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Finding behavioral health care right for farm people
 
My husband has been struggling with depression for years. It seems like he gets worse around harvest each year. His primary care physician sent him to a psychiatrist, but the two did not connect at all, nor did he connect with the psychologist in the office. 

He needs to see a counselor who understands farm life and can help him through what is bothering him.

These comments were shared by a farm wife in an email to me. Harvest is always a stressful time for most farm people. This year brings many agricultural producers more than usual uncertainty because of the drought.

Farm people may need more medical care this harvest, not only because of stress, but also because of exposures to greater-than-usual dust and toxic molds. Farmers may also need behavioral health assistance in greater numbers than usual, as indicated by recent increases in the numbers of people who are contacting farm crisis hotlines, helplines and websites in the states where these resources exist.

During a recent telephone conference involving people who manage farmer-friendly telephone and Web-based referral services, all the administrators on the call indicated an upturn in the number of callers during this summer and early fall. In particular, calls from livestock and dairy producers were more frequent.

Unfortunately, few farm crisis hotlines, helplines and websites exist in agricultural states and regions. Only eight states offer farmer-friendly telephone crisis counseling and referral services. They are:

•Iowa Concern Hotline: 800-447-1985
•Minnesota Crisis Connection: 866-379-6363
•Nebraska Rural Response Hotline: 800-464-0258
•New York FarmNet (New York and upper New England): 800-547-3276
•North Dakota 2-1-1 Helpline: 800-472-2911
•South Dakota Rural Helpline: 800-664-1349
•Vermont Farm First: 877-493-6216
•Wisconsin Farm Center Hotline: 800-942-2474

The term “farm crisis hotline” implies the availability of culturally appropriate telephone counseling at all times to callers who are engaged in agricultural occupations. The American Assoc. of Suicidology (ASA) accredits hotlines only if they are available 24/7.
Follow-up, such as referral for counseling or immediate intervention in case of an imminent suicide, is part of the service. Not all the hotlines listed here are accredited by the ASA.

The other listed services are helplines, which means they offer culturally appropriate advice about a variety of agricultural issues and referral for additional services, but at specific hours set by the helpline and not necessarily available at all times. Helplines may be accredited by the Alliance for Information and Referral Systems.
The hotlines and helplines can also be accessed by email through their websites. These help callers deal with a wide range of problems, including all types of behavioral health issues, farming questions and referrals. They are best able to serve only the residents of their respective states.

The National Suicide Prevention Lifeline (800-273-8255) is available to anyone at any time, but the telephone responders are not necessarily familiar with agricultural issues.

Farm and ranch people and farm workers willingly seek out farm crisis hotlines, helplines and websites. Some 22,000 callers yearly contacted the seven-state consortium of farm crisis services that was managed by AgriWellness, Inc., a nonprofit program that I directed from 2001-11.

Extensive evaluation of the AgriWellness program indicated callers appreciated that services were confidential, free and that telephone responders were familiar with agricultural issues. Follow-up counseling was provided by licensed professionals who had at least some exposure to training in agricultural behavioral health. In other words, the services were culturally appropriate.

The program saved many lives. During a one-year period, 56 callers had just attempted suicide; another 77 people reported a suicide plan and 685 reported suicidal ideation. One farmer commented, “I wouldn’t be alive today if I hadn’t made that call and got counseling.”

The U.S. Department of Health and Human Services (DHHS) termed these services a “best practice model,” which was included in its strategic plan, Rural Healthy People 2010: A Companion Document to Healthy People 2010. The AgriWellness portfolio of services is also included in the 2011 DHHS publication Rural Behavioral Health Programs and Promising Practices.

Currently there are few federal funds available to operate farm crisis services. It was requested that a national Farm and Ranch Stress Assistance Network should be included in the current farm bill. Congress is mostly deadlocked and unable to provide the behavioral health supports for farm people at a time when they are needed.

State appropriations, private foundations and grassroots projects such as church collections maintain the insufficient services that are available. Professional counselors who understand agriculture and the problems specific to farm and ranch life are too few and far between.

Farm people needing behavioral health care because of farming-related problems should ask if a prospective counselor is familiar with the unique issues involved in farming and keep asking around until the right match is found.

Michael R. Rosmann, Ph.D. serves on the adjunct faculty of the University of Iowa, lectures across the United States and abroad and owns a row crop farm in Harlan, Iowa. He is also a founding partner of the nonprofit network AgriWellness, Inc.
Send your thoughts and questions to him by email at mike@agriwellness.org – previously published columns are available for a small fee 30 days after they were originally printed, at www.agbehavioralheatlh.com
10/3/2012