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Sue Lani Madsen: Rural America must move past mental health stigma

UPDATED: Sat., May 12, 2018, 2:15 p.m.

When Theodore Roosevelt suffered a double family tragedy in 1884, he escaped to a cattle ranch in the Dakotas. The solitude and physical labor restored his mental health. Then his cattle herd was wiped out in the winter blizzards of 1886-87, and he went home to New York to pick up his family responsibilities and resume his political career.

Isolation, family pressures and economic stress are now recognized as major mental health risk factors. And the rugged Rough Rider image Teddy Roosevelt established as the archetype of American manhood makes it hard for many to seek help.

May is Mental Health Awareness Month and it’s time to get past the stigma of receiving medical care for mental health. #CureStigma is the latest hashtag campaign in health care.

“The rate of suicide in the agricultural community is gravely overlooked,” said Washington state Rep. Joe Schmick. According to the CDC, those working in the category of farming/forestry/fisheries have a suicide rate more than four times higher than the national average and 1.5 times higher than the next highest occupational category. Most of those affected are men.

Those statistics drove state Rep. J.T. Wilcox, of Yelm, to file HB 2671 with bipartisan co-sponsors, including Schmick, Rep. Eileen Cody, chairwoman of the Health Committee, and Rep. Jacqueline Maycumber. The bill directs the Office of Rural Health to establish a task force on removing barriers to mental health care, both physical access and cultural resistance. It passed on a unanimous 98-0 vote.

Suicide might be whispered between friends and family, but rarely discussed openly. In a culture built on the same “cowboy up” philosophy that restored Roosevelt’s mental health, asking for help feels like weakness.

Wilcox spoke of watching neighbors who “just wanted to keep farming” being pushed out of business. “There’s a heavy pressure, the weight of expectations from previous generations and a sense of failing the next generation,” said Wilcox. “All family businesses have transition pressures, but ties to the land and livestock make it personal.”

The variables necessary for success in any given year are beyond the control of the farmer, rancher, logger or commercial fisherman. Market fluctuations, timely skilled labor, predators, trade policy shifts, pests, disease outbreaks, machinery breakdowns, and an ever-compounding web of agency rules are all part of the context.

And weather. Weather drives every decision. A rural pastor once said her most important lesson after moving to the country was that weather is never good, according to farmers. Or if it’s good today, it’s sure to turn on them tomorrow.

Michael Rosman is a fourth-generation Iowa farmer who deals with untimely rain and harsh winters. As a clinical psychologist, Dr. Rosman is recognized nationally as a leader in the growing field of agricultural behavioral health, based on “understanding the cultures of farmers, ranchers and others involved in the production of food and fiber.” His work has demonstrated the need for a “culturally competent behavioral health workforce” familiar with the multiple pressures and seasonal rhythms of agriculture.

Dr. Rosman worked on establishing Seeds of Hope in the late 1990s, operated by a private nonprofit in a seven-state pilot. It led to development of the Farm and Ranch Stress Assistance Network, authorized by Congress in the 2008 Farm Bill but never funded. The network would have included culturally appropriate crisis hotlines and education for both mental health service providers and rural communities.

The state Department of Health Office of Rural Health is collaborating closely with the Office of Injury Prevention and Violence Involvement on developing the HB 2671 task force. Therese Hansen from the DOH IPVI acknowledged it’s an awkward name for an important group of occupation-based outreach, including suicide prevention. “We want to look at this holistically, not just suicide prevention but behavioral health services in rural communities.”

Agriculture is more than an occupational category, it’s a way of life and a culture. Current work-based programs rely on HR departments and managers to spot problems, irrelevant to the self-employed.

But even a macho man like Roosevelt realized he had to take care of himself before he could take care of his family. Reach out and talk about mental health. #CureStigma.


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