Rural Response to Farmer Mental Health and Suicide Prevention

Farmers and ranchers in the U.S. have demanding jobs that are often compounded by economic uncertainty, vulnerability to weather events, and isolation. Rural agricultural communities may also have limited access to healthcare and mental health services, which can make it difficult for farm and ranch families to receive support when they are experiencing extreme stress, anxiety, depression, or another mental health crisis. Addressing mental health challenges is critical so that farmers can successfully navigate other stressors that are common in their day-to-day lives.

In recent years, the economic outlook for farmers and ranchers has been worsening, leading to comparisons to the Farm Crisis of the 1980s. Increasingly, agricultural families and communities are struggling, contributing to higher rates of suicide among farmers.

This Issue Guide was developed in response to this rising mental health crisis in farming communities. It is designed to provide information about federal, state, and nonprofit resources and promising programs in rural communities that are addressing mental health needs in these populations. It also includes sections about key organizations working on mental health and agriculture issues and stakeholders who may be positioned to offer support to farmers and their families.

Understanding Farmers' Mental Health Concerns

During the Farm Crisis of the 1980s, the suicide rate among farmers and ranchers increased dramatically, as explained in The Farm Crisis, a 90-minute documentary by Iowa Public Television that examines this period. As the U.S. experiences the largest farming crisis since the 1980s, these issues have taken on new urgency. A 2020 Morbidity and Mortality Weekly Report (MMWR) article, Suicide Rates by Industry and Occupation — National Violent Death Reporting System, 32 States, 2016, reports a male suicide rate of 43.2 per 100,000 among farmers and ranchers in 2016, compared to 27.4 per 100,000 among male working aged adults across all occupations.

In this video, experts from national farm organizations discuss the challenges facing today's farmers, warning signs of suicide, and how communities can help farmers and their families:

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines mental health as:

“Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act, and helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.”

People experiencing a great deal of stress or living with mental health issues may struggle to maintain healthy relationships, have difficulty succeeding at work, or otherwise experience challenges while managing the demands of their daily lives.

Over the past few years, farmers and ranchers have experienced significant economic stressors, including:

• Falling commodity prices
• Natural disasters that have harmed crop yields and reduced herds and flocks
• Increasing levels of farm debt
• Labor shortages
• Trade disputes

While financial concerns are a major factor impacting farmer stress, they are not the only concerns. In addition to the ongoing challenges and stressors of farm life, farmers and their businesses have been impacted by the COVID-19 pandemic. They face challenges related to their own stress, the health and safety of their families and employees, and a wide range of global or national-level concerns, such as disruptions to food supply networks and the food service industry. The COVID-19 pandemic has also been disruptive to the social lives of farmers, preventing some from attending church services and connecting with fellow farmers at local cafes. Building Farm Resilience During COVID-19 is a collection of resources developed by the Cornell Small Farms Program to help farmers and communities.

These challenges contribute to higher rates of stress, mental illness, and suicide in farm and ranch families. To help address this mental health crisis, farm advocacy groups have developed resources like the American Farm Bureau Federation's Farm State of Mind website, which features a directory of rural mental health resources in every U.S. state and Puerto Rico.

These resources provide additional background information on farm-related stress:

• Why Farmers Face Unique Threats from Stress
  Farm Aid
  Fact sheet explaining the stressors farmers face and related mental health concerns.
• Mental Health in Rural America
  American Farm Bureau Federation, Farm Credit, National Farmers Union
  An August 2020 RFD-TV Rural America Live feature episode focused on farm stress and farmer mental health.
• Rural Stress Polling Presentation
  American Farm Bureau Federation
  Findings from a survey of rural adults, farmers, and farmworkers regarding mental health. Discusses stigma, access to mental health resources, and factors that impact farmers' mental health.
• Impacts of COVID-19 on Rural Mental Health
  American Farm Bureau Federation
  Presentation slides providing findings of a survey of 2,000 rural adults, addressing the perceived importance of mental health, issues of stigma, impacts of the COVID-19 pandemic on mental health, barriers to care, and other mental health topics.
• Understanding Key Stresses in Farming and Ranching
  North Dakota State University Extension
  Discusses many of the unique stresses that farmers and ranchers experience, explores their impact, and discusses resources for support.
• The Surprising Rate of Farmer Suicide
  HuffPost
  9-minute video telling the story of a Minnesota farmer who died by suicide. Ted Matthews, a psychologist specializing in farmer mental health, discusses the rising rates of suicide in the farming community.
• Farm Family Stressors: Private Problems, Public Issue
  National Council on Family Relations
  Describes a variety of key on- and off-farm stressors that impact the mental, physical, and financial health of farm families. It also discusses some of the ways in which these stressors can affect farming communities.
• Farmer Stress
  American Psychological Association
  Discusses farmer stress during the COVID-19 pandemic with links to resources on managing stress, seeking help, and mental health provider resources. Includes a video of a conversation about farmer stress as part of Farm Aid 2020.

Mental Health Needs in Agricultural Communities

A 2017 Rural Health Research Gateway Rural Health Research Recap, Rural Behavioral Health, compiles findings from several studies conducted by Federal Office of Rural Health Policy (FORHP) funded rural health research centers. The publication reports that mental illness is more prevalent in rural areas than in urban communities. At the same time, there are fewer behavioral health providers and other services available in rural areas to help people get treatment and support. Without these resources, people may continue to experience symptoms that affect their relationships, ability to work, and quality of life. The University of Minnesota Extension offers resources on their Coping with Rural Stress website, including information on mental health, stress and change, and strategies to help families cope with stress.

There is limited data available that examines rates of mental illnesses in specific occupational groups, like farmers and ranchers. The National Farmers Union, in the November 2018 article A Deeper Look at the CDC Findings on Farm Suicides, notes that occupational categories can also be difficult to classify using available public health data. However, researchers have found that people working in agriculture are at higher risk of many mental health conditions. Trends and Characteristics of Occupational Suicide and Homicide in Farmers and Agriculture Workers, 1992-2010, a 2018 Journal of Rural Health article, describes a study that found significantly higher rates of suicide in farm operators and workers compared to other occupational groups. Furthermore, farming is often considered to be one of the most stressful occupations and people working in agriculture have high rates of death from stress-related conditions like heart disease and hypertension, as described in a presentation by North Dakota State University Extension Family Life Specialist Sean Brotherson.

Some of the most common mental health conditions include:

• Stress is the body's reaction to an event or demand and can be a normal experience. However, extreme stress or stress that lasts for a long time can have physical, mental, or emotional consequences. Symptoms of long-term or chronic stress can be different for each person but may include irritability, headaches, trouble sleeping, heart disease, and diabetes.
• Depression is one of the most common mental illnesses in the U.S. and can interfere with how a person feels and thinks. It can be linked to genetic, biological, environmental, and psychological causes. Symptoms of depression include sadness, anxiety, feeling “empty,” irritability, loss of interest in hobbies or activities, and decreased energy.
• Anxiety Disorder – A person with an anxiety disorder may have panic attacks; extreme or long-lasting episodes of anxiousness about their health, finances, or required activities; or fears about a specific situation or experience. Anxiety disorders can interfere with social relationships, make it difficult to concentrate, or interrupt a person's sleep.
• Suicide is one of the leading causes of death in the U.S., but is preventable. Symptoms of a person who may be considering suicide include talking about feelings of hopelessness or shame and fears about being a burden to others. The person may also change their habits, including withdrawing from family and friends, or using drugs or alcohol more often. The 988 Suicide and Crisis Lifeline can provide resources for anyone in crisis, including their loved ones. The National Alliance on Mental Illness — 800-950-6264 — offers education programs and a helpline offering information and support. For more information on suicide prevention and data, see the CDC's Suicide Prevention section.

There are many other mood disorders and mental health conditions that may affect farm and ranch families, including bipolar disorder, eating disorders, and schizophrenia. The symptoms of these conditions vary. Moreover, mental health may not always be an issue affecting suicide risk. According to a 2023 report from the CDC, approximately half of people who died by suicide in 2020 did not have a known mental health condition, noting that life stressors can contribute to suicide.

Depression, anxiety, and other mental health issues can be serious diagnoses. Unfortunately, as described by Ohio State University Extension Educator Jami Dellifield in a July 2017 Successful Farming podcast, mental illness is not a “casserole disease” like other conditions such as cancer. While a tight-knit rural community may rally around a person who received a cancer diagnosis — offering to cook dinner or help with childcare, providing rides to the clinic, and checking in on whether he has taken his medication — that support is less often present for a person living with mental illness. This lack of support can occur because people are not sure how to help or because of lingering stigma in the community around mental health issues. Unfortunately, without this support, it can be more difficult for that person to recover or manage symptoms.

Substance use disorders are not considered a mental health condition, but can often co-occur with mental illnesses, as reported in the 2018 Journal of Rural Health article mentioned earlier. People may use substances to self-medicate when they are experiencing a mental health crisis or coping with stress; they may also experience poor mental health when abusing substances or living with a substance use disorder. According to a 2015 Substance Abuse and Mental Health Services Administration (SAMHSA) report, Substance Use and Substance Use Disorder by Industry, alcohol is the most commonly used substance by people working in agriculture, forestry, fishing, and hunting occupations. Depression, Alcohol, and Farm Stress: Addressing Co-Occurring Disorders in Rural America, a 2020 publication of the Mountain Plains Mental Health Technology Transfer Center Network, offers resources to help rural healthcare providers screen farmers, farmworkers, and farm families for alcohol use disorder and depression.

Recognizing that the opioid epidemic is increasingly affecting rural communities, the American Farm Bureau Federation's Farm State of Mind campaign provides resources, guidance, and information about life-saving prevention and treatment in order to reduce stigma and influence public opinion about opioid addiction in rural America.

Barriers and Challenges to Accessing Mental Health Care in Agricultural Communities

Rural residents face significant barriers to seeking mental health treatment, as explained in Barriers to Mental Health Treatment in Rural Areas in the Mental Health in Rural Communities Toolkit. Farm and ranch families may experience one or more of these challenges when a loved one is experiencing a mental health crisis or living with a mental health condition. For information on the impacts of COVID-19 on mental health in rural areas, see this slide deck from a 2020 presentation prepared by the American Farm Bureau Federation.

Barriers can include:

• Shortages of mental healthcare providers – Rural and low-income areas have the largest shortages of mental healthcare professionals in the country and struggle to recruit providers with background or fluency in the culture of agriculture. As a result, residents of rural and agricultural communities may have limited options for providers or may be waitlisted to receive services. Providers may be located a long distance away, may not accept a person's health insurance, or may be full and unable to see new patients at their practice. This map of Mental Health HPSAs (Health Professional Shortage Areas) shows in green the rural areas with shortages of providers:
• Stigma – People living in rural communities often have less privacy and anonymity than people living in urban communities. As a result, they may feel embarrassed or ashamed to be seen seeking mental health treatment. Farming culture also often celebrates stoicism and a do-it-yourself mentality, which can discourage people from asking for help when they are having problems. A 2008 Journal of Rural Mental Health article, Behavioral Health Care of the Agricultural Population: A Brief History, provides background information on cultural, environmental, and economic factors related to agricultural behavioral health.
• Instability at work – Agriculture is unpredictable, and a farmer or rancher's day-to-day schedule may be very different depending on the immediate needs of the operation. For example, livestock may get sick, or a storm could scramble plans for plowing or applying fertilizer. These demands can make it difficult for a farmer to make and keep appointments, especially when a counseling or behavioral health appointment does not feel as urgent as other demands.
• Changes in health insurance coverage – In order to benefit from income-based premium subsidies that were made available through health insurance reform, farmers need to estimate their income for the coming year. However, because farm income can be unpredictable from year to year, many farm families are unable to take advantage of this program. They may also lose their coverage mid-year if their income is much lower than expected and they are unable to keep up with premium payments. Instead, farmers and their families are often switching from comprehensive health insurance to more limited plans. While this can help lower monthly health insurance costs for the family, it may make it more challenging to find a provider that will accept their health insurance when they need care. It may also mean they have higher deductibles, which can make care unaffordable.

How Farmer Demographics Impact Stress and Mental Health

The 2017 Census of Agriculture made significant changes to previous methods in order to capture demographic information about the people who are involved in agricultural production and farm operations. According to Farm Producers, a 2019 brief reporting findings from the 2017 Census of Agriculture:

• 95% of U.S. producers are White
• 64% are male
• The average age of producers is 57.5 years old

However, it is important to note that the farming and ranching professions are growing increasingly diverse, with more women and people of color working in agriculture. See Socially Disadvantaged, Beginning, Limited Resource, and Female Farmers and Ranchers from the USDA Economic Research Service (ERS) for details.

Farmers and ranchers experience a variety of challenges and may be receptive to help in many different ways. While everyone can experience a mental health condition, there are some populations that may be experiencing unique stressors.

The average age of farmers continues to rise, as reported in Farm Producers. According to the National Center for Health Statistics report Health, United States, 2017 (Table 39), older people are more likely to have one or more chronic health conditions like heart disease or diabetes. Living with a chronic condition is a risk factor for mental illnesses like depression, according to the National Institute of Mental Health fact sheet Chronic Illness & Mental Health.

According to the ERS report America's Diverse Family Farms, 2021 edition, 89% of farms are considered small, meaning their gross cash farm income is less than $350,000 per year. Depending on the type of farm, 57% to 83% of small family farms operate at a high-risk level in terms of operating margin, nearly double that of large family farms, and nearly 40% of midsize family farms operate at a high-risk level. In 2020, 53% of small family farms and 52% of all family farms had at least one household member work off the farm in another occupation, which may happen when the farm income is not stable or sufficient to support the operator and his or her family. Additionally, COVID-19-related disruptions caused 11% of all farm households to experience off-farm job loss, with 12% of small family farms affected.

Building a Future with Farmers: Results and Recommendations from the National Young Farmer Survey reports that young farmers face additional financial pressures, including student loan debt and record high prices for farmland, which may be less significant for older and more established farmers who already have some assets. Young farmers also report high rates of concern about access to health insurance and health care.

Root Causes of Farm Stress

Many rural communities have a variety of attributes that affect mental health, as outlined in Factors That Impact Mental Health in Rural Areas in the Mental Health in Rural Communities Toolkit. For those with tight-knit families and communities, those relationships can be protective against poor mental health outcomes. On the other hand, risk factors for poor mental health that can be prevalent in rural areas and agricultural communities include:

• Social isolation
• Advanced age
• Higher rates of chronic medical conditions

Families who work in agriculture are tightly linked to their land and are therefore impacted by the environmental and financial systems that support their livelihood. Changes in those systems can have significant effects on mental health. Because the identities and lives of farm and ranch families are so closely tied to their occupation, they may also experience a variety of unique pressures that can increase their risk for poor mental health or mental illness. The North Dakota State University Extension video Understanding Key Stresses in Farming and Ranching highlights these concerns.

Commodity Prices

Commodity crops, including cotton, milk, wheat, corn, soybeans, and rice, are agricultural products whose price is regulated by the government. Commodity prices are often unpredictable, which can make it difficult for farmers to plan ahead. Prices may change based on the global supply of a crop, demand, trade patterns, and other large-scale economic trends. In recent years, prices for some commodities have fallen significantly, as shown in commodity price graphs developed by the USDA National Agricultural Statistics Service. The ERS publication America's Diverse Family Farms, 2018 edition reports that net farm income declined almost 40% between 2013 and 2017. Additionally, livestock farmers and ranchers experience similar volatility and little safety from subsidized insurance.

Other Financial Stressors

Farm financial challenges are often deeply linked to family finances, which can mean that a cash flow problem with the business will also spill over into the family budget. In addition to concerns about crop prices, farmers may have to contend with machinery breaking down and other financial risks. As mentioned earlier, unpredictable year-to-year incomes make it difficult for farm families to afford health insurance and they may choose plans that offer only limited benefits. This could in turn put the family at risk of an unexpected medical expense that may strain their budget.

The business of farming often requires taking on significant amounts of debt in order to purchase land, machinery, or livestock. Many farms operate on a revolving line of credit, called a farm operating loan, which is used each year to purchase needed materials, such as seed and pesticide. The farm uses its earnings after the product sells to pay back the loan. However, according the ERS website section Assets, Debt, and Wealth, the debt-to-asset ratio for American farms has risen in recent years and is projected to continue to rise. This means these farms are at an increased risk of insolvency — in other words, as the debt-to-asset ratio rises, farms are more likely to go bankrupt.

Weather

Extreme weather, including droughts, floods, and unexpected freezes, can destroy crops, injure or kill livestock, and damage stored products that are waiting to be sold. If the farm property is hit by an extreme weather event like a tornado or flood, the family's home or equipment may also be damaged. Unfortunately, these events are unpredictable and farmers and ranchers may have limited ability or time to prevent some of the worst effects. For example, as reported in the March 2019 NPR article Nebraska Faces Over $1.3 Billion In Flood Losses, the historic flooding in March 2019 that hit Nebraska and Iowa was estimated to cause over $1 billion in damages to infrastructure, crop, and cattle losses. In 2021, a historic drought placed even more pressure on agricultural producers in the Northern Plains and Western states.

Long Hours or Fatigue

Farming and ranching can be physically and mentally demanding work. During the busiest seasons or during a crisis, it can also include very long hours, resulting in fatigue. Operating machinery while sleep-deprived can increase risk of injury, and fatigue can be related to symptoms of stress and depression. As explained in the 2017 Current Opinion in Behavioral Sciences article Stress and Decision Making: Effects on Valuation, Learning, and Risk-taking, people are also more likely to make poor decisions while stressed, which can lead to additional problems in the future.

Interpersonal Issues

Many farms and ranches are geographically isolated, and in small operations, a farmer may only have one or two employees. These factors can lead to social isolation, which is associated with poor mental and physical health outcomes, as discussed in the July 2018 Bipartisan Policy Center publication Rural Aging: Health and Community Policy Implications for Reversing Social Isolation. Conflict with family or employees can also be a source of stress. Marital stress can also impact farm operations and contribute to overall mental health issues for farm families. For smaller farms, these groups may overlap, which can make it hard to set work or family problems aside and focus on other tasks.

Farming Identity

Many farmers and ranchers deeply hold their occupation as a core part of their personal identity. As described in the Journal of Rural Mental Health article Behavioral Health Care of the Agricultural Population: A Brief History, this can include a strong relationship with their land, which may have been passed down for generations in their families. Even when facing significant obstacles, they may feel a “generational obligation” to maintain the farm. If the farm fails and the family must move on to other places or jobs, the loss of this part of their identity — and the feeling of both personal and financial failure — can be devastating.

Developing Programs to Address Farmer Mental Health

Rural communities seeking to help farmers may choose to develop a program focused on farmer mental health. There are a wide range of tools and examples to build on.

Evidence-Based Toolkits

These toolkits offer a full range of considerations for developing rural community health programs:

Implementation Considerations for Communities Developing Programs to Address Farmers' Mental Health

Organizations interested in implementing programs to address farmers' mental health needs may want to consider some of the unique experiences and characteristics of farming and ranching communities.

Engaging Community Stakeholders

Family members, especially spouses and children, are key contact points in the farm and ranch community. Farmers' family members may be more likely to notice a farmer who is struggling. They can also be in a position to encourage their family members to seek help. Community organizations like churches or fraternal groups can offer educational programs to inform these families about the signs and symptoms of a mental health issue and how to connect their loved ones with key resources. In addition, there are a variety of community members who may be key parts of a farmer's support system.

Interventions and conversations with traditional mental health stakeholders, like mental health clinicians or school guidance counselors, can be beneficial in every community. However, farming and ranching communities can also benefit from conversations with a wide range of stakeholders. These stakeholders may be able to identify and reach individuals who would otherwise not be able to seek help or access care for a mental health issue. Key people to consider are those who frequently interact with the farm and ranch community. These people can include:

• Veterinarians
• Clergy and members of faith-based communities
• Insurance agents
• Financial lenders
• Feed store workers
• Beauty shop/barber shop employees
• Bartenders
• Milk haulers
• Local school teachers and principals
• Community colleges
• State agricultural finance counselors
• Farm Service Agency employees
• Cooperative extension offices
• Local affiliates of commodity or industry groups including the United Soybean Board, National Pork Producers, the Corn Growers Association, the American Farm Bureau Federation, or National Farmers Union

Most farmers and ranchers already have established relationships with organizations or individuals in their community who serve as trusted resources for both personal and professional needs. For example, a family may have a long-standing relationship with their local veterinarian or their barber. These individuals, then, may be more likely to identify a farmer who is struggling. The farmer, in turn, might be more comfortable talking about their concerns or stress levels with people with whom they have already established trust.

One way these stakeholders can successfully connect with farmers and ranchers is to focus the conversations around profession-specific stressors. For example, farmers may be more open to talking about stress due to falling commodity prices with a fellow farm professional rather than with a mental health worker who could be perceived to be less aware of the unique issues that farmers face.

Similarly, programs can address farmer mental health by providing training to stakeholders who frequently have stressful conversations with this community. For example, lenders or insurance agents may sometimes need to have hard conversations with farmers about their loans or financial status. Training can help these professionals be prepared to work with someone who may have an emotional reaction to difficult news. Additionally, programs can provide materials about local mental health resources to offices where these difficult and stress-inducing conversations occur.

Finally, trusted community members who work outside the farming profession (including faith leaders, barber shops, school teachers and principals, law enforcement, and others) may be open to learning how to support farmers' mental health. Breakfast learning groups, in which a group of various stakeholders come together for one or two mornings to discuss this topic, is one way to reach people who could identify a farmer in distress and offer referrals or other sources of help.

Reaching Farmers and Ranchers Where They Are

In addition to engaging a wide variety of stakeholders, there are multiple communication methods that a program can implement to reach farmers and ranchers.

Creating a meeting dedicated to mental health will likely not result in high attendance rates because of farmers' busy schedules and the stigma associated with mental health. However, programs can consider incorporating mental health information into existing local programming in the farm and ranch communities. For example, a seed dealer or co-op meeting could be a venue through which a program already has the attention of the target audience. During one of these already scheduled meetings, a program could invite a speaker to talk about stress, mental health, and well-being, and provide educational materials and a list of local mental health resources. For privacy reasons, these materials should be either included in a packet that every attendee receives or placed in an area where they could be picked up out of sight of others. Meeting leaders can also welcome participants to take copies of the materials to give to someone they may know who could use them.

Different forms of technology can present opportunities for reaching this group. Although the farm and ranch community has a higher average age than the general population, they are often very technologically-savvy. As a result, a telehealth approach may be an effective way to reach people who are otherwise unable to access mental health services.

Other options for reaching farm and ranch families can include publishing mental health information and resources in local newspapers, newsletters, and popular farming magazines and advertising on X, Facebook, and other social media.

In many parts of the country, breakfast clubs or coffee clubs are key social opportunities for farmers and their neighbors, who might meet once a week or once a month, to socialize and have breakfast in a local restaurant. These meals may also be key opportunities for a trusted member of the community — a healthcare provider or a member of the clergy — to come and speak briefly to the group about mental health and offer information about local resources.

Recognizing and Reducing Stigma

The stigma associated with mental health services often acts as a barrier to accessing mental healthcare. This issue is particularly relevant for farmers and ranchers because of the small rural communities in which they live. Sometimes, farmers and ranchers do not want to be seen walking into a mental health services building.

One way to alleviate concerns about stigma is by integrating mental health services into already existing services. For example, co-locating or integrating mental health services into primary care services will allow individuals to go to their regular clinic and access mental health services without fear of others knowing. Similarly, when possible, mental health services can be provided discreetly. For example, a crisis response team arriving at a farmer or rancher's operation can drive an unmarked vehicle and wear clothing similar to local residents.

Programs can also work to reduce the stigma associated with mental health issues. Having a popular celebrity figure talk about mental health or make a public service announcement could help farmers and ranchers see that many people are facing stressful times. In New Zealand, the Farmstrong program created a video about mental health featuring a famous rugby player whose family had a farming background. Having a respected athlete serve as an ambassador both legitimized the program and encouraged farmers and ranchers to improve their own mental health and well-being.

Finally, families can reduce the stigma around mental health by talking about their own difficult and stressful experiences on the farm. For example, grandparents who worked through the farm crisis in the 1980s can share their stories with their grandchildren to help current farmers and ranchers realize that they are not alone during this stressful time, and validate their experiences and emotions.

Framing Mental Healthcare and Mental Health Issues Differently

Access to all types of medical care can be challenging in rural areas, where people may live far away from clinical resources or treatment. While families may be willing to travel long distances for medical care, behavioral health or mental health services may not feel as urgent. Programs can work to change farmers' and ranchers' mindset around mental health by framing mental health concerns in relatable ways. One way to do this is by stressing the fact that a farmer or rancher is the most important part of their farming operation, not just as labor but as a key management tool, and that if their physical or mental health prevents them from working, they cannot be replaced as can a piece of equipment.

In order to avoid some of the stigma associated with terms like “mental health” or “behavioral health,” programs can consider using more accessible language like “wellness” and “stress,” depending on what terms are relatable to their local farm families. Additionally, the business of farming relies heavily on science, and farmers will likely appreciate information that is evidence-based. Programs may consider framing these issues around the science of well-being. Farmers are always striving to be better farmers. By informing them of the research behind well-being and the negative consequences of ignoring your well-being, a program can show farmers that caring about their well-being will in fact make them a better farmer.

When farmers are experiencing significant stress or another mental health issue, they can be tired and distracted, which can lead to more frequent accidents. As farmers know, accidents on the job may negatively affect their profit and productivity and may put others at risk.

Framing mental health in a relatable way is a key component of any program for farmers and ranchers. Using analogies and metaphors that are relevant to a farmer's lifestyle or daily demands can help get their attention and encourage them to consider the importance of addressing their mental health. For example, messages can note that farmers have a responsibility to maintain their mental health just like they have the responsibility to maintain their tractors and pumps to make sure their farm is in working order. Additionally, farmers typically have a list of assets associated with their farm, such as land, machinery, and fertilizer, which are necessary in order to be productive and successful. The health of people working on the farm, including the farm owners themselves, should be on the asset list so that it is built into their farm management approach. Good stress management is good farm management.

While it is important to highlight the negative consequence of not addressing mental health needs, programs should ultimately strive to empower farmers and ranchers, not scare them. Empowerment training includes incorporating resiliency thinking, rather than problem solving thinking, into educational materials or presentations and even using humor to help reduce any stigma or embarrassment farmers and ranchers may feel about the topic.

Understanding the Farming/Ranching Perspective

A program must also take into consideration the unique lifestyle of farmers and ranchers. Most notably, farmers and ranchers have a strong sense of pride associated with their farming operation. This pride often creates an assumption that they do not need any help and should be “tough” when faced with any issue, rather than turning to others for assistance. Farmers often do not like to ask their neighbors for help because they do not want to feel like a burden on their community members; however, finding out that they are not alone can provide reassurance.

Similarly, farmers and ranchers consider the farm part of their identity. This idea can be seen in the principle of the Agrarian Imperative, as described in a 2010 Journal of Agromedicine article of the same name, in which farmers and ranchers often feel deeply compelled to maintain their farm and the farming way of life. As mentioned earlier, some farmers may also feel bound to their farm by their family's longstanding history with that farm across generations. They remain dedicated to try to preserve it for themselves and their children, even if it means their mental health suffers. This generational commitment to farming can also create barriers with healthcare providers who do not understand the mentality of farmers and ranchers.

As technology has improved, farming communities have changed. Farming does not require as much manual labor as it did in previous generations, when neighbors might take turns pitching in on one another's farms to tackle and accomplish tasks quickly. Moreover, there are overall fewer farmers working in agriculture, and many also work off the farm and are less available to help one another. Current generations of farmers now have more alone time and some of the community aspects of farming are lost.

Because of these changes, it is important that the broader community rise up, support their local farmers, and let them know that the community values them. One low-resource way to show community support for farmers is to make yard signs with creative or upbeat messages that can be distributed in the local community. For example, these signs could say, “We love our farmers!” or “Buy local!”

Finally, one way to ensure a program will adequately help a farm and ranch audience is to find a partner organization that understands farming and the specific mental health needs of farmers. These efforts could include talking to membership organizations like the dairy association or honey producers. Farmers and ranchers will likely respond better to mental health outreach if they feel that the message is coming from someone who speaks their language. This concept of finding a culturally competent provider is particularly important in the case of telemedicine because the farmer or rancher needs to feel like they are talking to someone who understands their struggles, and not someone sitting in an office in an urban community hundreds of miles away.

Program Examples

In recent years, many organizations have developed and implemented programs that address mental health needs among farm and ranch families. These programs can provide promising and practical examples of what can work for agricultural communities trying to address this serious and timely issue.

This section describes several types of programs that successfully addressed mental health needs in their communities. Some of these programs have also been evaluated to understand their effectiveness and return on investment. Organizations that are interested in developing a similar program can and should consider their own community's strengths and needs to ensure it is a good fit, which will lead to better long-term outcomes. These examples can serve as inspiration for other rural communities:

Helplines

• A May 2019 Rural Monitor article, Preventing Farmer Suicides through Helplines and Farm Visits, highlights the work of two programs:
  • Minnesota Farm & Rural Helpline (833.600.2670) connects farmers and farm families to counselors, help with daily living (like childcare or food assistance), and financial/legal advice and is available 24/7 by phone, text, or email.
  • NY FarmNet offers a helpline as well as free, confidential, on-the-farm consultations.
• Hotlines and Mental Health Screenings Provide Needed Support, a May 2014 Rural Monitor article, features another helpline for farmers:
  • The Nebraska Rural Response Hotline, in operation since the 1980s through the support of Interchurch Ministries of Nebraska, offers farmers referrals for free stress counseling or legal advice.
• Vermont Farm First uses an approach modeled on employee assistance programs offered in the workplace. Farm owners and family members can receive information, brief counseling, and referral.
• The Farm Aid hotline provides confidential assistance for farmers experiencing distress or in crisis at 1-800-FARM-AID (327-6243) or by filling out an online request for assistance. The hotline is answered between 9:00 a.m. and 5:00 p.m. Eastern time by Farm Aid staff.
• American Farm Bureau Federation's Farm State of Mind directory offers contact information for helplines and counseling services, searchable by state and category.

Peer-to-Peer Learning

Many farmers are fiercely independent and reluctant to ask for help. Often, they may not wish to discuss their problems or worries with their neighbors and friends to avoid being a “burden.” For a farmer who is struggling or experiencing significant challenges, that may mean they ultimately withdraw from their social relationships and become increasingly isolated. However, understanding that other people are experiencing similar difficulties can increase their feeling of connectedness and encourage them to seek help, if they need it.

Other farmers are often an excellent and trusted resource to share messages about mental health and wellness. Because of their shared experiences, they can speak to the unique perspective, lifestyle, and attitudes of farm families.

Examples of programs that use peer-to-peer learning include:

• The Minnesota Farm Advocate program, supported by the Minnesota Department of Agriculture, offers free counseling and support for financial planning, lender negotiations, applications and appeals to farm programs, and referrals to legal, social, and human services. Farm Advocates are retired farmers who can provide a neutral support system for current farmers who are experiencing a financial or business crisis and the stress that often comes with these challenges.
• Farm Dinner Theater is a program started in Kentucky to bring together senior farmers in rural communities to talk about difficult topics, including farm safety, health, and well-being. A local planning committee offers suggestions of relevant topics for each event. These real-life farm experiences are then turned into humorous plays and farmers are recruited to be readers on stage. Between each play, a nurse facilitator leads a group discussion to identify possible solutions for the problems portrayed in the play. Research has found that participants share their new knowledge with non-participants and increase their activities around health and safety following the event. For more information on the Farm Dinner Theater, see the University of Kentucky Cooperative Extension Service's Farmers Dinner Theater Toolkit and our Models and Innovations feature on the program.
• Many farmers and ranchers use social media to connect with organizations and get local news. Organizations can use social media campaigns on Facebook or other platforms to share farmers' stories and encourage others to get help. For example, this Suicide Prevention Coalition of Iowa County, WI public service announcement was filmed on a family farm and shared on Facebook.
• Men's Shed is a member organization that addresses social isolation for older men by creating spaces for connection, peer support, and engagement in service activities.

Reaching Farmers through Ag-Related Programs and Organizations

Farmers and ranchers are busy, and their days can be unpredictable — a piece of equipment might unexpectedly malfunction, or livestock may get loose. This can make it difficult to make and keep regular appointments for counseling or other mental health treatment services.

There is also still significant stigma around mental illness and mental health issues in American culture, which is prevalent in many agricultural communities. As a result, farmers may be reluctant to seek out information or services for depression, anxiety, suicidal ideation, or other mental health issues.

Because of these barriers, some programs have found success by delivering mental health messages or services to farmers in non-traditional ways. This can include integrating information about mental health resources into existing programming or identifying key stakeholders that can reach farmers outside their medical or clinical relationships.

Example programs that use non-traditional vehicles for mental health and wellness messages include:

• Meetings and crop fairs – Commodity groups (like the Soybean Council or Corn Growers Association) can be key partners. Many farmers and ranchers are members of the local affiliate and will attend regular meetings or crop fairs to discuss new techniques or industry news. Because farmers are already gathered in one place and ready to learn, these meetings provide a good opportunity to distribute educational materials or bring in a guest speaker to discuss mental health and wellness.
• Potentially stressful locations – Some events or locations may be a source of significant stress for farmers and ranchers. For example, as farms go bankrupt and farmers have to sell their assets, a sale barn or farm auction where other farmers are gathered may be a good venue for a mental health professional to be present or for a program to distribute information and resources for farmers in crisis.
• Public service announcements – Commodity groups or other professional organizations may not have the staff resources to dedicate to an in-house mental health program, but they may still be interested in the topic area and in opportunities to partner with or support programs that are working with their constituents. For example, North Dakota State University Extension partnered with the North Dakota Bankers' Association to develop public service announcements about farm stress and mental health. These ads were shown during the broadcast of the state basketball tournament, which is watched by many people in rural North Dakota.
• Podcasts – During some times of the year, farmers and ranchers may spend 12 hours per day in their tractor. In addition to listening to the radio, podcasts are another frequently consumed media source. TransFARMation is a podcast produced by the Red River Farm Network and the Minnesota Department of Agriculture that features farmers and ranchers speaking directly to their audience about farm stress through personal stories and conversations with experts. It also offers information about local resources for seeking help.
• Veterinarians are often highly trusted partners and are sometimes one of the few people a farmer sees regularly, especially during busy seasons. A veterinarian may also be at the farm during very stressful times, including when livestock are sick. Because of this relationship, a vet could be a good partner for a mental health professional or other provider who is interested in providing services directly onsite for farm and ranch families. By traveling around with the veterinarian, the mental health professional will be able to reach a farmer who is otherwise rarely able to access mental health services.
• Social media – The U.S. Ag Centers Mental Health Awareness Campaign Promotional Toolkit provides organizations with social media materials for a five-week campaign to address the mental health of farmers. Resources include: messages for X and Facebook, hashtags, promotional images, and relevant organizations to tag and follow.
• Websites – Farm State of Mind is a website created by the American Farm Bureau Federation that offers a nationwide resource directory and information resources that support mental health for individuals working in agriculture. They also offer rural resilience training.

Online and Phone-based Counseling

Access to mental healthcare services can be very challenging for farmers and ranchers. There may not be a provider available locally, or the clinic may not be accepting new patients. Many farm families have limited insurance coverage, which could be another barrier to accessing care.

In addition to problems accessing care, farmers are often reluctant to visit a mental health clinic to receive services because they are concerned about privacy. In a small town, passersby might recognize their vehicle in the clinic parking lot.

Examples of programs that deliver mental health care services remotely include:

• Internet-based programs can reach people who are very remote and may otherwise be unable to access care. The only requirement is that the person have an available internet connection. For example, Thrive offers online, Computer-administered Cognitive Behavioral Therapy (CCBT) to treat depression for people who may not have access to a mental health care provider. This project uses an online system to deliver the intervention, and was adapted by a team of researchers at Montana State University to better fit the needs and experiences of rural communities. It is currently being evaluated using a randomized-control trial.
• Phone counseling – The Minnesota Department of Agriculture supports the services of two mental health therapists, Ted Matthews and Monica McConkey, who provide services to farmers and farm families anywhere in the state at no cost, either on the farm via Zoom or at a private, off-farm location that is agreeable to the client. They help with depression, anxiety, problem solving, stress management, relationship issues, and other challenges. Learn more in the May 2019 Rural Monitor article Preventing Farmer Suicides through Helplines and Farm Visits.

Engaging the Whole Community

Farmers have relationships with many types of professionals with whom they interact regularly, including bankers, lenders, feed store owners, and veterinarians. Sometimes these professionals have to give a farmer bad news themselves, or they may see farmers who are struggling and can offer a referral to mental health or crisis counseling services.

Examples of programs that partner with these stakeholders include:

• Farm Credit, the American Farm Bureau Federation, and National Farmers Union developed a free online course, Rural Resilience: Farm Stress Training, for groups and individuals that work with farmers and ranchers. Based on the farm stress program that the Michigan State University Extension developed for the USDA's Farm Service Agency, the course covers the signs and symptoms of stress and suicide, ways to effectively communicate with people under stress, and how to reduce stigma related to mental health concerns.
• The American Psychological Association (APA) partnered with agricultural advocacy groups and federal agencies to create Farmer Stress, which offers resources and support for farm community mental health. These resources include information on managing stress, seeking help, and training materials for mental health providers.
• The North Central Regional Center for Rural Development has partnered with the USDA Farm Service Agency to develop a program to help Farm Service Agency employees identify signs and symptoms of farmers who are experiencing distress or a mental health crisis. This training was also designed to teach employees how to communicate with farmers in distress, since they may be delivering difficult news.
• Similar to CPR training, Mental Health First Aid is a program that offers training to laypersons on how to respond when they witness a person in a mental health crisis. Instructors are generally also community members (for example, extension agents) who train members of the public to build community capacity. The curriculum includes an optional rural supplement which provides additional information about rural characteristics and assets for discussion during the course.
• The CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices offers strategies to prevent suicide at the community level, including strategies to create protective environments, promote connectedness, and identify and support people at risk.
• Down on the Farm: Supporting Farmers in Stressful Times is a 3-hour workshop created by the Minnesota Department of Agriculture and partners. It teaches people who live and work in agricultural communities how to recognize and respond when they suspect a farmer or farm family member might need help. It can be offered in-person or online. A free workshop toolkit is available for download, consisting of a PowerPoint slide set and a Facilitator Guide. The MDA encourages users to adapt and modify the materials for their own region and audiences.
• Farmstrong is a program in New Zealand that brings together a variety of stakeholders who are invested in improving farmer well-being. Rather than focusing only on crisis response, they are interested in promoting the science of well-being with the slogan “Live well to farm well.” Their activities focus on stress, healthy sleep, physical activity, mental health, and seeking help. In addition to producing informational materials and videos, Farmstrong also hosts social events and other activities to improve social connectedness and share messages about well-being in a positive, fun environment.

Tools and Materials for Farmers' Mental Health Programs

Many organizations have developed adaptable tools and materials that could be used in programs to address mental health needs among farm and ranch families. These tools can be incorporated in a comprehensive farmer mental health program or used independently to check on farmer mental health and well-being.

Tools to Recognize Stress and Mental Health Concerns

• Farm and Ranch Family Stress and Depression: A Checklist and Guide for Making Referrals
  Colorado State University Extension
  A resource for community members, including clergy, veterinarians, and school personnel, who regularly interact with farm families who may be experiencing stress. Lists signs and symptoms of stress, depression, and suicidal intent. Provides information on how to refer someone for help if they seem to be experiencing any of these symptoms.
• Ag Health Risk Assessment
  AgriSafe Network
  Web-based self-assessment for farmers, ranchers, and their families. Considers physical and mental health state and identifies preventive steps that could help reduce the risk for poor health outcomes. Results can be shared with a healthcare provider to start a conversation about mental or physical health needs. Includes a version specific to women.
• Agricultural Producers & Stress: When do You Need a Counselor?
  University of Wyoming Cooperative Extension
  Provides practical tips for farmers who may be considering whether and how to seek help from a counselor. Describes some of the common reasons why people may be reluctant to see a mental health professional, and offers ideas about how to find a counselor who is a good fit.
• Farm Safety Check: Stress and Wellness
  Upper Midwest Agricultural Safety and Health Center (UMASH)
  Provides information for farmers and their employees on the behavioral and physical signs of stress and how to respond. (Also available in poster format: Signs and Symptoms of Stress)
• Mental Health and the Impact on Wellness for Farm Families
  AgriSafe Network
  Handout for farmers and their families covering symptoms of poor mental health. Includes a two-question self-assessment tool. People who respond positively are encouraged to seek help from a healthcare provider. Defines common mental health conditions and identifies potentially stressful events for this population.

Posters, Handouts, and Flyers

• Signs and Symptoms of Stress Card and Poster
  Upper Midwest Agricultural Safety and Health Center (UMASH)
  Lists the behavioral and physical signs of stress and how to respond. Email umash@umn.edu to request a customizable version of the poster as a co-branded template. Also available in web format: Farm Safety Check: Stress and Wellness.

Presentations, Webinars, and Podcasts

• Cultivating Resiliency Webinars for Women in Agriculture
  University of Minnesota Extension-Women in Ag Network and the Upper Midwest Agricultural Safety and Health Center (UMASH)
  A webinar series for women who live and/or work on a farm. Focuses on reducing stress, maintaining relationships, self-care, support systems, and increasing joy and happiness.
• Dairy Girl Enhance Webinars
  Dairy Girl Network
  
  • Helping Dairy Farmers Through Tough Times: Signals of Stress in Farmers and What to Do
    Dr. Michael Rosmann, psychologist and retired farmer – A recorded webinar addressing dairy farmers and mental health during a difficult farming environment.
  • Let's Talk About Mental Health slide deck and summary
    Diane Rohlman, University of Iowa – Focuses on various stressors in the lives of farmers, how to recognize a stressor, and ways to mitigate stress.
  • Signs and Symptoms of Mental Health slide deck and summary
    Kristin Potterbusch and Tramaine El-Amin – Discusses the Mental Health First Aid program.
• TransFARMation
  Minnesota Department of Agriculture and Red River Farm Network
  A radio and podcast series featuring farmers. It increases awareness and reduce stigma about various stressors in farming and ranching life that can impact the mental health of producers and their families.
• Wellness in Tough Times
  Nebraska Extension
  A recorded webinar focused on the daily stresses of life for farmers and ranchers, coping strategies for dealing with stress, and how to help others.
• Managing Stress During Drought
  A webinar discussing farm stress management that was recorded during the 2021 drought, including a conversation between North Dakota State University Extension staff and farm stress experts.

Resources for Specific Populations

• Building a Future with Farmers: Results and Recommendations from the National Young Farmer Survey
  National Young Farmers Coalition
  Describes the results of the National Young Farmer Survey, and describes many of the challenges that are particularly relevant in young farm families, including business planning, access to affordable health care, and land access. It also discusses relevant federal resources for this population.
• Farm Stress and Mental/Behavioral Health
  Agrability
  A wide range of resources to help farmers with disabilities address mental health concerns. Includes videos and recorded webinars, resources for specific mental health issues, and more.
• Stress Management for Women Farmers & Ranchers
  University of California
  Describes the additional stressors women farmers and ranchers often face related to their role in the farming operation, the integration of home and work, the physical stress, and the stereotypes that make it difficult to receive equitable treatment. Identifies a number of constructive coping techniques.

Key Stakeholder Organizations

This section outlines key federal agencies, federally-funded organizations, and national membership organizations working on mental health issues in agriculture communities. These agencies and organizations provide resources, education, training, grants, and other funding opportunities to rural communities interested in developing or maintaining a mental health program targeted to farm and ranch families.

U.S. Department of Agriculture

The USDA Certified Mediation Program funds agricultural mediation programs to help resolve financial disputes in nearly every state. The USDA Farm and Ranch Stress Assistance Network (FRSAN) connects agricultural professionals to stress assistance programs through four regional programs.

USDA Cooperative Extension

The U.S. Department of Agriculture's Cooperative Extension System supports farmers and many state extension programs have developed resources to address farmers' mental health concerns, including the factors that cause stress. The Land-Grant University Website Directory identifies extension offices and other colleges and universities that help USDA address issues relevant to agriculture and rural communities.

Some examples of extension-sponsored resources include:

• Farm Safety and Health: Managing Stress, North Dakota State University Extension
• Health & Farm Vitality, University of Delaware Cooperative Extension and University of Maryland Extension
• Helping Farmers Cope with Stress, University of Maine Cooperative Extension
• Managing Stress During Tough Times, Colorado State University Extension
• The Personal Nature of Agriculture: Men Seeking Help, University of Wyoming Cooperative Extension Service
• Production Agriculture and Stress, Farm & Ranch eXtension in Safety and Health (FReSH) Community of Practice
• Resilient Farms, Families, Businesses & Communities: Responding to Stress, University of Wisconsin Cooperative Extension
• Resilient Minds: Managing Stress on the Farm and Resilient Farms: Financial and Management Guides, Michigan State University Extension

Ag Safety Centers

The National Institute for Occupational Safety and Health (NIOSH) Ag Safety Centers focus on the health and safety of agricultural workers, including mental health issues. Several of these centers have developed materials and resources targeted to addressing farmers' mental health.

Some examples of Ag Safety Center resources include:

• Mental Health Awareness Resource, Great Plains Center for Agricultural Health
• Stress and Mental Health, Upper Midwest Agricultural Safety and Health Center (UMASH)

State Government

State agencies and departments that serve farmers may offer resources. For example:

• Stress & Crisis: Get Help Now
  Minnesota Department of Agriculture
  Describes some of the resources that the state makes available to farmers in crisis. These include a confidential, 24/7 Minnesota-based farm helpline, a rural mental health counselor, mobile crisis teams, and links to other phone or text helplines.

See the National Association of State Departments of Agriculture (NASDA) State Directory for contact information and website links for each state.

National and State Farm-Related Organizations

A wide variety of farm-related organizations are developing resources to help farm families:

• Farmer Resource Network Online Directory
  Farm Aid
  Directory of over 750 organizations that help farmers with crisis assistance, legal help, financial counseling, and more.
• Farm State of Mind
  American Farm Bureau Federation
  Discusses the unique stressors associated with farming, warning signs of stress, steps to help someone at risk, and additional resources for individuals experiencing stress. This site also features a directory of rural mental health resources in every U.S. state and Puerto Rico.
• Managing Stress
  Iowa Corn Growers Association
  Provides stress management resources for farmers in Iowa including links to the Iowa Concern Hotline, the National Suicide Prevention Lifeline, AgriSafe Clinic Network, and Psychology Today.
• Mental Health Resources for Farmers and Ranchers
  Successful Farming
  A collection of articles focused on mental health, stress, depression, and suicide.