Editor’s Note: This interview first appeared in Path Finders, an email newsletter from the Daily Yonder. Each week, Path Finders features a Q&A with a rural thinker, creator, or doer. Like what you see here? You can join the mailing list at the bottom of this article and receive more conversations like this in your inbox each week.
Dante Chinni is a data journalist at NBC and the Wall Street Journal, as well as the director of the American Communities Project (ACP). His 2011 book with fellow Path Finder interviewee James Gimpel, Our Patchwork Nation, was a precursor to the work he does now grouping American counties by density, city-proximity, and population demographics.
Our conversation centered around a documentary short released by the ACP in February, “Teen Suicides in Rural America,” which investigates the tragic uptick in youth suicides in aging communities like Livingston, Montana.
Enjoy our conversation about Graying America, mental healthcare accessibility, and improvements in teen suicidality in Park County, Montana, below.
Editor’s Note: This interview contains frank discussion of suicide. If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.
Olivia Weeks, The Daily Yonder: What is the American Communities Project and what are the goals of its study of deaths of despair across America?
Dante Chinni: The ACP is a data journalism/research effort based at Michigan State University. We’ve used demographic data to break the nation’s 3,100+ counties into 15 different types of communities. Some are urban (such as our Big Cities and Urban Suburbs types) and some are more rural (such as Aging Farmlands, Rural Middle America and Graying America). The larger point behind the project is the place you live and the people you live around greatly impact the way you see and experience the world on a broad range of topics from economics to politics to culture.
The study of Deaths of Despair is being funded by the Arthur Blank Family Foundation. Their interest came from the work of Anne Case and Angus Deaton and their book Deaths of Despair and the Future of Capitalism. Deaths of Despair are those caused by drug overdose, alcoholism and suicide and the work of Case and Deaton found a spike in these deaths was behind declining life expectancy numbers for white Americans, particularly those without a college degree.
So, our mission was to merge these two concepts together. Do we see differences in Deaths of Despair in our 15 community types and if so, can we point to reasons why? Our work has found there are notable differences in the types, with the ACP’s rural places scoring especially high on Deaths of Despair as well as a set of blue collar Middle Suburb counties around the Great Lakes. Leading the way, by far, has been the Native American Lands counties, a small collection of scattered rural counties that are home to tribal communities. The “why” as always is harder, but I think our work sheds light on some possible factors.
DY: Your documentary short, “Teen Suicides in Rural America,” focuses on what you call “Graying America” and the Montana town of Livingston, in particular. What is Graying America and what is the relationship between age demographics and the prevalence of teen suicide?
DC: Graying America is one of our 15 community types. There are about 360 Graying America counties mostly based in the northern and western states. They tend to be rural communities with aging populations – many are retirement communities.
The age correlation on teen suicides is not clear. There may not be one. But the rural nature of these communities is likely an important factor. In our data we’ve found that the number of teen suicides is rising everywhere, but the numbers tend to be higher in rural places.
Again, there isn’t a certain answer as to why, but one theory is those communities tend to be more isolated and perhaps traditional in their views of what being a young person “should” be. It may be harder for young people that are a little different to fit in.
DY: I know you aren’t necessarily trying to establish a causal relationship between aging populations and the tragedy of teen suicides, but I’m wondering if its possible that firearm ownership is a confounding variable here. What evidence points to the conclusion that, more than just representing places with high gun ownership rates, graying parts of rural America are worse places for teen mental health?
DC: Gun ownership is certainly cited by experts as a factor in the higher rate of teen suicides in rural communities and the higher rate of suicides in general. I don’t think we can say that gun ownership is necessarily higher in Graying America, but we do know from previous work and survey work in general, that there tend to be higher rates of gun ownership in rural communities.
For our work, we chose a Graying America community in Livingston because 1) we knew about specific stories there from other work, and 2) we knew the figures for Graying America made it a good type to use to look at the broader trend. There was a cluster of ACP types around its numbers, including Working Class Country and Evangelical Hubs.
To be clear the numbers in those communities are still far lower than they are in the Native American Lands and the Aging Farmlands, but those places both had broader issues to address – the generational trauma of Native American communities and the extreme remoteness of the Aging Farmlands. We thought Graying America and Livingston let us explore the issue in a rural place that shared some common issues (and data points) with other largely rural places.
DY: In the documentary, the sister of a young man who died by suicide argues for more pro-mental health and anti-bullying campaigns. What are the evidence-based types of programming that can combat this problem? Are there targeted programs that work, or does the problem inhere in something more fundamental about an aging community?
DC: That’s a tough question to answer. We are really still at the beginning of understanding what programs work and how they work. We need large scale analyses of data and, frankly, time to watch for effects. That said, as we noted in the piece, there are early signs that the approach they have tried in Park County, screening kids of all ages to see if they are “OK” is making a difference.
A 2021 survey of young people in Park County showed an 18% drop in suicidal thoughts and a 39% drop in suicide attempts compared to 2019. Those are big changes outside the realm of statistical noise.
DY: In another interview featured in the documentary, Dr. Reza Hosseini Ghomi of Frontier Psychiatry says that, in Livingston, “the tolerance for trauma is higher here than what I’ve seen in other, better resourced places.” This feels a bit like a chicken or egg problem. Indifference to mental health services and lack of access to them might well be self perpetuating. What is the best entry point for making progress?
DC: Well, I think he is talking about the state of Montana in general there, but yes, that’s true and I think he makes that point. Dr. Ghomi is essentially arguing that there isn’t a lot that can be done currently because of resources. So, the threshold for action is higher, which ultimately compounds the problem. He also notes that the amount of trauma he’s seen in the state is remarkable.
One idea is using remote counseling more. Some have noted that remote counseling may have advantages in some rural areas because it helps mitigate hesitance to receive help. Rural communities tend to be tightly-knit. People know their neighbors and know what kinds of cars and trucks they drive. Having one’s vehicle in front of a therapist’s office can be hard for some people. This actually may be one positive to emerge from Covid-19. With the pandemic, Montana and other states moved behavioral health to video conferencing or the telephone. The impact was obvious. In 2019, one Montana clinic, Community Health Partnership, conducted about 100 visits for both medical and mental health visits. By the end of 2020 that number had jumped to more than 15,000.
This interview first appeared in Path Finders, a weekly email newsletter from the Daily Yonder. Each Monday, Path Finders features a Q&A with a rural thinker, creator, or doer. Join the mailing list today, to have these illuminating conversations delivered straight to your inbox.