Written evidence submitted by the National Farfmers’ Union (NFU)(MH0028)

1. The NFU represents 55,000 members across England and Wales. In addition, we have 20,000 NFU Countryside members with an interest in farming and rural life. Our purpose is to champion British agriculture and horticulture, to campaign for a stable and sustainable future for British farmers. Creating the right conditions for a thriving British farming sector includes promoting the health, safety, and wellbeing of our members.

Introduction

2. The NFU welcomes the opportunity to supply evidence and contribute to the EFRA Committee Inquiry entitled ‘Rural Mental Health’. As public health is a devolved issue, the NFU’s comments are primarily in relation to policy in England, although there are common challenges for people living in rural communities across the UK.

Questions and NFU Responses

Question 1 - What specific mental health challenges are faced by those living and working in rural communities?

3. There are some specific challenges faced by those working in agriculture compared to other occupations including:

• Isolated working
• Long working hours
• Adverse weather conditions
• Market volatility
• Above average risk of work-related accidents
• Above average levels of work-related ill health and in particular musculoskeletal injuries
• Poor rural connectivity both for business and personal use (broadband/digital)

4. In 2021 The Royal Agricultural Benevolent Institution (RABI) carried out a survey of health and wellbeing in the farming community in England[1] which found, among other things:

• Low levels of mental health and wellbeing with up to 36% of respondents probably or possibly depressed
• High levels of anxiety among women in agriculture
• Stress caused by multiple factors such as over regulation, the impacts of Covid and unpredictable weather

5. However, despite these challenges, the survey also found high levels of optimism for the future of farming business in England with 59% of respondents believing that their farming business is viable over the next five years.
6. Agriculture is one of the industries most affected by the UK’s exit from the European Union. Agricultural policy, including the support schemes available to farmers, are being re-written - the biggest reimagining of English agricultural policy since the Second World War. Old EU based ‘direct payments’ to farmers are being phased out and replaced with new schemes.
7. English farm businesses are therefore facing a perfect storm of uncertainty and disruption, some of which, such as Covid-19, could not have been envisaged when the timetable for direct payments reductions was planned in 2018, including:

• A worsening macro-economic forecast and volatility for farm businesses
• Rising inflation, cashflow disruption, continued trade disruption with both the EU and Northern Ireland, continued market volatility as a result of Covid-19
• A fierce retail price war

8. Farmers and growers are having to take considerable time to understand the significant implications of new and complex evolving policy and we know the uncertainty is having an impact on the wellbeing of our members.
9. The NFU is pleased to see that Defra is taking positive steps to increase resilience in farming with funding provided under the Future Farming Resilience Fund (FFRF) to help farmers:

• Fully understand the changes that are happening
• Identify how, where and when they may need to change their business model
• Access tailored business advice and wellbeing support

10. However, we suggest that support and advice provided under FFRF (that has the potential to alleviate causes of stress and anxiety for farmers) can be enhanced by:

1. Delivering advice face to face wherever possible (Covid allowing) as this has been identified as the preferred delivery method in evaluation carried out by Defra of the FFRF pilot programmes
2. Increased peer to peer involvement with the sharing of best practice
3. Extending support under FFRF beyond the current proposed end date of March 2025 to 2027 because:
1. An extended period will likely be needed in any event so as to reach the target of 32,000 farmers given the capacity of the market to deliver the planned interventions
2. Allow time for the opportunities that may be available to farmers under future environment schemes to be fully considered
4. Defra taking a more proactive role in reaching farmers who are currently in receipt of direct payments to increase awareness of the Agricultural Transition Plan, the potential for significant impacts on business models and the support available under FFRF.

Question 2 – What is the current state of mental health and suicide prevention service for those working and hose living in rural areas generally? Do they meet the specific needs of that community?

11. There is anecdotal evidence supported in a recent report from the Centre for Rural Research and the Farming Community Network (FCN)[2] that there is a demand for farm specific mental health support provided by service providers that understand the unique demands and characteristic of farming life. There are several farming help charities that provide support to farmers but funding for some is not secure. In addition, we are of the opinion that there is potential to increase knowledge and awareness of farming specific issues for rural GPs and other health service providers to give the necessary context to help improve delivery of help and support to the farming community.

Question 3 -What are the causes of higher-than-average rate of suicide amongst those working in agriculture? Are there linked professionals such as vets, that have similar issues? How effective are suicide prevention strategies offered to these groups?

12. Care is required when discussing suicide in relation to occupation as the data available is often not sufficiently granular in detail to allow definitive conclusions regarding suicide and occupation to be made.
13. In 2017, the ONS published a report[3] on deaths from suicide in different occupational groups for people aged 20 to 64 years, based on deaths registered in England between 2011 and 2015. The study looks at men and woman separately due to the marked sex difference in the risk of suicide (4 in 5 suicides analysed in the report were among men) and differences in the occupations favoured by men and woman.
14. For men, the study found an elevated risk of suicide among low-skilled workers, skilled manual workers, those working in arts-related occupations and as carers. For women, the study found an elevated risk of suicide among low-skilled workers, nurses, nursery, and primary schoolteachers in addition to those working in arts-related occupations and as carers.
15. In the discussion section, the report clearly states that farmers were not found to be at an increased risk of suicide whilst persons in elementary agricultural occupations are at an elevated risk of almost twice the general population.
16. The report uses a four-tier hierarchy[4] to classify occupations, which includes nine ‘major’ groups at the top and 369 ‘unit’ groups at the bottom. It is important to note that each unit group contains several related occupations and, therefore, even at the most specific level, findings still refer to several occupations at once. Six of the unit groups are related to farming but, for men, only half of these experienced enough suicides to produce reliable data. The three farming-related unit groups that did produce reliable data are:

• Agricultural and fishing trades – this group includes aboricultural consultant, bee farmer, gamekeeper, share fisherman, trawler skipper and tree surgeon
• Farm workers – this group includes agricultural worker, farm labourer, farm worker, herdsman and shepherd
• Farmers – this group includes agricultural contractor, agricultural technician, crofter (farming), farmer and herd manager

17. The report uses a common measure of mortality, called the standardised mortality ratio (SMR), which shows whether the number of suicides in a particular occupation group is high or low relative to patterns of suicide in the broader population of England. An SMR of 100 would indicate that the risk of suicide in a certain occupation group is the same as the national average, whereas an SMR above or below 100 would indicate a higher or lower risk of suicide respectively.
18. Out of 110-unit groups that generated reliable data for men;

• Agricultural and fishing trades carried the third highest risk of suicide with an SMR of 364 i.e., people in these occupations are over 3.5 times more likely to commit suicide than the broader population.
• Farm workers carried the 12th highest risk of suicide with an SMR of 221 i.e., they are more than twice as likely to commit suicide as the broader population.
• Farmers had the 60th highest rate of suicide with an SMR of 101 i.e., male farmers, for all intents and purposes, are no more or less likely to commit suicide than the broader population.

19. The three farming-related unit groups that did not produce reliable data for men are managers and proprietors in agriculture and horticulture, agricultural machinery drivers and fishing and other elementary agricultural occupations. An indication of the suicide risk for each of these can be given by stepping up the occupation hierarchy until reliable data is found. For instance:

• The managers and proprietors in agriculture and horticulture unit group sits within the other proprietors and managers sub-major group, which carries an SMR of 93 i.e., they are slightly less likely to commit suicide than the broader population.
• The agricultural machinery drivers unit group sits within the mobile machine drivers and operatives minor group, which carries an SMR of 147 i.e., they are around 1.5 times more likely to commit suicide than the broader population.
• Finally, the fishing and other elementary agricultural occupations unit group sits within the elementary agricultural occupations minor group, which carries an SMR of 191 i.e., they are just less than twice as likely to commit suicide as the broader population.

20. Of course, the further up the hierarchy a group sits, the more likely it is to contain occupations that are unrelated to farming. Therefore, this data has clear limitations in how it can be used to describe trends in the industry.
21. Unfortunately, none of the six farming-related unit groups produced reliable data for women, so the same approach of stepping up the occupation hierarchy needs to be taken to get an indication of the relative suicide risk. However, without jumping to the top of the hierarchy and including a vast array of industries, the only indication of suicide risk for women in farming can be given by the elementary trades and related occupations sub-major group. This group contains the farm workers and fishing and other elementary agricultural occupations unit groups, as well as construction and plant process unit groups, and carries an SMR of 192 i.e., on average, people in these occupations are almost twice as likely to commit suicide as the broader population.

Previous studies

22. As stated above, the report clearly states that farmers were not found to be at an increased risk of suicide. However, it also suggests that this finding may actually represent an improvement in the sector, as previous studies have found an increased risk among farmers. For example, a study[5] from 2008 found an elevated risk among male farmers, based on deaths registered in England and Wales between 2001 and 2005. A previous study[6] from the ONS itself also found an increased risk of suicide among male farmers, based on deaths registered in England and Wales between 1991 and 2000. It is worth noting that the latter study relies on a different measure of mortality, which may account for some of the apparent improvement. That said, a 2012 study[7] on how suicide rates in different occupations have changed over time across Britain found large reductions in several occupations, including farmers.

Impact of Covid on statistics

23. A report on suicide registrations in 2020 was published by ONS in September 2021[8] commenting on suicide by sex, age, and area of residence of the deceased. The report did not comment on occupation of the deceased. Points to note from the report are:

• Suicides in 2020 are statistically lower than in 2019
• The decrease is likely the result of a decrease in male suicides and delays in death registrations caused by covid

24. A further study by the University of Manchester published in April 2021 comments that despite higher levels of distress caused by the pandemic evidence suggests that overall suicide rates in England did not rise in 2020[9].

Reasons for an increased risk?

25. The ONS report says that attempting to explain suicide by occupation is complex as several factors may act together to increase risk, but it does gives three broad reasons why an occupation may carry a high risk of suicide:

• Job-related features such as low pay and low job security increase risk
• People at high risk of suicide may selectively go into particular kinds of occupations – for example, a high suicide rate among publicans may be due to those at risk of alcoholism being attracted to an industry where alcohol is freely available
• Having access to, or knowledge of, a method of suicide increases risk – the study found those working in agriculture-related trades are the most likely to die using a firearm, so the ability to access a method of suicide is likely to be an important contributor to the risk of suicide among those working in agriculture

26. So, to conclude care must be taken when discussing suicide by occupation in a farming context. From the evidence available it appears that those in the occupation of farmer are not at an elevated risk compared to the general population but that there is an elevated risk when the industry is considered as a whole, and all farming roles are taken into account. We suggest that further research to better understand who is at risk is required.

Question 4 - Is sufficient mental health support made available to rural communities following “shocks” such as flooding or mass animal culls?

27.    It is recognised persons experiencing shock events such as flooding, other extreme weather conditions and animal welfare crises are at risk of developing mental health disorders. NHS guidance suggests that around 70% of persons who experience major incidents are resilient despite experiencing distress. Distress that is experienced can be reduced if adequate and early intervention is made.
28.    However, feedback to the NFU from members is that when a major incident occurs frequently specific and targeted support does not extend beyond the initial incident response stage and ongoing support is not readily available. Factors that may make the task of providing ongoing support harder in a rural context are:

• Dispersed populations which may require more extensive efforts to identify people affected in comparison to those in an urban setting
• Demographic factors such as age which may impact on the agencies involved in a response
• Lack of knowledge of issues vital to farmers and farming businesses

29.    We suggest that there is scope to develop a major incident support pathway applicable nationwide to assist agencies in providing an adequate response and support provision to farmers experiencing shock events. If such a pathway is already in existence, we suggest that it is made more widely known to industry stakeholders, agencies, and organisations.
30.    Endemic animal diseases such as bovine Tuberculosis (bTb) present different issues to those caused by shock events. A bTb outbreak can have immediate financial impacts with the loss of culled animals and disruption to sales of milk and beef. Additional and longer lasting impacts can result from movement restrictions with animals staying longer on farm than would otherwise be the case resulting in financial pressure from increased labour, accommodation, and feed costs.  In the 12 months to September 2021[10] over 40,000 animals were slaughtered, almost 7% of registered herds were disease restricted and the financial cost of on a farm of a bTb breakdown on farm is £34,000.

Many farmers have strong emotional ties to their livestock and seeing animals destroyed (up to 40% of a herd culled in some cases) leaves some with a deep feeling of loss. In addition, many farmers face ongoing uncertainty after an outbreak with concerns over that more animals will be identified as reactors in tests during subsequent years. Greater recognition of these longer lasting impacts is required by agencies interacting with farmers who are experiencing a bTb outbreak as is the funding and provision of resource to support farmers such as that provided by FCN.

Question 5 - Does the Government’s recent investment in mental health services adequately provide for agricultural mental health?

31. The NFU welcomes investment in mental health provision, but the challenge will be to ensure this funding reaches rural communities as increasingly essential services are becoming inaccessible because local outlets have closed due to loss of viability[11]. This includes education, health, retail, leisure and specialist services for children and older people. Rural communities should receive the same services as available in urban locations and this is an important element of the need for levelling up Britain, not just between north and south, but also between urban and rural communities.
32. Furthermore, there is consistently lower capital investment per employee in rural areas than urban areas with predominately urban authorities receiving 49% more funding for local government services than rural authorities[12]. Rural areas also pay an average of 17% more per head in council tax than urban areas yet they typically receive fewer social services[13]. Coupled with average earnings less than in urban areas, the cost of living in rural areas is therefore disproportionately high.

Digital Access and Mental Health

33. Digital technology has a huge role to play in farming and rural life and accessing vital support. Access to digital services is so interwoven into society that the Joseph Rowntree Foundation use digital inclusion as a measure of social inclusion.[14] Access to digital services is becoming more important every day.  This has been particularly highlighted during the current global crisis surrounding Covid-19 which has demonstrated that digital connectivity is a necessity for every rural household. With the implementation of social distancing and working from home, the ability to connect with workplaces remotely and also with family and friends has been a lifeline for most people, including those who are having to isolate. Connectivity allows people to stay in touch, follow the news and NHS health and government guidelines, conduct business, and overall stay connected during this unprecedented time.
34. While the reasons for needing connectivity during Covid-19 are clear, 30% of farmers in a survey carried out by the NFU reported one or more additional challenges with internet access during lockdown[15]. One member reported that “virtual meetings are only possible if every other internet-connected device in the house is turned off” which is impractical in a household of numerous people. Similarly, another member highlighted that children returning from school and university stretched the capacity of the internet to beyond its operational limit. Better connectivity has to become accessible in a timely manner so rural households are better equipped to deal with a new reality of working from home for the foreseeable future and to help maintain access to public services (such as the NHS) and important social connections.
35. Digital infrastructure will also help tackle the issue of an increasingly aged rural population. The benefits of digital connectivity are wide-ranging, from tackling social isolation of older populations to encouraging new families and businesses to move to rural areas. If businesses can be run successfully through digital means, then it will incentivise people to work from home, create and expand businesses in rural areas, and overall view rural areas as a viable option for a dynamic and fulfilled life. Again, this has been highlighted by the current pandemic. The need for connectivity in rural areas is more important than ever. Furthermore, with 7.8% of the farming workforce being over 70 and therefore in the vulnerable group, the lifeline that digital connectivity gives cannot be underestimated.

Question 6 - 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?

36. Anecdotal evidence suggests that there is scope for government departments and agencies to better coordinate policies and their implementation in a farming context. A good example is provided by the ATP which will fundamentally affect the business model of thousands of farms making them unprofitable if measures are not taken to adapt and change. The fact that such a fundamental change to the farming business environment is taking place and being coordinated by Defra is arguably not known or factored into policy by other agencies.

January 2022