Farmers combat depression amid industry stressors
Trade wars, low milk prices, bad weather and isolation can add up to a lot of stress on area farms.
“On a good day, farming is stressful, but good days are just a distant memory in farming,” said Patrick O’Hara, a licensed clinical social worker who is about to retire as a clinical case manager for the New York Center for Agricultural Medicine and Health at the Bassett Healthcare Network.
“They’re at the mercy of the weather, the crops, the price of milk,” he said. “The production cost of milk is currently above what they’re getting. Every day they’re working 16 hours a day and they’re losing money.”
Throw in poor health coverage, a lack of mental health providers in rural areas and a stigma around mental health issues and that stress can contribute to serious mental health issues and even suicide among farmers, say mental health experts who work with rural populations.
Just consider Wyoming County, where five farmers have died by suicide this year, said Kate Downes, outreach director for New York FarmNet.
“People are really feeling the pinch, and they don’t know what to do,” she said. “So many of them are calling us and many of them are asking directly for counseling services.”
But for many farmers, asking for mental health services is not an option, Downes and others who work with farmers said.
Farmer Ben Simons put the issue succinctly.
“When (farmers) get down and desperate,” he said at a recent roundtable discussion of the issue with Congressman Anthony Brindisi, “they are not going to pick up a phone. They’re going to go out behind the barn.”
A Cornell University researcher working with Centers for Disease Control and Prevention data found that farmers make up the fourth highest number of suicides by profession, Downes said.
“I have not had that many farmers call up and just request counseling,” O’Hara said. “And I think that’s part of the problem with farmers. They’re reticent to reach out and ask for any help. If it comes to mental health services in a rural community, there’s a big stigma associated with mental health problems.”
O’Hara said he thinks suicides by farmers are underreported because it’s too easy to pass deaths off as accidents. And, he pointed out, stress and mental health issues make accidents more likely.
Consider a farmer working after dark in bad weather toward the end of a long day, he said. Now think of him trying to concentrate and make difficult decisions while under tremendous emotional stress, he said.
“It’s just an accident waiting to happen,” O’Hara said.
Brindisi, D-Utica, has taken on the issue of farmers and mental health, sponsoring a bipartisan bill to help by training agricultural workers to recognize signs of stress in farmers, creating a campaign to reduce the stigma of mental health issues in rural areas and to look for ways to identify best practices for responding to stress on farms and ranches.
“I’ve spent a lot of time talking with farmers across the district and hearing their concerns and what I’ve found (is) that the mental health needs of people living in rural communities are not being met,” Brindisi said. “And when you look at the statistics, the CDC reports that the suicide rate is 45 percent higher in rural communities than in urban areas. And that’s a problem I can’t ignore.”
Legislation alone won’t be the answer, though, Brindisi said.
“We have to have a conversation in this country about the stigma surrounding mental health and do a better job educating the public that it’s OK to come forward and ask for help.”
Both Downes and O’Hara expressed support for Brindisi’s bill, which addresses the issue in a way that’s similar to what their agencies are already doing — by using people who understand agriculture to check in with farm families.
The New York Center for Agricultural Medicine began training agricultural workers to recognize signs and symptoms of depression 20 years ago, sending out teams of nurses and social workers to farms, O’Hara said. O’Hara’s own job is mainly to help farmers who have become disabled figure out how to continue farming, often with the help of assistive technology, or to find new jobs, he said.
But he’s also a trained mental health counselor who brings that expertise into the situation when appropriate. Counseling is part of everything he does, he said, “whether they know it or not.”
Over the years, two of the farmers he’s worked with died by suicide, O’Hara said.
FarmNet also helps farmers in a variety of ways, offering free, confidential, on-farm consulting on a variety of topics. Financial and family consultants, who are social workers, go to farms in pairs, Downes said. They get more calls about financial crises than mental health ones, but once on the farm, the consultants help with whatever issues need help, she said.
A lot of their work now involves helping farmers to plan a life after they give up the farm, showing them all the skills they have that will make them good employees, she said.
“That’s a pretty heavy lift because farmers are farmers until the day they die,” she said.
It’s not entirely surprising that mental health issues arise on farms.
“Farmers are really isolated,” Downes said. “They don’t often leave the farm. They have that rugged individualism. … They’re going to pull themselves up by their bootstraps. They’re going to figure it out and they’re going to make it work. Farmers, in general, it’s not easy for them to ask for help, especially for matters around mental health.”
One farmer was put on an antidepressant by a primary care doctor because the farmer was having suicidal thoughts, O’Hara said. But he stopped taking it after a couple weeks because he didn’t want people to think he was “crazy,” O’Hara said.
And those kinds of issues are often compounded by barriers in rural communities. Those issues include a shortage of mental health providers, the distance between farms and mental health providers (which means more time off the farm) and the lack of good health insurance among many farmers, Downes and O’Hara said.
“And in a small rural community, you have a medical waiting room. … There’s no stigma associated with that,” O’Hara said. “Conversely, they go to a mental health clinic and they’re in a waiting room with other people and everyone in that waiting room has something going on mentally. …. There’s stigma associated with that and it’s hard to get away from that stigma.”
One trend that should help, O’Hara said, is toward integrative offices that offer both primary and mental health care so no one in the waiting room would know that another patient is getting counseling. He thinks, in general, that the best advice for struggling farmers is to see their primary care doctors who can listen and prescribe antidepressants, O’Hara said.
Telehealth, which can connect farmers to mental health providers via the internet, also has the potential to help, Downes said, but the lack of broadband internet in some rural areas is a barrier.
Downes does see some encouraging signs, though.
“I’m seeing a little more of our younger generation farmers,” she said, “they are more willing to ask for help. And that’s great.
“But we want everybody to be able to ask for help without feeling ashamed or guilty.”
By the #s:
Suicide rates per 100,000 for people older than age 10 by county urbanization level, 2013-15
• Large metropolitan: 12.72
• Medium/small metropolitan: 16.77
• Nonmetropolitan/rural: 19.74
• Total: 14.98
(Source: U.S. Centers for Disease Control and Prevention)