With farmers facing increasing stress and depression, Midwestern states and national farm groups are stepping up efforts to better provide services to mitigate the high suicide rate in the agricultural industry.
However, in rural areas, this care is more of a challenge.
Rural hospitals—often the primary source of health care services in these areas—are closing or merging. Since 2010, 23 hospitals have closed across the Midwest — a loss of nearly 1,000 beds, according to the North Carolina Rural Health Research Program.
An Institute for Nonprofit News research from 12 news outlets in seven states found that rural Midwest hospitals have cut services or merged with larger health systems in an effort to cope with financial and regulatory pressures.
Only two of these Midwestern hospitals were located in Illinois, but access to mental health services in rural communities remains difficult. Some groups decided to deal with the situation themselves.
For example, the GROW organization organizes meetings through Zoom, a video conferencing app, to help those in rural areas experiencing mental health issues.
And more than a dozen farm bureau directors in Illinois have taken it mental health ffirst aid courses that help people recognize signs of distress.
Harry Brockus — the CEO of Carle Hoopeston and Carle Richland in Central Illinois, a collection of hospitals serving 41 mostly rural counties — said there's a shortage of doctors nationwide, and recruiting in rural areas is even more of a challenge.
“We don't offer the amenities that doctors are looking for,” he said, “like shopping, schools and different entertainment venues.”
Other challenges in rural areas, such as transportation, housing and access to healthy food, can make rural health care cost-effective and unaffordable, Brockus said.
This has left rural America in a bind when it comes to mental health care.
“The hard facts about mental health and rural America is that more than 60% of rural Americans live in areas with a shortage of mental health professionals,” said Dennis Mohatt, vice president for behavioral health at the Western Interstate Commission on Higher Education during a 2018 webinar. by National Institute fTher Mental health for mental health and rural America. “More than 90% of all psychologists and psychiatrists, and 80% of Masters of Social Work, work exclusively in metropolitan areas. More than 65% of rural Americans receive mental health care from a primary health care provider, and the person responsible for responding to mental health crises for most rural Americans is a law enforcement officer.”
Adding to the problem of access is the high suicide rate in rural communities. The agricultural sector has the fourth highest rate in the country, according to January Centers for Disease Control and Prevention Study.
“What few Americans imagine is a farmer or rancher with severe depression,” Mohat said. “They don't think about the stress associated with a changing agricultural economy, where a single trade tweet from the President can affect soybean prices across the Midwest. They don't think about someone driving 150 or more miles to access care, let alone a psychiatrist or a psychologist or a different mental health professional driving a circuit to provide care like the track jockeys of yesteryear.”
RELATED: MENTAL HEALTH PROVIDERS IN FLOODED RURAL AREAS SHORT-HANDED BUT EXPECT MORE DEMAND
WAITING TIMES
In the rural areas served by Carle Hospital, patients come from 150 miles away for service, said Heather Hintz, director of behavioral health at Carle.
Wait times can be a problem.
“It's not unusual to wait three to six months for services,” Hintz said.
The hospital is working to hire more psychiatrists and fill vacancies, he said.
In the meantime, telepsychiatry can reduce patient wait times, Hintz said. Carle has also started hosting mental health first aid classes and virtual visits. It also creates a residency program in psychiatry.
“Our goal is to provide resources and get people to reach out for help,” Hintz said.
Telepsychiatry can be done via video or phone call. It's with a licensed provider, it's confidential and can be done from the doctor's office or a person's home, said Virtual Visits director Haley Miller.
Online therapy services through Carle are covered by many insurance companies. If they're not, appointments cost $49, he said.
Miller said people usually show up within a week of scheduling a behavioral health appointment.
FILL IN THE BLANKS
One group hoping to help fill the gap is GROW, a national community-based mental health mutual aid organization for recovery and prevention that has a chapter in Champaign County.
It provides free remote access to meetings through Zoom, which can be done via video or just audio, said Chris Stohr, National Coordinator of GROW In America. Zoom is available on computers and smartphones.
People can contact the GROW secretary at karen.shan@growinamerica.org or 217-352-6989. The secretary will then send a Zoom connection invitation.
Stohr said he encourages people to seek peer support or mutual health groups as part of their road to recovery. He said limited access to doctors, psychiatrists and therapists can be a problem for people.
Sometimes, groups like GROW are a better part of the therapy, she said. First, those in distress can build relationships. And, two, groups like this can help with treatment in ways that professional help may lack, Stohr said.
“You're not going to be able to call the doctor anyway and say I've had a seizure here and I need help,” he said, “but you can do that with peer” peer support.
FARMER MENTAL HEALTH
Carle, the hospital, reaches out to farmers through Mental Health First Aid classes, Hintz said. So far, the programs have trained more than 300 people throughout Central Illinois.
One of those people is Jim Birge, the director of the Sangamon County Farm Bureau. He said he attended the event because he has recognized the difficult times farmers are going through, especially in recent years.
A decrease in cash flow for farmers, several tough seasons in a row and the trade war — all these are raising the stress levels of farmers.
“We've seen an increase in depression and suicide with it,” Birge said.
Birge, who had a friend kill himself a few years ago, has taken it a step further. He organized an education in his own county.
On Dec. 12, eleven people who work with and around agriculture learned how to spot signs of mental distress, Birge said. He hopes to have more in the future.
Birge said he believes farmers don't know how to care for mental health issues. Many people have not dealt with this part of the health care system before, he said.
The second barrier to mental health care is overcoming the stigma and shame people think comes with providing mental health care, she said.
“If you have problems with your foot, go to the doctor,” Birge said. “The same goes for your head. There's a medical reason your head isn't working, and it might be a simple one.”
In the Carle training, “we were taught different skills and approaches to working with the person and not being judgmental,” Birge said.
They're also taught to help people access the help they need, which can range from just being there to listen to long-term professional help, she said.
“Sometimes, it's a matter of having someone to confide in and tell your thoughts to: if they're having suicidal thoughts or if things just didn't work out,” she said.
It's hard to get out of trouble, but having someone else to confide in is helpful, Birge said.
“Some people think, 'I don't know how to deal with this and I don't know what to do,'” Birge said. “But you can break it down into smaller problems until you get to the problem.”
It encourages people to come up and talk to someone. Talking to someone is better than no one, he said. Clergy and pastors are often trained in these issues as well, so reaching out to someone can be really helpful, she said.
“We have the means to intervene and we have to do something about it,” Birge said.
Claire Hettinger is the 2019 Illinois Humanities Engagement Fellow for the Midwest Center for Investigative Reporting. Have a story idea, question or tip? Contact her at claire.hettinger@investigatemidwest.org. Sky Chadde, Gannett Ag Data Fellow, contributed to this report.
Finding a Cure: The Quest to Save Rural Hospitals is a collaborative project involving Institute for Nonprofit News and INN members IowaWatch, KCUR, Bridge Magazine, Wisconsin Watch, Side Effects Public Media and The Conversation. as well as Iowa Public Radio, Minnesota Public Radio, Wisconsin Public Radio, The Gazette (Cedar Rapids, IA), Iowa Falls Times Citizen and N'west Iowa REVIEW. The project was made possible with the support of INN, with additional support from Solutions Journalistic Network, a nonprofit organization dedicated to rigorous and compelling reporting on the answers to social problems. For more stories visit hospitals.iowawatch.org
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