Mental Health Topics for Farm Families and Caregivers: An AgrAbility Virginia Program Resource

Introduction

Farm families may face mental health challenges due to financial instability from natural disasters, trade upheavals, and illness or injury (Reed & Claunch, 2020). Rural caregivers (those responsible for taking care of one or more individuals, for example youth or disabled adults) on a farm face a plethora of challenges in addition to difficulties associated with caregiving for another individual. Isolation is a large problem, which makes the development of a support group a priority.  Additionally, the farming population is aging, causing other problems to emerge. 

AgrAbility Virginia has prepared this document to assist Virginia farm families and rural residents with information related to caregiving and mental health. This publication is not intended to be used as a comprehensive mental health resource. Contact AgrAbility Virginia for more information for farmers and caregivers: https://agrability.alce.vt.edu/

The Importance of Mental Health

There is a great need for increased mental health professionals in rural America. The rural context is especially challenging for guaranteeing effective care (including prevention, diagnosis, and recovery services) in the area of behavioral health (including mental health conditions and substance use disorders) (Gale, Janis, Coburn, and Rochford, 2019). The rate of suicide in rural areas, for example, was 55 percent higher than in large urban areas between 2013 and 2015 (Gale, Janis, Coburn, and Rochford, 2019). The incidence of mental health concerns and crises within the rural population puts a demand on caregivers. These demands cause additional stress on the farm adding to an already stressful profession of farming. 

Agriculture affects the lives of all community members from the food we eat, to the health of the farmers who are at the heart of our subsistence. Sometimes farmers and farm workers sustain injuries, illnesses, or experience a disability that impedes their ability to work and reach life goals. AgrAbility Virginia promotes safety, wellness, and accessibility on the farm through education, rehabilitative services, and assistive technology. This program is a partnership among Virginia Tech, Virginia State University, Virginia Cooperative Extension, and Easter Seals UCP North Carolina & Virginia. AgrAbility Virginia uniquely integrates its programming into Virginia's rehabilitation and agricultural service delivery system to increase organizational capacity and provide the best quality education and services for farmers.

Key Topics and Resources for Farmers and Farm Families

There are a wide variety of online resources dedicated to helping farmers, farm families, and caregivers who are suffering from various mental health issues. This guide is meant to help those who have limited access to other professional resources or are looking for help and support. However, it is important that you seek a qualified health care professional for your mental health needs and questions.

Self-Screenings

A screening test can be the first step to recovery. It is quick, cost free, and can help give a likely diagnosis if someone is unwilling to visit a therapist, trying to determine whether to visit a therapist, or unable to access one.

Mental Health Screening Tools: Self-screenings to help determine if you may be suffering from a mental illness including: depression, anxiety, bipolar disorder, PTSD, substance use disorder, eating disorder, and psychosis. There is also workplace mental health survey and tests for parents and youth to take to assess mental health. To access these self-screening tools visit: https://screening.mhanational.org/screening-tools/

Stress

Farming is one of the most stressful occupations. Some stressors unique to farmers are: financial insecurity, changing government policies, and disease epidemic (American Psychological Association, 2021). Other influences impacting farmers mental health include pesticide exposure, climate variabilities, and poor physical health or past injuries (Daghagh Yazd, Wheeler, & Zuo, 2019). Additionally, expectations by family members to continue a family farm, physical health changes, balancing on and off-farm work, relationship difficulties can influence overall mental health (Braun & Pippidis, 2020). Prolonged stress leads to negative effects on your health and has the potential to lead to other illnesses including: heart disease, high blood pressure, diabetes, elevated depression, and anxiety disorders (Mayo Clinic Staff, 2021). Additionally, studies have demonstrated that the risk of farm accidents and injuries increases with stress (Simpson, et al., 2004; Tone & Irwin, 2021).

Signs of stress in the general population can include physical, emotional, and mental symptoms (Cleveland Clinic, 2021). Physical symptoms can include aches and pains, chest pain or the feeling of a racing heart, exhaustion and sleep disruptions, headaches, dizziness, shaking, high blood pressure, and other issues. Emotional and mental symptoms include depression, anxiety, panic attacks, and sadness (Cleveland Clinic, 2021). Signs of farm and ranch stress can be shown in different ways. These could include changes in normal routines, declining care of livestock, increases in illness or accidents, the overall appearance of the farm declines. Additionally, the children of stressed individuals may begin to act out (Fetsch & Williams, n.d.).

Here are additional resources about identifying and managing stress to increase on-farm safety that may be useful for farmers and farm families:

• Farm Stress & Decision-Making During Challenging Times: This is a resource guide that helps to identify stressors, describes the physical consequences of stress, and provides advice on ways to manage stress. https://farms.extension.wisc.edu/articles/farm-stress-decision-making-during-challenging-times/
• Safe Farm’s “Manage Farm Stress to Increase Safety” is a document that outlines common stressors, symptoms of stress on the farm, and different coping methods. It also includes a short quiz to check your stress level. Please visit at the following link: https://store.extension.iastate.edu/Product/Manage-stress-to-increase-farm-safety-Safe-Far

Depression

In 2019, 20.6 percent of adults experienced a mental illness, like depression (NAMI, 2021). Women experience twice the rate of depression as men do (Mayo Clinic Staff, 2019). Like farming, caregiving can be classified as a chronic stress experience (Schulz & Sherwood, 2008). This is because caregiving comprises all the defining factors of chronic stress:

• Physical and psychological strain across an extended period of time;
• High levels of unpredictability and uncontrollability;
• Can create secondary stress (for example in work and family relationships); and
• Requires a high level of vigilance on a regular basis (Schulz & Sherwood, 2008).

Caregiving has been determined to be a major public health issue (Schulz & Sherwood, 2008). Caregiving in a rural community provides even more challenges because rural caregivers have more limited access to resources, issues with transportation, and more isolation, among other factors (Henning-Smith & Lahr, 2018). This means providing these caregivers with resources and support is vital and should be a priority.

• Signs and symptoms of depression include:
• Changes in appearance,
• Unhappy feelings
• Negative thinking
• Reduced energy & diminished pleasure from fun activities
• Interpersonal problems
• Physical problems like aches and pains, headaches, or sleep issues
• Guilt and low self-esteem (Fetsch & Williams, n.d.)

Suicide

Evidence shows suicide is a large problem in rural communities (Gale, Janis, Coburn, and Rochford, 2019) but scant research exists on incidence of depressive symptoms and suicide among farmers in the United States (Reed & Claunch, 2020). Because of the elevated rate of suicide in rural communities, along with high rates of farm stress, it is important to be aware of warning signs that someone may be considering suicide. Robert Fetsch and Roger Williams lay out some signs of suicidal intent in their article, Farm and Ranch Family Stress and Depression: A Checklist and Guide for Making Referrals (n.d.):

• Anxiety or depression
• Withdrawal or isolation
• Helplessness or hopelessness
• Alcohol use
• Previous suicide attempts
• Suicidal planning
• Cries for help including making a will, giving away possessions, or making statements indicating they may end their life or that their life is not worth living.

Professional Assistance

Adults living in rural areas receive mental health treatment less frequently than their urban peers, despite a similar incidence of mental health concerns and mental illness across both populations. Additionally, adults in rural areas are more likely to meet with a provider with less training. Contributing factors include reduced access to providers, fewer specialized providers in rural areas, lack of care coordination in rural areas and lack of trained providers, and underutilization of available services (Morales, Barksdale, and Beckel-Mitchener, 2020). Rural America has a shortage of providers: as many as 65% of rural counties lack a psychiatrist, and over 60% of rural Americans live in “designated mental health provider shortage areas” (Morales, Barksdale, and Beckel-Mitchener, 2020). This makes access to mental health professionals challenging for many rural individuals. That said, there are many resources that are available. Many websites are designed to help individuals suffering from various mental health issues including individuals in the farming population.

There are a wide variety of free courses and support groups available in-person and online to help with various caregiving and mental health challenges. Many of these programs are certified by different U.S. government organizations, have curricula developed by psychologists, or are administered by mental health professionals. One noteworthy organization is Virginia NAMI which offers a large selection of free courses in different locations throughout the state. A course of particular interest is the NAMI Family-to-Family. This is an eight class program designed for family caregivers of individuals living with mental illness Visit: https://namivirginia.org/nami-family-family/ for more information. Mental health support groups in rural areas may be hard to find because of the low population density but there are courses and support groups offered solely online that focus on self-help through interactive programs Visit: http://namivirginia.org/programs/for-individuals-with-mental-illness/ for more information.

Star Behavioral Health Providers (SBHP) is a multistate resource that assist current military members, veterans, and their families in finding local behavioral health professionals that meet their unique needs. Visit: http://www.starproviders.org/ for more information. Additionally, http://www.caregiver.va.gov/ includes information specifically about caregivers of military members coping with PTSD or traumatic brain injury.

Telehealth

Telehealth allows individuals whose main barrier to accessing professional help is distance or transportation to get help through video or other media services. One reason telehealth is of interest is that it has the potential to transcend the rural barriers towards receiving professional services, and can connect rural Americans to highly trained and specialized providers. The telehealth environment has expanded greatly in the last few years and especially in light of the COVID-19 pandemic, when in-person healthcare has become riskier to both provider and patient. In the early months of the pandemic, the use of telemedicine more than doubled across the United States (Ralls & Moran, 2020). During the pandemic, many health insurance agencies (AHIP, 2021) along with Medicare (medicare.gov, n.d.) and Medicaid (Guth & Hinton, 2020) expanded coverage for telehealth visits to practitioners. This includes expanded telehealth access for behavioral health (e.g. mental health) services (Guth and Hinton, 2020). Doxy.me and Zoom are two ways providers use to connect with their patients using telehealth. This requires a reliable and strong internet connection—these continue to be barriers to access in rural areas. During the pandemic, Medicaid and other insurance providers loosened the definition of telehealth to include “audio-only” services (Ralls & Moran, 2020), this could help expand access to healthcare, including behavioral and mental healthcare in rural areas. During the pandemic and beyond, definitions of telemedicine as well as opportunities and barriers to access are constantly shifting, it is important to talk to your insurance provider and your healthcare practitioner to find out the most appropriate type of care for you.

Virginia Caregiver Resources

These resources are meant to help Virginia caregivers find services, support, and information in the state or in their community. Many of these resources have online support groups and ways to ask experts caregiving relevant questions.

• Family Caregiver Alliance Services by State—Virginia: Various resource, services, and programs for family caregivers in Virginia with contact information included. Visit: https://www.caregiver.org/connecting-caregivers/services-by-state/?state=virginia
• Virginia Family Caregiver—Solution Center: Helps locate local services and has links to various caregiving resources. Also includes a place to ask caregiving questions to experts or other caregivers. Visit: http://www.virginianavigator.org/vf

Virginia Mental Health Resources

These resources are available for Virginians seeking more information about mental illness and mental health services in the state, or who are experiencing a mental health crisis.

• NAMI: National Alliance on Mental Illness Virginia: Information, support, and resources for residents in Virginia living with mental illness or for someone in family which is living with mental illness. This can be found at: http://namivirginia.org/ Crisis Text Line: Text HOME to 741741
• Virginia Department of Behavioral Health and Developmental Services Provides resources and assistance to veterans suffering from PTSD, persons with mental health illness, and people recovering from substance abuse. More information can be found atwww.dbhds.virginia.gov
• Virginia Suicide Hotlinesbylocation. Visit: http://www.suicide.org/hotlines/virginia-suicide-hotlines.html for more information.

Resources to Assist Farmers Experiencing Financial and Emotional Stress 

These resources are directed toward farmers and farm families experiencing stress related to financial instability or other factors related to managing a farm business.

• Southern Risk Management Education Center Provides funding for educational projects to assist farmers and ranchers to manage and improve the complex financial risks associated with their businesses effectively.
• Virginia Farm Service Agency (FSA)Assists beginning farmers and ranchers who are unable to access financing from commercial financial agencies with direct loans. More information is available at https://www.fsa.usda.gov/programs-and-services/farm-loan-programs/farm-ownership-loans/index
• Virginia Foundation for Agriculture, Innovation and Rural Sustainability (VirginiaFAIRS)Provides financial assistance to rural folks and promotes cooperative and business development. More information available at https://www.vafairs.com/
• Farm Aid’sHot Line1-800-FARM-AIDFarmAid is a non-profit organization aimed at keeping families on their farms. Their hotline provides 24 hour service to distressed farmers and ranchers who are at risk of losing their farms through financial stress.
• Farmers Business Network Health Provides health insurance specifically designed for farmers according to their budget and health needs. More information can be found at www.fbnhealth.com
• Virginia Beginning Farmer and RancherCoalition (VBFRC)Assists beginning farmers and ranchers to establish and sustain their farms. They offer programs such as whole farm planning curriculum, social networking, and farmer mentoring and serve as a farmer support program for beginning farmers. www.vabeginningfarmer.org

Conclusion

The AgrAbility Virginia Programand VirginiaCooperative Extension aim to support the whole farmer. That includes addressing the mental and behavioral health of farmers and their families. It is our goal to help make your farm a place where you will be able to thrive. For more information, we have provided a list of additional resources for you to use that come from a number of national sources. Also visit the National AgrAbility Project’s (NAP)resources on mental and behavioral health for farmers, agricultural workers, and farm families. These resources can direct you to a number of resources that address depression, stress, addictions, and other mental/behavioral health concerns. Visit the NAP site here: http://www.agrability.org/resources/mental-behavioral-health/

References

America’s Health Insurance Plans (AHIP). (2021).Health Insurance Providers Respond to Coronavirus (COVID-19). AHIP. Retrieved from:https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/

Braun, B., & Pippidis, M. (2020). Farm and Farm Family Risk and Resilience: A Guide for Extension Educational Programming. University of Maryland Extension & University of Delaware CooperativExtension. Retrieved from: https://www.udel.edu/content/dam/udelImages/canr/pdfs/extension/economic-personal-development/Farm-and-Farm-Family-Risk-and-Resilience-Guide-1-17-20.pdf

Cleveland Clinic. (2021). Stress. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/articles/11874-stress

Daghagh Yazd, S., Wheeler, S. A., & Zuo, A. (2019). Key risk factors affecting farmers’ mental health: A systematic review. International journal of environmental research and public health, 16(23), 4849.

Fetsch, R. J. & Williams, R. T. (n.d). Farm and Ranch Family Stress and Depression: A Checklist and Guide for Making Referrals. Colorado State University Extension. Retrieved from: https://extension.colostate.edu/disaster-web-sites/farm-and-ranch-family-stress-and-depression-a-checklist-and-guide-for-making-referrals/

Guth, M. & Hinton, E. State Efforts to Expand Medicaid Coverage & Access to Telehealth in Response to COVID-19. Kaiser Family Foundation. Retrieved from: https://www.kff.org/coronavirus-covid-19/issue-brief/state-efforts-to-expand-medicaid-coverage-access-to-telehealth-in-response-to-covid-19/

Henning-Smith, C. & Lahr, M. (2018). Perspectives on Rural Caregiving Challenges and Interventions. University of Minnesota Rural Health Research Center. Retrieved from: http://rhrc.umn.edu/wp-content/files_mf/1535129278UMNpolicybriefcaregivingchallenges.pdf

Mayo Clinic Staff. 2021. Stress Management. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-symptoms/art-20050987

Mayo Clinic Staff. (2019). Depression in Women: Understanding the Gender Gap. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20047725

Medicare.gov. (n.d.) Telehealth. Medicare.gov. Retrieved from: https://www.medicare.gov/coverage/telehealth

Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mental health disparities. Journal of Clinical and Translational Science, 4(5), 463-467.

NAMI. (2021). Mental Health by the Numbers. National Alliance on Mental Health. Retrieved from: https://www.nami.org/mhstats

Ralls, M. & Moran, L. (2020). Telehealth in Rural America: Disruptive Innovation for the Long Term? Center for Health Care Strategies. Retrieved from: https://www.chcs.org/resource/telehealth-in-rural-america-disruptive-innovation-for-the-long-term/

Reed, D. B., & Claunch, D. T. (2020). Risk for depressive symptoms and suicide among US primary farmers and family members: A systematic literature review. Workplace health & safety, 68(5), 236-248.

Simpson, K., Sebastian, R., Arbuckle, T. E., Bancej, C., & Pickett, W. (2004). Stress on the farm and its association with injury. Journal of agricultural safety and health, 10(3), 141.

Tone, I. R., & Irwin, A. (2021, June). Safety in the Field: Assessing the Impact of Stress and Fatigue on Situation Awareness in Irish and British Farmers. In Congress of the International Ergonomics Association (pp. 274-283). Springer, Cham. AgrAbility Virginia is funded by AgrAbility Project, USDA/NIFA Special Project 2019- 2022 (41590-22326) and administered by Virginia Tech, Virginia State University, Easter Seals UCP North Carolina/Virginia, Inc., and Virginia Cooperative Extension. Visit us at www.agrabilityvirginia.org.