Making the Best of Economic Uncertainties

Making the Best of Economic Uncertainties

Michael R. Rosmann, Ph.D.

North Dakota State UniversityAgriculture Extension and Research

Fall Conference

Friday, October 16, 2009Holiday InnFargo, ND

1210 7th Street, Suite C

Harlan, Iowa 51537

Telephone: 712-235-6100

Fax: 712-235-6105

Email: [email protected]

Web site: www.agriwellness.org

Building hope and health in the rural agricultural community

Produced by Michael R. Rosmann, Ph.D., Oct., 2009

AgriWellness – Building Hope and Health in the Rural Community

Who We AreAgriWellness was founded in2001 to provide administrative support, technical assistance and provider training in the Sowing the Seeds of Hope region (i.e., Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin). We build culturally competent, accessible, affordable behavioral health services for the agriculture community.


Sowing the Seeds of Hope Farm Crisis Hotlines

Iowa Concern Hotline: 800-447-1985http://extension.iastate.edu/iowaconcern

Kansas Rural Family Helpline: 866-327-6578http://www.humec.k-state.edu/fshs/pfws/krfhprogram.html

Minnesota Crisis Connection: 866-379-6363http://www.crisis.org

Nebraska Rural Response Hotline: 800-464-0258http://uccnebraska.org/mission/RuralLife.html

2-1-1 NDhttp://www.mhand.org

South Dakota Rural Helpline: 800-664-1349http://www.rapidcitydiocese.org/Home/HomePage.htm

Wisconsin Farm Center: 800-942-2474http://www/datcp.state.wi.us/core/agriculture/farm-center


The SSoH Hotlines/Helplines Provide:The SSoH Hotlines/Helplines Provide:

Culturally appropriate telephone counseling to Culturally appropriate telephone counseling to callers who are employed in agricultural callers who are employed in agricultural occupationsoccupations

Three of the SSoH farm crisis services Three of the SSoH farm crisis services (Minnesota Crisis Connection, (Minnesota Crisis Connection, 2-1-1 ND2-1-1 ND, South , South Dakota Rural Helpline) are certified by the Dakota Rural Helpline) are certified by the American Association of Suicidology to provide American Association of Suicidology to provide suicide prevention 24/7suicide prevention 24/7

At least two of the SSoH farm crisis services At least two of the SSoH farm crisis services (Iowa Concern Hotline, (Iowa Concern Hotline, 2-1-1 ND2-1-1 ND) are ) are accredited by the Alliance of Information and accredited by the Alliance of Information and Referral SystemsReferral Systems


The SSoH Hotlines/Helplines Provide The SSoH Hotlines/Helplines Provide (Cont):(Cont):

All the SSoH hotlines/helplines offer information All the SSoH hotlines/helplines offer information and referral for professional behavioral health and referral for professional behavioral health services, other supports as needed (e.g., legal services, other supports as needed (e.g., legal advice, mediation, financial expertise, etc.), advice, mediation, financial expertise, etc.), community education, and most are able to community education, and most are able to offer support groups, educational retreats and offer support groups, educational retreats and home visits by outreach workershome visits by outreach workers

All the SSoH hotlines/helplines have state All the SSoH hotlines/helplines have state coalitions of supporters who may assist with coalitions of supporters who may assist with promotion and fundingpromotion and funding


Why Do People Farm?Why Do People Farm?

Agriculture is a noble and essential Agriculture is a noble and essential occupation, a profoundly spiritual way of occupation, a profoundly spiritual way of life.life.

- Michael R. Rosmann, Ph.D.- Michael R. Rosmann, Ph.D.

Those who labor in the earth are the Those who labor in the earth are the chosen people of God.chosen people of God.

- Thomas Jefferson- Thomas Jefferson


The Agrarian ImperativeThe Agrarian Imperative

Like many animal species, humans have a Like many animal species, humans have a basic need to acquire sufficient territory to produce basic need to acquire sufficient territory to produce the food and shelter required by their families and the food and shelter required by their families and communities. Also called “the agrarian communities. Also called “the agrarian personality”, this genetically programmed instinct personality”, this genetically programmed instinct drives farmers to hang onto their land at all costs. drives farmers to hang onto their land at all costs. The agrarian imperative instills farmers to work The agrarian imperative instills farmers to work incredibly hard, to endure unusual pain and incredibly hard, to endure unusual pain and hardship and to take uncommon risks. hardship and to take uncommon risks.


To farmers, “the land is everything.” To farmers, “the land is everything.”

Ownership of a family farm is theOwnership of a family farm is the

triumphant result of the struggles of triumphant result of the struggles of

many generations. Losing the family many generations. Losing the family

farm is the ultimate loss – bringing shamefarm is the ultimate loss – bringing shame

to the generation that has let down their to the generation that has let down their

forebearers and dashing the hopes for forebearers and dashing the hopes for

successors.successors.


Agriculture has two major

components: “Agri” and “Culture.”

It is necessary for health service

providers to understand the

culture of food producers as well as

the agricology of food production.


What are the Cultures of North What are the Cultures of North Dakota Agricultural People?Dakota Agricultural People?

FarmersFarmers

RanchersRanchers

Native PeopleNative People

Hispanics/LatinosHispanics/Latinos

Hutterites Hutterites

Others?Others?


Research has accumulated which Research has accumulated which

indicates that the agricultural indicates that the agricultural

population has a higher incidence population has a higher incidence

of depression, related to stress, of depression, related to stress,

than the non-agricultural population.than the non-agricultural population.


The relationship between stress and

performance is an inverted U-shape

function, that is, as stress increases,

performance improves until stress becomes

overwhelming; thereafter, as stress

increases, performance deteriorates and an

individual may become incapacitated.


Risk for Farm – Related InjuriesRisk for Farm – Related Injuries

Farmers experiencing high economicFarmers experiencing high economic

related stress are 2 – 3 times morerelated stress are 2 – 3 times more

likely to experience a serious injurylikely to experience a serious injury

than farmers not experiencing highthan farmers not experiencing high

stress.stress.Source: K. Thu, et al. (1997) Stress as a Risk Factor for Agricultural Injuries. Journal of Agromedicine 4(3/4) 181-191.


By its very nature, agriculture is

enmeshed in cycles of life and

death. It is more than

coincidence that farmers are

more apt to take their lives

during the planting and harvest

seasons than at other times.


Age-Adjusted U.S. Suicide

Rates by

Urban-Rural, 1970 – 1997

Source: Singh, G. K., & Siahpush, M. (2002). The increasing rural-urban gradients in U.S. suicide mortality, 1970 – 1997.American Journal of Public Health, 92(7), 1161-1167.


Comparison of Suicide by Farmers Comparison of Suicide by Farmers vs. Non-Farmers*vs. Non-Farmers*

FarmersFarmers Non-FarmersNon-Farmers

Rate is twice the national average.Rate is twice the national average. Rate is slightly below average.Rate is slightly below average.

Likely to occur in spring and fall.Likely to occur in spring and fall. More likely to occur in summer.More likely to occur in summer.

More likely to occur on Sunday, More likely to occur on Sunday, Monday and Tuesday.Monday and Tuesday.

More likely to occur on Friday and More likely to occur on Friday and Saturday.Saturday.

More likely to occur between 6:00 More likely to occur between 6:00 and 11:59 a.m.and 11:59 a.m.

More likely to occur in late p.m., More likely to occur in late p.m., early a.m.early a.m.

Firearms are main method.Firearms are main method. Greater variety of methods.Greater variety of methods.

Few attempts precede suicide.Few attempts precede suicide. Many attempts precede suicide.Many attempts precede suicide.

Source: Gunderson, P., Donner, B., Nashold, R., Salkowicz, L., Sperry, S., & Wittman, B. (1993). The epidemiologyof suicide among farm residents or workers in five north-central states, 1980 - 1988. American Journal of Preventive Medicine, 9, 26-32.


Characteristics of Callers to the Characteristics of Callers to the Sowing the Seeds of Hope Sowing the Seeds of Hope

Hotlines/HelplinesHotlines/Helplines

Reasons for calling the hotlines:Reasons for calling the hotlines:

Marital/family concerns – 24.6%Marital/family concerns – 24.6%

Problems coping with daily activities –27.7%Problems coping with daily activities –27.7%

Feeling Depressed – 27.7%Feeling Depressed – 27.7%

Alcohol/drug abuse – 4.9%Alcohol/drug abuse – 4.9%

Gambling – .6%Gambling – .6%

Stress over finances – 14.3%Stress over finances – 14.3%


Characteristics of Callers to the Sowing Characteristics of Callers to the Sowing the Seeds of Hope Hotlines/Helplines the Seeds of Hope Hotlines/Helplines

(Cont.)(Cont.) 79% lived on farms and were farmers79% lived on farms and were farmers

11% lived on farms and were connected with 11% lived on farms and were connected with agriculture but were not farmersagriculture but were not farmers

10% were farmers and lived in town10% were farmers and lived in town

1.6% of callers (i.e., 685 out of 43,852 callers) 1.6% of callers (i.e., 685 out of 43,852 callers) reported suicidal ideation; 77 persons reported suicidal ideation; 77 persons reported a suicide and 56 persons had reported a suicide and 56 persons had attempted suicide attempted suicide

54.5% of the callers were female54.5% of the callers were female


Characteristics of Callers to the Characteristics of Callers to the Sowing the Seeds of Hope Sowing the Seeds of Hope Hotlines/Helplines (Cont.)Hotlines/Helplines (Cont.)

88.7% of 43,852 callers were adults, ages 18 88.7% of 43,852 callers were adults, ages 18 – 64– 64

10.2% were adults older than 64 years10.2% were adults older than 64 years 1.1% were children and adolescents under 18 1.1% were children and adolescents under 18

yearsyears 86% were White/Non-Hispanic people86% were White/Non-Hispanic people 2.7% were Black/African-Americans2.7% were Black/African-Americans 1.9% were American Indians1.9% were American Indians 1.1% were Hispanic1.1% were Hispanic 8.3% were two or more races or not reported8.3% were two or more races or not reported


Behavioral Health Conditions of 122 Farm Behavioral Health Conditions of 122 Farm Residents Experiencing Economic StressResidents Experiencing Economic Stress

Primary Behavioral Health Condition Percent Marital and Partner Relationship Difficulties 21Parent-child Relational Problem 10Other Family Issues 9Adjustment Disorders of all Types 24Depressive Illnesses 18Anxiety Disorders 11Schizophrenia and Psychotic Disorders 2Substance Abuse* 5 *Substance abuse occurred as a secondary condition in 40% of the primary conditions.

Source: Rosmann, M. R. (1987). The rural revolution of the 1980’s: Where are we – where are we going? National Association of Counties Knowledge Transfer Workshop, Des Moines, IA.

40


The Arousal-Depletion Cycle*The Arousal-Depletion Cycle* The individual appraises the situation as threatening.The individual appraises the situation as threatening. The sympathetic nervous system becomes aroused with a flood The sympathetic nervous system becomes aroused with a flood

of neurotransmitter chemicals which prepare the individual to of neurotransmitter chemicals which prepare the individual to fightfight the threat or take the threat or take flightflight from the threat or simply freeze. from the threat or simply freeze.

Eventually, arousal depletes the nervous system of Eventually, arousal depletes the nervous system of neurotransmitters, resulting in deficiencies of neurotransmitters neurotransmitters, resulting in deficiencies of neurotransmitters normally associated with wellbeing, chiefly serotonin and normally associated with wellbeing, chiefly serotonin and norepinephrine.norepinephrine.

Now depleted of essential neurotransmitters and as a result of the Now depleted of essential neurotransmitters and as a result of the accumulation of cortisol, the individual feels tired but irritable, accumulation of cortisol, the individual feels tired but irritable, lethargic, and in short, depressed.lethargic, and in short, depressed.

Often additional threats trigger repetition of the arousal-depletion Often additional threats trigger repetition of the arousal-depletion cycle, leading to adaptational fatigue and chronic severe cycle, leading to adaptational fatigue and chronic severe depression.depression.

Multiple stressors wear down the individual’s ability to cope Multiple stressors wear down the individual’s ability to cope physiologically and psychologically, resulting in exhaustion, physiologically and psychologically, resulting in exhaustion, depression and even compromise to the immune system’s depression and even compromise to the immune system’s capacity to ward off diseasecapacity to ward off disease

Adapted from Antai-Otong, D. (1995). Psychiatric Nursing: Biological and behavioral concepts. Philadelphia, PA: WB Saunders. Produced by Michael R. Rosmann, Ph.D., Oct., 2009

There is a positive association between economic stress (e.g., There is a positive association between economic stress (e.g., unemployment) and suicide (Ortega, Johnson, Beeson and unemployment) and suicide (Ortega, Johnson, Beeson and Kraft, 1994).Kraft, 1994).

Depression and hopelessness often accompany Depression and hopelessness often accompany overwhelming stress (Davidson, 1996).overwhelming stress (Davidson, 1996).

Changes in family practices (e.g., increasing isolation Changes in family practices (e.g., increasing isolation because of fewer farmers and the need for family members to because of fewer farmers and the need for family members to work off the farm) fit with the family stress model (Singh and work off the farm) fit with the family stress model (Singh and Siahpush, 2002).Siahpush, 2002).

Suicide can be seen as a last ditch attempt to escape from Suicide can be seen as a last ditch attempt to escape from overwhelming stress and despair (Rosmann, 1999).overwhelming stress and despair (Rosmann, 1999).

Protective factors that reduce stress and its negative Protective factors that reduce stress and its negative consequences involve support from a web of connections consequences involve support from a web of connections among members of the extended family and the local among members of the extended family and the local community (Carson, Araquistain, Ide, Quoss, et all 1994; community (Carson, Araquistain, Ide, Quoss, et all 1994; Rettig, Danes and Bauer, 1991).Rettig, Danes and Bauer, 1991).


Managing Our Behavior

Behavior, like a feed ration, has

ingredients that can be varied to

maximize our well-being: what we

consume, how much and how hard

we work, sleep, recreate, pray,

laugh, talk and so forth.


Factors That Increase Factors That Increase Distress, Depression and Distress, Depression and

Suicide:Suicide: Severe economic stress, leading to Severe economic stress, leading to

restructuring or forced sale of livestock restructuring or forced sale of livestock and/or equipment and landand/or equipment and land

Exposures to certain classes of farm Exposures to certain classes of farm pesticides, including organophosphates, pesticides, including organophosphates, carbamates and chlorinated substancescarbamates and chlorinated substances

Sleep deprivation Sleep deprivation Serious physical illnessesSerious physical illnesses


Factors That Increase Factors That Increase Distress, Depression and Distress, Depression and

Suicide (cont.):Suicide (cont.):

Recent loss of one or more loved onesRecent loss of one or more loved ones

Unemployment Unemployment

Entanglement in illegal activitiesEntanglement in illegal activities

DivorceDivorce

Substance abuseSubstance abuse


Did You Know?Did You Know?Persistent sleep deprivation is Persistent sleep deprivation is

associated withassociated with:: Proneness to sleepiness when one should be attentive Proneness to sleepiness when one should be attentive

(e.g., while driving, operating farm equipment)(e.g., while driving, operating farm equipment) Slowed reaction time (ten hours of accumulated sleep Slowed reaction time (ten hours of accumulated sleep

deprivation is similar physiologically to .08 blood alcohol deprivation is similar physiologically to .08 blood alcohol level)level)

Verbal and motor mistakesVerbal and motor mistakes Poor memory recall as well as difficulty learning new Poor memory recall as well as difficulty learning new

informationinformation Emotional discontrol and increased proneness to violence Emotional discontrol and increased proneness to violence

and impulse discontroland impulse discontrol Immune system deficiency Immune system deficiency Cardiac difficultiesCardiac difficulties Mood disordersMood disorders Earlier deathEarlier death


Danger Signals of Excessive Danger Signals of Excessive Stress, Depression and SuicideStress, Depression and Suicide

Verbalizations about hopelessness (e.g., “It’s no use, nothing I do Verbalizations about hopelessness (e.g., “It’s no use, nothing I do works; what’s the use in trying anymore; I feel like giving up”)works; what’s the use in trying anymore; I feel like giving up”)

Verbalizations about loss of interest or pleasure in doing things Verbalizations about loss of interest or pleasure in doing things (e.g., “I don’t care about anything anymore; I haven’t laughed in a (e.g., “I don’t care about anything anymore; I haven’t laughed in a long time; nothing is fun”)long time; nothing is fun”)

Dramatic statements and threats (e.g., “I feel like shooting all my Dramatic statements and threats (e.g., “I feel like shooting all my hogs; I’m going to get that jerk if it’s the last thing I do”)hogs; I’m going to get that jerk if it’s the last thing I do”)

Avoiding social or public events such as church or kids’ sports and Avoiding social or public events such as church or kids’ sports and activitiesactivities

Isolation, retreating behavior, flat affectIsolation, retreating behavior, flat affect

Deterioration in appearance of the livestock or farm, too high Deterioration in appearance of the livestock or farm, too high somatic cell counts, pastures overstocked, machinery fences and somatic cell counts, pastures overstocked, machinery fences and farm buildings unpainted and in disrepairfarm buildings unpainted and in disrepair


Danger Signals of Excessive Danger Signals of Excessive Stress, Depression and Suicide Stress, Depression and Suicide

(cont.)(cont.) Decline in personal appearance from the usualDecline in personal appearance from the usual

Too many stressors occurring simultaneously (e.g., inability Too many stressors occurring simultaneously (e.g., inability to make payments to lenders, multiple animal deaths, to make payments to lenders, multiple animal deaths, natural disasters such as drought or tornadoes)natural disasters such as drought or tornadoes)

Persistent trouble falling or staying asleep or sleeping too Persistent trouble falling or staying asleep or sleeping too muchmuch

Near tears, such as the “lump in the throat” phenomenon Near tears, such as the “lump in the throat” phenomenon but without actual cryingbut without actual crying

Emotional paralysis, such as inability to make a decisionEmotional paralysis, such as inability to make a decision


Behaviors That Promote Release Behaviors That Promote Release of Productive Hormones Such As of Productive Hormones Such As Serotonin and NorepinephrineSerotonin and Norepinephrine

Vigorous physical exerciseVigorous physical exercise LaughterLaughter Deep sleep, with active dreamingDeep sleep, with active dreaming Physical intimacyPhysical intimacy Talking with persons you trustTalking with persons you trust Prayer and meditationPrayer and meditation Receiving comforting touchesReceiving comforting touches


AgriWellness ResourcesAgriWellness Resources

Check our website: Check our website: http://www.agriwellness.org, which lists http://www.agriwellness.org, which lists All the Sowing the Seeds of Hope helplines and the All the Sowing the Seeds of Hope helplines and the

helplines that are available in three other stateshelplines that are available in three other states Links to other helpful resourcesLinks to other helpful resources A glossary of agricultural and behavioral health A glossary of agricultural and behavioral health

termsterms Papers and publicationsPapers and publications Information about our biannual conference, along Information about our biannual conference, along

with conference proceedingswith conference proceedings


AgriWellness Resources AgriWellness Resources (cont.)(cont.)

AgriWellness newsletters: email us at AgriWellness newsletters: email us at [email protected] to receive: [email protected] to receive: Healthy Farmer, a newsletter for agricultural Healthy Farmer, a newsletter for agricultural

peoplepeople AgriWellness Partners, a newsletter for AgriWellness Partners, a newsletter for

agencies, organizations and individuals agencies, organizations and individuals interested in serving the agricultural interested in serving the agricultural populationpopulation


North Dakota ResourcesNorth Dakota Resources

Do you have a list of resources that includes:Do you have a list of resources that includes: 2-1-1ND2-1-1ND Your mediation services providersYour mediation services providers Your AgrAbility programYour AgrAbility program Your free Legal Aid serviceYour free Legal Aid service Mental health and addictions directoriesMental health and addictions directories Job retraining resourcesJob retraining resources Agronomic resourcesAgronomic resources Animal husbandry resourcesAnimal husbandry resources State subsidized health insurance providerState subsidized health insurance provider


North Dakota ResourcesNorth Dakota Resources(cont.)(cont.)

Farm Rescue – 701-252-2017; Farm Rescue – 701-252-2017; [email protected]@farmrescue.org

Rural Assistance Center: 1-800-270-Rural Assistance Center: 1-800-270-1898; [email protected]; [email protected]


Resources for Behavioral Resources for Behavioral Health Assessment ToolsHealth Assessment Tools

National Institute of Alcohol Abuse and Alcoholism National Institute of Alcohol Abuse and Alcoholism (www.niaa.nih.gov)(www.niaa.nih.gov)

National Institute of Drug Abuse National Institute of Drug Abuse (www.nida.nih.gov)(www.nida.nih.gov)

Screening for Mental Health, Inc. Screening for Mental Health, Inc. Telephone: (781) 239-0071 Telephone: (781) 239-0071 (www.mentalhealthscreening.org)(www.mentalhealthscreening.org)

Rural Assistance Center (www.raconline.org) Rural Assistance Center (www.raconline.org) Toll Free: 1-800-270-1898 Toll Free: 1-800-270-1898

SAMHSA (www.samhsa.gov/centers/cmhs/cmhs) SAMHSA (www.samhsa.gov/centers/cmhs/cmhs) Toll Free: 1-800-789-2647 Toll Free: 1-800-789-2647


National Occupational Research National Occupational Research Agenda - Agriculture, Fishing and Agenda - Agriculture, Fishing and Forestry Sector Council Agenda*Forestry Sector Council Agenda*

Intermediate Goal 5.5 – Develop and Intermediate Goal 5.5 – Develop and promote adoption of effective interventions promote adoption of effective interventions to enhance psychological well-being of to enhance psychological well-being of workers and to minimize the adverse affects workers and to minimize the adverse affects of stressful agricultural working conditions of stressful agricultural working conditions (e.g., economic forces, weather and (e.g., economic forces, weather and isolation).isolation).

*Adopted, December 2008


NORA Action Steps*NORA Action Steps*

Action step 5.5.1 – Develop a surveillance system to help Action step 5.5.1 – Develop a surveillance system to help qualify the types and extent of psychological disorders qualify the types and extent of psychological disorders experienced by agricultural workers. Use these findings to experienced by agricultural workers. Use these findings to develop research priorities.develop research priorities.

Action step 5.5.2 – Conduct targeted research on factors Action step 5.5.2 – Conduct targeted research on factors associated with psychological disorders, especially as associated with psychological disorders, especially as they relate to specific regional concerns or patterns. they relate to specific regional concerns or patterns.

Action Step 5.5.3 – Develop, implement and evaluate culturally Action Step 5.5.3 – Develop, implement and evaluate culturally appropriate educational and outreach programs for promoting appropriate educational and outreach programs for promoting psychological well-being of agricultural producers, farm psychological well-being of agricultural producers, farm workers and their families. Involve agricultural workers in workers and their families. Involve agricultural workers in their development and deliverytheir development and delivery

*Adopted, December 2008


The Food, Conservation and Energy Act of 2008 (i.e., The Food, Conservation and Energy Act of 2008 (i.e., The Farm Bill) authorizes a Farm and Ranch Stress The Farm Bill) authorizes a Farm and Ranch Stress Assistance Network (FRSAN) which contains the Assistance Network (FRSAN) which contains the

following provisions:following provisions:

Requires the Secretary of Agriculture, in coordination with the Requires the Secretary of Agriculture, in coordination with the Secretary of Health and Human Services, to make competitive Secretary of Health and Human Services, to make competitive grants to support cooperative programs between state Extension grants to support cooperative programs between state Extension services and nonprofit organizationsservices and nonprofit organizations

Each FRSAN shall provide stress assistance programs to Each FRSAN shall provide stress assistance programs to individuals engaged in farming, ranching and other agricultural-individuals engaged in farming, ranching and other agricultural-related occupationsrelated occupations

Funds shall be awarded to initiate, expand or sustain programs Funds shall be awarded to initiate, expand or sustain programs that provide professional agricultural behavioral health that provide professional agricultural behavioral health counseling and referral for other forms of assistance as counseling and referral for other forms of assistance as necessary through farm telephone helplines and websitesnecessary through farm telephone helplines and websites

Make available community education, support groups, outreach Make available community education, support groups, outreach services and activities, and home visits to deliver assistance in services and activities, and home visits to deliver assistance in situations in which a farm resident is homeboundsituations in which a farm resident is homebound


So Long!

Education

Making the Best of Economic Uncertainties