‘Pull yourself up by your bootstraps’ mentality often harmful to farmers during times like these

Broken arm? Go to the emergency room. Bad cough and cold? See a family practice physician. Eye strain? See an optometrist or an ophthalmologist. Sinus issues? See an ear, nose and throat physician.
Good answers.

Depressed, stressed, anxious, hopeless? Pull the shades and hide out in front of the TV; or drink an extra beer or two to numb reality; or re-start that tobacco habit you gave up years ago.
Wrong answers.

“It’s really tragic when drinking alcohol to cope is more acceptable versus coming to our clinic and talking to someone. It’s tragic that feels safer,” said Hannah Buteyn, LMSW, a licensed master social worker who specializes in counseling for individuals, couples and families. She’s part of behavior and mental health services team at Sioux Center Health.

“People start to abuse substances because they don’t want to acknowledge or make other people aware of their mental health issues. So they start drinking more or taking other things. So they’re trying to treat themselves, but it doesn’t work,” said Jeanne Kleinhesselink, DNP, FNP, a board certified psychiatric-mental health nurse practitioner and a board certified family nurse practitioner at Sioux Center Health. “There were a lot of jokes last spring when Covid started that people were drinking more, but now, if you look at the statistics, they are drinking more alcohol. I think alcohol is more easily abused in rural areas than anything else because it’s legal.”

“Another problem substance that people don’t really recognize is caffeine. When you have people who are tired all the time because they’re depressed, they drink an incredible amount of caffeine,” she said.

More abuse of substances and more personal isolation are two of the most common symptoms seen when people are facing additional stress or ongoing depression. Right now, farmers are at great risk of becoming lost in depression or other mental health challenges.

“My husband is a farmer, and he talks to lots of people who are all experiencing the concerns of low prices and drought. For him, he finds it most helpful if he can have someone else to talk to. But one of the downfalls of farming is that it is a very individual activity,” Kleinhesselink said. “Farmers are very independent. There is a ‘pull yourself up by your bootstraps’ kind of mentality that’s really challenging for us. We can provide resources, but that doesn’t necessarily mean they’re going to access them.

“If people would reach out and use a positive coping mechanism versus a negative coping mechanism, they’d be better off in the long run,” she said.

Buteyn said, “So much in farming is unknown or out of their control with the weather and markets, and that naturally produces stress. The Covid crisis has exacerbated or compounded the stress.” Kleinhesselink said because there are so many environmental things that are not under a farmer’s control, they sometimes try to control or manage other things – like their mental health – for which other people would normally seek professional help.

Another member of the Sioux Center Health team, Ashley Anderson, LMSW, said there is an unfortunate perceived stigma of weakness if someone seeks help with issues of depression or anxiety. Buteyn said it’s hard for anyone, regardless of their occupation or life situation, to take that first step to ask for help. “It is hard to be vulnerable to talk to someone when you’re struggling. But it does becomes easier as you do it. The other thing I keep telling people is, when things are hard or difficult, it doesn’t mean you’re failing or that you’re doing it wrong. It just means, objectively, that you’re going through a very hard time.”

How do you convince a very independent-minded farmer that it’s ok to ask for help?

Kleinhesselink said it’s always extremely helpful to have support from community organizations or at any public event where people gather. Buteyn said, “If the church can be a place of encouragement reminding folks that we have counselors in our area, coming from the church body that would have great weight. If pastors would say ‘Hey, we in the church think this is good and we encourage you to seek out support.’ Sometimes mental health support and the church can be seen as opposing each other, but the more and more we can bring that together and integrate, that will help get across the message that this is ok.”

As an example, Kleinhesselink praised the Maurice Reformed Church which has sponsored a suicide awareness walk for several years. “I really think that has helped make mental health issues less stigmatized, which is really the answer.”

When Sioux Center Health opened its new hospital and clinic facility, the organization purposely created the same waiting room for all patients. “So if you’re in our waiting room, no one knows if you’re waiting to see your family practice physician or one of us. So if you come to see us, it’s not like you have big sign on your head saying ‘Oh, I’m here to see mental health people.’ People who are anxious or hurting already feel isolated, and the unfortunate stigma of seeing a mental health professional can make them feel more isolated,” Kleinhesselink said.

She said if you suspect your friend is struggling, you should be talking to them and not avoiding them. “If your friend doesn’t want to talk to you and is isolating themselves, that’s a warning sign. That tells me that things are not going well. And then maybe you need to talk to their partner in business or their spouse, ‘Hey, I noticed Joe doesn’t want to do these things anymore. How do you think things are going?’” Anderson added that a loss of energy or losing interest in activities a person normally enjoys are also warning signs.

The Sioux Center Health behavioral and mental health team recommended asking questions such as: How are you doing? Have you thought about hurting yourself? Have you thought about killing yourself? “People are hesitant to ask those questions because they think they might be putting that thought in others’ minds. You’re not going to plant that seed – they may already be thinking it,” Kleinhesselink said.

Buteyn said. “Look for physical symptoms. Does it seem like they’re not eating very well or not sleeping very well? That may tell you that this has been going on more than just a bad day or a bad week. Ask good questions and listen. Say ‘me too’ when you can. A connecting conversation like that can have so much impact for someone.”

“A lot of times we ask if people are having hopelessness,” Kleinhesselink said. “Hopelessness is really hard to define. I tell my patients it’s like being stuck in a dark place. If you’re stuck, you need to find somebody to help you get out of that place. People sometimes won’t refer to hopelessness, but will say ‘I just feel overwhelmed. When I get home, I just sit down and can’t do anything else the rest of the night.’ Well, that’s being hopeless.”

Taking the first step towards seeking help for mental health is vital. The first step may not be the same for everyone, so here are resource choices the Sioux Center Health Team suggests:

– Sioux Center Health Behavioral and Mental Health appointments: 712-722-8222.

– Avera / Sioux Center Health Farm and Rural Stress Hotline: 1-800-691-4336. The hotline is a free and confidential service. Trained counselors can help you navigate these difficult times.

– ISU Extension and Outreach “Iowa Concern.” Talk to stress counselors over the phone or by email. 1-800-447-1985. caringexpert@iastate.edu.

– National Alliance of Mental Illness Northwest Iowa support group meets in Sioux Center on the first Tuesday of each month at 7 p.m. at Central Reformed Church. 712-357-5428. namiofnwia@gmail.com. The Sioux Center Health team noted that they’ve had patients attend this group and found it very warm and inviting.

– National Alliance of Mental Illness. 1-800-950-NAMI. In a crisis, text “NAMI” TO 741741.

– Visit your family physician. At least once per year, most family physicians have their patients complete a PHQ9 form that screens for depression. Anderson said, “Our providers are very analytical looking at the whole picture. They will look at symptoms like anxiety or headaches or stomach problems, and if there’s no medical evidence to back up there’s something physical going on, they will recognize mental illness factors may be at play.”

– Iowa Farm Bureau list of resources to cope with farm and rural stress: www.iowafarmbureau.com/Stress-Mental-Health-Resources.
YouTube videos. Search “mindfulness” or “meditation.”

– Books to read:
The Body Keeps The Score by Dr. Bessel van der Kolk
Maybe You Should Talk to Someone by Lori Gottlieb
Cognitive Behavioral Therapy Made Simple by Seth J. Gillihan
This Too Shall Pass by Julia Samuel
This is Depression by Dr. Diane McIntosh