Because rural areas are significantly less populated than urban and suburban areas, their needs are often overlooked, and they receive limited funding and support from the government. As a New Yorker, I was curious about the steadying trends in the state’s suicide rate over the years. As I dug deeper, however, I found that the rate continued to rise in rural areas with little notice, not making a blip on my line charts illustrating statewide trends.

Considering New York had the lowest suicide rate in the nation at the time, I knew it would not be easy to convey the need for rural services, resources, and support to policymakers and state decision-makers. This need had to be conveyed by the communities themselves, and they had to be compelling to win over limited resources. I wanted to offer my assistance in conveying their message.

Many topics discussed during the RLT were similar across counties, while some were unique. For example, some counties talked mostly about youth and young adults struggling with their mental health and how their parents were challenged to navigate the system for their care. Other counties talked about their older adult population, social isolation and loneliness, and how the approaches they use to reach the general population have not been as effective in reaching older adults.

All counties talked about limited behavioral health services, heightened stigma, long travel distances, and transportation issues as barriers to receiving care. We provided several recommendations in our report, including integration of behavioral health services into primary care settings, services that were significantly more prevalent in rural communities than behavioral health services and carried significantly less stigma.

Since completing the RLT and publishing our report, we’ve undertaken several efforts to help rural New York communities implement our recommendations. We’re working with Genesee and Orleans counties to dive deeper into community perspectives on addiction, mental health, stigma, and suicide risk through listening sessions with residents, health professionals, first responders, school staff, faith leaders, and legislators. We’re also training primary care providers on screening and intervention for substance use and suicide risk among young people using our Screening, Brief Intervention, and Referral to Treatment (SBIRT) and Suicide Care (SBIRT-SC) model.

SBIRT-SC combines universal screening with brief, evidence-based interventions. Providers use validated tools like AUDIT and DAST-10, followed by a five- to 15-minute brief negotiated interview that guides respectful conversations about behavior change. The suicide care component uses the Columbia Suicide Severity Rating Scale and Stanley Brown Safety Planning Intervention, with structured follow-up to monitor progress and barriers.

A major post-RLT initiative focuses on older adults’ mental health needs. We’ve modified SBIRT-SC to integrate social prescribing for adults 55+ in primary care settings. After screening for social isolation using tools like the UCLA loneliness scale, providers conduct brief interventions to identify contributing factors and barriers to engagement. Patients then receive referrals to community activities—mentoring, art classes, gardening, community service—that research shows reduce isolation and depression while improving mental well-being.

We’re currently piloting this social prescribing model in Western and Central New York primary care clinics, partnering with local community organizations. Growing statewide interest led to our invitation to present at the Adirondack Health Institute Summit in Lake Placid, where North Country providers can learn about implementation. This model addresses a key pillar of the state’s Master Plan on Aging and has significant promise for statewide expansion—NORC is ready to provide that support.