Can we make mental health and suicide prevention part of the conversation?

Suicide remains a major public health concern across the US and while suicide affects every type of geographic area, rural areas consistently have higher rates of suicide than urban areas. Additionally, the National Alliance on Mental Illness (nami.org) reports that more than 1 in 5 U.S. adults and 1 in 7 U.S. youth under 18 will experience mental illness in any given year. While the prevalence of behavioral health problems such as mental illness and substance use in urban and rural areas may be similar, meeting behavioral and mental health care needs in rural areas is more challenging. It’s important to remember that not everyone who has a mental illness or is going through a mental health challenge is going to attempt suicide, and that not everyone who attempts suicide has an underlying mental illness; however, often the resources and protective factors that contribute to mental wellness also protect individuals from suicidal thoughts or actions.

The National Rural Health Association published a policy brief addressing the future of rural behavioral health, and listed “4 A’s” to be addressed:

Availability, Accessibility, Affordability, and Acceptability of Behavioral Health Services

 Availability includes the resources like providers and services,
 Accessibility involves knowing where to obtain services, how to make appointments, travel, language barriers, and even time to take advantage of what resources are available,
 Affordability concerns the cost and whether someone has health insurance that will cover mental or behavioral health treatment;
 Acceptability refers to the negative perception and stigma attached to the need for services.

Acceptability is the one factor that individuals within the community have the most opportunity to influence.

Stigma is consistently listed as one of the biggest barriers to rural mental health care. The reasons listed for stigma are almost always the same:

Cultural values of self-reliance, pride in one’s ability to “fix it myself.”
Fear of judgement, embarrassment, feeling that expressing mental health challenges would be a sign of weakness or failure.
Concerns about confidentiality, when someone knows everyone is going to recognize their vehicle sitting outside the counselor’s office and what kind of talk that might spark, they might not want to make an appointment even if a provider is available.
And, concerns that a mental health provider might not understand the types of stresses unique to rural and agricultural life, what it takes to keep a farm or ranch functioning, fear that the advise they get won’t take into account the realities of not being able to just take time off, or find a job that is a “better fit,” or understand the weight of responsibility to the family legacy.

How can we break down stigma and encourage conversation?

We need to learn to push past the attitude that facing a mental health challenge is a result of personal failure or weakness. The quality of your physical and mental health is what allows you to function daily, to make good decisions, and be safe. People need to realize that they are the farm/ranch’s most important asset and that if they break down, the family and the farm suffer.

Individuals can take a private self-check periodically for their stress level on a scale from 1-10, 1-3 being low, 8-10 being high-stress. If you are consistently above about a 6, consider seeing a medical provider since stress has a big impact on physical health. Also, many providers these days ask a few mental health questions as part of the visit. It is as important to be honest with the medical doctor when answering those questions as it is to be honest about any other aspect of your health. Many of the articles mentioned mental health questions being part of the medical check-in as a way to reduce the concerns about judgement or confidentiality – seeing your vehicle outside a medical provider’s office might not spark the same kinds of conversation as being outside a mental health provider’s office.

Family and members of the farm community can learn to recognize warning signs, be willing to listen, be sensitive to signs of stress, and be willing to start the conversation by asking someone how they are doing and sharing their own struggles as a way to model talking about mental health. If someone isn’t ready to talk about how they are feeling, or maybe not able to identify what they are feeling, there are some factors to watch for:

Physical symptoms like insomnia, headaches, neck or back tension, fatigue, digestive issues
Pulling away socially, withdrawing from normal social activities
Feeling irritable, easily angered, anxious, confused
Feeling discouraged, hopeless about conditions on the farm

Pay attention to additional drivers of stress – is there currently something going on that would increase stress? For example, is the market especially volatile, has there been more extreme weather, pests/disease, extra workload, or if someone if experiencing additional challenges that tip the scales like equipment breakdowns. There are so many factors involved in agriculture that are outside our control that can lead to a pile-up of stress, that if left unmanaged can lead to suicidal thoughts or actions.

Impacts of poor mental and behavioral health on farmers and farm families include things like:

Lowered ability to make good decisions
Accident and injury
Chronic physical health problems
Potential for opioid and alcohol misuse or addiction

Members of the farm community, extension agents, the staff at the coop, financial advisors, and members of faith communities can team up with mental health providers and become knowledgeable about resources or programs that can support individuals and families. While work continues on improving access, availability, and affordability to important mental and behavioral health services, let’s work together on the acceptability factor. Normalize conversations about mental health, check in with family and people in your circle, consider sharing a challenge you face and being the person someone else can come to when they are struggling, and look for ways you can raise awareness and lower barriers to open conversation.

The following organizations and agencies have mental health and suicide prevention information and resources, including lists of providers, programs, awareness trainings, and more.
This list is provided as a source of information only and inclusion of any organization does not constitute an endorsement of the information or services provided on their website. The list may be incomplete.
Please also visit our Behavioral and Mental Health pages, including ManTherapy, Pregnancy-Related Depression, and CredibleMind.

Rural Minds (ruralminds.org)

Farm Bureau Initiative Farm State of Mind (fb.org/initiative/farm-state-of-mind)

Colorado Department of Agriculture (ag.colorado.gov/home/about-us/rural-mental-health)

Rural Health Information Hub (ruralhealthinfo.org)

Rural Mental Health

Mental Health in Rural Communities Toolkit

Rural Suicide Prevention Toolkit

Rural Response to Farmer Mental Health and Suicide Prevention

National Rural Health Association (ruralhealth.us)

Rural mental health challenges and hope for the future

American Foundation for Suicide Prevention (afsp.org)

Risk factors, protective factors, and warning signs