While many are working today to change the status quo, echoes of frontier mental health tragedies, like those depicted in the movie, resound in the rural West, where an appointment with a doctor of any kind might entail a two-hour drive one way. That’s if you can find a provider, if you have transportation and, as is often the case with mental health, if you can overcome the stigma surrounding your care.
Rural suicide rates increased 48 percent between 2000 and 2018, according to the Centers for Disease Control and Prevention. Men in rural areas are 40 percent more likely than their urban counterparts to end their lives. Women, universally less prone to suicide, are more likely to do so if they live with the specific challenges of ruralness, including those cited above, and higher poverty rates.
Turns out that the very elements we celebrate as rural Westerners — self-reliance, mental and physical fortitude, and being alone a lot — put our well-being at risk. According to the CDC, Alaska, Colorado, Idaho, Montana, New Mexico, Oklahoma and Wyoming have the seven highest suicide rates in the country.
In this part of Colorado, Joel Watts runs Integrated Insight Therapy, which employs about 40 therapists for clients in five counties, covering an area the size of New Jersey. (But imagine an early 19th-century New Jersey, with fewer than 240,000 people.) About 90 percent of their clients are on Medicaid.
When Watts considers the challenges to providing mental health services, he names lack of access and “rugged individuality” as big factors, along with some clients’ struggles with the boom-and-bust cycles of the oil, gas and mining industries.
“The mind-set is the biggest hindrance. ‘I can do it on my own. I don’t need help.’ People see it as a sign of weakness to reach out for help,” said Lee Halberg, until recently the director of the Mancos Public Library in Mancos, Colo.
Last summer, he was in his office when 15-year-old Dustin Ford and a young woman walked past the small brick building and toward the nearby Mancos River. Minutes later, a gunshot sounded. Dustin died, and the girl survived with injuries. They had apparently planned on dying together.
For the Mancos high school, which has about 40 students per grade, it was the second suicide in about a year.
Alanda Martin, a counselor at the school, is part of a team trying to help. Each year, they teach students about suicide prevention and distribute suicide screening forms. But 87 percent of the kids don’t complete the forms, she said.
“There is a ton of resistance here, from students and their parents. Accessing mental health services is not something they do,” she said.
Watts maintains a separate office in Delta, Colo., with a discreet alleyway entrance, he said, for “folks who don’t want to be found” seeking treatment.
Retaining staff, who mostly come from somewhere else, is another constant challenge. To be a therapist here means confronting outsider bias (if you’re from away) or insider bias (if you grew up here and have some kind of history or connection with everyone). No wonder clients are discouraged by turnover.
Help for those most at risk is increasing. In Montezuma County, public and private agencies pooled resources to form the Community Intervention Program. Operating from a single, unmarked van, two emergency medical technicians and a social worker responded to nearly 100 calls in CIP’s first two months. Most involve mental health, drug or alcohol addiction, homelessness or a personal crisis, according to Haley Leonard, spokeswoman for the nonprofit Axis Health System, one of the groups involved.
When summer visitors pour into this region, I wonder if they sense the quiet desolation that some of us who live here — no matter how fiercely we love it — must guard against.
In the middle of a snowstorm last winter, I thought of those women who had caught “prairie madness” in “The Homesman.” Squinting through sideways snow, with darkness falling, I struggled with chores. The horses were hungry and skittish when I gave them hay, most of which was taken by the wind. The chickens hunched their shoulders and looked straight ahead as I closed them in their coop.
The temperature dropped below zero. My thoughts ricocheted between concerns over livestock, livelihood, aloneness. As the house ratted and creaked, I considered my willful isolation, with miles of national forest and only a handful of neighbors nearby. The dogs and I slept by the wood stove, as we would for weeks, to keep the fire fed so my small house would stay above 50 degrees.
In the morning, the snow shone blindingly across the high desert, south to New Mexico and west to Utah. On my front stoop sat an ice-encrusted pan of lasagna. I never learned who left it. I hadn’t asked for help, but someone thought I needed it.