from http://www.csu.edu.au/research/crsr/ruralsoc/v4n3p2.htm 28/5/04

Meldrum, L. B.Ed.-B. Psych, M. Med.Sc. (2004). Member of the Australian Psychological Society Inc. Personal Communication