The Farmer Mental Health Crisis: Understanding A Vulnerable Population

The Farmer Mental Health Crisis: Understanding A Vulnerable Population


Good afternoon or good morning, depending
upon where you are. This is Luana Bossolo with the APA communications office. Welcome
to our webinar on The Farmer Mental Health Crisis: Understanding a Vulnerable Population.
This is a joint webinar developed by Farm Aid and the American Psychological Association.
Today’s webinar is being recorded; everyone who registered for this webinar will receive
a copy via email within the next 48 hours. The recording along with a transcript will
also be available on the APA website within 14 days. You will have an opportunity to ask
questions after we hear from our presenters; I encourage you to submit your questions as
you listen. You can enter your questions on the chat box on your webinar sidebar on your
screen. So, let’s get started. I’d like to introduce our panelists. Dr. Mike
Rosmann is a clinical psychologist who manages his family farm near Harlan, Iowa. He is known
nationally as an advocate and spokesperson for better behavioral healthcare for agricultural
producers. Mike is a past member of APA’s Committee on Rural Health. Meg Moynihan operates
a dairy farm with her husband and is a senior advisor at the Minnesota Department of Agriculture.
Her job focuses on creating and promoting support for farmers and farm families who
are experiencing stress and mental health challenges. Alicia Harvey is Farm Aid’s
Advocacy and Farmer Services director; she guides the organization’s advocacy, research,
farmer services, and policy-related activities. Today, over the next hour, you’ll hear about
the farming crisis in the United States and how it’s affecting farmers’ mental health.
We’ll talk about some of the stressors unique to farmers and discuss the cultural considerations
when it comes to supporting farmers’ mental health needs. And we’ll provide some resources
on how you can connect with farming communities in your states. First, I want to take two minutes to talk
about Farm Aid and provide a geographic snapshot of psychologists in rural areas. For those
who are not familiar with Farm Aid, it’s a nonprofit organization whose mission is to
keep family farmers on the land; it was started in 1985 when musicians Willie Nelson, Neil
Young, and John Mellencamp organized the first Farm Aid concert to raise awareness about
the loss of family farms and raise funds to help farm families. APA and Farm Aid staff
have been talking over the past year to identify ways we can work together to address the behavioral
and mental health needs of farmers and how together we can increase awareness among key
influential audiences to get more support to the agricultural community. We hope today’s
webinar will inspire psychologists to work with this population that is so central to
sustaining our country. So, let’s look at some geographic figures
of psychologists in the United States. What you’re seeing on your screen is a snapshot
of psychologists around the country; this is from APA’s Center for Workforce Studies,
which did an analysis of licensed psychologists across the United States. The purple areas
show where there are relatively more psychologists and the beige areas show where there are relatively
fewer psychologists. And when you look closely, you can see that there are relatively fewer
psychologists in the middle of the country and in the South. This snapshot provides some
context on availability of licensed psychologists in various regions of the US; many rural areas
are lacking in number of psychologists to help deliver services. So, this data is important
to factor in when identifying ways to provide support to farmers and it also signals some
opportunities and needs for psychologists in rural areas. And we’ll hear more about
those opportunities later on from Dr. Mike Rosmann, but now I would like to turn it over
to our first presenter, Alicia Harvey from Farm Aid. Alicia? Thanks, Luana. So, yeah: my name is Alicia
Harvey and I am the Advocacy and Farmers Services director here. Let me just start by saying
that we are really so grateful for this conversation with APA members who are interested in working
with this farm population. So, as Luana mentioned Farm Aid, it started in the time when newspapers
across the country had headlines of farm foreclosures and farmers dying by suicide. And so, since
1985, we’ve worked to provide immediate and effective support services to farm families
in crisis. That includes our national hotline and email service where we hear from farmers
and ranchers every day; it includes our national clearinghouse which we call the Farmer Resource
Network that features an online directory of organizations across the country who offer
assistance to farmers. It includes our Family Farm Disaster Fund and disaster programming
intended to help farm families recover from weather-related disasters and it also includes
our work really hosting and funding or co-leading trainings and conversations like this one
about the challenges and opportunities that farmers face. So, my goal here is really to give you a sense
of what the farming population writ large is experiencing right now. Our assessment
here at Farm Aid is that we are in a farm crisis and I think it’s just helpful to note
that while that’s the case. The dynamics of today’s farm crisis really touch upon ongoing
and sort of inherent aspects of agriculture that are sources of stress for farmers. So,
when we consider stress in farm country, it’s just important to acknowledge that there’s
a lot of inherent insecurity in this field and a lot that’s beyond the ability of farmers
to control. When we consider the realm of financial instability in agriculture, that’s
particularly amplified right now. Farmers are experiencing the worst economy they’ve
seen since the 1980s farming crisis. Since 2013, they’ve seen about a 50% drop in net
farm income and that’s a multi-year slump – year over year – which is an important nuance.
It means that farmers are eating into their equity without the ability to sort of refill
their coffers. Agriculture is also an incredibly credit-dependent industry; you have to take
out loans in most sectors of agriculture in order to purchase seeds or capital that you
need to operate the farm for the year. So, you can imagine that working in an industry
where you’re not necessarily expected to make a positive income is incredibly stressful.
In 2018, more than half of farm households had negative income. There’s this other marketplace
dynamic going on of ongoing consolidation throughout the sector and really quite remarkable
power held by very few corporations and this is true of many other sectors in our economy.
Agriculture is an incredibly consolidated sector and it’s well over the threshold of
what most economists would consider fair and competitive and that in practical terms for
a farmer translates to squeezed financial margins. It means restricted options for who
they can purchase inputs like seed from and who they can market their goods to, and it
also leaves the sector ripe for abuse. So. Across different sectors of agriculture, we’ve
seen the rise in unfair contracting terms that in effect lower prices for farmers or
even cost or abusive practices and there’s a fair amount of documentation around sort
of the correlation between consolidation in an area and drops in farmer income. A few
other things worth noting: one, just that agriculture is dependent on our natural world
– on soil and water quality, on weather… it’s influenced by pests and disease and these
are all things that are outside of the farmer’s control and that change all the time. And
then there’s the realm of politics and policy, which has many unknowns as well; so, regulations
can change. One of the things that’s making headlines these days is around trade conditions
and sort of the ongoing trade disputes with China and Mexico and Canada and the influence
that’s having on farm incomes. Honing in specifically on weather for a second,
I think it’s worth calling out that climate change is really translating to a rising frequency
and incidents of natural disasters across the country. Right now, there have been historic
floods in the Midwest that have caused billions of dollars of damage. Farmers have lost crops,
livestock, infrastructure, and many have not been able to plant in their fields this year
because they are under water. So, you can imagine that on top of a depressed farm income
that’s been year over year, when you’re eroding, you’re at equity and you have these outstanding
debt loads, a natural disaster becomes particularly terrifying and it’s leaving farmers for sort
of impossible choices. Do I plant something now and try to get some crop insurance payouts
or do I save capital and forego income altogether at least this year? It’s also worth knowing
that disaster relief programs generally fail to meet farmers’ ongoing needs. In most
natural disasters, what we see is sort of a rush of attention and compassion and funds
in the immediate aftermath of that disaster but there’s less support available in the
intermediate and long term when a sense of hopelessness and isolation can set in in rural
communities and the feeling of how long the road to recovery is and the fact that another
disaster… a disaster could strike on their path. One other thing worth noting about today’s
crisis is the dairy industry, which is in a particularly intense moment of crisis now.
It’s another sector where we see a lot of consolidation and unfair pricing at the heart
of the economy. There have been lawsuits, for example, around price manipulation going
on in the Chicago Mercantile Exchange. It’s an awesome… it’s also an industry where
a producer is definitely not guaranteed to recover the cost of production for milk. And
so, what we’ve seen since 1970 is a more than 93% drop in dairy farms across the country;
we used to have more than 640,000 dairy farms and today we have 40,000 about and that number
decreases literally every day. Every day a dairy is going out of business. Milk prices
are consistently below the cost of production and there’s a bit about the nature of dairy
farming in particular that makes that particularly harmful for the stress load on a farmer. So,
all of agriculture is… is intense; dairy farming is a 24/7 occupation. They are up
before the sun rises; they go to bed long after the sun sets; and they’re milking their
cows multiple times a day. And when prices are below the cost of production, that means
psychologically every time they’re going to milk their cows, they know they’re losing
money. And that is a different reality than necessarily planting seeds in one month and
then several months down the road harvesting it and seeing where the market is and it’s
just worth noting because there are multiple swaths of this country – particularly the
Midwest and the Northeast regions – where the dairy industry has shaped the landscape
of states like Wisconsin and Vermont, New York and Pennsylvania and there is this pervading
sense of helplessness rippling throughout not only the farmers in communities, but also
the rural communities that they call home. the loss of a dairy farm further taxes rural
economies like local banks, equipment dealers, and feed suppliers. So, we are absolutely seeing that over our
hotline here at Farm Aid. Since 1985, we’ve operated the country’s only national farmer
hotline and we provide a listening ear and support to farmers who are connecting with
us as well as referring them to a network of farm and rural support organizations across
the country who might offer mental health support and behavioral health services, financial
counseling, legal services, disaster relief and recovery resources. And farmers may come
to us looking for crisis assistance, but also just generally business assistance or legal
support or help to transition into different types of production. Since 2002, we’ve tracked
our annual contacts over the hotline, and we are in a period of really explosive growth.
So, in 2018 we saw a 109 percent spike in calls over the hotline and whereas in any
given year we might see between a quarter to a third of the calls being crisis-related,
on average last year 53% of calls were crisis calls and in some months as high as 75% of
the calls were from farmers who were in crisis. It became particularly severe in the latter
half of the year. What we see in moments of crisis is that there’s a real urgent need
for integrated services for farmers. So many of our farmers’ stressors are related to
pressing financial and legal challenges on their farm and farmers are often going to
go to service providers who are equipped to help them address these challenges first.
We need these service providers to be better equipped to understand and recognize red flags
around stress and behavioral health issues and they need the support of behavioral health
specialists who can step in and support the family during their time working with them.
So, we here at Farm Aid see a real opportunity for health care practitioners to connect to
our network so that farmers can more seamlessly navigate financial, legal, and behavioral
health support services that they need. And i will leave it there. Great – thank you, Alicia. Now I’d like
to turn to Meg Moynihan who will provide some additional information and particularly a
personal perspective, being a farmer herself. Thanks, good… good morning. Thank you and
thank you for having me; it’s a real honor to be here. I’m a great fan of therapy; i’ve
used it successfully more than once, but I do want you to know – I want to lay this out
– that I am NOT any kind of mental health professional myself. In fact, my tenure at
the Department of Agriculture for about a dozen years, I was the “Organic Lady”
and I made a kind of an abrupt turn, becoming the “Stress Lady” in 2016 and that really
was shaped by my farm life and farm experience and I want to give you just a taste of that
background so you can understand why I’m talking about what I’m talking about today and sharing
it with you. I was a city person all of my life, although as an adult I worked in agriculture,
but I married a dairy farmer and so I became a dairy farmer myself. My husband and I have
a 70-cow organic — they’re certified organic — dairy farm southwest of Minneapolis. In
2016, we received a letter from our milk co-op saying they were stopping our route and in
thirty days, they would stop picking up our milk and that was really very terrifying.
I… we dumped milk, looked around for another buyer, ended up dumping milk for a couple
of months and that meant every several days, we would open the bulk tank and out would
pour a thousand gallons of fresh, pure, snow-white, certified organic milk out to fields or down
the road to pigs, but the… the… the produce of all of our labor and concern was just basically
being thrown away. We… after two months of this, my husband really hit a wall in terms
of rejection and he decided he had had enough, and he was going to work off the farm and
I decided that I would take a leave of absence – city girl that I was – and I would try to
run the farm myself. We got onto a conventional milk truck, which meant getting a conventional
price – a regular price – for our organic milk and so, at least, we had some cash flow
but I will tell you that our revenue dropped by 2/3 and so we teetered there and I very
much kind of teetered by myself because my husband was over-the-road truck driving. So,
he was gone for the week, two weeks at a time for nine months — really half paralyzed and
half treading water and trying to decide what to do. Was there a future? Would we ever find
another buyer? How did I cope with all of these farm challenges and production challenges
– day to day work – that he had always been there to help… help me with? And it really
took an emotional and a physical toll on me; I ended up on Celexa which I’ve never…
never wanted to give up, but it… it really informed my perspective. We had a happy ending
nine months later and did find another organic buyer and are selling our milk into an organic
market, so things have stabilized, but during that time when you don’t know if you will
ever get out of the hole, the hole feels very, very deep and I am sure that you are no stranger
to those kinds of feelings. So, my piece here is to shift us from the external to the internal
and I think Alicia does a marvelous job talking about the environment… today’s environment
that farmers find themselves in and I’m going to talk a bit with the next slide about the
farmer as an organism in this environment. What makes farmers tick? Here are some of
the things that that I have observed over and above everything for… I would venture
to say most farmers a large majority is that farming is an intrinsic part of their identity.
It’s… it’s not just what they do is not just their job; it is who they are. I have
a colleague in North Dakota who talked about the 11th commandment being “Thou Shalt Farm”
and that is true for a huge number of farmers. On the other hand, there sometimes are producers
who are farming out of obligation and they feel a sense of obligation to their forebearers.
Many of us, particularly in my part of the country. Are on century farms where we are
third, fourth, fifth-generation farming and so there’s a sense of responsibility to those
who came before us and made this possible and carved the farmstead and the farm fields
out of the landscape and also a sense of obligation and responsibility to offspring, to those
who will come after us. And frequently that’s a very fulfilling sense of obligation but
I have met farmers who are farming because they really didn’t feel they had a choice
and that’s its own particular kind of bitter difficulty when you were the kid who stayed
home and did not go off into the world because somebody had to run the farm or you were an
only child and you didn’t really think you had a choice. And so now when you’re hitting
some excruciatingly difficult times in farming and you look back and can you even admit to
yourself, you know, “I’ve sacrificed myself for this stupid farm for how many years; I
never even liked it and now look at the state I’m in.” So, that brings its own kind
of challenges. Some of us married into it; that was my situation. I married into the
farm, became a farmer, and adopted the roles and responsibilities and passions and goals
that that my husband had and i opted in. Many farmers really can’t imagine doing anything
else; it is a fit for them. It is what they do; it is who they are. It is what they’re
comfortable doing, but by the same token, if you talk to farmers who are looking at
the possibility that perhaps they cannot continue farming, it’s really terrifying to them because
so many don’t think they are capable of doing anything else and I can’t tell you how many
people have said, “Well, i really don’t know what i would do because all i know how
to do is farm”. And, of course, those of us who have lived as non-farmers have a perspective
and a vision and can see that this person is a veterinarian; they are an agronomist;
they are a plumber; they’re an electrician; they’re a project manager; they’re a tractor
repair person; they have this; they’re an accountant. They’re… they have this wide
array of skills but they see it as a package of “I’m a farmer; that’s all I can do”
and so, with many of them either looking at the difficulties on their own operation and
the fragility but also seeing disasters happen to their friends and neighbors, it’s a terrifying
thing to do. Let’s go onto the next slide and talk a little
bit about the challenges that farmers face and the first thing I want to talk about is
this green triangle on the left. I think Alicia did a great job talking about all of the factors
over which farmers really have so little control and that’s… that’s the fulcrum down at the
bottom and then at the top the weighty part of that is this immense sense responsibilities
that in my experience farmers feel. I talked a bit about, you know, feeling responsibility
to the prior generations into the generations to come but really an overarching sense of
responsibility for like, ‘It is my job to make this farm work; it’s my job. I’m responsible
for my family, for the animals, for the land. I feel responsibility to the community; I
feel this is pressures of responsibility and I’m balanced on this little teeny tiny point
of control.” And so, I think it’s important to acknowledge that that tension is there.
The… some of the challenges that farmers face if we break them down — and this is
just a partial list – individually, I don’t think these are unique to farmers, but taken
as a whole I think they’re really important to consider. One of those is that we work
where we live. There most often is no going home at night; your work place is all around
you and there just is no separation, no getting away from it. And sometimes that’s the same
about the co-workers; frequently most or all of your co-workers are family members and
sometimes that’s immediate family members: in my case, you know, my husband but sometimes
it’s extended family members: parents in-law, parents, grandparents, brothers and sisters-in-law
and I think you have had enough experience as individuals to know that sometimes family
is great and sometimes families kind of your work at worst enemy but you know they’re your
family and on one sense you love them but some of them can be really shysters. And so
in some situations it’s the greatest thing in the world to work with your family; it’s
marvelous. but in some situations, you know, you can’t divorce your brother-in-law and
if he’s sneaking money out of the books or he’s not maintaining the equipment properly
or your sister-in-law’s bad-mouthing the family in town or you know whatever you don’t
have control over. There’s another layer of tension like, “i don’t like these people;
i love these people, but i don’t like them and i’m stuck working with them. I don’t trust
them; what do i do in this situation?” Multiple roles is increasingly challenging; many…
for quite a long time, at least one spouse on most farming operations has worked off
the farm. Most frequently, it has been the female spouse, a wife who has gone to town
to generate revenue for the operation, but also – very important – health insurance has
been a huge factor. So, she is a provider in that… that sense, then comes home at
the end of the day having put in all her time and attention to one profession, shifting
gears to family obligations but also farm obligations. So, in my case, if I’m at the
department of agriculture, i come home and i milk cows; i move fence; i feed calves;
i deal with chickens and frequently my day doesn’t end until 10 or 11 o’clock at night
and so and i have to then make that shift. That’s also happening more and more with what
the USDA likes to call the principal operator – like the farmer in charge, the man farmer
– and a lot of… a lot of the spouse farmers, you know -the men, I guess I would say – are
also taking jobs off the farm. So, they may be working as crop insurance adjusters; they
may have a job at a foundry in town; they may be a chemical applicator but they do things
off the farm as well to generate income. So, it’s like, you know, we’re trying to feed
the farm; I’ve got all these things that I’m worried about on the farm, but now I have
another employer and so burning the candle at both ends both physically and mentally
is really a challenge. I want to mention competition and envy and acknowledge that quite frankly
farmers aren’t always very nice to each other and there can be a tremendous amount of animosity
in farm neighborhoods. There is competition for resources like land; when farmland comes
up for rent, there’s competition of who’s going to get that, who is outbid whom. Same
thing when land comes up for sale; sometimes farmers feel like everybody else is watching
them, just waiting for them to go out of business. There’s always a big farmer in the neighborhood
that everybody can’t stand and you’re like, “Oh, I’m sure that the Smiths are going
to get my operation.” So, there are some of that competition and there’s also a sense
of envy and we can be very judgy people. In fact I have a… have a sadly deceased now,
older farm friend, farmer friend from Michigan who used to say, “If you think junior high
school students are bad in terms of being catty and gossiping, you should hang out with
a bunch of… a bunch of farmers,” because everybody’s watching each other looking at
each other. And in one sense, this is your community of people that you can rely on in
an emergency and they have your back all the time, but on the other hand, they’re not afraid
of judging you and, you know, you hear them judging somebody else and think, “Oh, I
bet he says the same thing about me.” Loss of peers and community is… has been stunning
over the last 20-30 years. There are fewer farmers all the time on the landscape and
it is becoming a very lonely place. I have a friend in southwest Minnesota who says,
“Meg, you know and Daniel and I moved to this farm in 1977 and I could look out my
kitchen window and I could see 13 other farmsteads dotted around and that was 13 other farm families
who were living the same life we were living and now there are two and all the land is
still in corn and soybeans and now wind turbines, but the people are gone.” And so, having
that… having people who, like I say, we’re going through what you were going through;
we’re living the same life; we’re experiencing the same things really has been a loss and
the isolation can be very crushing. And then, I think farmers also feel praise and blame
and it’s kind of like a whipsaw. You’re never quite sure if the public loves you because,
you know, you’re the yeoman farmer. Do you remember the the video game a few years ago
called “Farmville” where everybody wanted to be a farmer? And, you know, they’re the
salt of the earth and we love them and they’re the backbone of America, but then there are
media stories and all sorts of talk about, “Well, I don’t know these farmers now seem
to be millionaires and they’re poisoning our water and they’re using pesticides and they’re
mean to their animals.” And so, farmers aren’t quite sure whether they’re getting
it coming or going, so a lot of pressures. Let’s go on to the next slide and talk about
some data. I wanted to share with you some insights into
what specific pressures farmers are feeling. This is data that comes from 2017; it’s a
survey that we did – it had 543 respondents – and we surveyed not farmers themselves,
but people who work with farmers. And these are people from government agencies: these
were extension educators and farm management educators, veterinarians, law enforcement,
lenders – categories of people who are… they’re working on a regular basis with farmers.
And we said, “What are you observing in the farmers that you work with?” and this
is what they told us. The green bar is “Yes, I have seen an increase in this characteristic
over the past year”; the yellow is “I can’t quite tell if I’m seeing this or not;
it might be happening”; and the red is “I really don’t think this is a problem; I’m
not seeing this.” So, what to focus on are the green bars and this is again from late
2016-2017; look at the financial worries bar. Farmers have financial worries and this is
a year and a half or two years ago and we’re already up around 80 percent. Things have
just gotten worse. Anxiety increasing: look at least 1/3 suffering… observed suffering
depression or suspecting that there’s depression. Burnout is even higher than the depression;
people are working so hard to make things work and are just exhausted. Farm transfer
concerns: that’s a big thing in the part of the world that I live in generally, and in
the United States the farming population is aging and there are real concerns about what’s
going to happen to this farm when a) I can either no longer farm; I need to retire or
b) I die. And do I have children who can and should take over the farm? Does anybody want
to take over the farm? Can they afford to take over the farm? And some real worries
about that marital difficulties; I hear anecdotally from behavioral health providers in Minnesota
that they’re seeing more and more fractures in marriages on farms and that, you know,
20-30 years ago the divorce rate in farm… in farming was very low and that now it is
approximating that… that of the general population and perhaps Dr. Rosmann can share
more about that but… but that… that is anecdotally what I’ve heard. So, let’s move on and say given these challenges
and these pressures in the suffering that’s going on, why don’t more farmers seek help?
Why are they reluctant to get help, mental health, behavioral, financial, emotional support?
And I think there are some… there’s some internal dialogue that goes on and this is
what I hear them say when they share this information. Number one is the sense of “Well,
I should really be able to handle this myself. You know, this goes back to the responsibility
piece: “I am… I am in charge; I am responsible for making things work; and this is really
something I need to do myself, but if I needed help I don’t know where I would go. Where
would I go to find help? I mean, either I’d really don’t want to ask somebody for a referral;
there don’t seem to be a whole lot of mental health people around in the countryside here.
I know where to go for – for my blood pressure, diabetes, or my annual exam – my family doctor
but I don’t know how I would fill this need. And, you know, even if I could figure that
out, I bet that person would not understand. She’s probably some nice girl who just graduated
from, you know, head college and I bet she’s never had any… bet you can’t get a job in
the city, so she’s out here in the rural countryside. She’s probably really nice, but I bet she’s
never set foot on a farm and she’s not going to understand what I am talking about.”
And the other consideration is that “I bet other people would find out that I’m doing
this and they would think less of me. They would make fun of me; they might even take
that information to the banker and say hey, you know, I hear Kevin Studeman’s gone to
see a headshrinker and it probably won’t be too long before he’s got to give up his
farming, so why don’t you let me take over that loan and perhaps I could… I could move
in there and take that over? You know, keep me in mind when… when Studeman fails…”
That’s my husband’s name – Kevin Studeman. “When Studeman fails I’ll… I’ll take
that property.” Costs too much — this is a big one. We know that a lot of farms have
somebody working off the farm to get health insurance; that doesn’t mean they don’t have
enormous co-pays and if they are a family that is trying to make it work just in farming,
the out-of-pocket costs are massive and the premiums can be over 20,000 dollars a year
for the family before you even walk through the door. And then there’s an additional five,
six, seven thousand dollars in deductibles and so the idea of going to the doctor – even
the doctor – is intimidating, let alone, you know, “I’m going for something that’s not
a real problem. Like, if I lose my arm, of course I’m going to go to the doctor, but,
you know, if I just feel bad why, would I spend money on that?” And I will tell you
that when this happened to me and I decided that I had had enough of sobbing… alternately
sobbing and screaming and slamming doors during my little tizzy on the farm, I ended up emailing
my physician and saying, you know, “I’m crying and… and having really angry outbursts
multiple times a day, do you think I could be depressed?” But I wouldn’t go for an
office visit because I didn’t feel like I could afford it. So, that was the… that
was the Celexa hook up. I don’t have time: if I’m going to drive – I bet I have to drive
to see this. It’s at least ten minutes to town – could be half an hour, could be an
hour to the nearest mental health professional. So, even if I can get over my “Oh, I really
don’t want to do this”, do I… am I going to jump in the truck, drive an hour, have
this appointment which I’ve heard takes fifty minutes, drive home – there’s three
hours out of my day and I don’t have time to get everything done that I need to get
done, so I’m probably just going to feel worse and at the bottom of it, I will bet that there
is no solution here. I bet that nobody can fix what’s wrong and so I guess I’m stuck
here. Let’s go to the next slide. I think one of the really important messages
that we can’t say too often to people is that help does help and I wanted to share the story
that we have been sharing in the face of mental and emotional anguish that help helps and
this is the story of Doug Kramer who farmed here in the 1980s in northwest Minnesota.
He… he was on his farm and somehow he got into a conversation with an equipment salesman
in one day back in the farm crisis and the equipment dealer brought up the fact that
he had been going to see a therapist and this made a huge impression on Doug who said, “You
know, I guess maybe I’ll try that” and so he did. In fact, he went to one who wasn’t
a good fit and he was so committed to it that he found another mental health provider and
he said, “You know, the first few times I was really intimidated and I thought people
would see me, but then I realized I really needed the help.” So, he was willing to
share that story with other farmers. We have put this on the radio; we have made a podcast,
part of our series called “TransFARMation”. The link is down there and we have about eight
podcasts of farmers who have gone through various stresses talking about how they coped
about it. And this is Doug talking about his and he’s had all kinds of really positive
feedback from people. It’s like somebody, finally somebody, was brave enough to just
put it out there and say, “You know, help helps and you’re not alone; there are people
out to help us.” So, I think in the face of these these internal barriers that we see
and the environment that Alicia talked about, this message of help helps and being there
and helping guide people to that kind of support is really critical. And with that, I will
turn my piece over to someone who knows even more about support with Dr. Rosmann. Thank you very much. Alicia and Dr. Moynihan
have done a good job explaining the high rates of depression and suicide among farmers. I
would like to talk about how we, as psychologists and other behavioral health professionals,
can best assist the farming population. Next slide. It is important that we, as professional providers
of behavioral health care services, know something about farming as well as about behavioral
health. Farmers have a keen sense of knowing who they can trust, as has been pointed out,
and they necessarily seek experts who can assist them in optimizing their behavioral
health. We are more coaches than we are curative agents. Next slide. It is important, I think, for us to use the
term “behavioral health” or “behaviors” instead of “mental”, if we can. “Mental
health” seems mysterious to many rural and agricultural inclined people. On the other
hand, farmers are keenly aware of the behaviors of animals and are expert in understanding
animal behaviors. They also know about their own behaviors and realize increasingly that
they must manage their behaviors in order to function optimally as productive farmers.
So, it is useful for us, when possible, to talk about behavior, and – after all – the
behavioral sciences of psychology and others are based on the knowledge that has been accrued
about behaviors over the past hundred and twenty-five years or so. Next slide. It is important for us to keep in mind what
I like to call the four A’s. That is, our services must be acceptable — that is culturally
attuned to the needs of farmers and that often in… includes then some knowledge of the
stressors that Alicia and Meg have so cogently described. Moreover, I think we need to make
sure that our services are accessible at times and places when farmers need it the most.
Usually they seek assistance for behavioral health issues during weekends and evenings,
so we may need to be available at those times. Moreover, they like hotlines and help lines
that are manned by persons or responders who are competent in their knowledge of agriculture
as well as in behavioral health matters. It is important that crisis services are available
24/7 because farmers can’t always predict when they’re going to need to make an emergency
call. We also need to make sure that these services are affordable and in the languages
of the people engaged in agriculture. So, that may mean that the providers should also
understand or may have an ability to speak Spanish as well as English or the language
of other persons in the community who are engaged in farming. Next slide. What works best? Research has accumulated
over the past 15 or more years that actually goes all the way back to the farm crisis of
the 1980s. We know that best practices involve telephone hotlines and help lines that are
available at all times, but follow-up counseling is necessary. A great deal of benefit can
be achieved from one to five counseling sessions designed to help people manage behavior better.
We need to have knowledge of who is available in the community to provide ancillary services
such as medical care or legal advice, mediation, business consultation, and so forth. We also
know that community workshops work well because they bring together the rural farm producers
with the business community and it creates a network of supporters that is important
for farmers so that they know that they are not in it alone. It is finally important for
us that we evaluate our services and modify them as needed. Next slide. Who do we partner with? Well, if we’re going
to work in rural areas, we have some special needs to partner with many people who deliver
behavioral health assistance but aren’t necessarily behavioral health professionals. That often
means that we need to be familiar with the… the family doctor to prescribe medications
if the psychologist or professionals are not prepared and certified to dispense medications.
They also need to be familiar with the law enforcement community and to help them deal
with emergencies. Schools, extension, the faith-based community are in… of much help
to practitioners who locate in rural communities. Next slide. The National Health Service Corps was created
in 1995 or broadened in 1995 to include psychologists and other behavioral health professions. It
is a wonderful tool that persons who are interested in locating their work in rural communities
can take advantage of. They can approach their state office, or you can approach your state
office of rural health, because every state has an office of rural health: you can find
it online in the state government indices. If you approach that office to ask which areas
of the state and if the area where you live have been declared health professional shortage
areas. If that is the case, you can work for up to two years and receive reimbursement
for student loans totaling up to $50,000. What a benefit. Next slide, please. There also is a new resource that has become
available just this year. The Farm and Ranch Stress Assistance Network was passed as part
of the 2018 farm bill. The farm bill provided up to 10 million dollars for each of five
years. Currently two million dollars is being made available to four regional centers nationally.
These regional centers are in the Northeast, the South, the Midwest, and the West. The
centers are designed to assist follow-up development of state and local resources to assist farmers
with behavioral health issues. The four years following beginning in 2020 are to implement
these services and this creates opportunities for psychologists and other persons in behavioral
health professions. So, keep in mind this opportunity and explore it if possible. Next
slide. Thank you, Mike. Well, that brings us to questions;
I’m going to turn to our question chat room, and I see we already have a few submissions
and I’m going to open things up to to hear from Alicia, Meg, and Mike. And Alicia, if
you can unmute yourself there is one question at the top that I would actually like to direct
to you first: Jane asks, “What is the Farm Aid hotline?” So, could you give the number,
and could you just say a little bit more about the Farm Aid hotline? Yeah, absolutely: thank you for the question.
So, 1-800 FARM AID is the hotline and we also have the farm help at Farm Aid dot o-r-g email
service. So, both of these are available for farmers or ranchers or those concerned on
their behalf to reach out. It is available… we have staff operating the hotline during
normal business hours of the week and we commit to getting any kind of emergency or crisis
case responded to within 24 hours, usually before that, and any other concern within
48 hours of initial contact. Great, thank you. Diana asks, “Can you use
the slides elsewhere, acknowledging where they came from?” Absolutely. Everyone who
is attending this or if you registered and couldn’t make it today, you are welcome to
use these slides as is, acknowledging that they are copyrighted to APA and Farm Aid.
Also, when we send you the link to the webinar, you can share that, but better yet, once we
have it on the APA website in two weeks with a transcript we’ll make sure we go back out
to everyone who registered and give you that link and you are more than welcome to share
that with your colleagues. Next question: what is the difference in the
needs of immigrant farmers – those working on farms who are born outside of the US? Are
they less or more likely to see behavioral health support, stigmas, etc.? I’m going to
open this up to to all three of you; anyone… any of you want to start responding to this? Well, this is Mike – am I unmuted? Yes, you are; I can hear you. Good – there are many people who have come
into the United States seeking opportunities eventually to own land themselves but necessarily
beginning as farmworkers, migrants, or seasonal laborers or, in some cases, full-time laborers
in dairies and other agricultural industries. Many of these people come from countries where
behavioral health care is hardly available at all, except perhaps on an informal basis
from professionals, doctors, and neighbors. So, it is important that we reach out to them
in culturally appropriate ways. Some of the programs that have been created include Proteus
– P R O T E U S – which serves Hispanic farm workers and links them together with
professionals who can deal with behavioral health problems in their native language.
It is possible to approach telephone hotlines around the country and you’ll see that in
your resource slide. These hotlines have a capacity to bring a translation services…
service to answer in the language of the caller. So yes, it is important to be effective deliverers
by understanding the culture and the language of people who have come here because they
have less knowledge and familiarity with the American system of behavioral healthcare delivery. This is Alicia – I was going to add just
a few other things. I… you know, I’m not an expert in farm worker health – although
we do connect with migrant and farm worker organizations here at Farm Aid – but I think
it… you know, there’s additional… in addition to what Mike said, there are different power
dynamics at play for a lot of migrant and immigrant farmworkers. The language barrier
sort of already been referred to, but I think that plea… that connects to the accessibility
question and so it’s important if we’re wanting to reach these audiences to have those things
in mind. That’s part of the culture… culturally competent care point. And then I think, you
know, there’s even more barriers to affordable healthcare and insurance for that population
which is already a challenge for our farmers and ranchers anyways. So, it’s a great question
and the resource that Mike mentioned the… the Farmer and Ranch Stress Assistance Network
that the federal government is trying to get kick-started is meant to also reach farmworkers
and anyone engaged in food and agriculture. Thanks. Meg, anything you’d like to add? No, not really; I just wanted to emphasize
Mike’s point about remote access for some of these populations. You know, if you are
undocumented or if you have a family member who is undocumented, you think long and hard
about going anywhere because you are so vulnerable. So, you know, not… not going to the doctor,
not going to the grocery store, not going to your kids’ school and so the idea of
going out to an appointment can be really a barrier. So, I think access through other
means is a really important intermediate step. Thanks, and you know we have two questions
that actually are related to access and whether it’s by phone or through telehealth and I’m
gonna… I’m gonna ask those right now. The first one is from Jane: “And how do we help
when broadband access is not available is unavailable? there are no cell phones, no
internet in the hills of Appalachia.” This is Mike. That’s a difficult dilemma but
it is possible to obtain access to telehealth by approaching the… a medical clinic or
a hospital that links with expertise in behavioral health. There are many places that it is difficult
for persons to travel and telehealth can be a way to deliver services, but it must comply
with the state-approved requirements for delivery of services. So, it helps to approach hospitals
and health clinics for those particular needs. Thank you. Another related question is “Are
there plans to utilize telepsychology to increase access to care?” I mean, are you all seeing
anything in this area? Yeah, this is Alicia. It… there is new programming
coming out of the Department of Agriculture around telehealth in general and wanting to
link this Farm and Ranch Stress Assistance Network to some of the other programming that
they’re doing there, so I know at least the Department of Ag has been thinking about this
for sure. Great. I do want to add something, and I think
a few of the folks in the audience may be aware of this. There is a nationwide effort
PSYPACT. 12 states just this year have passed laws; it’s… that will allow this compact
situation similar to a driver’s license where, you know, with your driver’s license you can
drive across state lines. PSYPACT is also designed so that it… it provides opportunity
among those 12 states that have the laws – once it’s implemented – for psychologists to be
able to deliver some level of service to a patient that they may already be seeing. So,
if a patient you know goes away and is in another state for a while whether it’s vacation,
commuting, or for some other reason, the psychologist as long as he’s in the sort of another state
with the law will be able to deliver services. So, and we actually… APA put out a press
release about this congratulating ASPPB, which has been spearheading this effort; back in
May, we issued something. If you’re interested in learning more about it, you can either
google PSYPACT or you can go to the APA website and search for it. So, I think there’s potential
down the road with states implementing these laws and as it grows that I think will provide
the opportunity to deliver services via telehealth. I have another question here, but I want to
be mindful – we have three minutes left and actually before I ask another one or two
questions, could we jump to the resources very quickly? Thank you. I just want to note that these are resources
that you can all tap in to learn more about rural health issues, more about farming issues.
National Health Service Corps, which Mike talked about. You can access more of the data
that I’d shown at the beginning on the workforce on APA’s website page for the Center for
Workforce Studies. There’s also the Journal of Rural Mental Health. It… that journal
actually belongs to the National Association for Rural Mental Health and it is published
by APA Publishing. We have the Farm Aid resources on here, which Alicia had talked about a bit
earlier, SAMHSA. Also, I want to ask our three presenters – could you say a bit more about
some of the state-level hotlines? This is just a sample of some of the existing hotlines;
I know there are more of them out there, but I was wondering if the three of you could
say something about these. Well, this is Alicia. The ones that are listed
here if… from Farm Aid’s perspective are sort of the creme de la creme out there because
they do represent that integrated services approach. Where we are most confident when
a farmer is calling our national hotline that if they’re in one of these states we can put
them in touch with an outfit that, you know, may have an emphasis in any of, you know,
a three-legged stool of services: financial, legal, and behavioral health but that they
have some way of integrating and connecting with providers across the spectrum of those
services and so we… we are in touch with all of these all the professionals who work
these hotlines and they’re all stellar services. Thank you. We have one minute left and I’m
happy to say we’ve received a number of questions. What I would like to do is go through the
questions so that we can get back to each of the participants. We have your email addresses,
so I will work with our Farm Aid colleagues and Dr. Ross… Rosmann to answer your questions.
In the meantime, I want to thank everyone for joining today’s webinar; we’d like to
receive your feedback. You will get a survey along with the link to the webinar in the
next 24 to 48 hours, so please complete the survey. Many many thanks to our presenters
Mike, Meg, and Alicia and to the staff at Farm Aid and APA who helped contribute to
this webinar. I look forward to seeing your survey responses and thank you so much for
joining today’s webinar.

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