BREWSTER COUNTY — According to data collected by Texas Community Health News, Brewster County has the highest death by suicide rate in comparison to all other 254 Texas counties.
Mental healthcare accessibility has long been a challenge in Texas, especially in rural counties like Brewster, which can make combatting suicide difficult. Many factors contribute to mental healthcare inaccessibility in the rural areas of West Texas, including underfunding, a shortage of mental health care professionals and stigma surrounding discussions of mental health and suicide.
For various mental health conditions, the most effective treatment for patients is a combination of psychiatric care and therapy. Despite the essential role therapy plays in an effective treatment plan, Todd Luzadder, director of Mental Health Services at PermiaCare in the Odessa and Midland area, says that Brewster is experiencing a significant shortage of licensed professional mental health counselors.
“That’s something we continually struggle with and try to seek funding for,” Luzadder said. “There’s a shortage of those providers, and it’s especially difficult to recruit them to rural areas.”
Luzadder says that PermiaCare’s Mental Health Services have been using innovative ways to combat the lack of professional mental health counselors in Brewster through means such as telehealth technology to connect patients with therapists from other areas. However, this also has posed some challenges as licensing boards often don’t allow for much expansion in the use of telehealth technology due to limitations of many counselors only being able to practice in the state they are licensed.
“We got some therapists in urban clinics in Midland and Odessa,” Luzadder said. “Although, we’re still short-staffed in those therapist positions.”
Along with the high suicide rate, Brewster County also has an insufficient number of mental facilities to properly meet the needs of its population size. Many areas of Brewster County are isolated, which might cause many residents to not be aware of what mental health services are available.
Within the past year, the Big Bend area received funding for a Rural Border Intervention Team to assist in community outreach and education on nearby mental health services available to residents. Luzadder says that there is a growing increase in referrals in the tri-county area to mental health service programs as a result of this outreach.
Along with underfunding and mental health counselor shortages being barriers to preventative suicide treatment in Brewster County, mental health care professionals in rural areas of West Texas also often come across lingering stigma associated with mental health and suicide. There are many misconceptions about mental health and suicide that are prevalent, and Nicole Elliot, a licensed clinical social worker and director of Zero Suicide Services at West Texas Counseling in Guidance, says that she’s seen this stigma especially extend to middle-aged white males who might be more susceptible to feeling shame around discussing their mental health struggles.
“If they share that they’re having some mental health issues, they’re concerned about being perceived as weak,” Elliot said. “There’s still that myth of, ‘If I say the word “suicide” to somebody, that’s going to now plant an idea in their head,’ and the research shows that is not the case.”
Zero Suicide Services in West Texas works closely with local law enforcement in Tom Green County to collect data on suicides within the area, and this year, Tom Green County has had 14 deaths by suicide, and six of those deaths were men aged 70 or older by firearm. Elliot emphasizes the importance on the reduction of access to lethal means as being especially significant in suicide prevention in Texas.
“It doesn’t mean taking your firearms away forever,” Elliot said. “If there’s some way that we can slow down that access … so that there is some time and distance so that crisis can start to come down on the other side of that curve and start to lessen.”
Healthcare access is a challenge faced by many Americans due to a lack of insurance coverage and financial means to pay for care out-of-pocket. Even with insurance coverage, receiving mental health treatment can still be made difficult as many health insurance plans will not cover it.
Five percent of residents in Brewster County are on Medicaid or other forms of public insurance, while 7% of residents have Medicare as their only form of health insurance. PermiaCare in Brewster is currently working to combat financial barriers to mental health treatment by providing patients with access to care regardless of their ability to pay.
“If you have no ability to pay, we work on a sliding fee scale that’s based on your income,” Luzadder said. “The majority of our patients that do not have a funding source pay zero dollars to receive care.”
Other gradual changes have been made in Texas to integrate mental health into standard healthcare practices, according to Dr. Monica Hughes, director of Public Health Nursing for the Texas Department of State Health Services.
“Providers are doing depression screenings now for the most part,” Hughes said. “It’s best practice to do the screening for depression when you’re treating an adolescent for just a regular yearly evaluation, and I think that’s a really positive trend.”
This story uses data from Texas Community Health News at Texas State University. Specifically, it focuses on data related to the prevalence of suicide and depression as well as mental health facilities, which are based on data collected by Centers for Disease Control and Prevention as well as the Health Resources and Services Administration.
Editor’s note: This piece expands on mental healthcare reporting that The Big Bend Sentinel did in early 2024, and all articles in the series can be found at www.bigbendsentinel.com. Authorities suspect a death by suicide in Alpine on February 2, but an autopsy with a toxicology report is still pending completion.