[dropcap]D[/dropcap]iane Rohlman, an associate professor at the University of Iowa College of Public Health, made a tough appeal to the audience at the Iowa Women’s Landowner Conference last summer: “Raise your hand if you have ever thought about suicide, or know someone who has thought about it, or died from it.”

Even as people shifted uncomfortably in their seats and cast sideways and downward glances—every single hand in the room went up.

The sobering result is perhaps not surprising. It’s well known that the United States faces a growing mental health crisis. The suicide rate in the U.S. has increased 24% between 1999 and 2014, according to the National Center for Health Statistics at the Center for Disease Control (CDC). About 10% of the population has depression on their medical record, and anxiety, the most common mental illness in the U.S., affects 40 million adults, or 18% of the population, according to the Anxiety and Depression Association of America.

What is perhaps less known is that farmers are at the crux of this crisis. Farmer are twice as likely to die by suicide than the rest of the population, and they are the professional group with the highest suicide rate, according to the CDC.

The reasons are multiple: farming is an inherently unstable profession, dependent on mother nature (weather patterns) and market forces, Rohlman said in an interview. Farmers are also steeped in a culture of stoicism, which makes them both deeply independent, and also reluctant to seek help about an issue, mental health, that carries a lot of stigma. And, in much of rural America, where access to healthcare is patchy, that help may be far away.

Where farming runs deep

2017 Census Ag Atlas Maps – Number of U.S. Farms

Farming is still largely a family business: According to the 2017 Census of Agriculture, family farms produce 85% of U.S. farm products. For most farm families, farming is a business as well as a sustainable activity focused on keeping the farm alive. The drive to keep the farm runs deep, since farming has typically been practiced for generations. Holding onto the land is not just about staying afloat financially, said Michael Rosmann, a psychologist in Harlan, Iowa. It’s part of ancestral pride.

Other professionals with a strong sense of commitment to providing for others, such as police officers and members of the military, also have higher stress and suicide levels than the general population, Rosmann said, but farmers’ suicide rate is still twice as high as that for members of the military.

Also, like people in the military, farmers prefer talking only to other farmers about their problems, Rosmann said, adding that the most effective crisis hotlines are staffed by responders who grew up on farms—just as military hotlines are staffed by veterans or military personnel.

Taking that cue, Rosmann, who left city life on the East Coast to move back to a farm near rural Northwest Iowa, started a hotline and website called “Sowing the Seeds of Hope,” which ran from 1999-2011. Targeted at farmers and their families in Minnesota, Iowa, Wisconsin, South Dakota, North Dakota, Nebraska, and Kansas, helpline responders had both an agricultural background and mental health training. The initiative replicated similar efforts during the Farm Crisis of the 1980s, when farm exports collapsed after the embargo with the Soviet Union.

A perfect storm

Today’s trade tariffs with China have brought fears of a similar situation for farmers, Rohlman said. “The effects trickle down to every part of agriculture, from transportation to the economies of rural communities.”

Recent weather patterns have also created farm stress. According to the USDA, May 2018 to April 2019 was the nation’s wettest 12-month period on record. The rain delayed planting and set off anxiety about the potential for an early frost that could blight an already questionable harvest.

Another source of chronic stress for farmers is injury. Farmers have some of the highest levels of on-the-job injury, which can also lead to mental health issues, namely addiction, Rohlman said, which often occurs when farmers prescribed pain killers become addicted to them. She added that depression can also be a cause of injury. “People who have depression may have slower reaction time or make more mistakes,” she said, adding that being injured creates another source of anxiety for farmers since “in farming, you can’t really take a day off.”

But farmers’ most prevalent stressors mimic those of the general public, Rosmann said, including relationships, unpredictable circumstances, and chronic anxiety. Depression is the leading diagnosis among farmers, he added, while substance abuse alone comprises only seven percent, but it co-occurs with other problems 40% of the time.

If farmers’ stressors and diagnoses are fairly reflective of those in the general public, they face unique obstacles to actually getting help. “The culture of farming is to be stoic, independent and work hard,” Rohlman said. “Farmers are reluctant to ask for help because of the stigma associated with it.”

“They worry someone will see their truck parked outside of a clinic,” she continued. Furthermore, she said, “A farmer doesn’t want to open up to someone who is not a farmer because they won’t understand.”

It’s not just stigma holding farmers back, though, Rosmann added. Farmers don’t want a mental health diagnosis on their medical records because they worry it might affect their ability to get life insurance or disability.

Another problem is the lack of mental health care in rural areas. Showing a map of all 99 Iowa counties from the Health Resources and Services Administration, Rohlman explained that only about a handful are fully covered for mental health care—the counties with bigger towns. The vast majority of counties have a total shortage, meaning no mental health care provider for miles around. Other rural states show a similar pattern.

An issue without borders

These problems are not exclusive to the U.S. “When it comes to mental health and agriculture, I like to think there are no borders,” said Lesley Kelly, who farms with her husband and nuclear family in Saskatchewan, Canada. According to The National Survey of Farmer Mental Health from the University of Guelph, 35% of farmers are depressed, 58% have anxiety, and 45% report high stress. Also, 40% of farmers feel uncomfortable seeking help because of what others might think.

A couple of years ago, Kelly saw a tweet from a farmer about a farmer’s suicide and the need to “do more” for farmers. The message resonated with Kelly, 36, who’d suffered from post-partum-depression, and her husband, Matt, who suffered from panic attacks in the middle of their fields.

In response to the tweet, the husband-and-wife team made a video of themselves talking about their ups and downs, and put it out on social media. “Our goal was to normalize the conversation around mental health,” she said. They were expecting a few responses. The video went viral, generating responses from around the world. “We found out we were not alone,” Kelly said.

Inspired to literally “do more,” Kelly started a non-for-profit called the “Do More Foundation,” which promotes awareness of mental health issues among farmers, primarily through social media. It also builds communities and provides resources, and conducts research.

Kelly said that since she started the Foundation in January, 2018, her work has gotten the attention of people across the spectrum in agriculture, as well as the government. “We have started to see the dial being moved,” she said, adding that she served as a witness for a steering committee for the House of Commons that came up with ten recommendations to improve mental health.

Mental health is now on the agenda of agricultural trade shows, she added. A while ago, when she spoke at the largest trade show for farmers in Western Canada, “All four hundred chairs were taken, and the aisles and back of the room were full,” she said. “An older farmer cried the whole time and said the talk had saved his life.”

“We’re starting a conversation, and we have a long way to go,” she said. “We’re going to get there in my lifetime.”

Initiatives give hope

There are some encouraging signs in the U.S. as well. The 2018 Farm Bill includes a bi-partisan bill, the Farmers First Act, which allots $10 million annually for five years toward behavioral health resources such as counseling training programs. In addition, the USDA’s National Institute of Food and Agriculture (NIFA) started a competitive grant program called the Farm and Ranch Stress Assistance Network (FRSAN) to establish networks connecting farmers and ranchers to stress assistance programs.

Rosmann said local initiatives that emphasize a sense of community have also worked well. A particularly inspiring one, he said, is called STAND (Stakeholders Team Up for Action in New York Dairy), a collaborative workshop to combat stress among dairy farmers. In general, he added, farmers are better off the more support they have, so he recommends that they build a team of advisers that includes farm business managers, animal nutritionists and financial planners.

Another positive change has been the official use, at the federal level on down, of “behavioral health” instead of mental health.

“This is an intelligent paradigm shift that puts the control back to the person,” Rosmann said. The word ‘mental’ is stigmatized. “‘Behavior’ is familiar to farmers because they know cattle and swine behave in certain ways.” Farmers understand that animals’ behavior might depend on what they are eating, Rosmann added, so they might be more inclined to make the leap that their own behavior depends on how much they are able to feed themselves—with healthy activities like sleep, laughter, talking. “They understand the importance of keeping behavior under control.”