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Rural America is in mental health crisis

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Part 1 of a four-part series on mental health on the farm. Learn about the crisis, awareness, intervention and resources.

Two factors that make production agriculture an ideal occupation for many farmers — working in the country and being independent — are also catalysts for a mental health crisis in rural America.

Isolation and the fierce independence in agriculture create an environment where mental health issues thrive, says Oklahoma State University Extension Professor of Economics Shannon Ferrell.

“Many common factors in production agriculture tend to isolate us, physically and emotionally,” Ferrell said.

Ferrell, as a guest on a recent Ag Law in the Field Podcast hosted by Texas A&M AgriLife Extension Agricultural Law Specialist Tiffany Lashmet, said his work with farm families on legal issues (farm transition, for instance) made him aware that financial and other stresses put farm families at risk for mental health problems.

He said the pandemic brought a lot of those issues to the forefront and will continue to affect rural America for years to come.

“We see mental health as an issue across the board, but I think for American agriculture, it's a major issue and one with perhaps different causes than we see in other areas,” Lashmet said. “Why is mental health such an issue in rural America and for agriculture?”

Ferrell explained that late in the 2010s rural America “was on the precipice of a farm crisis that looked a lot like the 1980s.”

He said the high interest rates of the ‘80s were not apparent, but “pressure on commodity prices and input costs were.”

Writing on the wall

He said the pandemic exacerbated the problem. “We saw the writing on the wall, so many dynamic stresses on people, especially the isolated folks in rural communities who don't have connections available in other areas. They lack the tools to deal with that level of psychological impact.”

“We know that we have a mental health crisis in rural America, and we have to get resources out to these communities.”

Ferrell says Extension has a unique relationship with folks in the rural communities. “We have a legal background [Ferrell and Lashmet are both attorneys.] and as we help people with legal issues, we see that farmers are experiencing symptoms of stress — depression, anxiety, all those things.”

Download our guide to mental health, Being healthy: Mental health resources for farmers.

He said those stressors are common and friends, neighbors, and professionals who interact with rural communities should be aware. “Farmer, rancher, ag lender, financial professional, anyone at the intersection of the industry and producers, is in a position to see if those producers are struggling. Anyone can make a difference if they're willing to do a little bit of work.”

“We're connected with our neighbors,” Lashmet said. “We understand what's going on. We can look for things and we have the ability to help.”

Toxic grit

Shannon said the mental crisis is pervasive across rural America but is alarming in Oklahoma. “In Oklahoma, we are not okay.

“Oklahoma is third in the nation for mental illness across the board. We're second in the nation for substance abuse disorders, second in the nation for serious mental illness – that is, mental illness so severe that it has a marked effect on people's ability to interact with family and to perform at their jobs.”

He said a large segment of Oklahoma “is in a mental healthcare desert, more than 60 miles away from a mental health professional. It is hard for those residents to get to mental health resources.”

Much of state's crisis is driven by rural areas without access to mental healthcare services, as well as rural isolation, he said.

“Isolation in agriculture drives a lot of what we might call 'toxic grit.' We glorify our fierce independence, our self-reliance; we think we can handle any sort of trauma.”

Ferrell said the image of being tough, independent, and self-reliant often gets in the way of farmers admitting they need help.  

“That's where a lot of mental health issues start to flare up. Human beings do not have a limitless ability to process trauma without some sort of support. If folks keep internalizing it, it will have negative effects.”

He added that encouraging people in stressful situations to “suck it up, buttercup” doesn’t allow them to express when they're not okay. “We have to let people know that it's okay to not be okay.”

He said mental health issues are often viewed as weakness of character, especially in rural communities.  “That attitude discourages people from expressing that they're not okay. The cycle repeats over and over until they reach a crisis point.

“That's why we have a phenomenally high suicide rate in agriculture.  Agriculture is the fourth highest industry segment in the U.S. in terms of suicide rate.

“We have a drastically higher rate of completed suicide in agriculture. We have access to more lethal means than an average person in an urban setting. We've got to start talking about that.”

Early warning signs

Suicide ideation (thinking or talking about suicide) could be an early warning, he said.

 Ferrell said farmers might consider the isolation and the fierce independence in agriculture as job perks. “But we can't focus on that to the exclusion of earnestly connecting with folks, expressing when we need help and getting that help.”

“We have to start talking about it,” Lashmet said. “We also need to understand that our words matter and affect people. If somebody came to us and said very clearly that he or she was struggling and in crisis, possibly having suicidal thoughts, we would choose our words very carefully when talking to that person.”

She and Ferrell agree that the stigma of mental health issues gets in the way of seeking help or encouraging others to seek help. “We don't know who is carrying around those sorts of thoughts or issues,” Lashmet said. “So, we need to be careful of what we say.”

“We’ve set ourselves up culturally to hesitate to express mental health problems,” Ferrell said.  “Farmers, let's be honest, love to complain. But they can't complain about something that might be construed as weakness of character.”

He said they can complain about prices, weather, or other problems. “But they can’t admit that they feel depressed all the time, hopeless, like nothing they do matters. They can't say how those issues are affecting them.”

It’s time to change that mindset, Ferrell said.

“We need to change the way we ask, ‘how are you doing?’ Simply say, ‘no, I really want to know, are you doing okay?’ I want people to ask that question, seeking an honest answer. I think little cultural changes could make a big difference and could show people that we care.”

Thinking about self-harm

He said a friend or business acquaintance might encounter someone who expresses suicidal ideation. They might indicate that they are thinking about self-harm.

He said terms like “no point in me being around anymore; I'm better off dead,” should be warnings. “React to that person. Many people are scared of mentioning the term suicide because they're worried that they might push them closer to the edge.”

That’s not the case, according to clinical research, Ferrell said. “Research shows that is 180 degrees off. All the clinical research says that if you confront someone—not aggressively but helpfully — the evidence shows that you are demonstrating awareness of that person's suffering and care enough to ask them about their well-being. That will pull them back, not shove them forward.”

Lashmet said asking if someone is okay might “plant the seed. At some point, if they need to talk to somebody maybe they will remember that you were open to that.”

Ferrell said folks need to let people know they care about them. He said it’s okay to let folks know you love them. “No one has been struck dead when they said those words.”

If you or someone you love is feeling hopeless or suicidal, dial 988, the new three-digit dialing code, to be routed to the National Suicide Prevention Lifeline. When people call, text or chat 988, they will be connected to trained counselors.

Next in this four-part series: Awareness crucial for mental health intervention

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