Whilst farming was once idealised as a healthy and wholesome way of life, it is now recognised as an industry associated with high rates of injury, illness(NOHSC, 1998), disability and death(Franklin RC et al., 2001; Kirkhorn and Schenker, 2002; Leigh JP. et al., 2001; McCurdy and Carroll, 2000; Von Essen and McCurdy SA, 1998). There is also some evidence that the farm environment is hazardous to mental health, with farmers experiencing high rates of stress (Booth and Lloyd, 1999; Deary et al., 1997; Simkin et al., 1998a) depression (Sanne et al., 2004)and high rates of suicide amongst male farmers compared with the general population. In Australia, male farmers commit suicide at rates significantly higher than the general population and nonfarming rural males, with almost as many deaths caused by farm suicides as by work related farm accidents.(Page and Fragar, 2002b)
The stressful nature of farming as an occupation and a lifestyle suggests that farmers and farming families may be at particular risks for mental health problems. However there has been limited research that has examined the mental health issues experienced by farmers and their families in Australia. This study aimed to make a contribution to the currently under-research area. The aims of the project were; 1. To explore what farmers and farming families say led them to becoming depressed, anxious or to use drugs and alcohol in what they assert maintains a sense of wellbeing. 2. To investigate the barriers to effective care, for example, stigma, poor mental health literacy, service availability, and/or acceptability 1.1. Organisation of this Report In order to provide a context for the study this paper will firstly provide an overview of farming in Australia and a summary of research that has examined farming and mental health. There will then be a description of the methods and results of the study and the implications of these findings and directions for future research will be discussed.
2.1. The Nature of Farming Work Far from matching the idyllic image of a relaxed and peaceful way of life, the physical, economic, and social environment of the farm is characterised by a unique range of stressors that can impact upon the physical and mental health of farming families. Studies in the US (US Department of Labor, 1999), Canada (Pickett et al., 1999) and Australia (Fragar and Franklin, 2000) have identified farming as one of the most dangerous industries (Gerrard, 1998; McCurdy and Carroll, 2000). Farm environments are also characterised by a broad and changeable range of physical, biological, chemical and mechanical hazards (Mitchell et al., 2002); (Gerrard, 1998; McCurdy and Carroll, 2000).. The health outcomes of this environment include respiratory problems (such as asthma, extrinsic allergic alveolitis, bronchitis), zoonoses, acute and chronic poisoning, ergonomic hazards, and musculoskeletal injuries (Gerrard, 1998)..
In addition to these chronic and acute illnesses, the farm environment also produces a high number of farm-related injuries, with reported statistics only representing a fraction of the true number of injuries (Mather and Lowther, 2003) (Gerrard, 1998). In the United States alone, the cost of agricultural injuries was an estimated $4.57 billion in 1992 (Leigh JP. et al., 2001). The authors note that this figure is comparable to the cost of Hepatitis C yet, there are few resources devoted to the amelioration and prevention of farm injuries (Leigh JP. et al., 2001). A recent review of farm safety interventions further found that there has been little evidence of success in reducing the modifiable risk associated with farming (DeRoo and Rautiainen, 2000).
2.2. Farming and Family Life Farms are also unique as land, homes an occupation and a way of life are often handed down between generations(Wilkinson, 2005). Roles between work, home and family are often blurred with farming as numerous generations of the one family work to create an adequate source of income in often difficult financial circumstances (Melberg, 2003; Swisher et al., 1998). These characteristics can create a number of issues for farming families.
Farmers often live in close proximity and have more contact with parents and parentsin-law than non-farmers (Swisher et al., 1998). Whilst this proximity has the benefit of providing support, it can also impose demands and responsibilities, such as conflict over roles between generations and family members, and responsibility for dependent relatives. Family problems can become work problems and work difficulties can create family tensions (Weigel et al., 1987). Family tensions such as sibling rivalry and favouritism take on added meaning in the context of managing a large commercial enterprise (Kohl, 1976). Studies of family stress in farmers have tended to focus on two-generation farms and indicate that it is the younger generation on the farm who can be the most adversely affected (Weigel et al., 1987) (Marotz-Baden, 1988; Marotz-Baden and Mattheis, 1994).
An additional problem relate to the succession of the family farm. There is no customary or mandatory retirement age for farmers and many tend to work beyond the typical retirement age (Franklin RC et al., 2001) placing the younger generation of farmers in a dependent relationship with their parents for much longer than is typical. Issues around farm succession can lead to tensions between the two generations on farms. An Australian study, for example, found that 63% of farmers had not discussed the issue of farm inheritance with their children, and 84% had not spoken to their daughters-in-law (Gamble D et al., 1995). Another challenge relating to farm succession arises when young people do not want to continue farming. Whilst many farmers want to bequeath their farms to their children (Stanyer, 1994), increasing numbers of young people are leaving rural areas for the increased educational and employment opportunities offered by larger centres (McKenzie, 1994). This can create tensions in the family as the older generation of farmers perceive this as a loss of family heritage and have fears for the future of farming(Wilkinson, 2005).
The proximity of family to the work site on farms can make family conflict especially stressful for farmers (Swisher et al., 1998). Weigel et al’s (1987) study of conflict within farming families found that severe conflict negatively impacts upon quality of life of family members and in-turn reduces the productivity of the family business. Particular issues that lead to conflict and stress within the farm family include transition in farm ownership between family members (Gray and Lawrence, 1996) and the need to keep the farm intact to maintain profitability (Mather and Lowther, 2003). 2.3. Changes to Family Farming In Australia These family tensions have been intensified by the dramatic changes to farming practices over the last three decades (Gray et al., 1993).
In recent decades technological change and globalisation have fundamentally altered the trajectory of farming in Australia (Lawrence, 1999) The ‘technological revolution’ that began in the 1970s resulted in improved farm inputs such as fertilisers, pesticides and machinery, and led to greater productivity within farming and reduced the need for labour.(Black et al., 2000). However, diminishing terms in agriculture has meant that the cost of these inputs outstripped the prices received for farm produce(Black et al., 2000). Farmers responded to this situation by increasing the size of their landholdings and the scale of their operations to achieve economies of scale. (Lawrence, 1996)Greater levels of efficiency, paradoxically, contributed to further driving down the prices of farm commodities (Black et al., 2000) creating what some have described as a “production treadmill. (Schnaiberg, 1980).
The result has been farm amalgamations, fewer farming families (a decline of 22% since 1986) (Australian Bureau of Statistics 2003), and reduced employment of paid labour (Lawrence et al. 1990). The declining number of farms and the wider sourcing of farm inputs (Lawrence et al. 1996) also had a detrimental effect upon the economy and population of the towns servicing farming areas (Budge 1996). As Lawrence and Williams have noted: “more productive agriculture is coming to mean less productive and viable rural communities” (Lawrence et al. 1990 p. 40). It has also been suggested that farming communities are becoming “de-traditionalised”, as intense competition undermines traditional farming values including the “the significance of family, community obligations, and commitment to a “rural” lifestyle”(Lawrence, 1999)
2.4. Life in Farming Communities In addition to the issues associated with farming, life in small farming communities can also be associated with particular stressors. It has been suggested that there is a distinct set of social relations in rural, compared with urban areas that can create both stressors and resources for residents(Mellow, 2005). In their qualitative study of mental health Parr et al (2004) describe the distinct pattern of social interaction they found in a rural farming community in Scotland; People’s everyday lives and activities are highly visible, and, despite the physical distances involved between neighbours, it is hard to keep secrets… This social proximity means that several neighbours five miles apart may be intimately familiar with each other’s personal histories and family relationships… Crucially, though, we cannot assume that this form of social proximity will always lead to more caring communities, especially with respect to mental health issues…(p.403 Parr et al., 2004)
In fact, these authors actually found that the opposite was true in this population. There was a high level of social familiarity, however it was quite devoid of emotional support and care(Parr et al., 2004; Parr and Philo, 2003). Mental health problems were stigmatised, and limited availability of mental health services, high level of visibility in small communities, had a detrimental impacts upon people’s mental health and their ability to seek care (Parr et al., 2004).
2.5. Provision of Mental Health Services The level of service provision in farming communities can also place barriers on individuals’ access to care. Most farmers reside in rural areas (Australian Bureau of Statistics, 2003) and distance from health facilities and services has been consistently been shown to reduce their in rural populations(Veitch, 1995). A recent evaluation of utilisation of mental health services using the data collated through the 1997 National Survey of Mental Health and Wellbeing reinforced these findings, demonstrating regional inequalities in utilisation of mental health services(Parslow and Jorm, 2000). Living in a rural or remote location was negatively associated with use of psychiatrist services, and living in a remote area was negatively associated with use of psychologist services(Parslow and Jorm, 2000).
The maldistribution of the mental health workforce is likely to be a significant contributor to the rural/urban imbalance in utilisation of services. The majority of Australians who seek treatment for mental health problems receive this from a general practitioner(Andrews et al., 1999), yet there is a sharp decline in the number of GPs in rural areas (Australian Medical Workforce Advisory Committee & Australian Institute of Health and Welfare (AMWAC), 1999; Harding J, 2000). Using the RRMA classification, the AIHW found that in “large rural centres”, the supply rate was 13% below that of “capital cities”, whereas “small rural centres” and “other rural areas” had supply rates of 23% and 35% respectively less than “capital cities”. There is an even greater inequality in the distribution of specialist services with approximately 8% of psychiatrists and 12% of psychologists practising outside metropolitan areas – far below the proportion of Australia’s population living in these areas.
2.6. Farming and Mental Health Whilst there has been limited research on the mental health of farming communities some studies have revealed that farmers are at risk for a number of mental health problems and increased risk of suicide(Hawton et al., 1998b; Malmberg et al., 1999; Page and Fragar, 2002a; Simkin et al., 1998a; Simkin et al., 1998b) however these findings are not consistent. Whilst some authors have reported higher rates of depression and anxiety in farmers compared with most other occupational groups (Peck et al., 2002) (Eisner CS et al., 1998) (Peck et al., 2002; Roberts RE and Lee ES, 1993; Sanne et al., 2004) other research has found comparable or lower rates of depression compared with the non-farming population(Thomas et al., 2003b).
A more consistent pattern emerges in terms of suicide. In Australia the rate of mortality from suicide is only slightly lower than the rate of death from farming accidents and represents a significant public health concern (Page and Fragar, 2002b). Higher rates of suicide within farming communities have also been found in the United Kingdom(Charlton et al., 1993; Hawton et al., 1999; Inskip et al., 1996; Malmberg et al., 1999), Japan(Nishimura et al., 2004), Canada (Pickett et al., 1998) and the United States(Kposawa, 1999).
A range of factors have been suggested as potential reasons for these mental health and suicide. In terms of mental health problems physical illness (Pentinnen, 1995), financial and business related problems (Malmberg et al., 1999; Page and Fragar, 2002a) reluctance to seek help, (Peck et al., 2002), loneliness and isolation (Pickett et al., 1998) and exposure to pesticides (Stallones and Beseler, 2002) as well as the issues highlighted previously in this report. These factors in combination with ready access to lethal means (Malmberg et al., 1999), a more functional attitude toward death (Booth et al., 2000) have been identified as factors contributing to suicide. However there have been very few studies of the mental health of farmers in the Australian context. Thus there is an inadequate data to understand factors related to mental health in this population and develop appropriate strategies to address these issues. The present study aimed to begin to address this issue.
3.1. Study area and participant recruitment The study was undertaken in the Loddon Mallee Region of Victoria a large rural region in central Victoria that includes one major city, four smaller regional centres and a number of small rural towns.
Potential participants for the study were identified via farming organisations and relevant health and local government agencies in the region. The final sample of Figure 1 Loddon Mallee Region participating farmers (n=32, including both farmers and individuals married to farmers) covered a range of farm types, regions, and ages. Male and female farmers were represented in the sample in order to determine if any gender based differences in the experiences of farmers emerged. Whilst some female farmers identified themselves as “farmer’s wives” they had significant involvement in the daily running and management of the farm and thus were included in the sample.
3.2. Data Collection and analysis procedures Qualitative methods were used for a number of reasons. First, there have been very few studies that have examined the importance of place to the health of farmers, thus the exploratory nature of the study meant that it was important for participants to be able to identify features of their environment that they saw as important to health and wellbeing. Secondly qualitative approaches ground the experiences of place within an historical context (Kawachi I and Berkman, 2003)and the ability to examine in-depth the daily “life-worlds”(Dyck, 1995) of individuals.
A further consideration in using qualitative methods was that previous studies have identified that written surveys may be difficult for farmers to complete and understand (Booth and Lloyd, 1999; Hawton et al., 1998a). Therefore undertaking face-to-face interviews was seen as being a less stressful process for participants and potentially allowing them to greater capacity to describe issues more accurately.
The main topics explored in the interviews included; Characteristic of the farm (i.e. size, access to irrigation water, climatic conditions) and duration of time farming Satisfaction with farming as an occupation Positive and negative aspects of farming and living farming communities The nature of stressors experienced and their impact on wellbeing The ease with which participants felt they could discuss stressful experiences and/or emotional or psychological problems with others. Which individuals or groups participants were most likely to turn to for support during stressful periods/events or periods when they were experiencing emotional or psychological problems The extent to which participants felt that health professionals were useful in assisting them to dealing with stressful periods/events or periods
The majority of interviews were carried out in participant’s homes (n=31) and one was carried out at a local hospital. Interviews lasted between 40 minutes and two hours. Notes were taken during the interviews, and the data was audio taped and transcribed. The data was analysed qualitatively, using content, thematic analysis. Each transcript was read numerous times to provide an overall understanding of the key issues for each participant. From this process similarities and differences in the experiences of participants emerged and key themes emerged. As described by Harden (Harden J, 2005) the data analysis was a reflexive process and involved moving everyday accounts of participants experiences described in the data and social science explanations for these experiences.
4.1. Participants 32 participants were interviewed as part of the study. All the participants were involved in family farming and now were involved in corporate farms. The respondents ranged in age from 18 years to 65 years; with the average age of participants being 53 years and the median age 55 years. The average age of farmers in this sample was somewhat higher than the national average age of farmers, which is age of 51 years (ABS 2003). The majority of participants were involved in dairy farming (n=12), and cereal crops (n=9). The remaining participants were involved in mixed farming such as wheat, sheep, beef and goats (n=6), beef farming (n=2), cropping (n=1) and grape production (n=2).
Most of the participant’s lived in areas defined by the Australian Accessibility and Remoteness Index1 as highly accessible areas (n=17), the remaining participants living in accessible (n=12) and moderately accessible areas (n=3). Eleven of the participants were from dry land farms, whilst the remainder were from irrigated properties. There majority of participants were second or third generation farmers (n=19), with the remainder being the first generation involved in farming. Most participants also continued to have two generations involved in managing or working on the farm (n=21). 4.2. Factors leading to depression, anxiety or use of drugs. Participants were asked to identify the issues that they perceived as being associated with stress, mental health difficulties such as depression and anxiety, or substance misuse.
ARIA was developed to measure and classify the accessibility of 11,340 populated localities in Australia, as measured in the road distance to 201 service centres of various sizes [ARIA, 11]. It was assumed, and subsequent analyses confirmed, that an association would exist between the size of service centres and the availability of services (particularly government-provided services such as health and education). The values of accessibility were then interpolated onto a 1km notional grid across the country.
4.2.1. Financial Pressures All participants identified financial pressure as a major source of stress. All of the participants in the study had experienced times of financial difficulty, and accepted that ‘tightening one’s belt’ was a normal part of farming. For some participants this meant they literally went hungry, for others it meant cancel holidays or delay planned expenditure on household improvements. In the following extract Celia a female farmers provides a vivid example of the restrictions on the family budget. …we had nothing, we didn’t even have a television or a refrigerator used an esky we found at the tip it. Life was pretty dam tough, it was tough for me and it was extremely tough for the kids, we had no money. It never occurred to me that there was a group of people called Centrelink that might come to my aid… I just worked my guts out.
Celia’s attitude of accepting or looking for external sources of support was typical of most participants in the sample who tended to rely on family and friends for advice and support, or to deal with problems themselves, and whilst this type of self- reliance can engender resilience it has also been suggested as a barrier to farmers accessing health care (Thomas et al., 2003a).
Whilst participants in the study found material deprivation difficult, they also indicated that this was an accepted part of farming. However, it was when financial difficulties reached the level where farmers couldn’t afford to pay bills or were struggling to make loan repayments that stress levels dramatically increased. Participants talked about their experiences, and the experiences others in the community, of shame and social withdrawal during these times, particularly when they couldn’t afford to pay local suppliers and contractors.
The high levels of social knowledge and gossip that participants reported occurring in farming communities intensified these stressors, as there was a perception that everyone in the community knew about personal problems. When farmers reached these dire financial circumstances they also risked losing the farm, which had broad ramifications, as Louise, a second-generation farmer describes; …if they lose that [the farm] they lose not only a business and a job they lose their house and they usually lose their families. I think people forget that it’s not just a job it’s their whole life and often their own inheritance as well.
In this context self-reliance was a less adaptive coping mechanism as it could limit people’s willingness and receptiveness and to seek and accept outside assistance.
Participants responded in different ways to the financial pressures. None of the participants use terms such as ‘depression’ to describe how they were feeling, however they talked about feeling drained, worried, exhausted, being in denial, hopeless, and lacking in motivation during times. Two participants reported that they had increased their use of alcohol during these times, and another reported that most farmers she knew increased their alcohol consumption during times of financial difficulty. However all participants also reported that they tried to remain positive, optimistic and maintain motivation during these periods.
The attitude of Harry, a male dairy farmer, was typical of many men in this sample, when he described his approach to dealing with the impact of the drought on his farm; … I found it very difficult to get up and be enthused about my farm when it looked so shocking and I couldn’t do a dam thing about it. That was probably the most distressing thing and that used to get at me… but that didn’t last very long because I thought to myself here’s an opportunity to catch up on all these jobs that I’ve been putting off and I started on one side of the farm and I went right through. Those sorts of things kept me going and I look back and I’m pretty proud of what I’ve done. I got through those tough times.
A minority of participants did access to external advice and support that was of key importance in overcoming financial difficulties and the mental stressors that were associated with them. In the following extract Joe, a male dairy farmer, describes how a chance meeting with a financial advisor at a community event, reversed the family’s financial problems. I felt like “Was this really happening to us?” It can’t be happening, the worst possible scenario, I was in denial. You feel hopeless when you can’t do anything. It’s hard to get motivated and then you get that little spark of hope and someone switches a light on at the end of the tunnel for a few minutes and you’re up and away. That’s what our financial advisor did; he turned that negative situation around. There’s some poor buggers around that manage to dig themselves in deeper and deeper and won’t discuss it.
As Joe’s comment suggests, external advice and support can be extremely useful, but there is reluctance on the part of farmers to access it. In the instance cited above Joe’s meeting with the counsellor was purely accidental, however as the pro-active approach of the counsellor in participating in community events and openly discussing these issues meant these services were more accessible. This example may point to strategies useful in making health and support services more accessible to farming communities.