In July 2016, the Center for Disease Control & Prevention (CDC) issued a report on suicides by occupation and it sat almost unnoticed for over a year. Most people who read it assumed that armed forces veterans would be at the top of the list. That crisis had been a major news story for a long time. Most people were wrong.

Agriculture -- farmers and ranchers -- led the way and second place wasn't even close. Ag suicides are the greatest unreported tragedy of its kind in America and around the world. If veteran suicide in America is epidemic, ag suicide is pandemic. Here's the hard data: Suicides among a group labeled Farming/Fishing/Forestry totaled 84.5 per hundred thousand. Far behind in second place was Construction/Extraction at 53.3 per hundred thousand. Following up on the shocking CDC report, National Public Radio (NPR) and ABC News started researching this tragically overlooked crisis.

I called Dr. Mike Rosmann, a leading expert on mental health issues among farmers and ranchers and talked with him at length about ag suicide. A clinical psychologist who manages the family farm near Harlan, Iowa, he has the solid agricultural and academic background to know what he's talking about. He was a professor at the University of Virginia and the founding director of Prairie Rose Mental Health Center. Today, he works with AgriWellness and the Sowing the Seeds of Hope group and he is an adjunct faculty member of the College of Public Health at the University of Iowa. He is known nationally as an advocate and spokesperson for better behavioral healthcare for agricultural producers.

Q. Dr. Rosmann, recent reports by NPR and ABC News highlighted an unrecognized tragedy. Suicides among farmers and ranchers -- especially those in the dairy business -- have been agriculture’s most often ignored secret. NPR’s story was spurred by a letter dairy co-op Agri-Mark, included with its monthly milk check mailing to its members. Depression and suicide were major problems among its members, it said, and urged anyone who felt they were overwhelmed to seek help.

Low milk prices meant dairy farmers were covering barely 75% of their costs, a financial disaster that had been going on for several years. The financial losses meant many cash-strapped farmers were becoming more depressed about their future. After three Agri-Mark Co-op farmers took their own lives in the previous three years with the most recent being in January, the co-op included a chart showing the dismal 2018 milk prices forecast, and a list of suicide prevention hotlines. 

According to the CDC, farmers have a higher suicide rate than any other occupation, nearly twice as high as vets. What’s happening?

A. I am familiar with some of the aspects of the NPR and ABC news reports about the plight of dairy farmers and the controversy about the letter Agri-Mark sent with its monthly milk checks. I contributed to the NPR reports during a 45-minute interview. More importantly, there is a coalition of concerned persons, organizations and local agencies to try to help dairy producers who likely face being shut out from a purchaser of their milk. 

I am trying to help the coalition come up with responses that entail community meetings and other actions. I can also say more about what is known about why farmers take their lives by suicide than any other occupational group. 

Exposure to certain farm pesticides (mainly insecticides in the organophosphate, carbamate, organochlorine and neo-nicotinoid families) are implicated. Every farm circumstance is different, however.

Q. People in agriculture have a strong go-it-alone, solve-your-own-problems attitude that has been tagged as a major reason so many distressed individuals won’t ask for help. Is that true and what can be done about it?

A. To farmers, land means everything. Ownership of a family farm is the triumphant result of the struggles of multiple generations. Losing the family farm is the ultimate loss, bringing shame to the generation that has let down their forebears and dashing their hopes for successors.

Q. A few weeks ago, Washington state legislators unanimously passed House Bill 2671 which establishes a pilot program for free suicide prevention for employees of the agriculture industry. It seems to be similar to a proposed nationwide program called the Farm & Ranch Stress Assistance Network (FRSAN) program that you’ve suggested in the past. Is that state on the leading edge? Should other states consider something similar?

A. Yes, the Washington state initiative is modeled after the Sowing the Seeds of Hope project and FRSAN. Minnesota has already implemented a farm crisis hotline that does well-attended community farmer meetings, and visits to farms by trained counselors/business consultants, all funded through the Minnesota Department of Agriculture. I've heard that Illinois and Colorado are considering something similar.

(Rosmann sent this statement taken from a paper he wrote last year). The Nebraska Rural Response Helpline (1-800-464-0258) is a laudatory example of both governmental and private underwriting of the operation of a particularly useful behavioral health program for farmers and all rural residents of Nebraska. The Helpline depends on an annual state-wide non-tithe church collection, grants from private organizations, and on the Nebraska legislature to cover its costs.

All these entities pitch in to support the operation of the statewide telephone and website to offer crisis assistance to Nebraska’s farm and rural populations, along with redeemable vouchers to obtain one or more counseling sessions from professionals who are familiar with agriculture. 

Five other states besides Nebraska operate farmer-friendly behavioral health supports to callers:

·         Iowa Concern (1-800-447-1985)

·         New York FarmNet (1-800-547-3276)

·         Wisconsin Farm Center (1-800-942-2474)

·         Vermont Farm First (1-877-493-6216)

·         Minnesota Department of Agriculture (1-833-600-2670)

The Manitoba Farm & Rural Support Services (1-866-367-3276) provides telephone and online behavioral health assistance for the residents of Manitoba. Moreover, the Canadian Agricultural Safety Association, funded by their federal government, provides some types of psychological support services for Canadian farmers. 

Q. Ag suicide seems to be one of international scope with reports similar to the rates in the U.S. coming from New Zealand, Australia, the European Union and Canada. A survey by the University of Guelph showed 45% of Canada's farmers report high stress, 58% were classified with anxiety and 35% with depression. Is agriculture as a lifestyle doomed to such high rates of depression and suicide in developed countries?

A. Farmer suicide is not just a U.S. problem. Canada, Great Britain, Australia, India, practically all agricultural countries that are modern or are modernizing have the same issues. There is something going on that I think the “Agrarian Imperative” theory explains. It’s still just an explanatory theory, however, and more research and confirming data are needed. There are a few corollaries, such as the contributions of Attention Deficit Hyperactivity Disorder (ADHD) and genetic predispositions to overreact to threats, such as potential loss of the assets needed to farm successfully.

Dr. Dan Isenberg of the University of Washington, surveyed Kenyan farmers, looking at those who were particularly successful. He found a large percentage had ADHD. It's a condition that makes risk-taking, often an advantageous trait in agriculture, easier to accept. We're also seeing a proclivity among ag people of Germanic heritage to respond to adversity by working harder, a tendency that can lead to depression and suicide if their harder work does not result in a better outcome.

Q. Finally, let me ask two important questions. First, what are the warning signs we should look for in a friend or family member that might mean he or she is having a problem coping?

For the answer, Dr. Rosmann referred me to a paper he wrote last year.

A. There are observable signs of severe financial and emotional distress among farmers. Chiefly these are:

·         Verbalizations by farmers about hopelessness, such as “I feel like giving up because nothing I try works.”

·         Persistent loss of interest, laughter and pleasure in anything for days on end, and grim statements like, “Nothing is fun anymore.”

·         Threats, such as “I’ll get even, if it’s the last thing I do.”

·         Avoiding social and public events such as church, their children’s activities, and meetings.

·         Flat emotional expression for days on end that is atypical of the farmer.

·         Deterioration in the appearance of the farm, machinery, or livestock health that the farmer would usually not allow.

·         Decline in the farmer’s usual personal appearance such as disheveled clothes, sallow complexion, weight loss, etc.

·         Mention of feeling worried, distressed, difficulty sleeping, or no sleep for two or more successive nights.

·         Acknowledgement of “having a lump in my throat, but I can’t cry.”

·         Inability to undertake expected farm activities, such as harvesting crops when the weather is suitable, and difficulty making important decisions.

·         Recognition that too many major stressors are occurring simultaneously, such as multiple livestock deaths, pressing debts, natural disasters such as drought or tornadoes, losses of key supports such as a parent or long-term employee, etc.  Most farmers can manage two simultaneous stressors, but three or more may push them beyond their coping capacity.

In my experience -- and research findings agree, the first three and the last four signs are particularly important indicators of possible suicidal deliberation. Unfortunately, those who know best aren’t around to tell us.

There also are farming practices and physical health cues that farmers and the persons around them should pay attention to, including these:

·         Has the farmer been exposed recently and/or repeatedly during previous occasions to farm chemicals that affect the nervous system? 

·         Certain insecticides are among the most hazardous farm chemicals; they are designed to kill insects by altering the synapses of their nervous system (synapses are the spaces between nerve cells that are filled with substances that regulate nerve signal transmission); they overly stimulate the insects’ nervous systems and have the same effect on humans.

·         Other substances used on farms can also enhance undesirable neuropsychological changes, such as certain fumes, veterinary treatments for parasites, herbicides, and fungicides.

·         Dust in grain bins, animal facilities and sometimes during harvest operations can harm pulmonary functioning among working farmers that may limit oxygen intake and lead to neurological compromise.

Q. Second, what about resources? Where does a farmer or rancher go for help?

A. The first and most important decision for overwhelmed farmers and their families is to seek outside assistance. It’s a difficult decision because it involves acknowledging that they need external advice rather than relying solely on themselves. 

Self-reliance is a defining psychological trait of successful farmers, along with extraordinary tolerance for adversity.  Recognizing that outside assistance with emotional, financial, and legal issues is needed is a step in the right direction, and a major admission for people who maintain an agrarian livelihood.

What should farmers and their family members take into consideration when seeking an agricultural behavioral health counselor? Here are recommendations I have offered in the past, and with updated information:

·         Foremost, the counselor should be familiar with agriculture; I learned from Dr. Lynda Haverstock, past Lieutenant Governor of Saskatchewan and a psychologist, that understanding the culture of farming goes a long way toward establishing credibility as a “helper” to farmers

·         To find a counselor who has an agricultural background and/or understands the culture part through training and experience, farmers may approach farm crisis telephone helplines in the states that maintain lists of counselors in their states who have track records of helping farm families: the Iowa Concern Hotline (1-800-447-1985), the Nebraska Rural Response Helpline (1-800-464-0258), New York FarmNet (1-800-547-3276), Vermont Farm First (1-877-493-6216), the Minnesota Department of Agriculture (1-833-600-2670) and the Wisconsin Farm Center (1-800-942-2474)

·         Farmers in other states usually have to launch personal searches, because there is no national directory of agricultural behavioral health therapists; I encourage them to contact their physicians, local professional providers, and community-operated services to ask who in their area best understands agriculture; I also encourage callers to contact their state associations of psychologists, mediators, counselors, social workers, and other professions and to speak with the association director; this person may know association members in the state who work with farm people and farming issues

·         Interested persons can find the websites and telephone numbers of state professional associations online; sometimes the local county or regional Extension office director knows who can be a useful “helper”

·         I also recommend that to maintain confidentiality, callers should only use their first names when visiting with agency representatives and professional association directors

·         If the first selection proves unsuitable, don’t be afraid to try other choices; a “good fit” is more important than the academic degree of the counselor

·         The counselor should be willing to meet at times and places acceptable to the farm family, such as on a rainy day or weekend and at their home if appropriate (home visits by a counselor yield valuable information about the farming enterprise that save time during discussions)

·         Farm family members may want to ask if they can pay for services at a reduced private rate rather than through insurance, because any time an insurance claim by a professional provider is processed it goes through a national databank that keeps track of the diagnoses on the claim form; some diagnoses can make subsequent health and life insurance more costly if a chronic illness is registered on the provider’s claim for reimbursement; bear in mind, the provider cannot alter a diagnosis made in good faith and would be committing fraud if the claim is entered incorrectly

·         Sometimes the best agricultural counselors are not licensed professionals; they may be pastors, farmer coaches, or wise persons who listen well and can give useful advice.

NOTE: This column is the first in an ongoing series on suicides in agriculture.