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Resources are needed to overcome barriers that limit access to mental health care for people involved in the agricultural industry, particularly in Missouri's 99 rural counties, according to a report released Wednesday.

"Growing stress on the farm: The expanding economic and mental health disparities in rural Missouri" documents the expanding public health concern for the state's farmers and ranchers.

The report — put together by the Missouri Hospital Association, Missouri Department of Mental Health, Missouri Coalition for Community Behavioral Healthcare, Missouri Farm Bureau and the University of Missouri Extension — found a number of factors that "compound the stress and insecurity of production agriculture while limiting access to care for behavioral health."

"The mental health crisis in rural Missouri is more challenging than in urban communities, but may be particularly severe for the agricultural community," the report states.

Farmers and ranchers have a unique set of external challenges that affect them, it continues. Extreme weather events, economic pressures and foreign trade policies have influences on their mental health — and have combined to produce a series of lean years not experienced since the 1980s.

During the '80s, the country experienced record production, which led to commodity prices falling sharply. Exports fell, in part because of a grain embargo against the Soviet Union. And, farm debt skyrocketed.

"While the U.S. economy has experienced quarter-over-quarter growth since the end of the recession in 2008-09, the farm sector has experienced six periods of recession," the report states.

Farm bankruptcies continue to climb while prices for items such as corn, soybeans, wheat and other products are down about 47 percent since 2012.

Over the past two decades, Missouri has lost more than 16,000 family farms, according to the report.

Combined conditions contribute to rural residents having significantly higher rates of depression and suicides than those in urban areas.

Compounding the problem is the inaccessibility of mental health care.

"The rural behavioral health crisis is exacerbated by the agricultural crisis in Missouri," said Mat Reidhead, MHA vice president of research and analytics. "The behavioral health care system has too few assets in rural Missouri to address the scope of the challenges."

At the same time, said Reidhead, who is the primary author of the report, intimacy of small rural communities, a perception farmers are strong and independent, and perceived stigma of mental illness discourage people in crises from seeking care.

"The problems are related to access to mental health in rural Missouri," Reidhead said. "Rural Missouri has higher rates (of stress and depression) and much less access to mental health care providers."

According to the Health Resources and Services Administration, all of Missouri's 99 rural counties face shortages of mental health professionals. There are 57 rural counties in the state that have no licensed psychologists or psychiatrists, which creates large areas of "mental health deserts."

The report states, "These geographic barriers to access result in many rural populations forgoing care altogether or depending on hospital emergency rooms and other nontraditional services for their behavioral health needs. Farming households are disproportionately affected by shortages of mental health professionals in rural areas, with farmers being three times as likely to live in a Mental Health Health Professional Shortage Area."

Missouri only has 3.7 percent of the recommended supply of mental health professionals necessary to serve its population, according to the HRSA.

"The culmination of these factors is resulting in a growing mental health crisis in rural Missouri," according to the report.

From 2003-17, 3,780 rural Missourians died by suicide. The rate was 12 deaths per 100,000 residents in 2003. By 2017, the rate had increased to 21.3 per 100,000 — a 78 percent increase. At the same time, the urban rate had increased just 52 percent.

Data from the Centers for Disease Control and Prevention indicate the rate of suicides in rural Missouri counties is growing 50 percent faster than the rate in urban counties.

Rural males have the highest rate of suicides in Missouri — at 35.6 per 100,000 residents (double the statewide rate for the same group and five times the rate for rural females). In 2017, there were 329 suicide deaths in rural Missouri. Males accounted for 84 percent of them.

Few tools are available to overcome the influences affecting suicide rates in rural Missouri; however, several organizations are trying to extend mental health services locally in rural communities.

The Compass Health Network, which is the largest nonprofit mental health system in Missouri, in 2019 provided 94,000 psychiatry visits in rural communities, about half of which were done via telehealth.

The Missouri Department of Mental Health promotes resources for people struggling with stress, anxiety, depression and thoughts of suicide. The agency also provides resources for people who know others suffering with anxiety and depression.

Because men are most likely to consider suicide, Mental Health offers the HELPHIMSTAY campaign, (helphimstay.org) which is intended to prevent suicide among rural, middle-age males. It consists of statewide radio advertisement, billboards, social media ads and handouts distributed throughout rural Missouri.

The agency also provides discreet resource cards at places like gas stations, farm bureaus, grocery stores, barber shops, dentists or doctors' offices, and local feed supply stores.

Representatives from multiple institutions and agencies are updating the Missouri Suicide Prevention Plan using a public health approach, establishing a robust data collection and reporting system, and coordinating training needs.

They are also implementing school-based suicide-prevention programs.

Through the Missouri Coalition for Community Behavioral Healthcare, the state provides services to 201 clinics in Missouri. An emphasis is placed on providing 24-hour crisis care, using evidence-based practices and coordinating and integrating with physical health care.

The MU Extension is developing a catalog of resources, trainings and other information to help farmers and ranchers identify where to turn during crises, and to provide a full network of stress-assistance programs, including a stress hotline and prescription drug misuse education.

"Investments in infrastructure, telehealth, technology, workforce and access to mental health care are needed to promote mental health and well-being in rural Missouri," the report states. "In addition, investments in culture change are needed to overcome pervasive stigma surrounding mental health in agricultural communities. Societal perceptions of mental health should be no different from perceptions of physical health."

This article was edited at 1:29 p.m. Feb. 13 to reflect that the statistic reported about the number of family farms lost in the past decade applies to Missouri.

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