By Rebecca Hillel, Olivia Kraus & Sally Spencer-Thomas
“I believe it’s one area that farmers lack bad, they maintain their tractors, they maintain their pumps and everything but they don’t maintain themselves” (Harry, male farmer in Judd, Jackson, Fraser, Murray, Robins, & Komiti, 2006, pp. 7).
AttitudeTV New Zealand video here: https://youtu.be/VjfeXcukBRM
Working 80 hours a week on the farm your sole identity becomes “a farmer” – it’s what you’ve known your whole life. Then stress that is beyond your control becomes unmanageable – changes in weather, economics, technology – you start to feel overwhelmed but you don’t have the option to not get out of bed. The well-being of animals and family depends on you, and you can’t show that you are at all impacted, so you feel completely alone.
The stoicism of farmers helps them power through hardship and harsh environmental conditions often in great isolation, but when it comes to their mental health, this power through approach can be life threatening.
It’s not surprising then that “farming, fishing and forestry” is the industry with the highest suicide rates (McIntosh et al, 2016) – almost 7x higher than the general population.
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Farmers exhibit an array of risk factors for poor mental health and more specifically, suicidal risk. These risk factors are compounded by a demanding occupation that makes it difficult to prioritize treating mental health problems as well as a farming culture that discourages acknowledging and seeking help for psychological problems. The demands of the farming occupation, the nature of farming culture, and the risk factors farmers are prone to experiencing combine to put farmers at high risk for death by suicide.
Farmers’ high risk for suicide is reflected in both national and global suicide statistics (Behere & Bhise, 2009; Judd, Jackson, Fraser, Murray, Robins, & Komiti, 2006; Malmberg, Hawton, & Simkin, 1997). In India, Sri Lanka, Canada, England, Australia, and the United States, farming is associated with a higher suicide risk than that of the general population. It is also notable that rates of suicide among female farmers have increased over time (Behere & Bhise, 2009). Given that the high rate of suicide among farmers is a global problem, there is a critical need for suicide prevention, intervention, and postvention tailored to meet the specific needs of farmers.
Why are farmers at risk?
Photo Credit: Sally Spencer-Thomas
Access to and familiarity with lethal means. Studies indicate that farmers trying to die by suicide are most likely to use means to which they have easy access (Behere & Bhise, 2009). In India, for example, poisoning by pesticide consumption is the most common method. In England and Wales, on the other hand, firearms are more accessible, and thus they are the most-frequently used method for death by suicide.
Exposure to death. Not only do they tend to have easy access to firearms, but also experience in using them (e.g. killing sick animals (Malmberg et al., 1997; Malmberg et al., 1999).
High Stress Outside of their Control. Farmers experience high occupational stress and related problems, including concern over new laws, anxiety about changing farming methods, long working hours, unpredictability of weather, and financial problems resulting from market fluctuations (Malmberg et al., 1997; Malmberg, Simkin, & Hawton, 1999).
Family tensions. Since farming is often a family business, family problems are intricately tied to farmers’ livelihood (Malmberg et al., 1997; Malmberg et al., 1999). When conflicts arise in their families, farmers may lose their livelihood in addition to closeness with family members (Malmberg et al., 1997). Farming is not simply an occupation, but a way of life. Familial conflict as well as isolation due to the impact of modern technology on the farming industry may lead to a feeling of thwarted belongingness among farmers (Joiner et al., 2009).
Isolation. Farmers are becoming more isolated due to mechanization of farming (Malmberg et al., 1997).
Stoicism. Farmers tend to feel as if they need to stay positive when dealing with hardship. Expressing negative thoughts and feelings in farming culture is discouraged, which leads to stigma around mental health problems (Judd et al., 2006).
Some researchers have found poor mental health in farmers as evidenced by high rates of psychological symptoms, particularly depression (Malmberg et al., 1997; Malmberg et al., 1999). Other researchers have not found higher rates of mental health problems in farmers; this finding may not accurately reflect the mental health of farmers, but instead, a reporting bias related to stoic farming culture. Farmers also may experience poor physical health, and yet they are likely to continue working in spite of it because they cannot take time off to recover (Malmberg et al., 1999). If farmers do have to take time off due to physical problems, they may perceive themselves as burdensome, further increasing suicide risk (Joiner et al., 2009).
Women farmers
It is notable that women in farming may be particularly prone to poor mental health due to their own unique farming-related stressors. According to Behere and Bhise (2009), women in farming have demonstrated increasing rates of death by suicide. These authors speculate that these increased rates of death by suicide are due to stress, fatigue, and depression. Female farmers report stress due to farming operations as well as the impact of farming-related stressors on the “physical, social and financial well-being of all family members” (Behere & Bhise, 2009, pp. 243). Bhere and Bhise (2009) also theorize that this stress is due to role conflicts and a heavy workload that is only increasing. They explain that since the farming industry’s profitability has declined, many women have taken on more roles both in farming and outside of it in order to try to provide a supplemental income. At the same time, these women continue to try to fulfill the many responsibilities of the homemaker role. Ultimately, it is likely that a combination of risk factors contributes to the high rate of suicide among female and male farmers.
What protects farmers from suicide?
The little research done on resilience and protective factors among farmers McLaren and Challis (2009) has revealed that high levels of a sense of belonging among male farmers compensated for their high levels of depressive symptoms. This fits with Thomas Joiner’s interpersonal theory of suicide in which higher levels of social support and a sense of belonging are protective factors against suicide risk (Joiner et al., 2009). Speculatively, another protective factor for farmers may be that they would consider themselves burdensome if they were to die by suicide because they would leave their family with a tremendous encumbrance.
Photo Credit Ted Van Pelt
Barriers to Seeking Help
Access to care. The demanding nature of the farming occupation makes it difficult for farmers to acquire help when struggling. Furthermore, farming culture itself discourages acknowledging and seeking help for emotional problems. Additionally, help is hard to access and expensive. When farmers do choose to seek help, they may find a lack of health care professionals within their rural communities (Malmberg et al., 1997).
Reluctance to take time off. Being in a family business, farmers often feel a great responsibility to uphold their role in the business and as if they cannot take time off to receive much-needed help (Judd et al., 2006).
‘“We had one man walk nearly 30 miles to our house one day and yes when he was finally found he realised that he needed help. It seems to take some type of crisis for them to realise. Oh yes it’s very easy to go to the Dr for a broken bone or a rash or a cut or something but something in the head no, no, no. Strong farming men they don’t suffer from mental illness, none of that sort of business”’ (Jo, farmer’s wife in Judd et al., 2006, pp. 7).
Best Practices for Prevention
Photo Credit: William Garrett & Dianne Lacourciere
Because farmers face a unique set of challenges, as well as barriers to seeking mental health, it is essential that suicide prevention efforts are responsive to these challenges and barriers. Given that they tend to prefer the support and help of family members, friends, and trusted community members, to that of professionals, farming organizations could benefit them by functioning as leaders in prevention programs (Malmberg et al., 1999).
With so many farmers belonging to organizations such as the Samaritans and National Farmers’ Union (NFU), these organizations have great potential to reduce stigma, educate the community, and encourage and provide treatment to farmers (Malmberg et al., 1999). These organizations not only provide social support, and counseling, but also practical help, to farmers (Malmberg et al., 1999).
Sadly, farmers have few other resources for suicide prevention, partly due to a lack of funding. Sowing Seeds of Hope, for example, was a non-profit organization that ran from 1999-2010 (“Sowing Seeds of Hope,” n.d.). It provided hotlines to specifically address the needs of farmers, provided confidential and affordable outpatient counseling, trained professionals and residents to provide mental health support, and more. Though it appeared to prevent an increase in deaths by suicide during periods when increases were expected, such as in times of drought, flooding, and economic hardship, the program was unsustainable, given their lack of funding (“Sowing Seeds of Hope,” n.d.).
In addition to the support of friends, family, and organizations, farming communities might benefit from the involvement of general practitioners (GPs) (Malmberg et al., 1999). Because help from a GP is less stigmatized and more accessible than help from a mental health professional, GPs could play a critical role in the prevention of suicide by assessing for risk, recognizing somatic presentations of depression, treating depression, and integrating mental health checks into routine visits (Malmberg et al., 1999). Professionals including GPs, mental health providers, and police could also promote farmers’ relinquishing of guns when they are determined to be at risk for death by suicide (Malmberg et al., 1999).
Unfortunately, little research has been done on suicide intervention and postvention practices for farmers, despite farmers being at high risk for suicide. However, given that social support and sense of belonging were found to be protective factors against depressive symptoms and suicidal ideation in farmers, increasing social connection, support, and a sense of belonging in farmers is an important intervention (McLaren & Challis, 2009). Since the majority of farmers’ support comes from family and friends, and they are often reluctant to seek help from mental health professionals, family members and friends should be trained in how to respond to struggling individuals, and how to identify the need for professional help (McLaren & Challis, 2009). Just as social support is central to suicide intervention, it is likely central to effective postvention. Thus, after a death by suicide, farmers could promote healing through connection not only with loved ones, but with their greater communities. To this end, postvention efforts could facilitate farmers coming together in a public space after a death in their community.
Conclusion
It is apparent that there is a major need for mental health resources targeted at farmers. It is shocking, disappointing, and disheartening that many of the websites and articles one would expected to be helpful were outdated and did not contain valuable resources. There is also a dearth of research done regarding suicide intervention, prevention, and postvention in relation to the farming population despite the high level of suicide risk associated with this population. It is especially important to develop culturally-responsive programs that understand the unique needs and preferences of farmers, such as a reliance upon family, friends, and trusted community members, rather than professionals. It is unfortunate that funding appears to be the primary barrier, preventing the development and sustenance of mental health programs intended to support farmers and rural communities as a whole.
Resources
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Hotline, clinics, mobile crisis units
Farm Aid Hotline: 1-800-327-6243
AgrAbility
Farm Crisis Center
https://farmcrisis.nfu.org/
References
(2016). Depression on the farm [Online video]. AttitudeLive.com. http://www.agriwellness.org/ssoh.htm
Behere, P., & Bhise, M. (2009). Farmers’ suicide: Across culture. Indian Journal of Psychiatry, 51(4), 242–243. http://doi.org/10.4103/0019-5545.58286
Joiner Jr., T. E., Van Orden, K. A., Witte, T. K., & Rudd, M. D. (2009). The Interpersonal theory of suicide: Guidance for working with suicidal clients. Washington, DC: American Psychological Association.
Judd, F., Jackson, H., Fraser, C., Murray, G., Robins, G., & Komiti, A. (2006). Understanding suicide in Australian farmers. Social Psychiatry and Psychiatric Epidemiology, 41(1), 1-10.
Malmberg, A., Hawton, K., & Simkin, S. (1997). A Study of suicide in farmers in England and Wales. Journal of Psychosomatic Research, 43(1), 107-111.
Malmberg, A., Simkin, S., & Hawton, K. (1999). Suicide in farmers. British Journal of Psychiatry, 175(2), 103-105.
McIntosh WL, Spies E, Stone DM, Lokey CN, Trudeau AT, Bartholow B. Suicide Rates by Occupational Group — 17 States, 2012. MMWR Morb Mortal Wkly Rep 2016;65:641–645. DOI: http://dx.doi.org/10.15585/mmwr.mm6525a1
McLaren, S., & Challis, C. (2009). Resilience among men farmers: The Protective roles of social support and sense of belonging in the depression-suicidal ideation relation. Death Studies, 33(3), 262-276.
Perceval, M., Fuller, J., & Holley, A. (2011). Farm-Link: Improving the mental health and well-being of people who live and work on NSW farms. International Journal of Mental Health, 40(2), 88-110.
About the Authors
Rebecca Hillel is currently a third-year clinical psychology doctoral student at the Graduate School of Professional Psychology at the University of Denver. She has engaged in therapy with adolescents, adults, and older adults in varied clinical settings. In her free time, Rebecca enjoys reading, watching movies and TV shows, and exploring Denver’s food and music scene with friends.
Olivia Kraus is a doctoral student of clinical psychology at the University of Denver’s Graduate School of Professional Psychology. The majority of her experience is in the psychological assessment and treatment of children and adolescents affected by trauma. However, Olivia’s broader passion is working with people whose voices are often silenced, including youths, minorities, and the forensic population. In her spare time, Olivia enjoys cooking with friends, exploring Colorado, and doing nearly anything outdoors.
Sally Spencer-Thomas is a clinical psychologist, inspirational international speaker and an impact entrepreneur. Dr. Spencer-Thomas was moved to work in suicide prevention after her younger brother, a Denver entrepreneur, died of suicide after a difficult battle with bipolar condition. Known nationally and internationally as an innovator in social change, Spencer-Thomas has helped start up multiple large-scale, gap filling efforts in mental health including the award-winning campaign Man Therapy and the nation’s first initiative for suicide prevention in the workplace. In 2016 she was an invited speaker at the White House. Her goal is to elevate the conversation and make suicide prevention a health and safety priority in our schools, workplaces and communities. Connect with Sally at www.SallySpencerThomas.com and on Facebook (@DrSallySpeaks), Twitter (@sspencerthomas) and LinkedIn.