Why some people avoid seeking behavioral health treatment is not well understood. This circumstance is particularly relevant to agricultural producers currently, because many are struggling with serious stress that is increasing their vulnerability to anxiety, depression, substance abuse, and occasionally but infrequently, even to the risk of suicide.
Fortunately, Congress and the media (radio, television, print, etc.) are paying attention to the uncertain farm economy and its effects on the well-being of farmers, their families and communities. For instance, there is much concern about how proposed tariffs will affect the export sales of such agricultural commodities as soybeans, pork, and sorghum.
Behavioral healthcare services, and other forms of assistance, such as agronomic and business advice, are available in most places of the U.S. where people farm or furnish other agricultural products such as fish or lumber. Despite the increasing economic pressures that threaten many agricultural producers’ livelihoods, some of the persons in most need of emotional support avoid professional assistance that is available.
The factors that contribute to people avoiding mental healthcare when it is needed and how to overcome these barriers are not fully known. This is the first of two articles about what is known why some persons avoid behavioral health services and what to do about this circumstance.
A 2014 publication of the Association for Psychological Science indicated that in any recent given year about 60 million Americans experienced some type of mental illness but only about 60 percent of persons with a diagnosed illness seek the treatment they need.
From a public standpoint, the authors said, “Stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination, such as excluding people with these conditions from employment and social or educational opportunities. These displays of discrimination” can lead to internal stigma and social stigma.
Lately, ownership of guns has been connected to incomplete understanding of mental illness by some media. Seeking mental health treatment has little to do with dangerousness associated with gun ownership. It’s a form of stigma.
What does the term stigma mean? To answer this question I drew on experts in psychology and related behavior sciences. Stigma, according to a 2013 article by Graham Davey, usually entails discriminating behaviors directed toward people with such psychiatric labels as schizophrenic or bipolar. However, the term can be applied to anyone who acts strangely or defies norms.
Verbalizations, like, “She (or he) is mental,” illustrate such stigmatizing behaviors. This is commonly referred to as social stigma. It helps to explain why Senator Thomas Eagleton was removed as the vice-presidential running mate for Senator George McGovern in his presidential campaign in 1972, after it was publicized that Mr. Eagleton had been treated for depression.
Perceived stigma, also called self-stigma, describes the feelings of shame that many persons who experience behavioral health disorders feel. For both social and self-stigma, other persons and the symptom bearers may feel that mental health and substance abuse conditions are signs of weakness, are self-inflicted and could be overcome with sufficient will-power.
A 2009 study of 5,555 students in 13 U.S. universities reported in Medical Care Research and Review indicated three main findings regarding stigma about seeking mental healthcare: 1) Social stigma was higher than self-stigma; 2) Self-stigma was higher among students who were male, younger, Asian, from a foreign country, more religious, or from a poor family; and 3) The higher their self-stigma score, the greater they avoided seeking care in the form of psychotropic medication, counseling and reaching out to other sources of assistance, such as dormitory monitors and pastors.
Farmers especially don’t seek treatment, Alleah Heise said in the most recent issue of The Ag Progress Dispatch. “Shh. We don’t talk about that…mental health in agriculture,” she noted.
According to research studies during the past two decades in Australia and Great Britain, farmers take pride in being self-reliant; they work excessively hard to overcome adversity on their own, trust their own judgment and they have low ability to acknowledge or express mental health problems and to seek help. These behavioral styles contribute to farmers becoming successful but work against them during stressful times, when they would benefit by reaching out for assistance.
Research which my colleagues and I undertook over the past two decades indicates that negative stigma about seeking behavioral healthcare may be diminishing during recent years, and especially among younger and well-educated farmers. Many farmers and their families are beginning to consider mental healthcare much like they consider medical care for such problems as diabetes and back pain.
If medical care improves their capacity to work effectively and productively, behavioral healthcare can also help them farm optimally.