The word ‘farming’ can evoke images of rural idylls, rolling hills, prancing lambs and farmers toiling away to Cecil Alexander’s cherished hymn.1 It’s an enduring view that rural life is peaceful, healthy and ‘wholesome’. Indeed, some argue that these persistent stereotypes have served to prevent a deeper exploration of rural life and its hardships.
However, this winter’s storms and flooding have been unprecedented, impacting on the livelihoods of farmers, their capacity to plant crops and the loss of livestock. The hardships have become more visible, with one Lincolnshire farmer describing his 1,000-acre flooded farm as being 'a sea' and saying that it will be another 12 months before he is able to plant fresh crops.2 With climate predictions warning that farmers should be prepared for more adverse weather in the future – it’s a far cry from the pages of a James Herriot novel.
A report by Oxford Economics for the Institute for Family Business (IFB) Research Foundation3 reveals that there are 4.8 million family-run farm businesses in the UK, generating £15 billion to the gross added value of the UK economy. Day-to-day farm management issues can lead to family conflict and tensions about the business, including feeling a loss of control, communication breakdowns, verbal and physical abuse and marital difficulties – all of which contribute to stress levels.4 This is especially so during times of crises, adverse weather, a recession or the prospect of a farm closure.5
Long working hours also add considerable strain to farmers and their families. A major survey of farmers, farm managers and farm workers, undertaken by Farmers Weekly,5 found that British farmers work on average 65 hours per week, with some growers and livestock producers working in excess of 100 hours, rarely taking a day off, let alone an annual holiday. The survey revealed that the key creators of stress include workload, finances and relationships, with many farmers suffering the effects of sleep deprivation, including fatigue, as they juggle competing priorities.6
The agricultural workforce is growing older, with many farmers and workers continuing into their 80s. The 2017 report, Agriculture in the UK, revealed that the percentage of older people living in rural areas is as high as 56 per cent, with a third of all agricultural workers in the UK over the typical retirement age of 65 years.7 The proportion of people aged less than 35 years was around three per cent, and those in this age group are less vulnerable to isolation and loneliness as they tend to be more mobile, physically active and willing to engage with support services.
Two-thirds of people with dementia live and work in rural areas,8 and charities like the Farming Community Network (FCN), a voluntary organisation and charity that supports farmers and families within the farming community, has reported helping an increasing number of people affected by the illness. This includes providing help with accessing GP surgeries and often scarce healthcare services, as access to post-diagnosis support and other services, such as paid carers, is patchy and inadequate in many rural areas. The underutilised but highly capable counselling and psychotherapeutic workforce is ideally placed to provide this muchneeded support; however, more work is needed to identify what existing provision looks like, where the gaps are and what investment is needed.
It’s clear that claims of a rural mental health epidemic are not exaggerated. A survey undertaken by the Farm Safety Foundation (2018) found that 81 per cent of farmers under 40 believe that mental health is the biggest ‘hidden problem’ facing farmers today, and 92 per cent believe that promoting good mental health is crucial if lives are to be saved and farmers kept safe.9 While it is encouraging that young farmers are open to talking about their mental and physical health, older workers are less inclined to do so.
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Speaking to me last year, Sam Conway of the Farming Community Network (FCN) described a cultural barrier that often prevents farmers and their families accessing help from services that don’t fully understand farming and the demands of rural life. To meet this need, the FCN operates a support line, staffed by volunteers, who signpost callers to appropriate services, including counsellors who understand specific rural challenges. Farmers are particularly vulnerable to external forces, including disease, adverse weather conditions and international trade disputes. These create considerable financial pressures, with many farmers taking on significant debt, which perpetuates stress and mental illness. In most cases, a farmer’s place of business is also his or her home, meaning that there is very little respite from the stress and strain of work. Inevitably, perhaps, the strain for some is simply too much to bear.
Suicide in farming
In July 2016, Daniel Picton-Jones, an agricultural worker in Pembrokeshire, took his own life, leaving behind his wife and two young children.10 Daniel was 34 years old and had struggled with anxiety and depression since his early 20s. While his wife, Emma, tried to support Daniel over the years as he struggled to cope with the uncertainty and demands of self-employment, he became increasingly withdrawn and anxious. She urged him to see a counsellor and, despite assurances that he would, Daniel never took the first step – his social anxiety becoming a barrier. Daniel left behind a lengthy note, and a part of it stood out for Emma; he wrote: ‘You couldn’t help me, but you could help someone else.’
Inspired by the memory of her husband and realising there was a gap in mental health services in Pembrokeshire, Emma decided to set up The DPJ Foundation – named after Dan’s initials. The foundation encourages people in farming communities to open up about their mental health, and has a helpline and a counselling referral service, where professionals can visit farms and speak to those who are struggling.
Sadly, Daniel’s story is not an isolated one. Figures from the Office for National Statistics (ONS) suggest that levels of depression in the industry are increasing and suicide rates in farmers are among the highest in any occupational group, with some sources suggesting more than one farmer a week in the UK dies by suicide.11 Risk of suicide was also higher among those working in specific agricultural roles, such as harvesting crops and rearing animals (almost twice the national average).
While awareness about mental health in the farming industry is increasing, it’s clear that more needs to be done to provide support. Stephanie Berkeley, who leads the Farm Safety Foundation, said: ‘One thing has become evident: farmer health and wellbeing cannot, and should not, be ignored – by any of us. Simply pretending the issue does not exist or has no impact on the industry is not acceptable.’12
Reversing the stigma
Stuart Roberts is Vice President of the National Farmers Union, Chair of the Farm Safety Partnership (FSP) and committed to improving the physical and mental health of farmers and growers. Speaking to me last year, Stuart said: ‘British farmers and growers are incredibly passionate about the role they have in producing safe, traceable and affordable food for the nation, yet the environment they work in can often leave them feeling isolated, and the stress that comes with financial pressures, outbreaks of disease, volatile weather, as well as Brexit uncertainties, can leave farmers feeling vulnerable. We need to start treating mental wellbeing as we would a physical injury; but first we must be able to recognise when there is a problem and talk about it.’ On the provision of counselling in rural areas, Stuart believes that trained counsellors, who understand the context and unique challenges of farming life, should be available across all rural areas - this sounds like a call to our members, which surely all can support.
Tim Farron MP has previously submitted a written question, asking George Eustice MP, the Secretary of State for Environment, Food and Rural Affairs, whether he has had discussions with the Secretary of State for Health and Social Care on the suicide rate and general level of mental health among farmworkers in England. Similarly, Jim Shannon MP has asked whether any funding has been allocated to charities to help tackle depression in the farming community. In response, Mr Eustice referred to the UK Government’s suicide strategy prevention for England,13 and how this attempts to address these issues by ensuring that every local area has a multi-agency suicide prevention plan in place, so that local services can work together to implement tailored approaches to reducing suicides in their communities.
The agricultural workforce is growing older, with many farmers and workers continuing into their 80s
Two-thirds of people with dementia live and work in rural areas8
A third of all agricultural workers in the UK are over the typical retirement age of 65 years7
British farmers work on average 65 hours per week, with some growers and livestock producers working in excess of 100 hours, rarely taking a day off, let alone an annual holiday5
According to Stuart Roberts of the NFU, this doesn’t go far enough; and he has emphasised the need for greater NHS resources in rural areas to help those who are struggling: ‘Many farmers struggling with their mental health have turned to charities for support and these services will undoubtedly become even more important in the future. But this needs to go beyond charity support. We need to see the UK Government providing more resource in rural communities to ensure farmers can get the help they need and deserve.’
Action in Scotland
For many, the Scottish Government is leading the way in addressing rural mental health. The National Rural Mental Health Forum, embedded within the Scottish Government’s Mental Health Strategy (2017– 2027),14 was set up and is run by Support in Mind Scotland. The Forum recognises that people in rural Scotland experience depression, suicidal thoughts and feelings, self-harming behaviour and anxiety disorder, regardless of their age, gender or location, and that the isolation is made worse by remoteness, stigma and fear. In addressing this, the Forum highlights the importance of early intervention and prevention in non-clinical settings, offering shorter waiting times and mobile outreach support (including counselling) to all parts of Scotland.
The scale of challenges for those living and working in rural areas are reflected in the landscape. Around 98 per cent of land in the UK is classed as rural, yet less than 10 per cent of all people live and work in these areas, instead choosing to live in urban conurbations, towns and cities.15
Many studies have documented the impact of urban living on physical and mental health, with both mood and anxiety disorders more prevalent in city dwellers and the incidence of schizophrenia strongly increased in people born and raised in cities.16-18
While the recent focus has been on understanding and addressing mental illness and suicide in rural farming communities, services have been slower to keep pace with these developments.19 A lack of investment is evident and frequently cited by the organisations that are reliant on ‘hearts and minds’ volunteering. 20 Such organisations, often from the third sector, are not equipped to provide the specialist services, including talking therapies, that are so often necessary. Policy makers are quick to praise such organisations, allowing them to pick up the tab for underfunding in health services while a highly qualified and mobile workforce of therapists are under-employed.
Clearly, priorities need to change. A useful starting point will be to map counselling provision in rural areas, as little is known, either about the true scale of demand or how needs are currently being met. BACP is keen to further explore the issues outlined in this article and welcomes comments and views from members who are working in rural settings and who understand the landscape of provision for rural workers.
1 All things bright and beautiful. First published in Mrs Cecil Alexander's hymns for little children. 1848.
2 thelincolnite.co.uk/2019/11/lincoln-by-the-sea-anger-grows-as-marooned-farmers-survey -flood-damage/ (accessed 28 February 2020).
3 Oxford Economics: The state of the nation: the UK family business sector 2017–18. www.oxfordeconomics.com/recent-releases/ f060a8ac-a09d-4175-867e-fab8b368931a (accessed 28 February 2020).
4 Tees, Esk and Wear Valleys NHS Trust. Down on the farm – stress. www.tewv.nhs.uk/services/ down-on-the-farm-stress/ (accessed 12 February 2020).
5 Danes SM, Lee YG. Tensions generated by business issues in farm business-owning couples. Family Relations 2004; 53(4): 357–366.
6 Fit2Farm. Hard work and long hours take toll on farmers. Farmers Weekly. www.fwi.co.uk/farm-life/ health-and-wellbeing/fit2farm-farmers-weeklycampaign-to-improve-farmers-health (accessed 12 February 2020).
7 Office for National Statistics. Agriculture in the United Kingdom 2017. www.gov.uk/government/ statistics/agriculture-in-the-united-kingdom-2017 (accessed 15 January 2020).
8 Alzheimer’s Society. People with dementia in rural communities increasingly isolated. www.alzheimers.org.uk/news/2018-10-09/ people-dementia-rural-communities-increasinglyisolated (accessed 21 February 2020).
9 Farmers Guardian, Feb 2019. Four fifths of farmers under 40 think mental health is biggest problem facing sector. www.fginsight.com/news/ news/four-fifths-of-farmers-under-40-thinkmental-health-is-biggest-problem-facing-sector79371(accessed 15 January 2020).
10 My husband killed himself while I slept – in his note he left a message for what I should do. www.walesonline.co.uk/news/wales-news/ my-husband-left-killed-himself-15004743 (accessed 10 November 2019).
11 Farm Business. More than one farmer a week in the UK dies by suicide. www.farmbusiness.co.uk/ news/more-then-one-farmer-a-week-in-the-ukdies-by-suicide-2.html (accessed 21 February 2020).
12 Mind Your Head Campaign – Yellow Wellies. The hidden danger: mind your head over the coming weeks. Blog post, Feb 2019. www.yellowwellies. org/the-hidden-danger-mind-your-head-over-thecoming-weeks/ (accessed 21 February 2020).
13 Department of Health and Social Care. Suicide Prevention Strategy for England, 2012. www.gov. uk/government/publications/suicide-preventionstrategy-for-england (accessed 21 February 2020).
14 Mental Health Strategy 2017–2027. The Scottish Government, March 2017. www.gov.scot/ publications/mental-health-strategy-2017-2027/ (accessed 21 February 2020).
15 Department for Environment, Food and Rural Affairs. Statistical digest of rural England, November 2016 edition. https://assets.publishing. service.gov.uk/government/uploads/system/ uploads/attachment_data/file/571762/ Statistical_Digest_of_Rural_England_2016_November_edition.pdf (accessed 21 February 2020).
16 Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatrica Scandinavica 2010; 121: 84–93.
17 Krabbendam L, van Os J. Schizophrenia and urbanicity: a major environmental influence– conditional on genetic risk. Schizophrenia Bulletin 2005; 31: 795–799.
18 Lederbogen F, Kirsch P, Haddad L. City living and urban upbringing affect neural social stress processing in humans. Nature 2011; 474: 498–501.
19 Nicholson LA. Rural mental health. Advances in Psychiatric Treatment 2008; 14: 302–311
20 Local Government Association. Health and wellbeing in rural areas. www.local.gov.uk/ health-and-wellbeing-rural-areas (accessed 21 February 2020).