The First Sixteen Podcast - EP 010

Dr. Hagen: I love it so much. Working with the ag community has been challenging, but in all the ways that is fun. And working with farmers, particularly - they’re a motivated group of people. And when engaged in something, they are quite determined to make it better.

Sara: Welcome back to the First Sixteen, I am Sara Boivin Chabot

Kirk: And I am Kirk Finken. This episode is all about mental health on the farm. This can be a heavy subject. But we are going to do as farmers do… put on our work boots and get to it. We’re going to shine some rays of light on this subject.

Sara: The voice you heard was Dr. Briana Hagen. She is one of Canada’s leading experts on mental health in the farming sector. She is based in Manitoba and works with the University of Guelph.

Kirk: With the input of farmers, Dr. Hagen and her colleagues have done multiple national studies and developed a program called, In the Know. It has been widely tested on the ground. And it is being delivered now in several provinces. What we learned with Dr. Hagen was that the issue of mental health in farming is fundamentally different than in other sectors.

Sara: Talking with her, we gained insights and heard some messages we can share to improve mental health – on our farms, in our families and in our sector. Have a listen…

Kirk: Dr. Hagen, you mentioned how you love to work with farmers because of their can-do mentality. They are a special breed. What unique stressors do farmers face that contribute to their specific experiences with mental health?

Dr. Hagen: There are many, I think; you know, things like weather and finances, yield - things like that. Challenges with their crop or their herd. But there are other things that come with that that I think are really important to talk about. As part of my PhD work, I did seventy five in-depth one on one interviews with farmers. And folks talked a lot about farming legacy being a huge stressor on them. You know, people wanted to continue the legacy of their family farm that had been farming similar things for generations, but the land would just not allow it, or the changes in weather patterns would just not allow it. And you can imagine how that impact would compound over time when you have been raised to notice things or notice patterns that have been year after year after year. And then those are now shifting pretty drastically and relatively quickly so that it has consequences, right, on mental health. People feel like they’re a failure. They're not learning properly or they're not farming properly, listening to the previous generation properly, when really it's just rapidly changing and very extreme weather.

And then there would be tensions between the generations of farmers trying to figure out how to move forward in a way that honored the legacy. So you can imagine that that would have huge mental health impacts moving forward.

Sara: I’m hearing from you that a lot of the stressors are things that farmers cannot control.

Dr. Hagen: You hit the nail on the head. And the biggest overarching theme of the stressors is that there's this lack of control. So, you know, people talk about stress and decreasing their stress to help their mental health and they talk about taking control of situations. Well, what do farmers do with that? They cannot control some of those situations.

Sara: And has COVID-19 increased all of this?

Dr. Hagen: COVID is adding stress to the farmers in Canada. Things are different the way that they move their crops or the way that the prices are changing. Those are those are things that are still changing rapidly due to COVID. So they have to now have another stressor that they're trying to navigate or their families. Are their kids going to school or they staying home? There's added stress for everybody.

Sara: Speaking of families, in your studies and the interviews, did you find that there are also gender differences or gender factors?

Dr. Hagen: Yeah, gender was something that was also talked about a lot. The stress of being a female farmer was something that was talked about quite a bit by our participating farmers; not being taken as seriously, having this huge workload that's put on top of their farming workload with their families and responsibilities that were more traditional to female farmers. But now that they're stepping into kind of different roles, the workload didn't shift. It just got bigger and bigger. And that became a struggle and a stress.

Dr. Hagen: So you can see how it might impact women versus men a little bit differently, might impact families differently, and also might impact the farm based on size differently.

Kirk: Additionally, in your studies, what are the impacts that you're seeing?

Dr. Hagen: Some of the impacts are pretty dire. For example, our study showed that over a third of the farmers that we surveyed were could be classified as having depression. Fifty eight percent could be classified as having anxiety. Burnout was high compared to other occupations and normative data. Resilience was lower. And I'm saying this, all of these measurements that we used were not just do you have depression? Yes or no? We used clinical tools that are validated, scales that measure the likelihood that someone may need to be further screened for depression or anxiety. So that survey which was done, that was done back in 2016 and we're actually just about to roll out the next iteration.

So we'll be able to compare trends over time very, very shortly that will be going up. But that was a national survey that we did that looked at about eleven hundred farmers across Canada. So those those results were a little bit surprising, but not shocking. But they definitely are the negative impacts of stress. And then the other impacts that you hear about is people leaving farming. The stress is too much. They they are getting ill and then they leave. Or for women, they don't go into farming or they leave, they give up farming or they get jobs off the farm, things like that. Those would be some of the biggest impacts. And then, in other countries, we haven't measured this statistically in Canada, but anecdotally, we know this: that farmers are dying by suicide. And in other countries, we know that they're dying by suicide at a pretty alarming rate compared to other occupations.

Kirk: Wow. You’ve given us a really clear and sobering picture here. And I can imagine with farmers’ unique circumstances, it can be difficult to seek out help too, yes?

Dr. Hagen: Yeah, I think the only thing we haven't really talked about in terms of difference of issue would be the access to care and access to care that is accessible to to farmers themselves, something that they're willing to access help from. That's a little bit different, I think, versus an urban center, simply the geography. So having to travel to an urban center to seek care is something that's not necessarily an option for all farmers. Affordability is another thing when someone is feeling incredibly stressed that there's good likelihood financial strain is part of that. So if they can afford to seek the care and then they have to travel, take time away from the farm to travel hours to a center to receive care, the likelihood of that happening is lower.

Kirk: I am thinking that there is also a barrier if they seek care in a rural or small town setting.

Dr. Hagen: There's a chance that they don't feel comfortable seeking care there because their anonymity might be compromised. And they don't want someone in the community to see their truck outside of the clinic to know that they're seeking care. So any perceived stigma around mental health that might still exist could have bigger impacts on farmers than maybe in an urban center where you have that anonymity when you're seeking help. That's something that maybe COVID would be a silver lining of COVID, because we now are using these types of teleservices for so many things that I'm hopeful that that will trickle out to rural areas and perhaps they can access care in a more palatable way to them that it could be face to face, but not in person care.

Sara: Is there anything in the actual farming culture that makes it difficult to address mental health?

Dr. Hagen: One hundred percent, so something within our research that we found and we kind of coined it “farm credibility”. And farm credibility was when someone would talk about accessing care. For one farmer - I'll never forget his story -.It took him getting to a point where things were quite bad to finally decide to make the decision to go to access care just outside his community. But he went. And the advice he was given by the general practitioner at that point was that he needed to take two weeks off work. And as a farmer, it was not that's not an option. And that farmer who took it took a lot for him to get into that office and for him to be told, OK, take weeks off, two weeks off of your job. He said he got up, didn't say a word, left that office and he would never seek help for his mental health again. So having an understanding for these providers to know the day to day life of farming or just to have some agricultural literacy, to be able to help in a way that the strategies are helpful is something that needs to be done.

Kirk: These are a lot of unique factors and issues. So where do you start?

Dr. Hagen: We can start at the grassroots there and create some sort of agricultural literacy training or a program or just simple things to help rural mental health providers know kind of the ins and outs of agriculture that might help them better serve that community.

Sara: If I understand correctly, veterinarians seem to be an important part of the overall mental health strategy for the sector.

Dr. Hagen: Yeah, yeah. So I think you’re right, I think they are part of that kind of frontline team. And I think it's because farmers have relationships with their veterinarians. So, you know, vets come to do monthly herd health checks. They notice when, for example, farmers talked about noticing and fellow farmers when they might be depressed or incredibly anxious. They notice it in their livestock or they notice it in their barn. Their stalls aren't quite as clean as they normally are.

Dr. Hagen: The farmer themselves paces the entire time you're speaking to them in the barn. So there's these farm specific clues that weren't addressed in previous kind of mental health literacy type training.

Dr. Hagen: So all this to say, veterinarians were also people that farmers thought should be trained in mental health literacy because they would confide in them. But with that being said, vets are not mental health professionals, so they needed tools to be able to identify a situation that was going on and then know what to do next. Because it is not on a veterinarian to be able to be a full-time mental health support. However, when vets are noticing, vets are people too, and they care about the people that they’re working with, so they wanted tools to be able to have a conversation and then move to that next step of “what do we do.” So that was one of the intents of this, particularly the “In the Know” training, and we did train veterinarians as well, and we continue to.

Sara: So the training you developed is not just for farmers.

Dr. Hagen: Yeah, yeah, one hundred percent, mental health literacy training, is not just for farmers. It is created by farmers, for the farming community. So it's for farmers themselves. And then all of these point of contact people that are involved and love our farmers. So crop advisors, lenders, bank lenders who work with farmers, OMAFRA in Ontario, folks who work for the provincial organizations, people who drive milk trucks, people who write in Better Farming. You know, this was basically developed for anyone who works in their day to day role with a farmer.

Kirk: And how is your program farm-specific?

Dr. Hagen: Maybe you've heard of mental health first aid. So mental health first aid is a gold standard, wonderful program for a general population that basically teaches people about mental health. So building up knowledge and then building up confidence and capacity to be able to talk to others about mental health, to recognize signs and symptoms of mental health struggle and knowing how to intervene or help lead to intervention. But what we found when we tried to introduce that to farming communities was that it wasn't it didn't work as well as we wanted it to. And not that the programming itself was the issue. It was more timing cost. It's a two-day intensive in-person program. It has a cost associated with it. Taking time off from the farm to take this type of training wasn't and wasn't accessible to a lot of the people that we wanted it to be accessible to. And it also seemed a little more urban centric than our farmers really liked. They didn't find a lot of the examples relatable, and they wanted to be able to ground their knowledge in farming. So we created a new program, all the examples were farm examples, all of the mental health struggles that we talk about, we talk about in the context of farming or a farmer. And the programming is delivered by mental health professionals who are also farmers or married to a farmer or grew up on a farm. So they have that context, that farm credibility that people really needed in order to connect with the material. So I think programming like that, that has been evaluated formally and we know it works. Implementing those things in our farming communities is going to, I think is a great way to start.

Sara: And where does the program go next? Are you bringing it to other provinces?

Dr. Hagen: Yeah, getting them out to all the other provinces is something that I think is essential. So we just needed to make sure. So one of the things that we're obviously passionate about is making sure that these things work before ramping them up and making them national, because if they don't work and you bring them to farming communities without proper evaluation and they fall flat on their faces, you're not going to get farmers to come back to the next one that you try. So we wanted to take the care and the time on the back end to make sure that we developed the program with farmers, but also with all the evidence so that we could develop curriculum that made sense and then test it and make sure that the the impacts on knowledge and confidence about mental health issues and how to intervene and how to have conversations about them were long lasting. So we did a six month follow up to this training to make sure that the impacts of the training lasted and they did. So now we've hit the point where we're ready to launch everywhere. And that's what's happening now. So it does take longer, but hopefully that means that it's more of a permanent solution and not just a short term type of type of in and out type of programming. That doesn't last.

Kirk: You must be witnessing some great breakthroughs.

Dr. Hagen: We just recently had a session and we presented on what was happening with our research. And I had the organizer reach out to me after and say, you know, this person didn't want to reach out one on one, but they wanted to let you know that they were participating in their training and their husband was not, but was there and listening in the background as they were in their home due to COVID. But they were there and her husband has struggled with what she calls depression, but he wouldn't name for years. And so she took the training in order to help support him, more so than for herself, which we heard a lot with people coming to the In the Know training was I'm not doing this for me. I'm doing it for someone that I love or someone around me. And she said that after listening in the background, he sat down and kind of took part a little bit halfway through. And at the end of that training, he was able to put words to what he was feeling and said, you know what? I do think that this might be depression, and I think that I'm willing to reach out if there's someone who has that farm credibility to be able to talk to, which in our training we give a list of resources at the end based on the region

And they said that the next morning was the first morning in three years that he got out of bed excited to farm. And so, that was something to me that was… that’s not small. That's a big deal. That wasn't an anecdotal way, but a real like this happened yesterday and here's what happened today because of it. What was powerful for me, and I hope that that's happening in in kitchens, on farms as we move forward.

Sara: That’s a great story, that’s one farmer who got help when he needed it and it’s a path for others to get it too.

Kirk: You know, just being able to shine light on this whole issue feels hopeful. We hope it is for you - our listeners - too.

Sara: In the Know is a mental health literacy program. It’s bilingual. It’s aimed at farmers, temporary foreign workers, local workers, and anyone in the agriculture sector.Each session is about 3-1/2 hours long. As well as general information on stress, trauma, anxiety, depression, substance use and suicide, attendees can expect to cover the warning signs of those conditions — those to watch for both in themselves and in others. The program also gives tips on how to provide support and how to connect people to additional help.

Kirk: And there are other great resources out there, too. A good place to start is on the website www.domore.ag In Quebec, you have the very excellent Farmer Assistance Program delivered through the UPA. You can call them at… 1-888-687-9197

Sara: So, until our next episode, you know what to do.

Kirk: I do. I am going to try something new. And I am going to explore new ways to take care of mental health in our sector.