Mental Health Issues in Rural WI: An Insider Perspective on What Can Happen When Things Go Awry

While I do not typically start my day like the average farmer, I also do not always end my day like the typical mental health provider either. During the week, I find myself being called “Doc” and being in charge of providing therapy and assessment services for the approximately 50 to 60 teenaged to elderly people on my active caseload. On those extra special weeks, about once every two months, I am in charge of the on-call services for all of the clients seen in our group private practice outpatient clinic.

When I am not at the clinic, I am “on-call” to help complete daily feeding chores, care for a sick animal (large or small), chase down parts needed for repairs, be the spare tractor driver for harvest season, help plan out our family farm transition or complete that one additional volunteer task as a WFBF YFA committee member. (And, if you were wondering, yes, these on-call schedules do sometimes overlap.) So, when I hear the ongoing headlines about mental health issues on the rise in rural areas, it hits close to home…very close to home.

The Issue by the Numbers…

Suicide is the FOURTH leading cause of death amongst people in the US aged 35 to 54¹. What are the first three causes you ask?  Unintentional injuries (Yes, farmers, I am looking at you. Please be careful out there.), cancer and heart disease, to be exact². Yet, as a society, we do not look at death by suicide as the public health crisis that it is.

Data analysis performed on all deaths by suicide in the U.S. between 1999 to 2016 found that 453,557 people aged 25 to 64 years old died by taking their own lives³. Please stop and read that number again…453,557 people. That is nearly twice the size of the population of Madison, Wisconsin at the time of the 2010 U.S. Census. Closer to home, in 2017, 15.4% of deaths in Wisconsin were due to suicide; that equates to 926 people taking their own lives that year alone⁴.  That is, on average, one death by suicide every nine hours in the state of Wisconsin⁵!  

From 1999 to 2017, the United States rate of suicide increased from 10.5% to 14% of the overall population¹. Recent studies have shown that over the last two decades in the U.S., those who are male³, Caucasian², working-class, middle-aged⁶, and/or live in rural areas³, are at the highest risk to attempt suicide.

So, What Is Going On?!?

Historical trends of global suicide rates have shown a decrease when improvements in living conditions have taken place and a rise when deteriorations have occurred⁷.  Studies by economists have argued that recent increases in suicide rates in the U.S. have been due to overall decreases in economic and social well-being for many working-class rural Americans^6,8.  

As a mental health provider and a farmer, I have seen the effects of these reductions in economic and social well-being in my work with rural based clients, and in my interactions with my agriculture-based neighbors, friends and family members at/near home.

When was the last time any of us can remember going to an auction, Farm Bureau meeting/conference, customer appreciation day for the local equipment dealer or ag supplier, or neighborhood get together that these reductions in quality of life were not discussed or became the central topics of conversation? With the complicated and unpredictable weather and economic conditions of recent years⁹, I have witnessed even the most conscientious and business savvy ag professionals be blindsided by unforeseen circumstances that have forced them to take all of their ideal plans (…and back up plans) for the year (…or the business as a whole) and throw them away. The additional energy needed to rework plans and put out the proverbial “daily fires” forces people into the position of deciding whether or not to take even more time away from other important areas of life or watch the “fire spread.”  Under these circumstances, even the strongest of individuals, of no fault of their own nor due to any lack of trying to better the situation overall, can/do reach their maximum capacity to effectively manage stress.

Signs of Trouble

Those who live and work in the world of agriculture know that there is rarely a day or week that goes by that there is not some form of crisis that requires attention.  Frozen water line, broken silo unloader, sick animal, blown hydraulic lines on the skid steer; do these sound familiar? We all deal with these stressors; it is a normal part of life. When these stressors add up, anyone can reach their limit of ability to handle “one more thing.”  So, the question becomes, when do the normal responses to daily stressors turn into something more concerning that may require medical or mental health intervention?

Here are signs that it might be time to begin to address the problem¹⁰:

1. Low mood for several days
2. Loss of interest/participation in activities that were once routine and enjoyable
3. Reduced engagement in relationships with family and friends
4. Significant changes in appetite or weight that were not planned
5. Not caring for your/your environment’s hygiene or appearance
6. Sleeping too much or too little
7. Getting sick or injured more often
8. Chronic restlessness or inactivity
9. Fatigue or loss of energy
10. Feelings of worthlessness or guilt
11. Increased irritability, frustration, aggression, blaming, or lack of expression
12. Difficulty concentrating or making decisions
13. Increased spending sprees, gambling, or substance use
14. Recurrent thoughts of or talking about death or suicide

 What Can I Do for Myself or Others in Trouble?

1. DO NOT shy away from talking about your struggles or asking others about theirs if you think you are/they may be at risk. (Anyone can become overwhelmed by too much stress.)
2. Talk to someone you trust, a friend, family member, co-worker, boss, or spiritual leader.
3. Take a few slow deep breaths, daydream or pray.
4. Exercise, eat regularly timed healthy meals and limit alcohol or substance use.
5. Set aside enough time for sleep and relaxation; keep consistent wake and sleep times.
6. Focus on things within your control (examples: fixing equipment in the off season, making your favorite meal for dinner, setting goals for the upcoming year, establishing a plan for the next growing season).
7. Practice saying “no” if you are stretched too thin and are overwhelmed, and practice saying “yes” if you have been withdrawn and disengaged.
8. If the situation does not begin to get better, setting up an appointment with your medical provider or a mental health provider may be a good idea.
9. If the need for professional attention is immediate, call 911 or go directly to your local emergency room.
10. If you believe the situation is potentially dangerous due to the presence of weapons or firearms, the person is being violent or you feel someone has hurt themselves; you can call your local police department or 911 to request a wellness safety check.

Other Community Resources that Are Available

 National Suicide Hotline – (800) 273-TALK/ (800) 273-8255, 24/7 confidential and free support.

 Wisconsin Farm Center – 1-800-942-2474, free, confidential services for Wisconsin farmers. Available from 7:45 a.m. – 4:30 p.m. M-F or via email at farmcenter@wisconsin.gov

 Farmer Resource Network – List of 750 nationwide organizations that work with farmers on a variety of issues

USDA Disaster Assistance Programs – Ask about these at your local FSA office

USDA Mediation Services – Ask about these at your local FSA office

Wisconsin Law Enforcement Directory – Contact information for all county police offices in WI in case a wellness safety check is needed

Wisconsin Hospital Directory– Contact information and addresses for all hospitals in WI organized by county

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¹ National Center for Health Statistics.  (2018, November).  Data Brief No. 330.

² Center for Disease Control. (2018, July). National Vital Statistics Report.

³ Steelesmith, D., Fontanella, C., Campo, J., et al. (2019).  Contextual factors associated with county-level suicide rates in the United States, 1999 to 2016. Journal of the American Medical Association Open Network, 2(9). 

⁴ National Center for Health Statistics.  (2019, January).  Suicide mortality by state.

⁵ American Foundation for Suicide Prevention. (2020). Suicide facts & figures: Wisconsin 2019*

⁶ Case, A., and Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Science of the United States of America, 112(49), 15078-15083.

⁷ Weir, K. (2019). Worrying trends in U.S. suicide rates.  Monitor on Psychology, 50(3).

⁸ Case, A., and Deaton, A. (2017, Spring). Mortality and morbidity in the 21^st century.  Brookings Papers on Economic Activity.

⁹ United States Department of Agriculture. (2020, February). Principal farm operator household finances, 2014-20F.

¹⁰ American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5^th Ed. Washington, DC: American Psychiatric Publishing.