Suicide rates in the United States have increased 37 percent since 2000, according to the U.S. Centers for Disease Control. And in Minnesota, it’s increasing faster in rural areas, when compared to urban and suburban numbers.

A new report from the Center for Rural Policy and Development says there are unique challenges to rural life that make it harder to get help for those who need it.

“It’s difficult to get providers to go to rural areas. It’s difficult to maintain facilities in rural areas. Just because of the distance and everything, it costs more to provide service in rural areas,” report co-author Marnie Werner told MPR News Host Cathy Wurzer. “And as clinics and hospitals close, you lose that access. We’re working on figuring out how to get more providers out in rural areas, because it is an issue.”

Werner said there is one mental health provider per 700 residents in rural Minnesota, compare to one per 190 in the metro.

She said, while getting better, stigma may also keep people from seeking help.

You can hear Werner’s full interview by using the audio player above, or read a transcript of it below. It has been lightly edited for clarity.

Your report says rates are increasing across various groups. Can you put a face on those figures?

In rural areas, in general, the suicide rate has been going up. But there are specific groups where it’s higher than average, including farmers. Native Americans are also a big, important group. Their rate has always been higher. And then there are also younger people.

What role does isolation play in suicide rates?

Isolation is a big problem. When you don’t have someone to talk to, those thoughts can just swirl around in your head. And research has found that just being able to share your problems with another person can be a big help to just get those thoughts out of your head.

When you’re isolated like that, things just get worse, they seem worse. And so that’s why we talk in the report about the importance of people just noticing their friends and family, and noticing if they’re suffering, and not being afraid to talk to them if it seems like there’s a problem.

Folks living in small, close-knit communities may worry about privacy and confidentiality. Probably a number of people just don’t want to seek the help they need because of gossip, right?

In small towns, where everybody knows everybody else’s business, people are concerned that if they’re seen going in the door of a mental health provider’s clinic or office, that their neighbors will notice and they’ll just be like, “Oh, what’s he going in there for?” People don’t like to be talked about in that way.

They’re also concerned that if people see them seeking help, they’ll think, “Oh, he’s crazy,” or, “He isn’t able to fulfill that job or that role in the community because he has a mental health problem.”

The stigma issue has really been improving quite a bit over the last, you know, 20-some years, especially in rural areas. So it’s better, but it’s still not gone.

It’s the people themselves who may need help that are concerned about that stigma. And it’s important to help people understand that not everybody is talking about you and that people understand that you may need some help and that a lot of people are in the same situation.

I see that 82 percent of all the licensed mental health professionals practice in the metro area. So access might be pretty tough for rural Minnesotans.

We found that in the metropolitan areas, the ratio was, like, one provider to 190-some residents, whereas in the most rural areas, it’s one provider to 700-some residents.

It’s difficult to get providers to go to rural areas. It’s difficult to maintain facilities in rural areas. Just because of the distance and everything, it costs more to provide service in rural areas. And as clinics and hospitals close, you lose that access. We’re working on figuring out how to get more providers out in rural areas, because it is an issue.

What does help that is culturally competent for rural areas look like?

Rural has its own culture, just like any other community of people with similarities, whether it’s through race or religion. Even within Minnesota that varies from place to place. So you’ll have your southern Minnesota culture, which is really ag based, you go up to Northeastern Minnesota and the Iron Range, you have a different culture up there.

Some of the common factors in rural areas are a real sense of independence and a very strong work ethic, which is a very good thing to have. But it can also work against a person if they feel like, “I should be able to fix this myself. I should be able to think through this myself.” And so that can get in the way.

Also, the tight-knit families, which is a good thing, but it can also be a problem where the family members may say, “We can fix this ourselves. The family takes care of itself.” And providers need to understand those things. Because if they come in acting like “I am the doctor, I am the Ph.D., I am going to fix you,” that’s not going to fly in rural areas. People are also skeptical of outsiders. And so that’s a problem.

If you or someone you know is in crisis right now, please call, text, or chat 988 to connect with a trained counselor who can help you.