210908 PHOTO Suffering Bug KEITH

Editor's note: This is the second in a series of stories about mental health and suicide among farmers and ranchers. This story discusses suicidal thoughts, suicide and those grappling with its aftermath. If you or someone you know are having thoughts of suicide, help is available from the National Suicide Prevention Lifeline at 1 (800) 273-8255 and https://suicidepreventionlifeline.org/chat/.

The parched ground yields less and less each year, mirroring a yearslong slide in beef prices—meanwhile, the costs of equipment, feed, gas and life in general keep rising, sometimes out of reach. 

That’s the reality for many modern farmers and ranchers, especially in the drought-stricken West. All that stress, according to experts—and farmers and ranchers themselves—leads to mental health struggles. The rugged independence that makes farmers and ranchers so resilient also makes it hard for them to seek help when they need it. Couple that with family legacies that instill both pride and a fear of failure, and there’s a recipe for personal struggle brewing in pastures and tractor cabs, and across corrals and open ranges—and it often ends in tragedy.

In 2016, the federal Centers for Disease Control and Prevention released a report that showed that agricultural producers experience higher suicide rates than any other occupation.

But despite the grim outlook—and the unavoidable rural isolation that surrounds it both socially and physically—inroads are being made locally and across the nation to get help to those who need it, even if they don’t know how to ask for it.

Michelle Grocke, an assistant professor at Montana State University and a health and wellness extension specialist for the university, said that a "community-driven need" led MSU Extension to start working on projects geared toward the mental health of agricultural workers. Grocke and Alison Brennan, another MSU assistant professor who is a health and wellness extension specialist, learned while working for the extension just how pressing of an issue agricultural workers' mental health is, they said.

Grocke and Brennan conducted a survey of 137 agricultural producers across Montana and found that producers' top four stressors were financial worries, production costs, lack of time and workload. The top three resources that the respondents expressed interest in were learning through a brief online course; discussing topics of stress, health and wellness with someone they know well at informal events; and participating in community planning sessions to address health and wellness. 

Because the survey showed that most people wanted to access resources online, Grocke and Brennan launched the Montana Ag Producer Stress Resource Clearinghouse website in 2020, which aims to provide agricultural workers free tools to manage stress, Grocke said. Using these tools, when a stressor emerges, agricultural workers might be able to turn an unhealthy long-term stress into a manageable short-term one, she said. The website also offers a "validated" survey, she said, that people can use to measure their stress level, which had been completed 140 times as of July 2021. If the survey results show that an individual has high levels of stress, it will take them right to the “Get Help Now” page, which features Montana mental health providers who agreed to be on the resource page. The website had 7,668 unique page views from April 2020 to July 2021, Brennan wrote in an email. 

"We're constantly revamping our content based on how many minutes people are spending on each page," Grocke said. She said she can't measure how many people have connected to a counselor through the website, but she can be sure that it has been effective in spreading awareness, given the number of page views.

Darla Tyler-McSherry, who currently works as the director of student health services at Montana State University Billings and has a master’s degree in health and human performance from the University of Montana, sees that same dynamic of stress and a struggle to access mental health care among farmers and ranchers everyday. 

But those things are personal, too: In 2016, her father killed himself at the same family ranch where he was born in 1934 and where Tyler-McSherry grew up. 

Tyler-McSherry said she has been in health promotion and wellness for her whole career—but for some reason had tunnel vision when it came to the people closest to her, because she thought she would naturally know if they weren't OK. 

To try to make a difference after her father’s suicide, Tyler-McSherry founded Ask in Earnest, a group that works to raise awareness about suicide in rural populations. She said she did not know that suicide in rural areas was an issue "until it hit home." 

She said the nonprofit also works to educate people about mental health and self care—for example, the importance of good sleep, hygiene and nutrition, and healthy stress coping mechanisms for managing mental health issues. In addition to educational material and resources published online, through Ask in Earnest, she also speaks and distributes material at agricultural events including fairs, rodeos and industry conferences. And she talks to people—a lot.

She said she's mentally replayed the morning that her father died "thousands of times." She said she wondered what she missed—what she didn't pick up on—in the days and the weeks leading up to his death. Ten days before he died, she had a great conversation with him, she said, and "dad seemed like he was dad." It is shocking how quickly things can change, she said.

"If I had any idea that my dad was suicidal, I would have been right there," she said. 

About 80% of people who die by suicide exhibit warning signs, Tyler-McSherry said. She said she encourages everyone, especially people in the agricultural community, to "take a step back" and ask those closest to them how they're doing, and then listen non-judgmentally. People need to ask in earnest, she said, just like one of her father’s friends told her that her father used to do. 

"We want to do whatever we can to not have another farm family or another ranch family go through this awful, life-changing experience." she said, observing that losing someone to suicide comes with a lot of guilt, and it "stays with people." 

Grocke said that the coronavirus pandemic has made it especially difficult for individuals to rely on healthy coping mechanisms. Brennan cited a December 2020 study conducted by the American Farm Bureau that showed that in rural communities, 66% of farmers and ranchers reported their mental health being impacted by the pandemic—only 53% of rural adults in other professions said the same.  

"[Ranchers and farmers] will spend exorbitant hours taking care of their cattle, taking care of their horses, taking care of their crops, feeding them and watering them and making sure they're as healthy as can be. And unfortunately ranchers and farmers don't always do that with themselves," she said.

Boulder area rancher Steve Carey said that many use drugs and alcohol as a coping mechanism. 

"A lot of people just pack along alcohol as they're riding," he said, adding that he worries about some people who drink day in and day out. 

Many farmers and ranchers use it as a way to destress, he said, and many forget that it is a depressant. He said he quit drinking himself a few months ago, and his dad quit drinking when Carey was in third grade. 

Tyler-McSherry said she thinks her nonprofit has been successful, based on the feedback she's gotten from people when she speaks at events. However, similar to the resource clearinghouse website, Tyler-McSherry said it was hard to measure the success of her project. It is hard to measure how many suicides were prevented as a result of the information she has provides—it's difficult to quantify things that did not happen, and to determine why—and she cannot measure how many people were connected with resources. 

She said she had tables for her nonprofit at the Northern International Livestock Exposition Rodeo in Billings for the past few years, and many people stop and tell her that they appreciate her work, and say that her work is "definitely needed" in the ranch and farm community. She said people come up to her and confide in her. 

"They'll say, 'I've never shared this with anyone else, but I wanted to let you know, I'm so happy I didn't pull the trigger.'"

Additionally, she said, she is encouraged by the number of visits to the organization’s website, including page views from Japan and Germany. She said she thinks that her nonprofit and other organizations are making headway in fighting the stigma of mental health in rural populations. 

"I have misunderstood stigma before. I thought it meant people didn't want to talk about it. But actually people do want to talk about it, and what we have to do is create those safe, supportive environments," she said.

Mike Rosmann, an Iowa farmer with a doctorate in clinical psychology, has raised animals all his life. He's also one of the nation's leading psychologists in agricultural behavioral health and he teaches at the University of Iowa. 

Like Tyler-McSherry, he believes that the agricultural community is making progress with the stigma surrounding mental health. He said that when he worked for crisis centers in the '80s, many of the calls from agricultural workers were rooted in desperation. Now, he said, many of the calls are because producers want to learn how to improve their mental health. He believed the shift was due in part to increased media coverage: Agricultural magazines have published stories—many of them by Rosmann—about mental health, which he thinks has been effective in normalizing the subject. 

Tyler-McSherry said there are many "easy" things that people can do on an individual level to prevent suicide.

She said she encourages people in the agricultural community to ask each other how they're doing. She said that it is not only important to ask for help for yourself, but to also ask others if they need it too. She said that in order to keep others safe, "we have to risk feeling vulnerable and awkward." These conversations probably already happen at cafés and on branding day, she said, but likely not as frequently as they should. 

"It's not a sign of weakness to say you're not OK. It's actually an incredible strength,” she said. 

Tyler-McSherry also spoke of the importance of connecting individuals with resources—that could be crisis lines, a counselor or a religious leader—who might be better equipped to provide help. Studies have shown that if people who have attempted suicide get the help that they need, 90% won't make another attempt, she said. She added that church leaders play a large role in rural communities' mental health. 

Carey said it's been helpful to talk about his stressors at a church he attends outside of the county, where he is not surrounded by his neighbors and can therefore sidestep the stigma that surrounds mental health. There's an older man at his church who has a small ranch and is "very understanding" of what agricultural workers go through, he said. 

"That helps a lot, having a mentor who doesn't see it on the same scale but understands," Carey said. 

At local rancher roundtables run by MSU Extension, ranchers in the area gather to talk about issues and topics unique to them, such as beef genetics. Carey said the rancher roundtables would be a good opportunity to spark conversation about mental health, and that incorporating talks about mental health in that setting could be casual and not forced. It hasn’t happened yet, though.

Kaleena Miller, an MSU agriculture and natural resource extension agent for Jefferson and Madison counties, said she ran the roundtables last winter. She said that she wasn't aware of a rancher roundtable that focused specifically on mental health, but she thinks it is a "good idea, and something they should think about for this winter."     

Carey said that Miller has a good relationship with the local ranchers. Miller said she is not a trained mental health professional, but she has been trained to recognize suicide warning signs and to connect agricultural workers with mental health resources.

Katie Levine, the Rocky Mountain area director at the American Foundation for Suicide Prevention, said that the foundation has several programs to mitigate stigma. The most successful one is called Talk Saves Lives, she said, adding that raising awareness and normalizing mental health issues is one of the "key factors to helping to reduce the suicide rate." The 45–60-minute group workshops, which the foundation has targeted specifically at farmers and ranchers, among other groups with high suicide rates, provide participants with the most up-to-date research about suicide, including common risk factors and warning signs, and teach individuals how to support others through crisis situations, according to the foundation's website. Levine said it is vital to "make the community aware so they can act as a support network for their peers."

Brennan said she is also involved in the Western Regional Agricultural Stress Assistance Program, which was initiated by Washington State University. The program's goal is to team up with 13 states across the Western U.S. to provide more funding, assistance and outreach to improve mental health among agricultural workers, Brennan said. According to Rosmann, the program is one of four regional programs across the U.S. that conduct relevant studies and provide training for professionals and non-professionals—including extension workers, veterinarians and others who work with agricultural workers. He said developing the trainings is "taking a while."

Rosmann added that the program will also work to apply for grants and raise money to provide better crisis services and community workshops, make health information available through local farm service agencies, and provide affordable mental health services to agricultural producers. 

On Aug. 10, the program had an “AgrAbility Training Workshop,” according to its website. Miller wrote in an email that the event offered "Question, Persuade, and Refer”—more commonly known as QPR—training and that Tyler-McSherry presented and spoke about Ask in Earnest. Tyler-McSherry said QPR is like mental health CPR: a 90-minute training to teach individuals how to help someone in crisis and have difficult conversations about suicide. 

Levine acknowledged that raising awareness and mitigating stigma is not everything. Another major obstacle is the lack of access to mental health care in rural communities, she said. 

Brennan said there is an absence of providers in this area—people must travel long distances to get services and then endure long wait times once they get to a facility. Additionally, she said, many people lack health insurance or reliable technological infrastructure for telehealth, or both.

The AFSP is currently working on providing more accessible crisis services by implementing the new 988 crisis suicide lifeline, Levine said. It will exist parallel to 911, she said, and is much easier to remember than the current 1 (800) 273-8255 lifeline number, she said. The 988 crisis hotline number is slated to go live in July 2022 and will replace the longer number.

However, there are still many "barriers to cross" to implement this new lifeline, Levine said: The foundation still needs state funding to support the program, and needs to establish the infrastructure to support it, including hiring more staff to manage an anticipated increase in call volume. The call center recognizes the importance of having diverse staffing, so that if someone from a rural area in Montana calls the lifeline, they can speak with someone from that same area who understands the issues, she said. 

For long-term care, Levine said she was excited about the potential of telehealth, especially because it might increase the likelihood that a farmer or rancher would find a provider that they could relate to.

Rosmann stressed the importance of "culturally acceptable" services, which has been worked on by many extension agencies. Part of this, he said, is requiring that providers have some personal experience in agriculture. Often, he said, agricultural workers don't feel comfortable seeking help from health providers because the providers don't know anything about the unique stressors that farmers and ranchers face. 

"You have to speak like a farmer or rancher. I think a farmer or rancher can tell in five minutes whether the psychologist or behavioral therapist has a grasp of agriculture, because the language is different," he said. 

For example, when many people hear "AI," they think of artificial intelligence, Rosmann said, but he thinks of artificial insemination. He said the people who serve farmers and ranchers have to know about the cultural codes to be accepted.

Carey said he was searching through mental health providers at one point to see what counseling was available via telehealth, but there were only a handful of providers that actually lived in Montana that would understand rural life. 

He said that access to services is also difficult because, for ranchers, the best time to "get away" is not during business hours when many services are available—it's later in the evening or really early in the morning.

His insurance plan has options for telehealth and mental health care, he said. He used telehealth services to get a prescription for his allergies and it saved him a lot of time, he said, adding that he thinks it would be a good option for ranchers who do not have time to drive into the city to receive care.

He said that in terms of receiving help in person, if ranchers are spotted by other ranchers as they seek care, they won't go back again. 

"There's a little bit of stigma. I think it's one of those things that's been building generation after generation," Carey said. 

Carey said the stigma can be tough because there is a lot of competition between ranches, and, at times, animosity that formed over a feud from "generations" in the past. He said it is difficult when the only people who might understand you are the people you also compete against.

Tyler-McSherry said that when she's presenting to the medical community, she acknowledges that if they don't come from an agricultural background, they likely will not fully understand the stressors that their farming and ranching clients face. She said she suggests that providers "bridge that gap" by putting a rain gauge outside their homes.

"Next time your client comes in who's a rancher, maybe you guys can talk about rain. Because ranchers are like farmers, and they're always talking about weather and rain," she said. 

She said it's important for health care providers to show their clients that they are making an attempt to understand their lifestyle and perspective. 

Alternatively, Carey said, a counselor with experience in family matters, especially working with family business, would also be beneficial, even if they don't have experience in agricultural work.

Rosmann said it is important for people who do business with farmers and ranchers to have some mental health care training. He said that an increasing number of veterinarians are getting second degrees in counseling or public health so that they can better assist their customers with personal issues in addition to livestock issues.  

Carey said he thinks this solution could work because many agricultural workers go to the veterinarian for their own health issues instead of the hospital. His cousin, he said, once drove past two hospitals and instead went to a vet for physical trauma. Ranchers are also more susceptible to cancer, heart issues and, of course, broken bones, Carey said. He said he thought it would be helpful for doctors—or veterinarians, if that's who someone sees instead—to screen for these medical and mental health issues once they hear someone is a rancher. 

"Farmers and ranchers will talk to their veterinarians," Rosmann said.

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