Mental health concerns in rural communities
Agriculture is a very stressful occupation because there are so many challenges and unknowns that affect daily life. Even if a person is really good at what they do, there are outside factors over which we often have no control, such as the weather or markets.
A person can go broke in spite of “doing everything right” when markets for farm products crash or a devastating blizzard, flood or drought wipes out what producers have worked so hard to produce. The heartbreak and sense of failure can be overwhelming.
Depression, suicide, drug abuse and addiction are problems that affect urban and rural populations in all parts of the country, but suicide and drug deaths are actually higher in rural America. The Center for Disease Control reports that rural areas have a higher suicide rate than non-rural areas, yet farmers, ranchers and people in rural communities often have limited access to the diversity of mental health care they may need. Usually there are very few services offered in small towns, and people have to travel to reach them.
Typically, the closest providers are general practitioners, and there is very little specialized care. Often the first step for some people is to utilize a telephone crisis intervention program. There is also a lot of misunderstanding about mental health services because many people think in terms of “mental illness” (which raises the image of being crazy) rather than “mental health” (which is important to every human being’s life). Many people are reluctant to seek help because they feel it would look like some kind of failure on their part (rural folks are supposed to be strong) and signify that there is something wrong with them. The close-knit nature of small communities can also heighten stigma around seeking treatment. There is sometimes a fear or sense of shame if someone sees your car parked at the only psychologist’s office. Embarrassment/shame may be felt more acutely in small rural towns because of the lack of anonymity.
People who live in rural communities also face unique challenges in accessing care for mental health problems. Some of these challenges, according to the Western Interstate Commission for Higher Education (WICHE) are the fact that rural folks are less likely to be insured and more likely to travel long distances for help, and less likely to recognize mental illnesses.
Availability is another challenge; more than 60% of rural Americans live in areas where there’s a shortage of mental health professionals. Most psychologists, psychiatrists and social workers practice in urban areas. There are very few professionals trained to work in rural areas, and the individuals they serve may have trouble acknowledging a mental health problem. The most common barrier to treatment, according to one study is the belief that “I should not need help.” Other common barriers include not knowing where to go, distance, mistrust of counselors or therapists, “not wanting to talk with a stranger about private matters.”
Cynthia Beck, a university student completing her honors degree in psychology, intends to go to graduate school to become a clinical doctoral psychologist. She intends to open a mobile mental health service practice. “Currently I am a rural suicide intervention responder covering most of southeastern Saskatchewan. I have been doing this for almost five years,” she said.
“I am independent, so people typically find me by word of mouth. I’ve now responded to more than 200 calls. Many of those people were not yet at a point of having an active plan for suicide, but some of them were. They had all reached a point where they knew they couldn’t continue the way they were, and had to do something. I am proud to have not lost anybody that I have worked with in the four years that I have been doing this,” she said.
A LIFE PLAN
What she tries to do first is help people identify reasons for having a life plan instead of just having a death plan. “I tell people that they always have options; that ultimately it is their choice regarding which plan they go with. When you tell them that they have a choice, this opens up more possibilities and you give them back some control. Generally the people who are in that place of raw desperation feel they have no more control,” Beck said.
“When you tell them that it’s their choice, you ignite hope again, giving them back a bit of control, and something to reach for. I help them work on a life plan, help them choose a life plan, and try to get them into services that can help. Depending on how severe their problems are, this might mean going to a hospital that night, intervening with medical services, or getting them worked into the health care system,” she said.
In the rural environment, there may be inconsistencies in care because often the doctor in a small town doesn’t stay very long; there is a lot of turnover. “For someone who is dealing with anxiety or depression, when a new doctor comes along they have to tell their story over again and basically start over, and many people are reluctant to do that. At some point it becomes too exhausting. That’s what I found when I was seeking help, and that’s why I went back to the university in 2015,” she said.
“I no longer could be angry with the situation and needed to be able to do something to be part of the solution. My husband and I also farm, so I am familiar with the challenges producers face. I went through my own severe mental illness; it had been building for a while and then in 2009 it reached the surface. Today, when people phone me and say they have to do something because the pain has to end and they don’t know what their options are other than killing themselves, I can relate to that. I’ve been there. I have lived that. I am usually very direct and honest with the people who call,” she said.
THE BEST APPROACH
There are concerns that a direct approach might give someone the idea of suicide but Beck is convinced that being honest and direct, and frank with people, is always the best approach. “It frustrates me how people use euphemistic language around such a serious and straightforward topic. There are no shades of suiciding.”
Many people feel utterly alone when they make that choice and if they can talk to and open up to someone who has been in that same spot, in their shoes, there is a degree of movement away from that total feeling of desperate aloneness. “If I share a little of my story, or tell about the moment I realized I needed to do something, the desperate person feels more connected,” she said. If they can talk to someone who has been there, who got through it and back to a “normal” life, it gives them hope. They realize they could get past this, too.
“Most people don’t realize that I still deal with depression. They look at me and say, ‘You’re happy. You farm and you have kids and you are at their hockey games all the time, and how do you have time to be depressed?’ But this is what you can do, after being in a place of darkness. This is what hope and optimism looks like,” Beck said.
“Farmers and ranchers live and work in a constantly frustrating environment where we have little control over most of what goes on in our lives. We can’t control weather, markets, input costs, machinery costs, calf prices.” There are also accidents and freaky bad luck. There will always be challenges — which include mental health challenges — to overcome, when we look at all the variables in our lives.
“Many agricultural producers face unique barriers to accessing mental health care that sometimes people in mainstream health care may not be aware of. It’s one thing to wait six months after you finally reach the breaking point and muster the courage to call for help. You phone the health line, and they tell you someone will call you back. They call you back and set up an appointment for you that’s probably three to six months away. So you maybe think you can try to hold on that long. But three to six months from now, you may be in a busy time — seeding, or harvest, or calving. If you are in the middle of harvest, the chances of you getting off that combine (or taking time out during a difficult calving season) are poor.”
DOING THE JOB AT HAND
People who work at a 9 to 5 job can usually say they have a doctor’s appointment and need to take a couple hours off, and still might get paid, or can take a sick day or holiday time to do it. They are still earning an income. But for people in agriculture, everything depends on you doing the job at hand.
“Taking that one day off, to drive 2 hours to go see a mental health practitioner, may not be feasible. What if there’s a frost that night? What if you lose a quarter of your income because you went to that appointment? This is why we need to define what accessible actually means. Many people think mental health services are available, so they are accessible, but this would be like me saying to a person in a wheelchair that there’s a bathroom on the third floor (but no elevator to the third floor). There might as well not be a bathroom for that person. It’s the same with mental health services, for someone in agriculture,” Beck said.
She feels there is at least a little more awareness now of the problems. “This is a first step. In 2009, when I was needing help, the only solution available was for my doctor to put me in the psych ward to get some sleep. I couldn’t do that; we were in the middle of harvest and had two small children. There was no way that I could be gone from home, because my husband would be looking after two small children in a combine, and who would be feeding them? I would be worse off worrying about them while I was away in a psych ward. We have a lot of services today that did not exist back then; we have come a long way, and that’s hopeful,” Beck said
“If you or someone you know needs support, take steps to learn what help is available and accessible. Social media provides the opportunity to connect with others, which helps decrease some of the isolation we face in agriculture. Many areas now have crisis services or mental health supports of some kind. The internet has information and strategies for mental health. There are also online therapy programs available. There are some things beyond anyone’s control, but taking that first step to help ourselves is one piece we need to hold onto,” Beck said. ❖
— Smith Thomas is a cattle rancher, horseman, freelance writer and book author, ranching with her husband near Salmon, Idaho. She can be reached at firstname.lastname@example.org.