Online therapy could be a tool to prevent farmer suicide, experts say

Every 11 minutes, someone takes their own life, and the suicide rate is higher in rural areas than in urban areas. The exact rate of farmers who die by suicide is still unknown, says Rebecca Purc-Stephenson, a University of Alberta psychology professor.

"Research shows that the suicide rate among those working in agriculture is higher than the national average. In 2016, the U.S. suicide rate among male farmers was reported to be higher than the national average."

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The high rate of farmer suicide means that many rural communities have a mental crisis on their hands, says Jeff Winton, a rural upstate New York dairy farmer and founder of Rural Minds, a non-profit mental health organization. Winton, who recently lost his nephew to suicide says the loss was unexpected as he and his nephew worked together on Winton's dairy farm.

Farming communities should not only learn when someone needs to talk but also know their resources to guide those needing support. Winton believes that farmers should be more open about depression, mental health, offer a listening ear, or help a struggling farmer connect with a mental health professional.

Who is at risk?

"There are lot of studies that report on what might place farmers at risk, but we never really know what was going on in the farmer's life in the months or days leading up to the suicide," says Purc-Stephenson.

Farming is one of the many occupations with the highest burnout and chronic stress rates. Most farmers are working toward two goals: trying to maximize production and maintain the farm. Purc-Stephenson says the goals are co-dependent and influenced by various unpredictable factors, including weather, commodity prices, animal health, change in family dynamics, and new government regulations.

"Each farmer experiences the same amount of stressors, but not all will have suicidal thoughts or behavior," adds Purc-Stephenson.

Purc-Stephenson says that the most at-risk group may be white male farmers aged 35 to 65. Her research found that within this group, farmers that had experienced many stressors, such as financial strains without any relief, saw themselves as farmers. In addition, most farmers in her study reported that they felt emotionally connected to the land they are stewards of and struggled with envisioning themselves being able to make another career without agriculture.

"Many felt stuck in a hole they couldn't escape," she says. For most, that feeling is the emotional driver for those who choose to die by suicide.

A University of Illinois Urbana-Champaign farmer suicide study also found that older men and women with rural backgrounds were likely to die by suicide if they had health problems. At the same time, younger men were more likely to take their own life if they were experiencing relationship problems.

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At Risk Farmers Face Hurdles

Winton says his nephew could have gotten the help he needed if the community had adequate mental health resources. Many barriers limit the farming community's ability to seek help.

"Rural America doesn't have the healthcare system that many urban and suburban areas do," says Winton.

Most practicing psychologists and psychiatrists work solely in metropolitan areas. According to the National Institute of Mental Health, about 65% of the counties in the U.S. do not have a practicing psychiatrist, and 81% of rural counties don't have a psychiatric nurse practitioner available for a mental health crisis.

Most rural communities receive mental health care from their primary healthcare provider and work with a law enforcement officer during an emergency, says the National Institute of Mental Health.

"If you find a primary care doctor that you can get an appointment with, that doesn't mean they are necessarily trained on mental health or what somebody could be struggling with, such as depression," Winton adds.

Compared to urban areas, most rural areas that do offer mental health services lack a choice in providers, says the National Institute of Mental Health. The limited number of resources strengthens the stigma that marks mental health in rural communities, and people can often feel ashamed to seek out the help they need, says Winton.

"The reality in a small town is everybody knows your business. So, even if you do decide to go and seek help, and there's a healthcare provider that treats people with mental illness nearby, no one wants to see their pickup truck parked up front because, in a small town, we all know what each other's pickup trucks look like," he says.

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Would farmers benefit from online therapy?

During the pandemic, most healthcare professionals leaned on telemedicine as a tool to see patients. It also has been an aid in improving mental healthcare access for some rural areas. But it's not a silver bullet to improve rural healthcare as many areas lack a strong broadband internet infrastructure.

Due to stigma, farmers often struggle with seeking help for their mental health issues. The key to eliminating the stigma of asking for help starts by increasing farmers' options to have a private and safe place to go when they finally seek help. "This culture tends to emphasize stoicism, self-reliance, and privacy. But, during the pandemic, there's been a shift as more people became more willing to talk about mental health," says Purc-Stephenson.

Cynthia Beck, a Master's student in the Clinical Psychology program at the University of Regina in Canada, saw online therapy could open the door for farmers seeking help for mental health issues.

Beck, also a Canadian beef farmer, recently finished a clinical study asking if agricultural producers would engage in online therapy. Around 30 Canadian farmers participated in a five-lesson eight-week course with do-it-yourself guides and an option to access a therapist via email or telephone. Beck hypothesized that 25% of the 30 farmers would drop out of the course.

To her surprise, her study saw that farmers had an 82% completion rate compared to the general population in the clinical research study, which had a 31% dropout rate.

"A major difference we saw was that ag producers were more engaged with the additional resources than the general population," says Beck.

Beck also found that farmers were interested in course materials. About 90% of the farmers download all 20 guides from the course, says Beck. Farmers also said they wanted more time with the course's therapist.

"Producers told us they felt like they were speaking with a peer or friends because they felt the program completely understood them," says Beck. "One participant told us that engaging in the course gave them more confidence and improved their overall view of help-seeking."

"Farmers are more comfortable talking to a therapist or someone who gets it," says Purc-Stephenson.

Beck says the study proved that online therapy is a usable psychological intervention tool for farmers. Farmers expressed the course was worth their time and helped them feel less anxious and depressed, says Beck.

The only limitation was broadband access, farmers said.

One farmer reported that he finished the course from the seat of his combine on his smartphone, says Beck.

"This farmer told us, 'There was a next button, a previous button, and a skip button. If you can auto steer a tractor, then I am sure you could run the site,'" she says.

If you see signs that someone on your farm is feeling overwhelmed or you need to talk to someone there are many resources available. The AgriStress Helpline is available 24/7 call 833-897-2474. You can also call or text the National Suicide Prevention Life line by dialing 988 or 800-273-8255. For those in need of emotional support day or night, you can text GO to 74174.