Governments and organizations that provide mental health support to farmers dealing with depression, anxiety, and isolation have traditionally focused on overcoming the stigma associated with getting help — but that isn’t the barrier farmers face, according to a new study by a research team led by rural sociologists at Penn State. The bigger issues, they found, are rural health care shortages, long wait times for appointments and travel time, as well as high health care costs.
The team said the most recent findings from their ongoing five-year study, published in the Journal of Rural Studies, suggest that more effective programs with added resources to address financial challenges — including efforts to help farmers navigate complex and time-consuming paperwork — could do far more to help farmers.
Farmers experience mental health problems at up to five times the national rate, according to the American Farm Bureau Federation, often related to stress caused by financial pressure and debt, uncertainty about weather and markets, and worries about farm succession and labor shortages. These concerns can be compounded by isolation in rural areas. Despite several organizations and governmental bodies investing in mental health programs for farmers such as counseling, suicide hotlines, and educational workshops, many farmers still don’t use available support. According to the researchers, it was believed that this unwillingness resulted primarily from the social stigma associated with mental health challenges.
“This study is the first to look simultaneously at farmers’ willingness to seek help as well as their ability to actually get it,” said study senior author Florence Becot, Nationwide Insurance Early Career Professor and Agricultural Safety and Health Program leader in the College of Agricultural Sciences. “Overall, the investments in programs have been made with limited understanding of farmers’ ability and willingness to engage with mental health support.”
Becot has been studying the mental health struggles farm families face — ranging from coping with extreme weather, volatile markets, limited health care and child care access, low incomes, worries about losing the farm, and the physical toll of farm work — and what to do about the situation, for more than a decade. She has advised agricultural policymakers in Washington D.C. on strategies to address the problem.
Other studies on this subject, she explained, have been focused on one of two perspectives: Asking how farmers respond to stress, investigating whether they are willing to get help; or determining what mental health care looks like in rural areas, considering cost, accessibility and acceptability.
“But what we do here is put those two approaches together, assessing both farmers’ willingness and ability,” she said. “Based on what we heard from people who regularly work with farmers, we found that many farmers appear to be more willing than able to seek help. And that applies for financial and mental health challenges, meaning that they appear more open to getting help than what previous studies have inferred, but run into barriers that makes it harder to get help.”
Instead of asking farmers, the researchers asked “key informants” — people who work closely with farmers in their communities — why farmers aren’t getting the mental health support they need. The research team — including the paper’s first author, Sarah Ruszkowski, research technologist in the Department of Agricultural and Biological Engineering — conducted interviews with 64 farm organization staff, university extension agents, agricultural service providers and health organization staff in three states, asking them about what they observe farmers doing when facing challenges.
Key informants can provide different perspectives on what they see among the farmers they interact with in a professional and personal capacity, Ruszkowski said. In some instances, relationships of trust and mutual understanding with service providers and community leaders are built over many years and as a result, these service providers and community leaders are uniquely positioned to serve as counselors to farmers.
“Many of the key informants in our study play a key role in developing and/or offering programs and resources,” she said. “As such, they have an acute understanding of how farmers engage, or not, with programs as well as the reasons for engagement.”
Similar barriers affect farmers getting both financial and mental health support, Ruszkowski pointed out. Some of the same factors shape both willingness and ability, she said, such as costs, lack of internet access, time constraints, complexity of program eligibility, cultural norms around independence and self-reliance, geographic isolation, and limited availability of services. Based on these findings, the researchers said, current approaches to providing farmers support for mental health challenges may be misdirected.
“Instead of asking, ‘how do we convince farmers to seek help,’ the focus should be on how we can remove barriers that prevent farmers from accessing help when they want it,” Ruszkowski said. “We also have to be thinking about the potential unintended consequences of programs that focus too much on convincing farmers to seek help and working on themselves. Indeed, some key informants shared that farmers were frustrated when meeting with people who were being overly cautious about the topic because they wanted to discuss their stress.”
On a practical level, Becot explained, the study suggested that programs and resources to address financial challenges should include efforts to help farmers navigate paperwork that can be time consuming and complex. When it comes to programs and resources to address mental health challenges, efforts should be focused on resolving rural health care shortages, reducing wait time to get an appointment and travel time, as well as lowering health care costs.
“Finally, financial and mental health supports should be linked because for farmers, financial stress and mental health are deeply connected,” Ruszkowski said. “Programs should be coordinated rather than treated separately.”
