Some rural attitudes toward mental health care are improving; access and stigma remain barriers

Ranching can be isolated, lonely work.
(Adobe Stock photo)

Farmers and ranchers must deal with mental and physical stresses that other professions don't demand. When it comes to mental health checks, both groups face isolation, social stigma that discourages asking for help, and a "frontier" legacy of being able to do it all. "This 'frontier' way symbolizes a rugged and independent way of life, characterized by the ability to survive and thrive in harsh and isolated conditions," reports Mike Watkins for Progressive Farming. "This also applies to dealing with mental health issues and the attitude that no outside help is needed."

Linnea Harvey, Rural Renewal Initiative coordinator in the Department of Agricultural Education at Oklahoma State University, explains "it's a complicated mix of barriers that play into the reluctance to seek mental health services," Watkins writes. "Harvey says many of the smaller farms she has worked with didn't have hired help. The more she got to know these farmers on a personal level, the more she saw the constant stress they were under. . . .No one talked about it, but there was a lot of loneliness, depression and anxiety."

Medical providers in more remote places often offer more integrated care that begins with a primary care doctor; however, referrals to more specialized care from psychiatrists can pose a challenge. "According to the National Alliance on Mental Illness, it's estimated that as many as 65% of rural counties do not have psychiatrists, and more than 25 million Americans living in rural areas are in a designated Mental Health Professional Shortage Area," Watkins reports. Getting to see a psychiatrist might mean traveling to another county or city, which some farmers or ranchers may not have the time to do.

The pandemic opened some opportunities for care that can specifically help rural individuals seeking mental health treatment, including telehealth. Watkins adds, "Still, in rural communities, which tend to be disproportionately older, people are often uncomfortable or unsure how to use the technology."

What are the signs that someone may need mental health support? Cate Jones-Hazledine, co-director of the Panhandle office of the Behavioral Health Education Center of Nebraska, "believes changes in someone's behavior is a big one, as is feeling or acting angry or irritable, and changes in sleep patterns and appetite, among others," Watkins explains. "Any thoughts of suicide or self-harm should be taken seriously, and help should be sought immediately."

Overcoming the mental health stigma that many rural residents have is a work in progress. Watkins writes, "Until there is a crisis, mental health care is often not a priority for most farmers and ranchers, although changes in attitude are happening." Jones-Hazledine told him: "Kids are growing up with services available at school, and this helps reduce stigma and normalize seeking help when needed. . . .Things are improving, and more resources are becoming available."