Creating a Mental Health Support System for Kentucky Farmers
"We ain’t never had a program before that dealt with rural mental health, or mental health, period, out here."
This month’s story from The Goldenrod’s food and drink labor reporter, Michelle Eigenheer, is about a promising, first-of-its-kind program in Kentucky addressing the mental health of farmers and breaking down old stigmas that still linger in many rural pockets of our state.
If you live in a farming community—or are part of a farming family—I’d ask you to share Michelle’s piece with a friend or loved one this week. It could help save a life.
If you’re in crisis, there are options available to help you cope. You can call the National Suicide Prevention Lifeline at any time to speak to someone and get support. For confidential support available 24/7 call 1-800-273-8255 or visit https://go.usa.gov/xftYC.
As dawn broke in the early morning hours of December 11, 2021, residents and aid workers began to get a clearer view of the damage caused by a late-night tornado that left nearly 200 miles of wreckage across 11 counties in western Kentucky. The EF4 tornado—one in an outbreak of over 60 that caused $5 billion in estimated damages across six states—killed at least 77 people and sent more than double that number to emergency rooms.
Among the neighbors and rescue workers who poured into communities like Mayfield to help pull people from the rubble and offer hot meals in the December cold were Dr. Cheryl Witt and Dale Dobson, who met with farmers to take stock of their unique needs. Witt and Dobson are members of a campaign called Raising Hope, a coalition including the Kentucky Department of Agriculture and Cabinet for Health and Family Services, Southeast Center for Agricultural Health and Injury Prevention, and a number of state universities that formed in 2020 to offer critical resources and education to support the mental health of Kentucky farmers and their families.
Along the tornado’s path, farmers found their buildings demolished, equipment missing or damaged, and livestock killed by the destruction, debris and devastating winds. An estimated 30 poultry barns were leveled in the night; a hatchery and the 8 million eggs inside were destroyed; grain mills and silos were toppled or torn apart, exposing the livestock feed inside to the storm’s rain and rendering it unsafe for consumption. Hundreds of cattle and other livestock were injured and killed, sometimes even carried away by the 190-mph winds. Total estimates for damages and losses are still being assessed, over a month after the supercell storm.
“We’ve had two tornadoes come through…and laid flat [farmers’] whole livelihood, just laying there on the ground to pick up and rebuild, and then the snowstorm…you have tragedies,” says Dobson, a KDA farm safety officer and Hodgenville-area farmer who has taught farm safety for 20 years. He joined Dr. Witt—a sixth generation farmer and nurse who teaches at the University of Louisville in addition to serving as the Raising Hope project manager—with the intention of expanding ideas of farm safety to include mental health and physical wellness.
The devastating storms are the latest in a series of acute struggles that farmers across Kentucky and the nation have faced since the start of the pandemic, adding to a growing list of stressors that have negatively impacted the mental health of farmers and their families for decades.
Farmers and agricultural workers have among the highest reported rates of suicide across all occupational groups, according to studies from the CDC. With this in mind, Raising Hope formed and outlined immediate goals: reducing the stigma of mental healthcare among farming communities; increasing education and awareness around mental health; showing farmers appreciation from their communities; and using data collection methods to get a better view of the issue.
Support from Rep. Brandon Reed (R-Hodgenville) secured funding from the state legislature’s appropriations fund, providing $500,000 for 2020 and again in 2021. The group worked quickly, enacting programs to improve existing infrastructure and build a network of crisis and risk assessment training access throughout the 56 Kentucky counties that showed the highest number of indicators for crisis.
They began QPR training—a method of crisis response that follows a directive of Question, Persuade, Refer to identify and interrupt a mental health crisis so that the subject can be directed to care—and educated 57 QPR trainers across the state who, in turn, trained 450 key community members on how to recognize and aid those who may be considering self harm or ending their own life.
They invited doctors and nurses to the annual farm machinery convention, and offered health checkups for attendees. Partnering with Western Kentucky University, they developed a rural suicide prevention training that focuses on “response measures for farmers in crisis and the application of cultural sensitivity and humility.” CRUSHing Farmer Suicide—Cultural Respect, Understanding, Sensitivity, and Humility—is currently available for healthcare professionals in the form of a free, one-hour continuing education program.
They then turned to the state’s crisis hotline: backup call centers were located in Miami and New York at the time, creating unneeded confusion and complications during critical conversations with rural populations.
“During that time, you want to be able to talk to somebody who understands and can connect and relate to you,” Witt explains, giving examples of how different accents and lack of knowledge about stressors, like those specific to rural or farm life, can be obstacles between the person in crisis and the one who answers the call. “You don’t need a communication barrier at that time.”
Now, at least 95 percent of all in-state calls to the National Suicide Prevention Lifeline (1-800–273-8255) are answered by someone within one of the commonwealth’s own call centers. Callers are now also asked, as part of the existing call intake process, if they’re a farmer or member of a farming family. This was added as part of a data gathering effort to better understand the mental health crisis.
“Because we used our original money to build and expand our projects, that really gave us a lot of ammunition, if you will, to put in for federal funds and be awarded them,” Witt explains. In December 2021, the federal government issued a $500,000 grant to the Department of Agriculture to further expand Raising Hope’s projects and partnerships.
The additional funding has allowed Raising Hope and partners to implement a farmer appreciation grant program. It is also funding the development of a mental health curriculum specifically for rural youth aged 9-12, as well as a peer-to-peer mobile app similar to those used in veterans groups that will center “mental health and wellbeing-focused online interventions” and include access to just-in-time telehealth services. The curriculum is slated to pilot in fall 2022, while the app is entering user testing in the coming weeks.
This grant is part of a nearly $25 million investment by the USDA’s National Institute of Food and Agriculture (NIFA) to 50 state-level projects in an effort to expand or create mental health and stress management resources for farmers and ranchers across the country.
(Witt on her home farm, via KDA Facebook)
The list of stressors and potential crisis factors for farmers is long: they are isolated within the acres of land that they farm; their income is greatly affected by fluctuating commodities pricing and supply chain failures; their crops and livestock are subject to damage or ruination from factors out of their control like climate change and natural disaster; even exposure to insecticides has been linked to higher rates of depression. Farmers are also more likely to suffer chronic pain from a lifetime of manual labor, and have increased access to lethal means, such as firearms and heavy machinery. A number of studies on farmer mental health note that reported rates of suicide are likely low because deaths can easily be misreported or mistaken as farming accidents.
The pandemic compounded many of these stressors. Ongoing tariffs in the Trump-era trade war with China hit US agriculture hard. And 2020 payments to compensate for those financial losses largely missed small producers and family farms: CNBC reports that two-thirds of the $28 billion Market Facilitation Program went to the top 10 percent of recipients. The report outlines the disparity: companies at the top received an average of $164,814 per payment, while the bottom half of recipients received, on average, less than $2,500 per payment. Meanwhile, bankruptcy rates for farms in the Midwest, including Kentucky, rose 23 percent from June 2019 to June 2020.
In financial turmoil, many small-scale and family farm operations are not facing just a loss of income: losing the farm can also mean losing the house, losing an identity, or failing a family tradition.
“I farm—six generations now. You talk about something you’re passionate about, it’s all those internalized feelings and attachment to the land. That’s me. I live it every day,” Witt explains. “Because farming is such an identity, as farmers age and are unable to [continue working], that also mentally affects a lot of farmers. Farmers will define good health by their ability to get up and work. So when they can’t do that, it absolutely does a number on their psyche.”
Dobson’s explanation is more succinct: “Everything is tied into one thing: If I lost my job [at KDA] today, I’ve still got my home and my farm to go to and work. [If] I lose my farm, I lose my home. My living. My identity. My everything.”
When Dobson began mental health outreach with farmers in the communities where he teaches farm safety, he used challenge coins as a prop to turn everyday conversations toward oft-stigmatized mental health subjects. Turning the coin in his hands gave him an opening to incite a promise from those he works with, he explained.
“When you shake my hand and take my coin, you take my challenge,” he tells them. “You give me your word that if you feel down, you’ll call somebody. You call me, you call the 800-number on the back, anytime. You find somebody.”
Breaking through the barrier to a discussion about mental health opens a door for stories and disclosures that may otherwise be withheld for years, even decades. He tells them, “I’m not saying anyone is suicidal, I’m saying some of us have good and bad days.”
“I had one farmer, we’ve been friends for 30 years. We shook hands, he held my hand and says, ‘You been involved in suicide?’” Dobson recounts.
Dobson, who has encountered a number of cases of self harm, including the loss of his best friend, says that the farmer then shared that his first wife had taken her own life in front of their young son—and for 35 years had never said a word about it to Dobson or most others.
He points to this disclosure as a sign that things are changing for the better.
“Raising Hope is going to change the world,” Dobson declared on a phone call from Atlanta, where he was attending a farm safety training. “We ain’t never had a program before that dealt with rural mental health, or mental health, period, out here. There’s a stigma about it, there’ve been no conversations about it. And farmers, some of them, are starting to talk about the bad days and the gloom and doom.”
Dobson continued. “Everyone’s had to go pick up a friend or neighbor and know somebody that took their lives. The world’s changing on that part for the good, because we’re communicating.”