By April Simpson
Pew Trust Stateline
On most days, therapist Becky Kopp-Dunham counsels farmers and other clients across 10 North Dakota towns from her home office on a crop and cattle farm in Morehead, Minnesota.
With a reliable internet connection and videoconferencing service, Kopp-Dunham can inform and treat patients in rural and remote places.
“I’m a hands-on therapist, so I do a lot of art and games and music and movement, and I thought, ‘How am I going to be able to pull this off? We’re just on a screen. But I’ll try it,’” Kopp-Dunham said. “I’ve been very pleasantly surprised of how I’m able to connect with people.”
She and her colleagues call it “farm-to-farm therapy,” but it’s widely known among medical providers as telehealth delivery of mental health services. It’s just one of the many approaches states are taking to address mental health among rural and agricultural populations, as the need rises against the backdrop of a struggling farm economy.
This year at least seven states, including Colorado, Kentucky, Minnesota, New York, Texas, Oregon and Wisconsin, considered bills to boost local mental health authorities. Several, including Minnesota, New York and Wisconsin, focus on agricultural communities. Some are related to strengthening farm finances, but also intended to support mental health and well-being. It’s unclear to what extent state efforts will fulfill the need.
Rural residents experience mental disorders and drug addiction just as much as their urban counterparts, and their need for mental health services is similar. But rural suicide rates are greater than urban ones, and the gap has grown steadily since 1999.
Farmers ‘in a Fragile Place’ After Historic Midwest Floods
And yet, rural people have less access to treatment sources. There’s a stark lack of providers in rural counties given the vast territory and small populations. Most areas with a shortage of mental health providers are partially or entirely rural, according to the U.S. Centers for Disease Control and Prevention. And since 2010, 119 rural hospitals have closed.
As self-reliant people, farmers often are suspicious of mental health resources. In small-population places, where people may know their neighbors’ vehicles and routines, rural people can lack anonymity, which experts say is key to accessing and receiving treatment.
Many counties in Nebraska, the Dakotas, Kansas and other states depend on agriculture for their economy. Across the country, while residents of booming big cities were most likely to have growing incomes, rural areas and small cities had very mixed outcomes in per capita income between 2016 and 2018, according to a recent Stateline analysis.
Nebraska counties, which have been the victims of floods, the trade wars and a weak ethanol market, suffered the biggest income losses.
U.S. farmers with midsize operations, long battered by low commodity prices, face new uncertainties amid increased competition from large corporate farms and President Donald Trump’s trade war with China.
For more than a year, weather extremes have devastated nearly every region of the country — hurting farmers’ returns on commodities such as soybeans, cotton, pork and dairy products. There is now widespread attention on farmers’ mental health.
Midwest Farmers Suffer After Floods: ‘I Got My Life in This Ground’
Between 2001 and 2015, large metropolitan counties saw 257,000 suicides, compared with 173,000 in smaller metro counties and 115,000 in rural counties.
Over that period, large metros had a suicide rate of 11.9, compared with 17.3 in rural areas, according to the CDC.
In October, the U.S. Department of Agriculture announced the regional recipients of four grants totaling $1.9 million to provide stress assistance programs to people in agriculture.
The grantees will launch the Farm and Ranch Stress Assistance Network, which was authorized in the 2018 farm bill signed by Trump last December. The funding will support more rural mental health research, programming and trained staffing.
The farm bill also increased the annual budget for the Distance Learning and Telemedicine Program, from $75 million to $82 million, through fiscal 2023. The program helps rural communities use telecommunications to address challenges related to isolation and low population density.
In October, U.S. Sens. Chuck Grassley, an Iowa Republican, and Jon Tester, a Montana Democrat, introduced the Seeding Rural Resilience Act. The bill would train government employees to identify distressed farmers and talk to them.
The bill also would provide $3 million to create a public service announcement to raise awareness of rural suicide and stress. And it would direct Agriculture Secretary Sonny Purdue to assemble a task force of agricultural and rural leaders to determine best practices for responding to farm and ranch stress.
Finally, U.S. Sens. Amy Klobuchar and Tina Smith, both Minnesota Democrats, and Rep. Tom Emmer, a Minnesota Republican, in October announced a $235,000 USDA grant to CentraCare Health System to expand telehealth services across central Minnesota.
The money will equip 10 clinics across nine counties with video technology over a two-year project estimated to serve about 2,000 patients.
State Action
Despite partisan clashes, the Wisconsin legislature approved $200,000 for a program that provides mental health counseling vouchers and workshops to farm families. In addition, a task force on suicide prevention led by Republican state Rep. Joan Ballweg has advanced eight policy recommendations, including financial aid for farmers taking business management classes.
The suicide rate is three times higher in rural areas of New York state than in urban areas, CDC data shows. Statewide, the suicide rate increased 30% from 1999 to 2015.
Meanwhile, Minnesota increased its annual appropriation to the state Department of Agriculture from $113,000 to $250,000 to add a second therapist focused on farmers and other statewide mental health counseling to farm families and business operators through the state college system.
In April, the University of Minnesota Extension formed a task force to provide educational programs and resources related to stress and mental health.
The Telehealth Solution
High Plains Mental Health Center serves 20 rural counties across 19,000 square miles in northwest Kansas. For roughly a decade, it’s offered telehealth for psychiatric services and some counseling. Of the 100,000 people in its coverage area, roughly 6,000 use the center’s mental health services.
Experts say there’s a limited but growing awareness of telehealth as a viable option for rural residents needing mental health services.
Telehealth’s benefits include linking clients to behavioral health practitioners in faraway places and bypassing the stigma of being seen parking a vehicle at a counselor’s office. Although farmers typically work from home, they don’t work 9 to 5, and they don’t take days off.
Telehealth seems like an obvious solution for serving people in hard-to-reach places, especially as advocates stress crisis situations in Farm Country, but regulatory and infrastructure challenges limit its reach.
Ted Matthews was Minnesota’s sole state therapist serving farmers for more than two decades, until the legislature appropriated money for a second therapist earlier this year.
Matthews travels the state to meet farmers in their homes or at designated locations. He doesn’t use videoconferencing because of a lack of equipment and infrastructure and prefers counseling face-to-face.
“This isn’t going to sound very nice. [Telehealth is] better than nothing,” Matthews said. “And at this point, I would say that’s pretty good, because what a lot of areas are getting is nothing. So, my fear is that it’ll become the norm instead of a stopgap.”
This story by Pew Trusts Stateline is a truncated version of the original.The complete story is here.
