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Rural mental health

Posted on October 28, 2012 by Simon Haley — No Comments ↓

18.10.12 Discussion archive

There is still a social stigma attached to mental health issues, but it has become easier to seek help. Farming can be lonely and detached – farmers are 3 times more likely to commit suicide than the average person, and are classed by the Government as an ‘at risk’ group.

The pressure of ‘keeping the family farm going for future generations’ contributes heavily to farmers’ anxieties and the often-felt difficulty of getting away from the farm and its daily ritual, struggling with the elements, financial problems and unsympathetic, bureaucracy adds to stress levels. The discussion was notable for the many honest and frank responses.

It was considered that more outlets, forums and online discussions are needed for people to share their experiences and worries, and that information for both sufferers and their family and friends needs to be more accessible.

The rural mental health discussion held on Thursday 18th October 2012 generated a total of 1,158 tweets on the topic from its 130 participants. By adding together the number of followers of each person who took part, and bearing in mind that if you follow someone you can then see everything that they tweet or retweet, then this discussion reached 173,000 followers in total. In addition, bearing in mind that these followers could be following a number of those who took part, these tweets generated 1.4 million impressions! This was our most popular chat to date and we were trending at one point on Twitter in the UK, around 9.30pm!

The title of this discussion was “rural mental health” The aims were to facilitate an open and honest discussion on the topic, and to raise awareness, as it is so important that people feel and know that they are not alone, and that there are people to talk to whether it is in person, by phone or online. A full summary of the discussion can be found here: http://storify.com/AgriChatUK/agrichatuk-rural-mental-health-discussion-18-10-12

The discussion facilitated first-hand experience of the subject, along with experiences being shared and advice being given and directions to other forms of support. There was also a guest panel of tweeters to help answer specific questions and to provide guidance. This included Norman Lamb MP, minister for social care, Professor Louis Appleby, an adviser to government on mental health, Glyn Evans of Farm Crisis Network, rural psychiatrist Dr David Middleton, Karen Messruther of RSABI Gatepost, and Alison Fairleigh of Rural Mental Health in Australia.

There were lots of new faces who had not participated in an AgriChatUK discussion before, and there also appeared to be several people who had set up Twitter accounts especially for the session. Although it was sad to hear that so many people had or were suffering from mental health problems, it was great that so many felt able to start to talk about it. Professor Louis Appleby commented after the discussion had finished that he was really impressed by the determination of those who were tweeting to tackle the problem going forward.

Q1a have you or someone you know suffered from mental health issues? when did you realise something was wrong?

  • Someone I know is very ‘up & down’. Makes life difficult for all around, no chance of them going to doctor-they don’t see anything wrong
  • Probably first realised when they withdrew from their friends and started avoiding company
  • A farmer called for a chat, he couldn’t see any positives or any way forward, I had never heard him that low
  • Just using the phrase mental health can put people off expressing how they feel when they are anxious or suffering low mood
  • Unfortunately different people show signs differently, even to the point of not realising or accepting the problem
  • Seeking help is the first step to recovery. It’s important people know where they can find help
  • Knowing what to look out for in depression can raise your level of suspicion that someone might be suffering in silence
  • Combination of demographic and “culture” makes it so difficult, especially for men, to admit mental health issues
  • I have often found that the most seemingly resilient people in farming are most prone to anxiety and stress

Q1b how did you deal with these issues? did you seek professional advice? if you did seek help was it useful?

  • For us it was a case of ‘living the episode’ He wasn’t prepared to talk, it took 15 years to get help
  • Key part of effective strategy to prevent suicides is tackling stigma of mental health issues
  • I called some local friends and rural stress network, next day I got a text, saying thank you
  • Lots of support agencies including Farm Crisis Network and RABI, also check out Institute of Rural Health website http://www.rural-health.ac.uk/
  • Many don’t know they’re depressed, others do but the person suffering will NOT talk.
  • Agriculture is an industry where each member is a vital gear in the machine. You have no option but to keep going
  • Suggest a better approach to start e.g. Asking for awareness of symptoms of mental health

Q2a what sort of counselling services/professional help is available to rural communities throughout the UK?

  • Part of the problem is rural waiting lists can be epic, over 8 months for assessment, things get worse in that time
  • In Australia mental health literacy and access to services is a huge part of this
  • Major battle is getting person to accept need for help
  • Wherever you live and however far away you think help is, there’s always somewhere you can reach out for recovery
  • We used local NHS mental health team when who were okay for short term crisis but not long term support, led to regression
  • Government’s £1.5m suicide prevention strategy is welcome – will it specifically include the farming community and if so how?
  • In Scotland you can call GatepostTweet on 0300 111 4166. We can support by listening and help to access services
  • Mental Health Matters helplines in NE England, Coventry/Warwickshire & Kent, We’re out there waiting to help.
  • In Kent we had ‘Kent Farmline’, but it ran out of funds. Luckily FCN has stepped in and we now have a Kent FCN service

Q2b for our agrichatuk panel – what should people DO if they’re worried about a loved one, or if they think someone is feeling suicidal?

  • We get calls to our Helpline from people worried about others. Sometimes need to recognise what’s happening to others
  • Start by listening to them and how they are feeling often this is enough to start to change the way they feel
  • I found physiotherapist a great help. And they have good insights into stress, maybe a good first port of call
  • If they believe someone is suicidal it is very important to ask the person directly & then find appropriate help
  • If things do not improve, encouraging people to see their GP is a good first step
  • People push & push themselves until breaking point. Would be great to recognise the signs & seek help before crisis
  • Talking it through to be able to decide on treatment is good, but talking is a major hurdle
  • People often cope with huge amounts of stress before it begins to show
  • GPs have access to a variety of treatments, not just pills as people will often assume

Q3a if you were feeling depressed/anxious/stressed/suicidal would you feel you had someone to talk to about it? could you talk about it?

  • My friends in the army say their training to manage stress is don’t worry about stuff you can’t change
  • I was at a low point. Long hours, stressful work, credit crunch panic! Took openness, honesty & courage to overcome
  • I think agriculture’s big problem is, and in my case as herdsman was, no option, no one to take my place
  • Do you think men are more reluctant to talk about these things then women?
  • Been there – talk to a loved one they will listen and it helps more than you ever think. Talk before it’s too late
  • What can you do if the person WILL NOT accept anything wrong? Especially when it’s been going on for years? We can all see signs
  • Exercise is great way of switching off the brain for a bit
  • I could talk to my partner, but he’s a doctor with unusual training. I wouldn’t want to talk to employers or most others
  • Is the social role of Marts and pubs underestimated by policy makers?
  • Think one of the key things friends and family can do is to listen and NOT say pull yourself together
  • Even the most ‘modern’ of younger men, many are afflicted with worry about their ‘image.’ Talking comes less easily
  • The trouble is until you are in the position to need help you don’t know how you would react
  • If we could educate people more that depression/stress anxiety isn’t a weakness they wd be more likely to talk
  • Only because I work for RABI and work with Farm Crisis Network, not sure I could turn to family, friends or stranger to talk
  • I wish I had told employer I needed to sort out health issues. But you worry about your job, home and family
  • Most important part in listening is to be non-judgmental (note judge….mental) so sufferer can truly unburden

Q3b what can we do to make it easier for people to find /seek support from such professional sources?

  • This is where mental health awareness is very important. Having empathy & making time to listen
  • Just being listened to without judgment is such a relief when you’re worried/stressed
  • Wave a magic wand and give everyone more time for each other
  • Quite often it is one that encourages the other in not being so reluctant to talk about these things.
  • Worth saying national suicide prevention strategy sets out priorities & evidence, relies on local services to adapt & put into practice.
  • A friend suffered with depression badly but he found dairy farmers in the same position and they helped each other
  • Guess there comes a point where it’s important, as well as listening, to point someone to expert help
  • Stigma in small rural communities can make it difficult to see someone locally. Having a variety of services is important
  • 1) Awareness campaign on how mental health can impact many people and it IS NOT A WEAKNESS. 2) Visibility of sources of help
  • Depression is seen as taboo and not an illness, a change in perception may alter peoples’ actions when they are poorly
  • Certainly the contact details for agric specific counseling services are not easy to find

Q4a have you ever had suicidal thoughts? would you know how 2help if you suspected someone was stressed/feeling suicidal?

  • We often assume people will think the worst of us when actually they’re just concerned and keen to help
  • Do you have Mental Health First Aid in the UK? Can highly recommend this program for suicide intervention
  • Conversations about mental health can help dispel myths that still surround it, there is no shame at all in asking for help
  • If you keep getting headaches then there is a underlying cause that needs diagnosis. Same with depression!
  • When living in fear & silence in a violent relationship. Just wanted to slip away at the time
  • I would now, only because I’ve been through it. But, unless the person is ready to want help it can be fruitless
  • I worry that if I was depressed I’d lose stability in society e.g. losing my gun license so perhaps would struggle on
  • Felt all sorts of lows but not that bad. Am adept at hiding – par for course! Aware of others way worse off.
  • A lot needs to be done in the world of farming me and my dad suffered major depression when we lost our dairy herd
  • I have to say the unique problem agriculture faces is that you can’t get away from it. It’s all around you
  • Yes I have 2 friends who have tried (and thankfully failed) to end their lives. Both are now living full and happy lives

Q4b do you feel today there are greater pressures in farming leading to a rise in stress & anxiety? what are they/how to mitigate?

  • Definitely. Being subject to factors outside of their control, e.g. market forces, climate, government regulation
  • It is so important for a couple of weeks a year to get away, anywhere
  • Animals are brilliant for helping to cope- always seek out my furry four-legged in his field
  • Definitely more pressures than previously-after 23 years married to a farmer he’s a lot more stressed than he was
  • There’s too much bureaucracy & threat of SFP cuts when a tiny error is made but Dept not penalised if they err
  • Definitely the pressures are greater – more regulation, animal diseases, the weather, supermarkets, pressure from finances
  • Exercise is one of the best forms of ‘first aid’ for milder forms of depression. Lots of evidence
  • Animals often the one thing that gets someone out of bed in morning when they’re depressed. Wonderful things!
  • Def more stress nowadays. bTB is a huge stress, because it puts pressure on finances
  • Have we lost the ability to appreciate what we have? 20 years ago – longer, harder hours, but also took time out
  • Ironically the speed of communication & multiple options can make it worse. Pressure builds faster
  • We had animal health issues. The Vets called it mismanagement. but we were both working 16hour days on 100 cows

Q5a are farmers too reticent to talk about problems? is a problem shared a problem halved, or instead seen as weakness?

  • Livestock markets are a great place to talk
  • Yes but when you’re stressed you don’t stay around as don’t want to chat, vicious circle
  • The Pasture to Profit discussion groups are a great source of mutual support and camaraderie in tricky times
  • Many definitely see it as a weakness. Mental health problems shouldn’t have such a stigma
  • Farmers reticent definitely-NE Scotland farmers especially as it’s the nature of the beast here
  • Farmers tend to be self-sufficient, it is the nature of the job. Seeking help may incorrectly be seen as a weakness
  • Who would they talk to? Neighbours more likely to talk about weather/ mart prices….
  • I think the role of reps, vets and those who visit farms is essential as sometimes the only person they see that day
  • A guy I knew shot himself 3 months ago over some land he might of lost due to paper work error
  • How can we resolve this? If they broke a leg they’d seek help
  • Talking and seeking help is not weakness, it’s a strength. But how do we convince people of that? It’s a huge cultural shift
  • Farmers suffer the weight of history “I’m not going to be the generation that loses the family farm” that’s a lot of pressure
  • Good ideas, but some farmers I’ve spoken to haven’t been to the mart in years due to bTB restrictions
  • Yes, reticent. Other risk factors: money worries, alcohol, isolation, access to chemicals & firearms
  • Farmers can approach things differently. I often get questions on phone about policy, then actually have craic about life!

Q5b what impact has twitter/social media had in identifying/helping to resolve rural mental health probs?

  • If I feel sorry for myself, go on twitter and usually find someone who has had a worse day!
  • It’s important that people living in isolated places across the UK (and world) reach out online and speak out
  • It’s a great help! Not everyone has internet at home though, and it can be more expensive rurally
  • Not everyone has knowledge of their options re internet, and some aren’t comfortable online yet
  • I think that is why twitter is great, often easier to chat to strangers, nice to know you’re not alone
  • I think this is key. Social media a massive boon to people in isolated places
  • Twitter is good for realising that there are others in the same situation, can also be used anonymously
  • Social media, internet quite useful, but just makes easier to self-diagnose/see what’s available. Sufferer still has to take action!
  • Social media often seen as problem e.g. cyber-bullying, but can be vital support for isolated people
  • Having a friend to talk to can be the greatest help. Ironically, social media can help provide a friend at a distance

Q6a is there still a “grin & bear it” mentality & stigma of mental illness & health issues in farming? how do we overcome this?

  • We take note of this amazing discussion and access all the help needed and spread the word
  • Awareness of the different forms of mental health problems, there are many
  • Perhaps that is much a British trait as much as anything…but rural isolation exacerbates it
  • A family member had depression for years for exactly that issue anxiety and worry about the future. Feels helpless
  • Through more positive publicity i.e. case studies from sufferers who have successfully sought help?
  • Yes and a “nobody else’s business” mentality too
  • Things have to change from top down.
  • When the farm is all you know and love the threat of it going can only beat you down and make you feel responsible for it
  • When you’re at the bottom of despair sometimes you don’t know it. To have help is great but helpers also need to go looking
  • Getting farmers to talk about mental illness is not easy but it often leads to a conversation about “someone I know”
  • Very common, quiet support understanding and love is the first effective medicine
  • It’s not just farming. Some groups it’s the same. Older generation, forces etc don’t want to say anything as they seem weak

Q6b “stress is also caused by changes in perception of farmers & of their place in rural society” what are your thoughts on this? 

  • Government policy has almost made farmers out to be villains-is it any wonder so many are leaving/stressed
  • bTB is a HUUUUGE issue. The stress from that alone on the farm is immense
  • This has been identified as a significant contributing factor to the high rate of rural suicide in Australia
  • Perceptions of living in big farmhouse, lots of kit etc gives the impression of wealth/success but not always case
  • Suicide can be impulsive act in response to trigger event, e.g. relationship break-up. That’s why access to crisis support vital
  • Bring it down a level. Older farmer may feel pushed out whereas a young farmer home from college may struggle knowing place
  • Not really. Those changes happened in the 70’s
  • Level of misconception about life of farmers – ‘darling buds of may mentality’ another wall for suffers to fight
  • Yes- mainstream media often negative view, but also very up and down, e.g. positive for #sosdairy, but awful for #btb

Q7a what can be done to improve &maintain mental health &wellbeing of people in farming? what would help?

  • Key issues. How can we get this more widely talked about beyond social media/tonight?
  • Utilise local farming networks -sharing difficulties can help. It can be an isolating profession which can impact on mental health hugely
  • We need a multifaceted approach that increases knowledge around mental health AND changes attitudes
  • Try to raise awareness of the support services available and how they can be accessed
  • In the olden days “Discussion Groups” used to be common but not so much now. How about resurrecting them?
  • I agree that isolation is a huge factor. Not necessarily just geographically but emotionally. Encourage others to talk
  • What about rural peer support? As experts by experience they may know key issues and problems. Mental wellbeing checks?
  • As with all mental health issues, group meeting to show common understanding and support will help
  • Any mention of mental health at agricultural college? I didn’t go. Surely that would prepare entrants so they’re more aware of signs
  • Better education, should be part of H&S in Agri colleagues, can YFC help?
  • Agriculture needs more health & safety and mandatory ‘well man’ health check ups
  • Farmers often very busy when reps etc come around. Can’t see them being too receptive to some1 wanting 1/2 hr+ of their time..
  • As ever, analogising, once you know the horse is thirsty, can lead to water but not make it drink. Is it the right water
  • Mental health & physical health are inextricably linked. One often precedes the other

Q7b how much does peer pressure &clinical workaholism contribute to problems in the farming community? i.e. pub yields, long days

  • Rural isolation, long working hours, bad year, farmers tend not to talk about their problems thus become more isolated socially.
  • I think it’s more to do with having to get the work done before the weather breaks again (here certainly)
  • When you work with animals you are ‘married’ to the job, it includes the long unpredictable hours. It’s a choice in life
  • Yes, trigger often after period of escalating risk – not sleeping, drinking, avoiding friends
  • Unfortunately the don’t ask don’t tell mentality re depression is a cultural thing & effects the whole of society
  • Peer pressure a huge issue in mind of sufferer ‘everyone else is fine/doing better/more successful=battered self esteem
  • Can have opposite effect. Knowing your peers have the same problems, harvesting etc can be a comfort. Not alone
  • Working long hours, generally alone, =thinking time and tiredness, both can build depression

Q8a is going to see a therapist/psychiatrist/psychotherapist still viewed negatively in farming? does this stop people seeking help?

  • Too costly both financially and time. Very long waiting list here, sometimes months
  • The only way to overcome it is to allow depression to be spoken about openly without the fear of being stigmatized
  •  I think its pride before anything that stops people seeking help even if they know they need it
  • Yes, impediment for many, especially at early stages when help could be most valuable. Again, crucial for all to be aware & mindful.
  • I think in some circles it is, but it isn’t just Farming that’s like that. Most industries still have the taboo
  • Like any other job, these still have their stigmas and are not viewed the same as going to see a physical Dr – shouldn’t be!
  • Also we are very isolated daily, working alone, it becomes harder to seek help if you need it.
  • It’s definitely pride and fear of unknown of what is available. Confidentiality is key
  • I no longer get hung up with the Real Man tag. I am what I am. Real men talk about their feelings
  • Reminded of a very successful farmer who spent time (c. 20+yrs ago) in “therapy”/spec unit. Now seems fine, stigma then

Q8b how much do you know of resources such as care farming/ecology/green care? can agriculture & rural areas help in their rehabilitation?

Links to more information

 Simon Haley and Alan Spedding, 21 October 2012

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