Creating a Suicide Prevention Program for Farmers and Farmworkers

Background

In 2018 the Centers for Disease Control and Prevention reported that suicide rates for farmers, ranchers, and other agricultural managers were two to three times the national average (Peterson et al., 2018). This circumstance has created a call for action for available service entities to support farmers in their regional contexts. Over the years, Extension has developed some resources to serve farmers and ranchers in distress. One example is the University of Nebraska's drought response, which included behavioral health messaging and support services (Bosch, 2004). Additionally, the trusted role of Extension was articulated in a case study of Wisconsin farm families who received charitable financial assistance during the ongoing farm crisis in the 1990s: "What is interesting is that churches and Extension were perceived as being more responsive to farm families than the helping agencies—social services, community action, health care agencies, and mental health agencies—in communities" (Williams, 1996, "Survey Results," para. 8). With its respected and well-connected nature both as a point of contact for agricultural workers and referrer to local services, Extension is a natural center for housing suicide prevention programs for farmers and farmworkers.

Due to the high national suicide rates in the agriculture industry, in 2018 the Washington State legislature passed Substitute House Bill 2671, directing the Washington State Department of Health to initiate a suicide prevention program for the industry. The Department of Health task force then chose Washington State University Skagit County Extension as the contracting entity for a pilot project, commencing in spring 2019. Our team of Skagit County Extension professionals is implementing the project. During the project's initial stage, from March through September 2019, we focused program activity on collaborating with experts, building institutional capacity, and leveraging the Extension platform. Here, we report on those endeavors to benefit others undertaking development of suicide prevention programs.

Pilot Program

Collaborating with Suicide Prevention and Behavioral Health Experts

Initially we attended a train-the-trainer event for Working Minds (https://www.coloradodepressioncenter.org/workingminds/), a program focused on suicide prevention in the workplace. We and other Extension staff have participated in additional training and workshop opportunities focusing on suicide prevention, mental health, and agricultural health and safety to influence agriculture-specific trainings implemented through our pilot program.

We have collected formative research about suicide in the agriculture industry and consulted and established collaborative relationships with local behavioral health specialists, out-of-state Extension workers, and other farm stress experts to shape the design and development of the pilot program. In addition, the Washington State Department of Health has provided guidance and insight into material creation, program activities, and collaboration with existing suicide prevention campaign personnel.

Building Institutional Capacity

We have taken inspiration from existing farm stress and behavioral health promotional materials created by Extension offices in other states. On the basis of best practices for suicide prevention messaging, we designed and developed wallet cards, brochures, and posters that include information on suicide warning signs, stress factors, and strategies for alleviating and managing stress in the context of agricultural occupations. To ensure that our outreach and program materials reflect cultural differences among agriculture workers, including the Latinx farmworker population, we continually elicit input from social workers who serve farmworkers, Extension staff, and other stakeholders in the agriculture community to tailor content for linguistic and cultural relevancy. We have noticed a dearth of Spanish-language materials on agricultural stress and hope to share our original Spanish materials and translations with Extension in other states.

An English–Spanish website is maintained through the county Extension website to leverage existing user engagement and direct traffic to information on suicide warning signs, mental health diagnostic tools, local resources, stress management strategies, and upcoming relevant training opportunities and events. The website also serves as a resource providers and professionals can use to access and disseminate information and program materials to clients, customers, and coworkers.

Leveraging the Extension Platform

We hosted a farmer and rancher–specific QPR (question, persuade, refer) training at the county Extension office, where a community health coordinator taught suicide risk recognition and referral skills. We advertised the training with the goal of reaching agencies and "informal helpers" who have regular contact with farmers, such as friends, family members, neighbors, faith leaders, and agricultural service industry workers.

Many Extension workshops dovetail with suicide prevention in that they provide social interaction, offer education and recommendations that improve farm economies, and promote farm safety (reducing traumatic exposure) and thus counteract the three suicidal factors of thwarted belongingness, perceived burdensomeness, and acquired capability of enacting lethal self-injury (Joiner, 2005). We plan to envelop short bilingual suicide prevention and stress management trainings into popular workshops during the winter months when farmers and farmworkers are more available. 4-H leaders also will be included in the planning and implementation of suicide prevention training, as children in farm families can be affected by, signal, and help alleviate farm family stress (Norrell-Aitch & Stewart, 2019).

The trusted role of Extension has allowed for the opportunity to cross-promote information at organized community events, classes, and workshops. Extension staff have disseminated print materials at county fairs and horticultural events alongside displays featuring additional agricultural programs.

Additionally, in September 2019 we participated in the National Suicide Prevention Lifeline's #BeThe1To message campaign for National Suicide Prevention Month and adapted bilingual materials for the agriculture industry.

Conclusion

From our experience in the initial stage of the Washington State University Skagit County Extension Suicide Prevention pilot program, we recommend that parties interested in starting a similar program collaborate with suicide prevention/behavioral health experts (including those specific to the agriculture industry), build institutional capacity (through suicide prevention trainings), and leverage the Extension platform to maximize program reach. For us this has taken the form of suicide prevention education both for the county Extension staff and the public, formation of a support network through a website, and creation and dissemination of model outreach materials. In less than 6 months, program efforts have been highlighted by the media and affirmed by the Washington State Department of Health. We plan to continue the development and refinement of the pilot program through ongoing participation in trainings, revision of materials, implementation and evaluation of program activities, and maintenance and expansion of partnerships.

Acknowledgments

We express gratitude to Reese McMullin Holford, Neetha Mony, and Therese Hansen, representing the Department of Health, and the entire 17-member task force for providing guidance, insight, and expertise regarding addressing suicide prevention/behavioral health in the agriculture industry. We thank other Washington State University Skagit County Extension staff for their willingness to translate and distribute outreach materials alongside their own program outreach. We owe many thanks to Stephanie Morgareidge of United General District 304 for giving time and effort to conduct the initial QPR for Farmers and Ranchers training at the county Extension office. We thank Skagit County Public Health staff for informing the pilot program with regard to the current landscape of mental and behavioral health services and resources and for connecting us with aligned stakeholder groups. Appreciation also goes to Sean Brotherson of North Dakota State University and Dr. Robert Fetsch of Colorado State University for providing consulting time and collaboration in our adaptation of their farm stress materials.

References

Bosch, K. R. (2004). Cooperative Extension responding to family needs in time of drought and water shortage. Journal of Extension, 42(4), Article 4FEA3. Available at: https://www.joe.org/joe/2004august/a3.php

Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

Norrell-Aitch, K., & Stewart, J. (2019, June 19). MSU Extension managing farm stress. Retrieved from https://www.canr.msu.edu/resources/youth-farm-stress

Peterson, C., Stone, D. M., Marsh, S. M., Schumacher, P. K., Tiesman, H. M., LiKamWa McIntosh, W., . . . Luo, F. (2018). Suicide rates by major occupational group—17 states, 2012 and 2015. Morbidity and Mortality Weekly Report, 67(45), 1253–1260. https://dx.doi.org/10.15585/mmwr.mm6745a1

Williams, R. (1996). The on-going farm crisis: Extension leadership in rural communities. Journal of Extension, 34(1), Article 1FEA3. Available at: https://www.joe.org/joe/1996february/a3.php