Written evidence submitted by the British Association for Counselling and Psychotherapy (BACP) (MH0021)



The British Association for Counselling and Psychotherapy (BACP) is pleased to provide a submission to the Environment, Food and Rural Affairs Committee inquiry into Rural Mental Health.


BACP is the leading and largest professional body for counselling and psychotherapy in the UK, with over 60,000 members. Our members are drawn from the various professional disciplines in the field of counselling and psychotherapy, working in a broad range of settings including agriculture, education, private practice, healthcare, workplace support and within the third sector, as well as working with clients across all age-groups.





Over recent years we have been working closely with a network of rural support organisations, research institutions, Trade Unions and charities working to tackle a growing ‘mental health pandemic’ in UK farming. During this time, we have also worked closely with and listened to our members, many of whom provide frontline counselling services to farmers and their families. We have long been aware of a growing mental health crisis in UK farming, with services struggling to meet demand as pressures increase on workers. Many people living and working in rural communities have reached tipping point, with their ability to cope outweighed by the scale of the problems they face; including poor weather, rising unemployment, policy challenges, changing consumer trends, supply chain issues and disease.


The COVID-19 pandemic has exacerbated existing challenges within rural farming communities, and the legacy impacts of the pandemic will likely outlast the health crisis itself, including changes to communities, widening inequalities, mental ill-health, revenue challenges for government and rising unemployment. In rural communities, the pandemic has served to exacerbate existing problems including the supply of migrant labour, supply chain issues and increased isolation for some already vulnerable or ‘harder-to-reach’ farmers.


In an industry so integral to our daily lives, and one already affected by high rates of poor mental health and suicide, it is vitally important to understand the issues and we therefore welcome the opportunity to participate in discussions and make recommendations about how the government can improve mental health provision and outcomes for those in rural communities. 



















What specific mental health challenges are faced by those living and working in rural communities?


People living and working in rural communities face a multitude of challenges, many related, that can place them at a greater risk of mental and physical ill health. These include farm succession and family relationships, policy changes, rising unemployment changing consumer demands, isolation, inequality and challenges with disabilities, adverse weather and disease.


Within rural communities, some groups have been shown to be at greater risk of mental ill health than others. For example, women, farmers who keep livestock, and those running smaller enterprises are the most likely to be struggling with their mental health, according to the Royal Agricultural Benevolent Institution (RABI) Big Farming Survey (2021).


The survey found that whilst 36% of the entire farming community described themselves as “probably” or “possibly” depressed, for women in agriculture, the figure was 43%.  Similarly, the survey showed a strong correlation between farms with livestock and reduced mental wellbeing, with 47% of farmers in the pig sector, and 39% of upland grazing and dairy reporting that they were “probably” or “possibly” depressed.


With the vast majority of UK farms day-to-day farm management issues can lead to family conflict and tensions about the business, including feeling a loss of control, communication breakdowns, verbal and physical abuse and marital difficulties – all of which can contribute to higher stress levels. 


Long working hours also add considerable strain to farmers and their families. A major survey of farmers, farm managers and farm workers, undertaken by Farmers Weekly, found that British farmers work on average 65 hours per week, with some growers and livestock producers working in excess of 100 hours, rarely taking a day off, let alone an annual holiday. The survey revealed that the key creators of stress include workload, finances and relationships, with many farmers suffering the effects of sleep deprivation, including fatigue, as they juggle competing priorities.


Alongside the devastating financial impact of the COVID-19 pandemic, disruption to everyday life have also taken their toll on those in rural communities. The cancellation of important events in the farming calendar, as well as limitations on being able to travel and visit others, have served to exacerbate the feelings of isolation and loneliness already common in rural communities. This also made accessing face-to-face support even more challenging. The Big Farming Survey found that for farmers the pandemic ranked alongside unpredictable weather and concern about the future of the farm as the most significant causes of stress and anxiety.


Research commissioned by the National Rural Mental Health Forum and Support in Mind Scotland (SiMS) showed that 93% of people living and working in marginalised rural communities believed that the COVID-19 pandemic had a negative impact on their mental health and wellbeing. The report, launched in February 2021, focused on the experiences of LGBT+ people, young carers and refugees and asylum seekers living in rural Scotland. Two of the key issues it highlights are the loss of face-to-face contact and a lack of access to local support.



What is the current state of mental health & suicide prevention service provision for those working in agriculture and those living in rural areas more generally? Do they meet the specific needs of that community?


Current provision for mental health and suicide prevention services do not adequately meet demand. This was the case prior to the pandemic, which has placed further strain on a network of services made up of a combination of IAPT (in England), community and voluntary providers.


BACP accredited service providers, many of whom work exclusively with rural workers, point to an urgent need for better designed service tailored to meet the specific needs of those in rural communities. Those providing counselling would benefit from training to better understand the rural context and improve engagement with communities that are traditionally hard to reach due to cultural and physical barriers.


Online counselling services, such as those provided by Kooth and Quell via RABI, provide an opportunity to reach more people, though the digital divide may make access problematic in some remote areas. Additionally older people are less likely to seek help through these channels, partly due to a lack of digital capability and partly due to a preference for traditional face to face services.


The 2017 report, Agriculture in the UK, revealed that the percentage of older people living in rural areas is as high as 56 per cent, with a third of all agricultural workers in the UK over the typical retirement age of 65 years. Those in these age groups are more vulnerable to isolation and loneliness, unlike younger farm workers who tend to be more mobile, physically active and more willing to engage with a range of support services. 


Two-thirds of people with dementia live and work in rural areas, and charities like the Farming Community Network (FCN), a voluntary organisation and charity that supports farmers and families within the farming community, has reported helping an increasing number of people affected by the illness. This includes providing help with accessing GP surgeries post-diagnosis support from other services, which tend to be patchy and inadequate in many rural areas.


The underutilised but highly capable counselling and psychotherapeutic workforce is ideally placed to provide this much needed support, however more work is needed to identify what existing provision looks like, where the gaps are and what investment is needed.


What are the causes of the higher-than-average rate of suicide amongst those working in agriculture? Are there other linked professions, such as vets, that have similar issues? How effective are suicide prevention services offered to these groups?

A review of the literature on rural suicide indicates that a growing body of empirical, theoretical, and prevention work has been conducted on the topic, with an increasing number of countries represented and articles written. These show that a range of risk factors contribute to the higher-than-average suicide rate amongst those working agriculture, and they include:













Is sufficient mental health support made available to rural communities following “shocks” such as flooding or mass animal culls?

As previously noted, the demand for mental services outstrips supply in many rural areas. The focus of any additional mental health investment has to be concerned with levelling up the inequities in provision in a targeted way that is designed to meet the specific needs of those living and working in rural communities. In doing so there will be less need to respond reactively to crises or shocks with temporary interventions or measures. The goal instead is to be build resilience and empower rural communities for the longer term.


Does the Government’s recent investment in mental health services adequately provide for agricultural mental health?


We welcome the government’s investment in mental health services, but as already been noted, the rural mental health landscape requires specialist, targeted investment to meet the unique myriad of challenges faced by those living and working in rural communities. This cannot be achieved by a one size fits all approach or within a single funding settlement. Targeted additional investment is required to support existing service providers and develop new approaches to addressing the growing mental health crisis in UK farming.


In recent months we have worked closely with RABI and BACP organisational members providing counselling services to develop and pilot an innovative new model of face-to-face delivery – alongside existing online services – that will shortly be rolled out for rural workers in England. The model includes a number of elements that will aim to address some of the key challenges associated with delivering mental health services in rural communities. This includes providing qualified BACP registered therapists with training designed to increase their awareness of the rural context and challenges, ensuring that they better understand the needs of farm workers (and their families) and to help build trust and improve engagement. We aim to work closely with the service delivery organisations over the course of the pilot and will capture and share any key lessons.


How joined up are key actors, such as Defra, DHSC, NHS England, Public Health England and Local Government in their approach to improving quality of, and access to, mental health service in rural and agricultural communities?

Many commentators refer to a rural mental health crisis and, as the above shows, there are a number of factors that contribute to the landscape of poor mental health in rural/agricultural communities. Addressing this complex picture will require a joined up multi-agency approach, one in which public bodies, policy makers, funders, charities, stakeholder organisations and those living and working in rural areas work together.


It is unclear how joined up these key agencies are, though the view from the ground is that they are not. Defra and other devolved administrations should consider what role they might play in co-ordinating, supporting, or facilitating a joined-up landscape of support for farming mental health.


However, any such collaborative work must seek to address a number of factors contributing to poorer mental health, including the economic, social, physical and psychological determinants. This work could be captured within dedicated local rural mental health strategies and action plans, which would aim to build better opportunities for good mental health and wellbeing, community strength and more responsive and accessible services.



Implications and Recommendations





Sources and further reading


Big Farming Survey (2021). Royal Agricultural Benevolent Institution (RABI). https://rabi.org.uk/wp-content/uploads/2021/10/RABI-Big-Farming-Survey-FINAL-single-pages-No-embargo-APP-min.pdf


Brew et al. (2016). The health and wellbeing of Australian farmers: a longitudinal cohort study. BMC public health, 16.


British Academy 2021. The COVID decade: Understanding the long-term societal impacts of COVID-19, British Academy, London.


Davies AR, Grey CNB, Homolova L. 2021. Supporting farmer and fisher communities in Wales through uncertainty: two mixed methods studies, European Journal of Public Health, Volume 31, Issue Supplement_3, October 2021, ckab165.587.


Ford et al. (2018). Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study. PLos One. https://doi.org/10.1371/journal.pone.0193952


Guerrero et al. (2018). Rural Mental Health Training: an Emerging Imperative to Address Health Disparities. Academic psychiatry, 43, 1-5.


Garnett P, Doherty B & Heron T. 2020. Vulnerability of the United Kingdom’s food supply chains exposed by COVID-19. Nat Food 1, 315–318.


Goffin (2014). Farmers’ mental health: A review of the literature. ACC Policy team.


Hagen et al. (2019). Research trends in farmers’ mental health: A scoping review of mental health outcomes and interventions among farming populations worldwide. PLoS One. https://doi.org/10.1371/journal.pone.0225661

Herron et al. (2020). “Talk about it”: changing masculinities and mental health in rural places?. Social Science and Medicine, 8, 258.


Hirsch, J. K., & Cukrowicz, K. C. (2014). Suicide in rural areas: An updated review of the literature. Journal of Rural Mental Health, 38(2), 65–78. https://doi.org/10.1037/rmh0000018


Hubbard et al. Are Rurality, Area Deprivation, Access to Outside Space, and Green Space Associated with Mental Health during the COVID-19 Pandemic? A Cross Sectional Study (CHARIS-E). International journal of environmental research and public health, 18(8). https://www.mdpi.com/1660-4601/18/8/3869#

Jensen, E. J., Wieling, E., & Mendenhall, T. (2020). A phenomenological study of clinicians’ perspectives on barriers to rural mental health care. Journal of Rural Mental Health, 44(1), 51–61. https://doi.org/10.1037/rmh0000125


Judd et al. (2006). Understanding suicide in Australian farmers. Social psychiatry and psychiatric epidemiology, 41, 1-10.


Kelly et al. (2010). Mental health and well-being within rural communities: The Australian Rural Mental Health Study. The Australian journal of rural health, 18(1), 16-24. https://doi.org/10.1111/j.1440-1584.2009.01118.x


Kelly et al. (2010). Determinants of mental health and well-being within rural and remote communities. Social psychiatry and psychiatric epidemiology, 46, 1331-1342.


Klingelschmidt et al. (2018). Suicide among agricultural, forestry, and fishery workers: a systematic literature review and meta-analysis. Scandinavian journal of work, environment and health, 44(1), 3-15. https://www.jstor.org/stable/44709297


Landscapes of support: Farmer wellbeing and rural resilience through and beyond the COVID-19 pandemic. Funded by the Economic and Social Research Council (ESRC), as part of UK Research and Innovation’s rapid response to COVID-19. https://research.reading.ac.uk/landscapes-of-support/


Lawrence-Bourne et al. (2020). What Is Rural Adversity, How Does It Affect Wellbeing and What Are the Implications for Action?. International journal of environment research and public health, 17, 7205.


Lobley M, Winter M. and Wheeler R. 2019. Chapter 7 Farmers and social change: Stress, well-being and disconnections. In Lobley M, Winter M and Wheeler R (eds) The Changing World of Farming in Brexit UK, London: Routledge, pp. 168- 201.


Milner et al. (2015). Workplace suicide prevention: a systematic review of published and unpublished activities. Health promotion international, 30(1), 29-37. https://doi.org/10.1093/heapro/dau085


Milner et al. (2018). Suicide by occupation: Systematic review and meta-analysis. British journal of psychiatry, 203(6).


Milner et al. (2015). Workplace suicide prevention: a systematic review of published and unpublished activities. Health promotion international, 30(1), 29-37. https://doi.org/10.1093/heapro/dau085


Monk A. 2000. The Influence of Isolation on Stress and Suicide in Rural Areas: An international comparison, Rural Society, 10:3, 393-403.


Nye C and Lobley M. 2021. Farm labour in the UK: Accessing the workforce the industry needs. CRPR.


Phalp L, Corcoran R, Eames C, Naik A. 2021. An exploration of the relationship between adverse events on the farm and suicidal ideation in farmers. International Journal of Social Psychiatry. November 2021.


Price L. 2012. The emergence of rural support organisations in the UK and Canada: Providing support for patrilineal family farming. Sociologia Ruralis, 52(3), pp.353-376.


Roberts & Lloyd (2013). High-risk occupations for suicide. Psychological medicine, 43(6), 1231-40. https://doi.org/10.1017/s0033291712002024


Roy et al. (2015). “Do it All by Myself”: A Salutogenic Approach of Masculine Health Practice Among Farming Men Coping With Stress. American journal of men’s health, 11(5), 1536-1546. https://doi.org/10.1177%2F1557988315619677


Roy et al. (2014). Help-seeking among Male Farmers: Connecting Masculinities and Mental Health. Sociologia Ruralis, 54(4), 460-476. https://doi.org/10.1111/soru.12045



Sanderson Bellamy A, Furness E, Nicol P et al. 2021 Shaping more resilient and just food systems: Lessons from the COVID-19 Pandemic. Ambio 50, 782–793.


Skegg et al. (2010). Suicide by Occupation: Does Access to Means Increase the Risk? Australian & New Zealand journal of psychiatry, 44(5), 429-434. https://doi.org/10.3109%2F00048670903487191 


Weaver, A., & Himle, J. A. (2017). Cognitive–behavioral therapy for depression and anxiety disorders in rural settings: A review of the literature. Journal of Rural Mental Health, 41(3), 189–221. https://doi.org/10.1037/rmh0000075


White V, Hurley P, Hall J, Lyon J, Tsouvalis, J, Rose DC, Little R. 2021. Engaging ‘harder to reach’ farmers: the roles and needs of skilled intermediaries. Research Summary. Universities of Sheffield and Reading.


Windsor & Gunnell (2019). Occupation-specific suicide risk in England: 2011–2015. British journal of psychiatry, 215(4).


Younker & Radunovich. (2022). Farmer Mental Health Interventions: A Systematic Review. International journal of environmental research and public health, 19(1), 244. https://doi.org/10.3390/ijerph19010244