It’s no secret that rural residents tend to be sicker, more cash-strapped, have less access to primary and mental health care, and are more susceptible to substance use disorders (SUDs). On top of that, rural communities often face transportation barriers and limited access to jobs that pay a living wage. The outcome is higher rates of depression and suicide.
A report, “Growing Stress on the Farm: The Expanding Economic and Mental Health Disparities in Rural Missouri,” puts it this way: “Driven by what has come to be known as ‘deaths of despair,’ life expectancy for rural Americans is more than two years shorter than their urban counterparts, largely due to higher rates of drug overdoses, alcohol-related diseases, and suicide. As a leading cause of death in rural America, suicide has a particularly devastating effect on farm families.”
Economic factors contribute to suicide rate
Missouri’s rural suicide rate is growing 50% faster than nonrural suicide rates. The farm economy is a major driver. Slow recovery from the Great Recession, extreme weather, untenable commodity prices, tight lending conditions, and foreign trade policies have packed such a punch that today, there are 16,000 fewer Missouri farms than 20 years ago, according to the report.
A St. Louis Federal Reserve Bank’s article, “A Tale of Two Economies: Farmers Struggle Despite Strong U.S. Economy,” points to 2013 as the beginning of a downward pull on farming revenues. “At a time when the overall U.S. economy continues to boom, the U.S. agriculture sector has continued to struggle amid falling farm income and deteriorating agriculture credit conditions,” the article states. “Over the past five years, U.S. economic growth has continued to strengthen. The growth in U.S, real gross domestic product (GDP) has averaged 204 percent per quarter since 2013. Down on the farm, though, conditions have been far from robust. From 2013 to 2017 net farm income – considered to be a broad measure of farm profitability – fell 39 percent, from $123.8 billion to $75.5 billion.”
In 2014, U.S. trade policies with China contributed to near record-level stockpiles of crops and livestock. Midwestern producers, according to the Federal Reserve, saw low bushel prices – reducing net farm income by 40%. With farm credit drum tight, farmers find themselves struggling to operate and pay debt.
Extreme weather conditions persisted in 2018 and 2019, forcing Missouri farmers to experience the sharpest decline in net income in the Midwest.
By October 2019, the Federal Reserve reports, combined bushel prices (corn, soybeans, wheat, and other products) fell by 47% since 2012.
Losing a legacy
Grief, often associated with the death of a loved one, has many layers. The family farm is akin to a legacy passed from one generation to the next. The sacrifices, physical, emotional, and environmental stressors, don’t always manifest bumper crops and high yields. And with the unknowns that each year brings, farmers relentlessly do the work – perhaps operating on sheer faith. They’ve seen their parents’ and grandparents’ do it, and somehow it worked out. But when the tide changes, and there’s no way out – what’s been a legacy, what was expected to remain a permanent fixture for the next generation and the next – is gone, it’s traumatizing.
There were 110,986 farms operating in Missouri in 1997, according to Census of Agriculture. By 2017, that number decreased by 14% to 95,320 – and 15,666 families were left unable to maintain their farms.
“Grief is a natural response to loss,” said Jessie Wolf, a social worker at Mayo Clinic Health System. “It is the emotional suffering we feel when something we love is gone. When families lose their farms, they experience grief. They grieve for the loss of financial security, the loss of a job, the daily routine, their personal identity and the farm-related social contacts. Many families find themselves in a low place.”
Professional shortages, escalating suicide rates, and the emergency department
When farmers find themselves in that low place, fear of stigma may keep them from seeking help. And if there is access to a mental health provider, anonymity goes by the wayside because in most rural communities everyone knows who’s where by their car or truck.
On top of that, rural areas tend to be health professional shortage areas (HPSAs). Every one of Missouri’s 99 counties has a shortage of mental health professionals, according to Health Resources & Services Administration (HRSA). There are 57 Missouri counties without a licensed psychologist or psychiatrist, resulting in multiple mental health deserts in rural communities.
The Department of Agriculture reports farming households are three times more likely to be located in a Mental Health HPSA. Further, Missouri has the fifth-highest number of designated Mental Health HPSAs in the country. With only 3.7% of the need for mental health professionals met in the state, Missouri has the largest shortage in the country. (Kaiser Family Foundation)
This shortage is compounded by escalating rural Missouri deaths by suicide. “Between 2003 and 2017 – the most recent 15 years of available data – 3,780 rural Missourians died by suicide,” as stated in the Growing Stress on the Farm report. “In 2003, Missouri’s 180 rural suicides marked an age-adjusted rate of 12 deaths per 100,000 residents, slightly higher than the nonrural rate of 11.9. However, in 2004, a significant gap in the rate of suicides for rural Missourians emerged that persists today. By 2017, the rural rate of suicide deaths had increased by 78% to 21.3 per 100,000, while the nonrural rate increased by 56% to 18.0 per 100,000.”
The report also states that data from the CDC signals the rate of rural suicide deaths in Missouri is 18% higher than the nonrural rate – and it’s growing 50% faster.
Rural men between the ages of 35 and 44 have triple the statewide suicide mortality rate.
With escalating rates of suicide and ideation (suicidal thoughts), and a shortage of mental health providers, emergency departments are doing what they can to fill the gaps. The report states that over the last decade, visits to an ED because of suicide attempts and ideation have increased by 177%.
Rural communities need more mental health resources
“We are alarmed by the growing number of patients with suicide attempts and ideation,” said Stacy Davidson, R.N., Emergency Department Supervisor, at Ray County Memorial Hospital in Richmond, Missouri. “We are able to keep them safe and deescalate the crisis, and even develop safety plans before they discharge. A better system is needed. The health care system fails mental health patients every single day. Emergency departments are not designed to be the safety net for the growing number of patients with suicidal attempts or ideation.”
Davidson is calling for more collaboration at state and federal levels to improve mental health care and to make it a priority.
A few places to find help
The U.S. National Suicide Prevention Lifeline is 800.273.TALK (8255).
Another farmer who has been there, Jason Medows, offers a weekly podcast, “Ag State of Mind with Jason Meadows: https://globalagnetwork.com/ag-state-of-mind-with-jason-medows/podcast. Also, access his blog at https://agstateofmind.health.blog
MU Extension offers resources at https://extension2.missouri.edu/program/agrability and on the Show Me Strong Farm Families Facebook page at https://www.facebook.com/ShowMeStrongFarmFamilies/
Health Care Collaborative (HCC) of Rural Missouri, 660.259.2440, HCCNetwork.org. For clinic locations, visit LiveWellCenters.org.
About the report:
“Growing Stress on the Farm: The Expanding Economic and Mental Health Disparities in Rural Missouri,” released by Missouri Coalition for Community Behavioral Healthcare, Missouri Department of Mental Health, Missouri Farm Bureau, Missouri Hospital Association, and University of Missouri Extension, can be found at: http://bit.ly/GrowingStressOnTheFarm.