Mental Health Risks to Farmers in England and Wales                                                                                    Page 7

 

Written evidence submitted by Miss Viola King Forbes (Research Coordinator at University of Oxford) (MH0032)

A woman and child walk on a farm near the Scottish borders, 14 August 2017.
Research has suggested that farmers are at higher risk of mental illness and suicide. This document evaluates evidence and provides an overview of factors that influence mental health in agriculture. It also evaluates existing support available to farmers and outlines potential actions to reduce future risks.

Background

Surveys among farmers indicate that most believe that mental ill-health is the biggest problem in agriculture[1]. 64% of farmers surveyed by Farmer’s Weekly feel positive about their physical health but only 55% of farmers feel positive about their mental health[2]. The Health and Safety Executive has not published data on stress in farming. However, in 2019, 102 suicides by individuals working in agricultural and related trades were registered in England and Wales[3]. This accounts for 2.2% of suicides in 2019. Similar data for Scotland and Northern Ireland has not been published but some studies have found elevated rates of suicide in both countries[4],[5]. High rates of suicide in UK agriculture indicate mental ill-health. Government ministers[6],[7] have also acknowledged this issue.

The results of research into the impacts of the COVID-19 pandemic have not yet been published[8]. Likewise, the impacts of the 2020 Agriculture Act and Environmental Land Management Scheme are not yet measurable. However, disruption can cause a loss of identity and increase suicide likelihood[9]. Therefore, support that pre-empts mental ill-health in agriculture may decrease the effects of future change. As mental ill-health in farmers can affect animal-welfare[10] or cause farmers to leave the industry9, support may also increase food sustainability and security in the UK.

Research

A study in 2012 indicated that farmers in the UK have higher levels of mental ill-health than non-farmers[11]. Research in countries such as Norway[12], Canada[13], Australia[14], France[15], and Finland[16] have also found this, as did 71% of papers comparing the health of farmers and non-famers in an international review of 167 studies. 18% found lower levels of mental ill-health in farmers and 11% reported no difference[17]. One study found no difference in mental health between farmers and non-farmers but did find that farmers were 2.5 times more likely to think life was not worth living[18]. Studies may underestimate levels of mental ill-health in farming as farmers can be hard to reach[19] and depressed individuals may be less likely to respond.

Studies have reported high rates of suicide in farming[20],[21],[22]. It is possible that access to firearms and pesticides increases suicide risk[23]. Data can vary due to different methods of categorising farming occupations and cause of death. Data on suicide by occupation often only includes ages 20-64 as the ‘typical working age3. However, in 2000, 25% of farmers were over 65. This grew to 32% in 2016 as 86% of farmers over the age of 65 did not want to retire10. Therefore, it is possible that data under-reports the number of suicides in farming.

Factors influencing mental health and suicide in farming

Though reports are varied on the level of mental ill-health in UK agriculture, studies have identified a unique set of factors that could drive mental ill-health in farming[24]. Figure 1 illustrates how different types of factors intersect to increase risk. Factors can be intrinsic to farming or contextual. Research suggests that uncontrollable factors which increase feelings of powerlessness are most hazardous to mental health[25].

Financial difficulties

Farm incomes can change greatly each year as they are subject to market fluctuations. This uncertainty can cause sustained anxiety25. The average farm income fell by 9% from 2019 to 202026. Dairy farms had average business incomes of £84,800[26] compared to the UK average income of £29,900[27]. However, grazing livestock farms had an average income of £9,400 - £22,80026. In 2019, the average level of debt per farm in England was £234,400[28]. Rural poverty is a driver of stress20 and one UK study in 1997 found that 79% of farmers worried about money[29]. This statistic may have changed and should be updated. Low incomes also drive young farmers to leave farming as some farms cannot support multiple incomes[30].

Policy changes and paperwork

Consistent or significant changes in policy can cause disruption and confusion17,29. Many farmers benefit from government subsidies[31] but policy fatigue has been observed19 and some fear government penalties for failure to complete paperwork. Paperwork was the most common cause of stress in multiple studies25. One found that 62% of farmers had problems with paperwork and 56% had difficulties understanding forms29. On small farms without hired labour, admin frequently falls to farmers’ wives25  who are often unpaid24. This can create hidden stress.

Poor work-life balance

Poor sleep quality has been associated with obesity and depression[32]. Farmers often work inconsistent, long hours. A 2018 survey (not peer-reviewed) with more than 700 farmers found that the average working week was 65 hours compared to a national average of 372. Many hours are spent alone which increases loneliness29. Respondents also only take 11 of 28 allowed days paid annual leave. 68% felt they did not get enough sleep and 40% wanted help balancing work and time off2. On family farms, it is also difficult to separate home and work which can make it hard to relax[33].

Poor physical health

As a physically intensive occupation, farming can maintain fitness but also increases risk of physical health problems which contribute to mental ill-health17. In 2000, 43% of farmers had physical health problems21. In 2018, 10% reported injury in the past year2. This number is likely underreported24. In an ageing population30, the effects of physical health problems may be increased. Exposure to farm chemicals is also a risk to physical and mental health17. Farmers often must continue to work despite ill-health or allow the welfare of their animals to deteriorate20. This can increase pressure and result in a sense of claustrophobia.

Traumatic events

Farmers must deal with changing conditions and uncontrollable events. Unpredictable weather can complicate planting and harvesting schedules25 but when farmers view this as part of the job, it causes less stress25. However, climate disasters can cause emotional and financial damage. There is little research on climatic disasters in the UK. However, studies have found droughts negatively influence mental health in Australian farmers17,14. This may become a risk in the UK as climate change increases the likelihood of drought[34].

Epidemics also increase stress. In 2009, 50% of farmers surveyed by the Farming Community Network were upset or worried about the bovine tuberculosis outbreak, and 20% felt panic[35]. Bovine spongiform encephalopathy (mad cow disease) and foot and mouth disease (Box 1) outbreaks have also increased stress in affected areas[36],[37],[38].

Agricultural crime also affects trust in farming and increases feelings of fear, vulnerability, and anxiety[39].

Community pressure

Studies have identified a rigid patriarchal community in farming9. This affects men and women. Men tend to inherit farms or manage the farm their wife inherits. It is common for women to give up their legal rights to an income or take on extra work to support the farm which can increase stress9 and some studies have found higher rates of depression in farming women than men13,[40]. Women who wish to split farm assets in divorce have been called ‘gold-diggers’[41]. Pressure and conflict can also be increased on a family farm15,17 as multiple generations may rely on the farm for housing and income24,23.

Rigid community values can also be challenging for LGBTQ+ farmers23. Evidence in the UK is largely anecdotal[42] as farm surveys often omit questions on sexuality, but a study in the US found LGBTQ+ farmers can face rejection and mental ill-health[43].

Negative public perception

Some farmers think that the public does not understand the challenges of farming and feel undervalued23. Anti-meat campaigns may affect farmers[44], but there is limited research on this.

Evaluation of existing support

Government

The government provides direct payments which currently deliver 61% of farms’ net profit. Between 2014-15 and 2016-17, 42% of farmers would have made a loss without direct payments31. However, following the UK’s departure from the European Union, the Agriculture Act 2020 and new Environmental Land Management Schemes are to be implemented. Direct payments will be removed, and farmers must adapt. As discussed, (page 2), policy changes increase stress in farmers. The government also formed a Loneliness Strategy in 20187 and provides an advice helpline but many farmers do not trust government due to payment delays19 and disagreements over epidemic control35.

National Health Service

One study found that in the 3 months before committing suicide, farmers were equally as likely to visit their GP as non-farmers but were less likely to discuss their mental health21. There is a lack of awareness of symptoms of mental ill-health10 which may decrease help seeking. Some farmers seem to prefer self-help materials which maintain anonymity in rural communities where they are more likely to socialise with their GP37.

The COVID-19 pandemic may have been an added barrier to accessing help as centralisation has reduced rural health services10. Research on the effects of COVID-19 on the farming community has been commissioned by the Economic and Social Research Council[45].

Community

Community support can be particularly effective as farmers trust other farmers to understand their issues37 (Box 1). Families can also be a source of support and having a spouse has been found to reduce mental ill-health[46]. However, some farmers feel pressure to support their families and though both men and women experience mental ill-health, higher male suicide rates3 may be linked to stoic attitudes and stigma25 that prevent help-seeking23,[47]. One study suggests working with the macho culture to frame help-seeking as strong13.

Changes in farming have resulted in larger, fewer, farms25 which has fragmentated the community and decreased sense of belonging, which can protect against depression[48]. COVID-19 restrictions have also increased isolation. With fewer visitors to farms, symptoms of mental ill-health may go unnoticed10.

Box 2: Farming organisations in the UK

Farm support organisations

There are several farm support organisations and charities that provide services to farmers (Box 2). These are effective as they are tailored to farming needs and can collaborate on larger projects. The National Farmers Union is the largest farming support body and frequently communicates with government[49]. For smaller organisations, service provision is often underfunded and dependent on local volunteers so it is not always available30.

Many farmers are unaware of the services available to them[50]. Initiatives such as #agmentalhealth week use social media to raise awareness of farming issues and reports suggest more farmers are discussing mental health30.

Further possible action

Improve data collection

Most studies on mental health in farming in the UK are more than 10 years old. It is argued that this is a symptom of neglect of the wider rural community13. Research funding to increase understanding of the extent and regional distribution of the issue[51], will enable more targeted support. RABI (Box 2) is undertaking a survey of 26,000 farmers which may highlight changes over time[52].

Work with existing community structures

Reports suggest that the Department for Environment, Food, and Rural Affairs should be more engaged. However, as farmers trust other farmers, it is recommended that DEFRA should work with existing local structures and encourage collaboration where service provision is patchy, rather than implement new approaches30. Respected farmers may act as mental health ambassadors13 to encourage attitude changes in agricultural communities, colleges, and schools46.

Provide proactive support

Support that pre-empts problems may reduce their impact. The Farmstrong wellbeing programme in New Zealand provides farmers with mental and physical health self-assessment tools. Similar tools are recommended in the UK such as mental health first aid training as reports suggest upstream support is too generic30. This will be useful in advance of ELMS implementation.


Mental Health Risks to Farmers in England and Wales                                                                                    Page 7

 

References:

 


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