As federal dollars begin flowing into rural healthcare, an important question deserves an answer: Will this historic investment help prevent suicide deaths?
Paul Quinnett, Ph.D. | QPR Institute | October 2026
The federal government has committed $50 billion over five years to transform healthcare in rural America. All 50 states submitted applications, and the first round of funding is being distributed.
This is welcome news for rural communities struggling to maintain hospitals, recruit healthcare professionals, and provide timely access to medical and behavioral health services. It should be a light at the end of the tunnel for those thinking about suicide while driving a tractor across a cornfield.
But there is a question I hope federal and state officials, county commissioners, hospital administrators, and public health leaders will ask as they decide how to spend this money:
Where, specifically, is suicide prevention in these plans?
I ask because funding behavioral health services is not the same thing as funding suicide prevention. Not by a long shot.
A major cause of preventable death
Suicide remains one of America’s leading causes of premature death. In 2024, it was the second leading cause of death among Americans ages 10 through 44. The burden is particularly severe in many rural communities.
In 2024, Alaska, Wyoming, and Montana were among the states with the nation’s highest suicide rates. These are places where long distances, workforce shortages, and limited access to specialty care can make responding to a suicidal crisis especially difficult. Sometimes a visit with a mental health professional requires a ride in a bush plane across the tundra. If you consider a two-hour drive to a professional reasonable access, then you haven’t tried to drive across North Dakota in the wintertime.
We have known about these disparities in access to care for years.
Now, with an extraordinary federal investment underway, we have an opportunity to do something for the people we say we care so much about when we sit down to baked chicken wings and potato skins with sour cream.
The question I’m asking is whether suicide prevention will be a specifically identified, funded, and measurable objective—or simply something we assume will happen when we expand behavioral health services. I worked in public mental health for decades and while we expanded our services constantly our suicide rates stayed about the same in our county. And I directed a 24-hour crisis line as well as the emergency mental health services for half a million people. We did just about everything but really focus on preventing suicide among the people who would never call us and never voluntarily walk through our front door. There is an old saying that you can’t solve a problem you don’t know about. And I’m worried that we might keep our focus on one thing while the other thing continues to cost us lives.
What does the funding evidence show so far?
The Rural Health Transformation Program provides states with substantial resources to improve access, strengthen healthcare workforces, expand technology, and address behavioral health needs.
The early funding announcements show considerable activity. Rural health centers are receiving support for facilities, information technology, workforce development, and integrated care.
These are worthwhile investments. Rural America needs them.
But an initial examination of publicly available awards does not yet tell us how much money is specifically being directed toward preventing suicide attempts and deaths.
There are encouraging exceptions.
Wisconsin, for example, issued a Rural Health Transformation funding opportunity offering up to $500,000 in first-year support to expand Sources of Strength, an evidence-based youth suicide prevention program, in rural and semi-rural schools.
Here, suicide prevention is not merely implied. It is explicitly named, with a proposed activity and dedicated funding opportunity.
That is the kind of clarity we should look for in every state’s rural health plan.
We do not yet know how many other states have made comparable commitments. Nor should we conclude that the absence of the word suicide in a brief award announcement means no suicide prevention work will occur.
But if suicide prevention is an intended outcome, why not say so? Why not specify what will be done and how success will be measured?
Rural communities are already taking action
There is good news that deserves recognition.
Across rural America, hospitals, school districts, agricultural organizations, county health departments, and community groups are already offering QPR suicide prevention training. They are also offering training like ASIST and perhaps other programs of which I am not aware.
In Wisconsin, rural-serving Aspirus Health has offered QPR training for community members. Similar initiatives are appearing in rural schools, farming communities, and local public health programs elsewhere.
This is exactly the kind of activity we should encourage.
Most people experiencing a suicidal crisis do not begin by announcing their intentions to a health professional. Their distress may first become visible to a family member, coworker, teacher, pharmacist, pastor, or friend—or something said to a bartender in perhaps the only tavern within 50 miles. For 10 years I lived in The Bitterroot mountains of rural Idaho near a village of 70 people. If you wanted to know what’s going on in town you needed to hang out and buy a beer at the only tavern within a 35 mile drive. Why we haven’t trained bartenders and hairdressers as suicide prevention gatekeepers is beyond me.
These are the people who may notice that something is wrong.
They do not need to become mental health professionals. They need to know what to look for, what to say, and how to help.
Suicide prevention begins before the clinical door.
Recognition is not enough
Training communities to recognize suicide risk is only part of the solution.
Once someone is identified as being at risk, what happens next?
In many rural communities, the nearest mental health professional may be hours away. A hospital emergency department may have no specialist trained in suicide-focused treatment. When I went to our rural hospital ER after cutting my hand and they found out I was a psychologist they quickly sewed up my hand and then offered me a job. They had no one on staff who knew how to talk to people thinking about suicide. If a patient expressed suicide ideation, all they could do was hire sitters to accompany them in the emergency room for hours on end until they could get a bed at Kootenai Hospital in Coeur d’Alene, or try to detain them at the state hospital in Orofino. Neither discharge plan would appeal to anyone I know.
We cannot solve this resource problem simply by training more people to recognize danger and then expecting already overburdened hospitals to manage every crisis.
We must also expand access to effective clinical care.
One promising approach is the Collaborative Assessment and Management of Suicidality, or CAMS, an evidence-based clinical framework specifically designed to assess and treat suicidal patients.
Research supports CAMS for reducing suicidal ideation, although results differ across studies and outcomes. It is one of several suicide-focused approaches that deserve consideration.
With appropriate training, supervision, and *telehealth capacity, rural clinicians could deliver suicide-focused treatment without requiring every community to establish a new specialty clinic. I’m sure they already are but not nearly enough capacity has been built.
We should also strengthen the human connections between identification, referral, treatment, and recovery.
Trained community supporters, peer specialists, and more advanced helpers such as QPR Pathfinders may have important roles in maintaining contact, helping people navigate services, and supporting continuity of care. These helpers do not replace clinicians. They help people reach them and remain connected.
A crisis call may save a life today. Recovery usually depends upon relationships tomorrow.
What should rural health transformation accomplish?
If suicide prevention is to be a meaningful part of this historic investment, I would suggest four practical commitments.
First, states and counties should explicitly identify suicide prevention in their rural health plans, particularly where suicide mortality is high.
Second, they should invest in community recognition and early intervention. That means preparing the people most likely to encounter someone in distress, not just those employed in healthcare.
Third, rural residents need timely access to clinicians trained in evidence-based, suicide-focused assessment and treatment, including CAMS and other appropriate approaches.
Fourth, states should measure what they accomplish. How many people were trained? How many were identified and connected with help? Did referrals result in care? Are suicide attempts and deaths declining over time?
Training counts and referral numbers are useful measures of implementation, but they are not substitutes for evaluating health outcomes.
An opportunity we should not miss
The Rural Health Transformation Program offers an unusual opportunity to build prevention capacity in communities that have long struggled with limited healthcare resources.
It would be unfortunate if we invested billions in treating the consequences of suicidal crises without also investing in preventing those crises from becoming fatal.
We are never going to produce enough mental health professionals to recognize every person at risk of suicide.
But we can train the people who already know them. We can make evidence-based treatment more accessible. And we can build dependable connections between community recognition and professional care.
The federal money is beginning to move.
Before it is all committed, I hope someone in every state and county planning process will ask a simple question:
How much of this investment is specifically intended to prevent suicide deaths, and how will we know whether it worked?
Preventing suicide, it’s what people do.
References and sources
Centers for Medicare & Medicaid Services. (2025). All 50 states seek to transform rural health with CMS. https://www.cms.gov/newsroom/press-releases/all-50-states-seek-transform-rural-health-cms
Garnett, M. F., & Zehner, A. M. (2026). Changes in suicide rates in the United States from 2023 to 2024. NCHS Data Brief No. 572. https://www.cdc.gov/nchs/products/databriefs/db572.htm
Wisconsin Department of Health Services. (2026). Sources of Strength Project: Rural Health Transformation Funding Application. https://www.dhs.wisconsin.gov/contracts/sources-strength-project-rural-health-transformation-funding-application.htm
National Association of Community Health Centers. (2026). Rural Health Transformation Program: Year 1 awards. https://www.nachc.org/wp-content/uploads/2026/10/2026-10-06-RHTP-Dashboard.html
Wisconsin Department of Health Services. Suicide prevention: Strategies. https://www.dhs.wisconsin.gov/prevent-suicide/strategies.htm
The effectiveness of CAMS compared to alternative treatment conditions: A meta-analysis. (2021). https://pubmed.ncbi.nlm.nih.gov/33998028/
Reducing short-term suicide risk after hospitalization: A randomized controlled trial of CAMS. (2023). https://pubmed.ncbi.nlm.nih.gov/36162692/
Quinnett, P. G. (2023). The Certified QPR Pathfinder Training Program: A Description of a Novel Public Health Gatekeeper Training Program to Mitigate Suicidal Ideation and Suicide Deaths. Journal of Prevention, 44, 813–824. https://doi.org/10.1007/s10935-023-00748-w
AI Disclosure
The ideas, opinions, clinical experience, and occasional provocations are mine. Quigley helps me get them onto the page, and I review what we produce before it goes out into the world.
