Background
Mental health pressures on the agricultural community
Isolation and loneliness and rurality
Agricultural incomes and housing
Family, community and social cohesion
Physical demands and working hours
Unpredictable environmental factors
Regulation and bureaucracy
Gender and age
The gap in current mental health provision
Aim and research questions
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Understanding the farming context and target population.
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How best to engage farmers in a mental health intervention.
Methods
Recruitment and sample selection
Familiarisation with the data
Generating initial codes
Searching, reviewing, defining and naming themes
Reporting of the results
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The overall research questions driving the project.
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The questions the participants responded to most during the interviews.
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The set of questions that had been developed to inform the coding process.
Results
Recruitment and participant characteristics
Interviewee | Gender | Profession |
---|---|---|
1FM01 | Female | Farmer |
1FM02 | Male | Other |
1FM03 | Male | Farmer |
1FM04 | Male | Other |
1FM05 | Male | Farmer |
1FM06 | Male | Other |
1FM07 | Male | Other |
1FM08 | Male | Farmer |
1FM09 | Male | Other |
1FM10 | Male | Other |
1FM11 | Male | Other |
1FM12 | Male | Other |
1FM13 | Female | Farmer’s wife |
1FM14 | Female | Other |
1FM15 | Female | Farmer’s wife |
1FM16 | Female | Farmer’s wife |
1FM17 | Male | Farmer/Other |
1FM18 | Male | Farmer/Other |
1FM19 | Female | Other |
1FM20 | Male | Other |
1FM21 | Male | Other |
Outcomes of thematic analysis
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Understanding the farming context and target population (GUIDED items 1 & 3).
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How best to engage farmers in a mental health intervention (GUIDED item 8).
Study aim | Initial questions guiding the coding | Themes | Subthemes |
---|---|---|---|
Understanding the farming context and target population | How can everyday life in a farming community affect mental health? | Everyday life | Work-life balance |
Isolation and loneliness | |||
How does the daily management of the farm affect mental health? | Farm Management | Technology and social media | |
Production, people management, learning and teaching | |||
External pressures | |||
Livestock and farm production | |||
Financial aspects | |||
How does age affect the way individuals in the farming community look at mental health? | Age and gender | Effects of aging | |
How best to engage farmers in a mental health intervention | What are the best ways of reaching/engaging people in the farming community with support options for their mental health? | Engagement | Appropriate wording when talking about mental health |
Recognising need for help | |||
Religion | |||
Normalising mental health issues | |||
Approaching the conversation | |||
What types of mental health training is appropriate to the farming community? | Training | Mental health training for supporters of the farming community | |
Health & safety and the inclusion of mental health training | |||
Personal stories and experiences of what can help (emergent theme) | Who: Individuals, organisations, & companies | ||
What: Examples | |||
How: Case studies | |||
Anecdotes |
Theme 1: everyday life
Theme 1.1: work-life balance
“You can relate their poor mental health to their business and actually - it’s very often the case that a farmer’s farming life is not a business, it’s their life. They’re not doing it, they’re living it. Farming is a lifestyle.” (1FM02. Male. Other).
“And then if you do it in another way where there’s quite a few bachelor farmers, are they eating properly, you know, that’s an observation, and tidiness when you do go into a house, and I am old school, it’s how tidy is the farm? That’s another observation, and then the livestock. So there’s a culmination of quite a few things that you can try and do and help that takes the pressure of them.” (1FM12).
“Whereas a traditional male thinks they’ve got their job and that’s it, now I’m painting a pretty bleak picture, I’m not just saying that’s not exactly what happens in my experience but there is a tendency for that to happen.” (1FM15).
Theme 1.2: isolation and loneliness
“Personally I think you’re missing the point. And the point is that farmers are lonely. Very, very lonely just now. I mean, particularly with COVID just happening, I find that in my line of work I’m having less contact with my farmers and they’re wanting to have more contact with me just simply because there’s nobody coming up the farm drive anymore.” (1FM06).
Theme 2: farm management
Theme 2.1: technology and social media
“And then just IT literacy, so many of the folk that I came into contact with in the office was when staff mainly went online and they [the farmers] weren’t online at all, they didn’t have a computer at home so they just wanted to come in and get help with the paper form, or that was the only time they used the computer was when you sat with them and done their SAF online with the computer in the office.” (1FM14).
Theme 2.2: production, people management, learning and teaching
“Farming people aren’t people persons […] most people or most farmers are farmers because they have a passion for growing crops or they have a passion for livestock. Really it should be turned around the other way because […] the best way to get results is first by making the most of the people that work for you because they are your biggest asset that you’ve got.” (1FM16).
“So if the staff are ticking, if they’re good and they’re producing the goods at the end of the day his job is easier to run, it’s when things go horribly wrong and you’ve got to juggle it and you’re not in your comfort zone, that’s when perhaps you do need a different set of mental health skills, but if you can keep your staff right it makes all the difference.” (1FM16).
“I was talking to my niece who did a degree at [University] three years ago now and she said, you know, ‘we did very little on marketing, we did very little on wellbeing of people and how to manage people, it’s still basic agriculture’.” (1FM16).
Theme 2.3: external pressures
“So to me that’s the, you know, yeah the long hours and the bad weather and the isolation is tricky but that on top of the poor public perception or poor public understanding, to me I think that’s the key, so it’s educating everybody else.” (1FM15).
Theme 2.4: livestock and farm production
“Perhaps the cattle weren’t bedded up as well as they normally would, they weren’t looking as good nick, you know, things weren’t as tidy as they were and he was picking up on people which he thought were struggling mentally.” (1FM17)
“But the stock thing, that takes a wee bit of time for that to happen and that’s the real difficulty, that’s the one that, like, once we see it obviously it’s straightforward to try and do something about that, but the bother is you’re too far down the line then.” (1FM09)
“If you’re a livestock farmer with one employee and that employee has to go off because he’s got a meeting, ’well can’t you do it in the evening or d’you have to go because I really can’t do this job on my own and it’s going to rain tomorrow’ or ‘the cows need milking’ you know, oh dear, there’s no room and it won’t take much for them to tweak. I don’t know but I don’t hear many farming employees with hobbies?” (1FM16)
Theme 2.5: financial aspects
“This farmer doesn’t like it when an agent is required because that costs money. This farmer works a colossal amount of hours and the margins are small. If farming was more profitable, it would be easier to afford an agent when required and it would be possible to afford to pay for someone to cover for a couple of days to get some time off. Currently this farmer doesn’t get time off.” (1FM03)
“Looking at and getting their paperwork up to date cause that sometimes can be… mail unopened just thrown in a corner and things just getting on top of them, so one of the things we’ve done here is send my secretary and get all the mail, sorted everything all out, VAT is something that they get behind with; it’s little things like that and that helps break the ice.” (1FM12).
Theme 3: age and gender
“I mean, farming is an older person’s profession/occupation, whether farmers like to think that or not, you look at the statistics and the average age of a farmer in the UK is… I think it might even be up over 60 now, and people of that generation are of a certain mindset when it comes to talking about feelings and particularly with a certain stigma that’s attached to mental illness.” (1FM04).
“A lot of the younger generation going into to farming say, ‘I want to take on the farm but I see my parents life and how stressed they are and their life is 24/7 farming and I’m worried about that happening to me. The concept of work / life balance, of family is more important to them than it has been in previous generations.” (1FM10).
“It’s a traditional male thing as well, you know, as working women we have had to do our work to the best of our ability but we’ve also, […] you’ve got the laundry, you’ve got the food, you’ve got the dog to walk, you’ve got the family to keep up with, you’ve got birthday presents to buy, you’ve got all this, so you learn to prioritise, as a female in a traditional environment you learnt to prioritise a little bit better so you’re not so likely to get bogged down in any one particular area because you’ve got other things to think about.” (1FM15).
Theme 4: engagement
“Yeah, I think my view is there’s two distinct elements to that and the first is reaching them and the second is encouraging them to open up, and I think they’re very different things.” (1FM04).
Theme 4.1: appropriate wording when talking about mental health
“Yeah, ‘how are you getting on with things?’ you know, or I would say ‘is life getting on top of you?’ or ‘is there anything I can do to help with a situation?’” (1FM06).“I think the best phrase is ‘are you coping?’” (1FM09).“For some, it might be a turn off but for others not. For me it depends on my audience I don’t always talk in terms of mental health, I talk in terms of- struggling, struggling with wellbeing, not being in a good place, feeling low, feeling distress – or I talk about stress – because if you are under prolonged stress…….I talk about stress being an normal and natural part of life but too much stress and prolonged exposure to high levels that we can’t cope with is ……….so sometimes you come at it from that angle rather than talk about mental health.” (1FM10).
“I think the benefit, if you can call it that, of mentioning suicide is that it puts the focus on farmers to realise the very real and very serious consequences of not having early intervention, and I suppose the risk of focusing purely on positive elements and not mentioning any of the serious consequences is that some people might under-estimate the importance of it. […] What it will also probably do is it will probably resonate with a lot of farmers who know somebody who has committed suicide and if they can make that link between early intervention in mental health and suicide then that might encourage them to get involved, you know, sort of thinking ‘oh my good friend Jim committed suicide therefore it can be no bad thing to try and stop that happening’, whereas if you just focus on the early intervention and the positive that can bring they might not quite make the bridge between the friends that they know who have committed suicide and the benefits of getting involved in this scheme.” (1FM04).
Theme 4.2: recognising need for help
“….it’s a bit of experience I suppose. I just know if somebody’s really down and then what I do is I make sure that all his neighbours go and visit him, you know, I phone up all his neighbours or folk that I know know him and just say ‘keep your eye on so and so, I don’t think he’s in the best of places’ and between us we get there. Between us we get there.” (1FM06).“…that’s what I mean where you go off at tangents and talk about things that are completely alien to what you’re trying to find out and then you just quietly work, it’s a bit like fishing isn’t it, you just quietly bring the net in and then you can summarise the true situation within the business.” (1FM12).“In a situation like that, I’ll quite often revert to a third party, even if it’s slightly false – “I was speaking to a man in Inverness, life’s getting him down – I said I’d get a phone number for him that he can phone to help him feel a bit better”” (1FM02).
“….possibility of a local farmer as a ‘go to’ person for help, I do not like the idea of an interfering person. A ‘go to’ farmer would be perceived as someone who likes to interfere and know someone else’s business.” (1FM03).
“I’ve been speaking to you and the boy’s just let out the sheep I was wanting to take a photograph of so I’m afraid I’m going to have to go at the moment, sorry about that.” (1FM08).
“….I would not feel comfortable trying to interfere with someone’s life. I wouldn’t know what to say or do if I was concerned about a farming mate who seemed down.” (1FM03).“….I would not go to someone or an organisation who I haven’t had contact with before or who I have never met.” (1FM03).
“Well I don’t think that the vast majority of people are comfortable broaching the subject or bringing it up because they don’t know what to do and they’ve not had any training in how to handle it.” (1FM05).
“Not really but I think if you’ve got some kind of knowledge, you don’t need to be from a background, it might help in some cases but no, you just need to be somebody that’s approachable.” (1FM09).“And, you know, the sort of hippy social worker type coming around is not going to find it easy, I’m being stereotypical here but they’re not going to find it easy to get that respectful relationship going, especially if farmers are bogged down in their own little kingdom and they’re not getting out much.” (1FM15).
Theme 4.3: religion
“Another thing I’d say is that in England, a lot of support is delivered through the church or other organisations affiliated with the church.” (1FM10).“I’ve suggested it to our church group that we have a dedicated person within our presbytery just calling on farmers day in/day out. It doesn’t have to be much, you could do about 20 calls a day quite easily ‘hello, how you doing, I’m so and so, we’re not going to shove anything up your nose or down your throat or anything like that, but is there anything we can do?’ and that’s what’s needed, it’s somebody calling.” (1FM06).
Theme 4.4: normalising mental health issues
“Having people to share their personal stories and experiences and how they sought help, what personal barriers they had to overcome to get the point where they could ask for help and how getting the help impacted and supported them.” (1FM10).
“Probably just that, just make it so routine that it’s not a stigma to talk about it. But I would say just more sort of coverage or presence of the fact that, yeah, mental health issues are there in the agricultural sector and there’s also a support network available.” (1FM14).
“Most farmers have a review with the bank manager, most farmers meet their vets several times, most farmers meet their accountant once or twice a year, you know, you can go 20 years without seeing your GP but you’ll see your accountant a couple of times a year. So maybe we’re looking at it the wrong way round [laugh], maybe it’s other professionals, not necessarily health professionals who should be helping?” (1FM20).
“I think that’s it, and I know the stigma’s better and I think on a sort of personal level I do worry that we often think of a down day as something to do with your mental wellbeing, but you’re actually meant to, you know, you do have days where you’re a bit low, it doesn’t mean you’ve got a mental health, it’s whether you’re low or, and stress is healthy as well, well not stress but pressure’s a bit healthy but if it goes on for too long it becomes stress; so it’s not all so… you know, stripping away the fact that it’s okay to feel different every day, but it’s just when you’re down or low for a long time that’s when it is, and I worry that there’s almost like an impact on you, not that you should be having mental wellbeing but almost like ‘ocht I can’t be bothered today’, that’s not a mental wellbeing issue, but if you feel like that for the next five days maybe you need to be thinking about it, but it’s okay for a day.” (1FM19).
Theme 4.5: approaching the conversation
“Well it takes an awareness of others to recognise the changes in them and that requires the people around them to be clued up on it as well and be able to know how to react and how to signpost and that goes down to, you know, your vets visiting, your surveyors visiting and maybe them being trained to be able to or mental health first aid trained to be able to recognise the signs and be able to support, because you’re right, if farmers are working 24 hours for seven days a week they won’t see the small changes until suddenly they’re big changes.” (1FM18).
“So they’re still having to get on with the work whilst they’re either grieving or going through these issues, you know, if they’ve got mental health issues the cows have still got to be milked.” (1FM05).
“An organisation called ‘Fieldnurse’ has drop in clinics at some of the auction marts in Lancs where you turn up and there’s a qualified nurse there who will do your basic health check – cholesterol and all the other measurements that you do on a basic health check but they’ll also have a chat and they can understand – they’re either drawn from or can understand the farming community quite well so they’re the kind of people who are happy to have a chat and they can also make a referral – so people don’t have to make an appointment and go in to town or to some doctors, they can go and see them when they’re at the auction mart in an environment that feels familiar– they don’t even have to take their wellies or overalls off.” (1FM10).
Theme 5: training
Theme 5.1: mental health training for supporters of the farming community
“Yeah. I think we are placed well to raise it with farmers because we are speaking to them on a regular basis but we are probably not as it stands at the moment the best people to be doing that because that’s not where our strengths as a profession lie, we’re more practical than that and that’s where the training would fit in, so rather than find somebody who is well trained to deal with the situation, try and find a way for them to meet more farmers, it maybe makes more of a sense that people who are seeing farmers are receiving a little bit of training to spot warning signs and to raise the subject with farmers.” (1FM04).
Theme 5.2: health & safety, and mental health training
“I think one way that you can get to these people and also to the farmers is health and safety. I think you want to make a course mandatory that they’ve got to go on and perhaps get a certificate to say that I’ve been on the course to understand or recognise symptoms of mental health problems; I really do think that’s about one of the only ways you’re going to get through, and make it part of the same thing as the chain saw people, you know, you have to do a refresher every three years, it only needs to be half a day but that is where you’ll meet up the tractor drivers or the livestock people will meet up and they will recognise because they’re talking about tractors or they’re talking about livestock, they will recognise within that group and they’ll start talking then.” (1FM16).
RES: That’s it, that’s exactly it and if it works I’ll be happy to look at that as ‘I know you maybe don’t want counselling but can I send you to this Live Life to the Full and maybe try some of that to see how you get on with that?’ and the thing is to remember, and I don’t know if that’ll matter, but dyslexia is quite high in farming.INT: Oh good point.RES: It’s about 10% of the population and 25% of farming. (1FM19)
Theme 6: personal stories and experience
Theme 6.1: who: individuals, organisations, & companies
Theme 6.2: what: examples
“I don’t know if you’re aware, I won’t mention names but there is an almost retired farmer in this area who has an email group and he invites people round to his place once every so often for a coffee and a blether which I think is fantastic, but it’s mostly retired farmers, but if you’re working you’re not so likely to make the time to go. But you know, something like that when you are meeting with people that you’re already comfortable with is probably good, but there’s fewer opportunities for that.” (1FM15).
Theme 6.3: how: case studies
“One of the things I have found – anonymous case studies work very well. If you can get those into the farming press, or into some sort of media they may be reading at home so if they have switched off from going to farmers’ meetings or attending community events, they may still be reading local newspapers or the farming press so if you can get case studies from farmers who are willing to talk about their own mental health issues and get that out in the public domain, I find that’s a useful way of trying to reach those folk.” (1FM11).
Theme 6.4: anecdotes
Impact on plans for future pilot RCT
Change | Reason |
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- LLTTF made significant changes to the content of the farming specific modules.- | - To tailor it towards the farming community in response findings of the qualitative research findings. |
- Paper copies of the LLTTF intervention made available. | - To allow an alternative format for those who experience poor internet connectivity or problems with technology. |
- Standardised questionnaires used at baseline and at several subsequent points during the period of follow-up. | - To help farmers reflect on their own mental health, as some report being oblivious to their declining wellbeing over time. |
- Support offered alongside LLTTF. | - To address the problem of loneliness and isolation, and to provide support with technology and accessing the online modules. |
- Practical support for farmers (such as help with completing forms and interpreting an information leaflet), is provided in our study by RSABI. | - For those who are struggling with paperwork or feeling trapped within farming life. |
- Images, leaflets etc. | |
- Same images used in leaflets and online promotion. | - To promote recognition and reinforcement which might cause people to become more familiar with the idea of the study. |
- Leaflets and social media referencing ‘crofting’. | - To capture the demographic of crofters who may not identify with the label of ‘farmer’. |
- The intervention is made available in both written and video format online. | - Modules in video format help to provide additional options for those who struggle with reading. |
- Participant information sheet and consent forms are re-written to be understandable to a wide range of reading ages. | - To consider the high proportion of farmers who may have difficulty with reading. There was a struggle to balance the mandatory university requirements for informed consent with a format that was suitable for this audience. |
- Videos of other farmers talking about mental health and wellbeing, to supplement written materials. | - To respond to suggestions of using case studies of others in the farming community and normalising mental health issues. |
- Images of farmers, rather than of livestock. | - To reinforce the concept of farmers looking after themselves, not just their animals. |
Meeting farmers where they are
| |
- Using social media for recruitment. | - To reach farmers who may use social media and also to overcome some of the difficulties of recruiting during COVID lockdowns. |
- Leaving leaflets at petrol stations, veterinary practices, auction marts, agricultural solicitors, machinery suppliers etc. | - To target recruitment at places where farmers are likely to visit. |
- Using church ministers and church offices as gatekeepers for recruitment. | - Acknowledging the importance of religious organisations to many in the rural community and targeting recruitment through these. |
- Recruiting through the Scottish Women’s Institutes and sports clubs, e.g. curling clubs. | - Targeting specific sports and local community groups that are known to be popular with people in rural areas. Also to specifically target women. |
- Recruiting through the Young Farmers Associations. | - To specifically target younger farmers or those who may recognise mental health issues amongst older friends and family members. |
- In person recruitment at Livestock Auction Marts by members of the research team. | - Face-to-face contact is seen to be one of the most important aspects of recruitment in the farming community. |