Dr. Farmer's Observations On Rural Mental Health

A graduate student, James Lind, interviewed me regarding my work in rural mental health. Here are excerpts from that interview.

JL: Tell me what makes rural mental health different or a specialty area of practice?

VF: What jumps out at me as being different from the usual mental health issues are farm stress, family business complications and relationships, rural marriages, huge financial investment and risk, and the interplay between the demanding profession and being self-employed while working at your family residence. Life in rural communities has its own value system with unique pressures and stressors as well as its benefits and joys.

JL: Do I perceive there to be a stigma in rural areas against seeking out mental health services?

VF: Well, I think the stigma that some farmers and ranchers carry because of their more traditional, independent, and self-sufficient values gets in the way of being smart about their lives.

The anonymity issue and accessibility of services are obstacles to overcome. If you can get rural men in a safe environment where they know their thoughts won't come back to them, then they can talk, but you have to go several counties away before they feel safe. So you have to create retreats or other types of experiences that gives them the safety they need.

But I do think the stigma has broken down. I think the mental health system has gotten more relevant and people see the value of it now, whereas 30 years ago it was a foreign concept or a sign of weakness to go for help.

There's a lot of denial about depression, family problems or denial about alcoholism. There is a strong stigma about admitting you have a drinking problem rather than a mental health problem. Family doctors and mental health professionals become gatekeepers for the alcohol and substance abuse professionals who are trying to fight this battle. I find a lot of multiple issues co-existing like excessive drinking, anxiety, stress, depression, marriage and family problems.

JL: What skills or what kind of characteristics do you think are essential for psychologists who work in rural areas?

VF: You need to be approachable and down to earth. It doesn’t go well if your client perceives you as being better than they are. They are looking for acceptance. They don't want to be intimidated by somebody pretentious. Being respectful makes a huge difference.

You have to be real and genuine. Rural people like that. They don't like big words and they don't like people who are caught up in themselves.

Being conversant and knowledgeable about rural dynamics and relationships sets them at ease. They don't want to feel like they are having to educate someone who doesn't really know their problem. Travel is no object in terms for people wanting to see the right person.

You have to be trustworthy in terms of keeping confidences because everybody knows everybody in rural communities. You are in a very delicate system so you cannot blow it in an ethical sense because that could really hurt people.

Dual relationships interfere with good treatment and is ethically dangerous though unavoidable in rural communities. I think there's a clinical half-life to a professional living in a small community. If you're there too long you're no longer objective.

Too many people get to know you and you know too many people. You get to know the relatives and the impact of your counseling on other people and you start self-censoring what you do and say in therapy. It's better to be a circuit-rider than to live among the people you are treating in small communities.

JL: A lot of your work has been centered on farm families, the farm crisis, etc. Do you think we are over the farm crisis, and do you think that the family farm is a thing of the past? I grew up on a family farm, so I have a real interest and fondness for this way of life.

VF: Things look rosy in agriculture for the next couple of years. Family farming is becoming bigger and more businesslike but it is still family farming.

With weather, lack of control over prices, cost of inputs, drought, disease, land costs and rentals, globalization, there is always a lot of pressure and stress. No matter when you're going out of business; it hurts. It hurts worse during good times. The mental health community needs to be prepared to care for those people and help them with transitions and coping.

It's important to give farm families validation, faith and hope so they can move on or cope under stressful conditions. I do think there is a crisis on the farm. Sometimes it is more widespread than others. Because of their strong attachments and family heritage, a lot of people are in denial or emotional turmoil about their situation in farming.

JL: My last question is what words of wisdom or advice would you offer to myself or anyone else who aspires to work in rural areas as a psychologist?

VF: There is room for creativity and lots of opportunity. More needs to be done than you can imagine. It's an undeveloped field. This is one part of psychology that is not tied up by bureaucracy. The work is great, the people are neat, and you can network with really good people.