Rural Farmers Face High Suicide Rates and Decreasing Access to Mental Health Care

Claire Hettinger and Pam Dempsey February 19, 2020

Carle Foundation Hospital employees showcase virtual technology, which are being used to fill some of the mental health care gaps in rural areas.

Edi­tor’s Note: This sto­ry was orig­i­nal­ly pub­lished on the Mid­west Cen­ter for Inves­tiga­tive Reporting.

With farm­ers fac­ing increas­ing stress and depres­sion, Mid­west­ern states and nation­al farm groups are mak­ing more efforts to bet­ter pro­vide ser­vices to alle­vi­ate the high rate of sui­cide among the agri­cul­ture industry. 

Yet in rur­al areas, this care is more of a challenge.

Rur­al hospitals―often the pri­ma­ry source of health care ser­vices in these areas―are clos­ing or merg­ing. Since 2010, 23 hos­pi­tals have closed across the Midwest―a loss of near­ly 1,000 beds, accord­ing to the North Car­oli­na Rur­al Health Research Program. 

An Insti­tute for Non­prof­it News inves­ti­ga­tion by 12 news out­lets across sev­en states found that rur­al Mid­west hos­pi­tals have reduced ser­vices or merg­ing with larg­er health sys­tems in an effort to deal with finan­cial and reg­u­la­to­ry pressures. 

Only two of those Mid­west­ern hos­pi­tals were in Illi­nois, but access­ing men­tal health ser­vices in rur­al com­mu­ni­ties remains dif­fi­cult. Some groups have decid­ed to address the sit­u­a­tion themselves. 

For exam­ple, the orga­ni­za­tion GROW sets up meet­ings over Zoom, a video con­fer­enc­ing app, to help those in rur­al areas expe­ri­enc­ing men­tal health issues. And more than a dozen farm bureau man­agers in Illi­nois have tak­en men­tal health first aid class­es that help peo­ple rec­og­nize signs of distress.

Har­ry Brockus―the chief exec­u­tive offi­cer of Car­le Hoope­ston and Car­le Rich­land in Cen­tral Illi­nois, a col­lec­tion of hos­pi­tals that serves 41 most­ly rur­al counties―said there is a physi­cian short­age across the coun­try and recruit­ment to rur­al areas is an even big­ger challenge. 

We do not offer the ameni­ties that physi­cians are look­ing for,” he said, such as shop­ping, schools and dif­fer­ent enter­tain­ment venues.” 

Oth­er chal­lenges in rur­al areas, such as trans­porta­tion, hous­ing and access to healthy food, can make rur­al health­care costs inef­fi­cient and unaf­ford­able, Brockus said. 

This has left rur­al Amer­i­ca in a bind when it comes to care for men­tal health.

The cold hard facts about men­tal health and rur­al Amer­i­ca is that more than 60% of rur­al Amer­i­cans live in men­tal health pro­fes­sion­al short­age areas,” said Den­nis Mohatt, vice pres­i­dent for behav­ioral health at the West­ern Inter­state Com­mis­sion for High­er Edu­ca­tion dur­ing a 2018 webi­nar by the Nation­al Insti­tute for Men­tal Health on men­tal health and rur­al Amer­i­ca. More than 90% of all psy­chol­o­gists and psy­chi­a­trists and 80% of Mas­ters of Social Work, work exclu­sive­ly in met­ro­pol­i­tan areas. More than 65% of rur­al Amer­i­cans get their men­tal health care from pri­ma­ry health­care provider, and the men­tal health cri­sis respon­der for most rur­al Amer­i­cans is a law enforce­ment officer.”

Adding to the prob­lem of access is the high rate of sui­cide in rur­al com­mu­ni­ties. The agri­cul­ture indus­try has the fourth-high­est rate in the coun­try, accord­ing to a Jan­u­ary Cen­ters for Dis­ease Con­trol and Pre­ven­tion study.

What few Amer­i­cans pic­ture is a farmer or a ranch­er with seri­ous depres­sion,” Mohatt said. They don’t think about the stress asso­ci­at­ed with a chang­ing rur­al econ­o­my where a sin­gle tweet on trade by the Pres­i­dent can tank soy­bean prices across the Mid­west. They don’t think about some­one dri­ving 150 or more miles to access care, let alone a psy­chi­a­trist or a psy­chol­o­gist or a dif­fer­ent men­tal health pro­fes­sion­al dri­ving a cir­cuit to deliv­er care like the cir­cuit rid­ers of the past.”

Wait times

In the rur­al areas that Car­le hos­pi­tal serves, patients do come from as far as 150 miles away for ser­vice, said Heather Hintz, direc­tor of behav­ioral health at Car­le. Wait times can be a problem. 

It is not uncom­mon to wait three to six months for ser­vices,” Hintz said. 

The hos­pi­tal is work­ing to hire more psy­chi­a­trists and fill vacant posi­tions, she said. In the mean­time, Car­le is tak­ing steps to reduce wait times, Hintz said. Car­le has start­ed host­ing men­tal health first aid cours­es and pro­vid­ing telepsy­chi­a­try and vir­tu­al vis­its. It’s also cre­at­ing a psy­chi­a­try res­i­den­cy program.

Our goal is to pro­vide resources and get peo­ple to reach out for help,” Hintz said. 

Both telepsy­chi­a­try and vir­tu­al vis­its are with a licensed provider and are confidential.

Telepsy­chi­a­try can be done from a doctor’s office while vir­tu­al vis­its can be done on a per­son­al cell­phone or com­put­er from a person’s home, said Vir­tu­al Vis­its man­ag­er Haley Miller.

Online ther­a­py ser­vices through Car­le are cov­ered by many insur­ance com­pa­nies. If they are not, appoint­ments cost $49, she said.

Miller said peo­ple are typ­i­cal­ly seen with­in a week of sched­ul­ing a behav­ioral health appointment.

Fill­ing in the gaps

One group that hopes to help fill in the gap is GROW, a nation­al com­mu­ni­ty-based mutu­al help men­tal health orga­ni­za­tion for recov­ery and pre­ven­tion that has a chap­ter in Cham­paign County.

It pro­vides free remote access to meet­ings through Zoom, which can be done over video or just through audio, said Chris Stohr, a Nation­al Coor­di­na­tor of GROW In Amer­i­ca. Zoom is avail­able on com­put­ers and smartphones. 

Peo­ple can con­tact the GROW sec­re­tary at karen.​shan@​growinamerica.​org or 2173526989. The sec­re­tary will then send an invi­ta­tion Zoom link. 

Stohr said he encour­ages peo­ple to seek peer-to-peer sup­port or mutu­al health groups as part of their road to recov­ery. He said the lim­it­ed access to doc­tors, psy­chi­a­trists and ther­a­pists can be a prob­lem for people.

Some­times, groups like GROW are a bet­ter part of treat­ment, he said. For one, those in dis­tress can build rela­tion­ship. And, two, groups like this can aid in treat­ment in ways that pro­fes­sion­al help may be lack­ing, Stohr said.

You’re not going to be able to call up doc­tor so and so and say I’ve had a cri­sis here and I need help,” he said, but you can do that with mutu­al help” peer.

Farmer men­tal health

Car­le, the hos­pi­tal, is reach­ing out to farm­ers through Men­tal Health First Aid cours­es, Hintz said. So far, the pro­grams have trained more than 300 peo­ple through­out Cen­tral Illinois. 

One of those peo­ple is Jim Birge, the Sang­a­mon Coun­ty Farm Bureau Man­ag­er. He said he attend­ed the event because he’s rec­og­nized the dif­fi­cult times farm­ers are liv­ing through, espe­cial­ly in recent years. 

A decrease in cash flow for farm­ers, many dif­fi­cult sea­sons in a row and the trade war―all of it increas­es farm­ers’ stress levels. 

We’ve seen an increase in depres­sion and sui­cide come along with that,” Birge said. 

Birge, who had a friend die by sui­cide a few years ago, has gone a step fur­ther. He orga­nized a train­ing in his own county. 

On Dec. 12, eleven peo­ple who work with and around farm­ing learned how to spot signs of men­tal dis­tress, Birge said. He hopes to have more in the future.

Birge said he thinks farm­ers lack the knowl­edge of how to get care for men­tal health con­cerns. Many peo­ple haven’t dealt with that part of the health­care sys­tem before, he said. 

The sec­ond bar­ri­er to men­tal health care is over­com­ing the stig­ma and shame that peo­ple believe comes with get­ting men­tal health care, he said.

If you have trou­bles with your foot, you go to the doc­tor,” Birge said. It is the same with your head. There is a med­ical rea­son that your head isn’t work­ing, and it may be a sim­ple reason.” 

At the Car­le train­ing, we were taught dif­fer­ent skills and approach­es to work with the indi­vid­ual and to not be judge­men­tal,” Birge said. 

They also were taught to help peo­ple access the help they need, which can range from just being there to lis­ten to long-term pro­fes­sion­al help, he said.

Some­times, it is a mat­ter of hav­ing some­one to con­fide in and tell them your thoughts: if they are hav­ing immi­nent thoughts of sui­cide or if it is just things haven’t been going right,” he said. 

It is dif­fi­cult to talk your­self out of the prob­lem but hav­ing some­one else to con­fide in is help­ful, Birge said. 

Some peo­ple think, I don’t know how to deal with this and I don’t know what to do’,” Birge said. But you can break it down into small­er prob­lems until you have the prob­lem tak­en care of.” 

He encour­ages peo­ple to reach out and talk to some­one. Speak­ing with some­one is bet­ter than speak­ing with no one, he said. Cler­gy and pas­tors often have train­ing in these mat­ters as well so reach­ing out to some­one can be real­ly help­ful, he said. 

We have the means to inter­vene and we should do some­thing about this,” Birge said.

Sky Chadde, Gan­nett Ag Data Fel­low for the Mid­west Cen­ter, con­tributed to this report.

The Mid­west Cen­ter for Inves­tiga­tive Report­ing is a non­prof­it, online news­room offer­ing inves­tiga­tive and enter­prise cov­er­age of agribusi­ness, Big Ag and relat­ed issues through data analy­sis, visu­al­iza­tions, in-depth reports and inter­ac­tive web tools. Vis­it us online at www​.inves​ti​gatemid​west​.org

This arti­cle is part of the series Seek­ing a Cure: The quest to save rur­al hos­pi­tals,” a col­lab­o­ra­tive project includ­ing the Insti­tute for Non­prof­it News and INN mem­bers IowaWatch, KCUR, Bridge Mag­a­zine, Wis­con­sin Watch, Side Effects Pub­lic Media and The Con­ver­sa­tion; as well as Iowa Pub­lic Radio, Min­neso­ta Pub­lic Radio, Wis­con­sin Pub­lic Radio, The Gazette (Cedar Rapids, IA), Iowa Falls Times Cit­i­zen and N’west Iowa REVIEW. The project was made pos­si­ble by sup­port from INN, with addi­tion­al sup­port from the Solu­tions Jour­nal­ism Net­work, a non­prof­it orga­ni­za­tion ded­i­cat­ed to rig­or­ous and com­pelling report­ing about respons­es to social prob­lems. For more sto­ries vis­it hos​pi​tals​.iowawatch​.org

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