Sarah Jones poses with a flock of her sheep at Red Hill Farms which straddles the Tennessee state line in Allen County, Kentucky, on June 2, 2023. (Kentucky Lantern photo by Austin Anthony)

This story discusses suicide and mental health among farmers. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988. You can also text “KY” to 741741.?

A thousand hungry mouths must be fed before farmer Sarah Jones can eat.?

Seven days a week — sometimes during 100-hour work weeks — Jones and her family tend their land and animals in southcentral Kentucky and northern Tennessee.?

They put the earth, their animals and hired hands before themselves. Finding time for self care when your job is a 24/7 lifestyle is nearly impossible.?

That’s why experts say farmers face unique mental health challenges that a coalition called Raising Hope, out of the Kentucky Department of Agriculture, is aiming to address. Staff know of at least four people who are alive today because of the coalition’s efforts. It was established in 2021.?

Stressors stretch beyond the hours of labor the Jones family puts into Red Hill Farms, though finding laborers “willing to smell like a pig” and put in long hours has become more challenging with time.?

The availability and affordability of land, too, is a challenge for farmers looking to start or expand. They’re often up against developers. Weather is unpredictable. Everything – from labor to feed – costs more now.?

And, Jones said, it’s concerning when members of the public don’t understand what farmers do.?

“That’s changed dramatically as more and more people are more and more generations removed from agriculture and the farming lifestyle,” she said. Many “really don’t understand where their food comes from.”?

Elizabeth Gordon, who does marketing work with Raising Hope, said the coalition’s mission is twofold. It seeks to decrease mental health stigma and suicide rates among farmers, which may be worse than numbers show thanks to underreporting in rural areas. But it also exists to educate non-farmers about the farming lifestyle.?

“It’s hard to appreciate when you don’t understand,” said Gordon.?

In addition to destigmatizing mental health, she said, Raising Hope staff also try to destigmatize the farmers themselves.?

“They don’t stand in a field with pitchforks,” she said. “They’re … very technologically advanced.”?

The need: more access to mental health resources, less stigma ?

In 2020, someone in America died by suicide every 11 minutes, the Centers for Disease Control and Prevention found. Rates were worse in rural areas, yet rural folks tend not to get mental health help as frequently as those in urban areas, according to the National Library of Medicine.?

The University of Kentucky said in 2022 that at least 109 farmers in Kentucky died by suicide between 2004 and 2017. Farmers 64 and older were at higher risk. From 2012 to 2015, male farmers were twice as likely to take their lives.?

Yet farms make up a massive chunk of the commonwealth’s land, according to Kentucky AgriTech.?

In 2022, there were more than 73,000 farm operations in the state, according to the State Agriculture Review. Chickens, calves and cows were the biggest livestock productions reported in that data. Kentucky produces the most beef of any state east of the Mississippi River, making it a massive contributor to the food supply.?

The lifestyle comes with a measure of independence, experts said, that can make reaching out difficult.?

Cheryl Witt, a researcher and sixth generation farmer from central Kentucky, said stigma and cultural differences sometimes keep farmers from getting help.?

“In the general population, there’s high rates of stigma seeking help for mental health,” said Witt, whose doctoral dissertation was on depression rates among female farmers in Kentucky and Tennessee.?

“But when you deal with a farming population, particularly men, you have that masculine, highly independent, self-reliant, male attitude or cultural beliefs … you just don’t do that. That’s just not something you do,” she added. “You can handle it, or you’re going to handle it yourself.”?

And often, they must handle it alone because the public doesn’t understand what they face – and not all health care providers are culturally competent enough to understand their unique challenges.?

Jeanne Ward, whose passion for mental health advocacy grew during her Ph.D research into rural health disparities, said it’s crucial that health care providers understand those specific stressors in order to best treat the whole farmer.?

“When you go to the fair, you see the shiniest stuff,” the registered nurse explained. “You see the beautiful animals and that happy version of farmers that we’re used to.”?

But behind the scenes, in the day-to-day, she said, “farmers are really faced with a lot of uncertainty that makes the occupation more challenging.”?

They are, Ward said, disproportionately affected by suicide as a result.?

Raising Hope – one coin and conversation at a time?

Raising Hope got its start in 2021 and is a holistic, multi-faceted approach to improving Kentucky farmers’ wellbeing.?

Coalition members go to farming events around the state and do physical health screenings. They also educate non-farmers about farming.?

The physical screenings are important because poor physical health can contribute to poor mental health – and many in rural communities live far from primary care. Driving to a doctor may take too long, causing a to-do list to grow even longer. Telehealth helps, but isn’t always possible or applicable.?

Staff also distribute mental health challenge coins and have passed out more than 1,300 since Raising Hope launched.?

The coins are small, physical tokens meant to remind farmers that they and their work are appreciated. They also encourage them to reach out for help when they need it.?

Jones keeps her challenge coin in her wallet. It is, she said, “a continuous reminder that … I’m not alone. That there is somebody that understands and … has an appreciation … to what I might be experiencing.”?

Beyond individual help, the coins can help build connectedness among farmers, which Ward said is a “protective factor against suicide.”?

“Self compassion is really important too. We want people to understand that we’re all imperfect, and everybody has mental health challenges,” she said. “We want to normalize it and get people talking about it versus facing these problems alone, which often doesn’t have a very good ending.”?

On top of the coins, the coalition puts out ads about mental health and sets up booths at farming events. The digital side of the coalition is huge, Ward said.?

“With the stigma of suicide and mental health issues, not everybody wants to come up to us at a booth at an event,” she explained. “So that’s why these digital campaigns are so powerful, because we are actually able to confidentially serve farmers and the farm communities.”?

Future goal: Form a nonprofit??

Witt, the researcher, said primary coping mechanisms for farmers that she’s found include faith, prayer and social interaction with likeminded people.?

Staff will also distribute small bluetooth speakers for farmers whose trucks or tractors don’t have radios, Gordon said.?

A good podcast or music can “free their mind a little bit so they don’t just worry all the time,” she said.?

Other interventions include teaching nursing students how to interact with and treat farmers in a culturally competent way, as well as providing farmers the option when calling 988 to identify as a farmer and get specialized help.?

These interventions take money, which is why Raising Hope staff want to move toward forming a nonprofit. Doing so would allow ?it to accept donations.?

A health care workforce that understands farming is important, though. Without it, Jones said, stigma worsens.?

“We make up such a small percentage of the population. There are very, very few people that can even fathom the stress and the workload that I have,” she said.?

Talking about it is nothing to be ashamed of, she said.?

“Farmer mental health is an issue and it’s not something to keep a secret. It’s okay to share,” she said. “It’s normal for farmers to feel stress…it’s normal for farmers to feel defeated. And so if you’re having those thoughts, there are other people that have had those thoughts too.”?

Just “take care of those thoughts,” she said. And: Have a conversation with someone about how you’re feeling. You’re not alone.?

The photo captions have been updated to clarify the location of Red Hill Farms.