[image_credit]MinnPost file photo by Gregg Aamot[/image_credit][image_caption]Downtown Litchfield[/image_caption]
As chair of the American Psychological Association’s (APA) Committee on Rural Health, Phillips, who lives with her family in Litchfield and works for Meeker Memorial Hospitals and Clinics, has a front-row seat to the unique impact that modern political and economic crises have on the mental health of rural residents.
“The stressors of life have had a devastating impact on farmers and farm families,” Philips said. “In rural communities, we’re seeing higher rates of depression, anxiety and suicide. It’s a disturbing trend.”
Phillips chalks up those increased rates of mental illness in part to a general reluctance among small-town residents to talk openly about their mental health — or to seek care from a mental health professional. Though Phillips observes a growing willingness among urban folk to talk about their mental health, in small towns across America, people still tend to keep their psychological struggles close to the vest. The pressure caused by this level of secrecy can be the source of other negative consequences, including physical maladies like hypertension, muscle pain and intestinal distress.
In an effort to get word out about the state of rural mental health — and the benefits of seeking mental health care — Phillips recently hosted “Improving Mental Health Care by Understanding the Culture of Farming and Rural Communities,” a webinar sponsored by the APA. Some 1,040 people — mental health professionals, agricultural workers and rural residents — registered.
“We tried to reach as many farmers and farm families as possible,” Phillips said about the webinar. “We wanted to provide up-to-date information about what is going on in the rural communities that pertains to the mental health of farmers. We were hoping to get people talking about ways they could make positive change.”
Recently, Phillips and I talked about her practice — and about her efforts to encourage small-town folks to open up about the state of their mental health.
MinnPost: What are some of the most pressing mental health issues in rural Minnesota?
Kristi Phillips: We know that suicide completion rates and depression rates are higher in rural areas of the state than they are in the urban centers. And we are now seeing that the income-to-debt ratio has reached an all-time high among farmers in this country. That is creating significant mental-health stressors on our farming communities.
MP: How do economic problems impact a person’s mental health?
KP: Tariffs, rising debt and declining incomes are a significant source of stress. Plus, many farmers or their family members hold off-farm jobs to cover their costs, and to provide health insurance. COVID has created job losses that are hard on these families. They’re losing insurance coverage, and the loss of income from those jobs can feel significant. I’ve had farmers say to me in session that the stress of survival in these times is “like carrying a boulder on my back.” They tell me that the threat of financial collapse seeps into all aspects of their lives.
MP: Was it hard for you to build a client base in Litchfield?
KP: We have many farmers and people working in the farming community here. It was only after two or three years working in Litchfield that I got my first farmer as a client. I’ve worked in rural health for the past 13 years. In a small town, it takes people a long time to trust you and feel comfortable seeking your services.
MP: How did you get that first farmer to come in and see you?
KP: It wasn’t directly. A local physician, an ER doc, called me and said she’d recently seen a farmer in the hospital. He’d come in with all the signs and symptoms of a heart attack, but after she ran all the panels, they all came back negative. Sensing that some of what was going on was stress and anxiety, she referred the farmer to me for individual psychotherapy. He refused to come. It wasn’t until his spouse put her foot down that he agreed to make an appointment.
MP: Do you see a lot of this kind or resistance from your patients?
KP: This is a pretty typical story. Farmers are generally hesitant to enlist mental health services. Often I will see a farmer when a medical issue that brings them in. Farmers in general tend to be people who want to handle their problems on their own. Some of that’s what makes them successful as farmers: They are independent and used to having big, broad shoulders to carry all the burdens.
MP: Why do you think that suicide and depression are on the rise in rural communities?
[image_caption]Kristi K. Phillips[/image_caption]
MP: Is it just farmers who are experiencing this rise in mental illness? Or do these larger issues also impact their family members?
KP: It’s not uncommon for a farm family to share the same plot of land and build all of the family houses there. They may have grandparents, parents and kids all in relatively close proximity. During this time of COVID-19, with day cares and schools closing and elder cares closing, life is turned upside down. In the farming community, the support role of the spouse has always been really important. Now that person needs to stay at home and homeschool the kids and keep an eye on the grandparents. People aren’t getting breaks like they used to. Many spouses had off-farm jobs that helped pay the bills and provided them with a break from the stresses of family life. With household responsibilities piling up and without an opportunity to partake in restorative activities like working off-farm, spending time with friends or going out for coffee, it is a recipe for mental health concerns.
MP: What strategies do you use to encourage local folks to make — or keep — an appointment with you, to take better care of their mental health?
KP: I try to explain to patients that taking care of our mental health is very important. I say that scientists now understand that when we get more anxious and stressed it has an impact on our immune systems. We can get sick because cortisol, the body’s stress hormone, is attacking our organs. I explain that taking care of our mental health is one way to avoid getting sick.
MP: I grew up in a small town. Back then nobody talked about their mental health. I’ve lived in the city for decades and many people here now seem pretty comfortable talking about mental illness. Are attitudes changing in rural communities?
KP: There is still a perceived and real stigma in rural communities about seeking mental health care. If you’ve ever been to a waiting room in a rural clinic, many times it’s like a social hour. It seems like everybody’s there. When you are wanting a zone of privacy around your mental health, this kind of thing makes people hesitant to go in.
One silver lining is telehealth. Since COVID hit, and I’ve been able to provide remote mental health services. Because of that, I’ve seen more famers and farm families than ever. More clients are willing to meet with me via telehealth because it offers more privacy. They don’t need to come into the clinic and risk seeing all their neighbors in the waiting room.
MP: Clearly the privacy that telehealth provides is a major plus. Do you see other benefits to remote therapy?
KP: Things are just so much more spread out in the country. I’ve had clients who’ve had to drive an hour each way to see me. At harvest time, that kind of time commitment is just not possible. Telehealth opens up new options. I can be working with patients wherever they are. They can have an appointment on their smartphones. My therapy appointments last 45 minutes to one hour. Telehealth makes that time commitment more obtainable for busy people. And we can schedule appointments at flexible times. I can work around their schedules.
MP: That flexibility is probably important, because people are juggling so much right now.
KP: Since I began offering telehealth, I’ve had almost a zero percentage of no shows. That’s completely the opposite of how it is for in-person appointments. If someone isn’t there at the scheduled time, I can almost always reach them: Most people carry their cellphones with them wherever they go. Maybe they’ve been distracted and forgotten their appointment. When I reach them on the phone, they’ll say, “I completely forgot the time. Let me pull over.” They can meet with me wherever they’re at.
MP: Is telehealth particularly helpful in Greater Minnesota, where mental health providers are few and far between?
KP: In Litchfield we are an underserved shortage area for mental health care. This is where I think telehealth can be especially helpful. If people don’t show for their in-person appointments, it is difficult to fill. We don’t have many of those kinds of issues with telehealth. People who are actually registered for appointments are getting seen. And we can see more patients in a day. People don’t feel like they have to take a half day off work just to travel to an appointment. They can say, “I’ll see you over my lunch hour,” and we can make that happen.
There are so many benefits that have come from telehealth. It’s unfortunate it took a pandemic for us to finally get comfortable with using these tools to make our lives better.
MP: After hearing your enthusiasm, it almost seems silly to ask you this, but do you see any disadvantages to telehealth?
KP: You do miss some of the micro-expressions that you’d observe in person. Some clients say they find telehealth impersonal or uncomfortable. But the benefits exponentially outweigh those types of issues.
MP: Do you hope to continue offering telehealth as an option for patients into the future?
KP: Yes. The majority of my patients want to be seen by telehealth. I would still encourage having the first evaluation appointment face-to-face if that is an option, but into the future, I want people to be able to offer the option of a telehealth visit. Having this option has been so helpful in my practice: I’m hoping that we will be able to get that messaging out to the insurance companies, to get them to see the data that shows just how beneficial this option has been for our patients in the rural communities.
MP: What drew you to rural mental health? Has it always been a passion of yours?
KP: Actually, this is my third career. Right out of college, I moved to San Francisco and worked in the wine industry. Then I taught middle school for five years. During that time I realized that I enjoyed the interaction with students, getting to know their personalities and helping them with barriers they were encountering. When I had my own children and wanted to stay home with them, I started taking classes at night. Eventually I got my master’s and doctorate in clinical psychology. When my partner finished medical school, we moved to Minnesota so he could do his residency at North Memorial.
[cms_ad:x104]MP: Do you like living and working in the country?
KP: I do. I like small towns. I grew up in rural eastern Washington state, in a town of 5,000. I now live in a town of 800. My father was the director of mental health services for the county we lived in, so I always had therapy in my blood. This job was a natural fit for me: I’m curious about people and feel amazed and fortunate to be able to help people who are actually making changes in their lives, who are working to make their lives better.
MP: Do you offer therapy services outside of Litchfield?
KP: On Fridays, I have a private practice in Wayzata. For some time, I had received calls from physicians who were heading up their medical practices. They were seeking mental health care but didn’t want to be seen within their own clinics. So I set up this private practice. It’s nice to get that diversity in my work, to have a private practice but also have a base in a hospital and clinic.
MP: Do you see similarities between your Wayzata physician clients and the Litchfield farmers?
KP: There are actually many similarities between the farmers and the doctors. Both work hard. They are hard-charging, high-achieving, independently minded leaders who are used to being able to chart a course and get the results they’ve been looking for.
MP: It must feel especially hard for these kinds of people to live in a world that that feels like it’s out of hand.
KP: That’s a big part of what we are dealing with now. Many of the farmers I work with are taking external world events and internalizing them as personal failings. Some of the physicians are doing that, too. Though they have done nothing to influence what is happening in the world, they somehow feel like they carry the responsibility for it on their shoulders.
That’s where I feel I can be the most helpful, challenging those expectations about what is under their control. This is different from what happened to folks in past generations. This is a cascade of things happening all at once.
MP: What therapeutic approaches seem to work best for your patients?
KP: I have found that cognitive behavioral therapy, or CBT, has been very effective in my work with farmers. In CBT, you challenge a patient’s assumptions, the past schemas, and provide them with other options for response. It turns out that people do the best they can with the options they believe they have been given. When you open up more options for response, that’s were change occurs. I’ve seen CBT being extremely helpful in many cases these days.
MP: In your role at the APA, you’ve been an outspoken advocate for more openness and transparency around mental illness and seeking mental health care. Why do you think that it’s important to be open about our mental health?
KP: We need to get more comfortable talking in groups and with individuals about the state of our mental health, just like we would if we had an issue with our physical health. Being able to say, “I’m feeling stressed out today. Here’s why,” is so important.
People have an easier time talking about their diagnosis of diabetes than their diagnosis of anxiety. Just last week one of my clients said while we were in the middle of our telehealth session, “If I push my laptop down that’s because someone came in.” I’ve been working with this person for a year and they still didn’t feel comfortable telling people that they’re seeing someone. So many people are still not comfortable talking about their mental health.
MP: So you’re saying that if people were more open about their mental health, more people would feel comfortable getting the help they need?
KP: We have a saying we use in psychology: “Never worry alone.” If we can get people to see a psychologist or talk to a family member or loved one about their mental health, that’s the first step. When people try to go it alone and it builds up and there is nobody challenging their negative thoughts, the brain can misfire and we can start believing those thoughts. That’s why it’s really important to have someone who can help you understand that some things are outside of your control.
MP: Not worrying alone means talking to others. That can be a therapist — or friend or family member.
KP: If everyone could just open up more it would help with destigmatizing mental illness. We’re fine with talking about a broken leg but not about our mental health: When it gets to the point that we treat the brain just like any other organ, that will be a real breakthrough. We still haven’t moved the dial that far in the rural communities. That’s why I’m working hard to get out the message that caring for our mental health is just as important as caring for our physical health.
The Trump trade wars with China have had a devastating effect on farmers and ranchers across the country, yet they continue to support Trump. That’s difficult to understand.
Further, the values I thought were held by the farmers in my extended family (honesty, hard work, spiritual faith, etc.) are not shared by our president, not in the least. Trump lies constantly, doesn’t have a clue about working and sweating, selfless service is an unknown concept to him, he cares little about America’s friends and treats them with disdain, and all of his waking hours are spent endeavoring to enrich himself at the expense of our country.
And despite his frequent posing with the flag for photo-ops, Trump has little or no understanding of the values represented by our flag. He’s nothing more than a fake patriot who hugs the flag and then quickly walks away – as if the flag were just another of his mistresses.
I didn’t read the entire article as I became concerned for the way the physician was couching her words about mental illness and therapy.
To the farmers who are reading this article, please know that I have been treated for depression and anxiety for about forty years. I use medication and talk therapy. The word “psychotherapy” sounds frightening to most people and should never be used in this climate. It is a word of days gone by when using Greek words sounded impressive. They are no longer impressive to most of us.
The words “psycho” and psyche” are Greek words which other otherwise meant to mean the word “mind” in today’s English. Greek words are over rated.
To my friends in the farming community, talking about your feelings and about your stress should become as easy as talking about the effects of insects eating at your crops. This should become a necessary part of life. You are not “weaker” for talking about that which ails you. You are stronger.
Keeping in your emotions can create greater upset. Learning to talk about emotions is something which at first may feel uncomfortable, but as the years go by, it becomes easier and second nature.
The author of this article time and again commented that there is stigma in rural communities. Stating this once would have been fine, but more than once and we are creating a self-fulfilling prophecy.
I have greatly gained from taking medication and learning to talk about feeling stressed, depressed, and anxious. Talking about these things is like letting steam out of a narrow container. It relieves tension and allows us to regain our comfort.
Fairview Health Services, and other health services in Minnesota, uses telemedicine to help people with these issues. I speak to my psychiatrist once every two months, and more frequently if need be. A long-time friend of mine, Patrick Robinson, MA, is a telemedicine therapist for Fairview Health Services in the Twin Cities metro area. He takes calls from around the state and typically helps with depression and substance abuse concerns.
Psychiatrists work with medication; psychologists work with talk therapy.
If you need to talk to someone with experience, there are plenty of professionals in Minnesota who are gifted and have great credentials. The science of mental health has come a long way in the past forty years, and there are ways to help virtually anyone.
Several months ago, MinnPost did a story about a group called Wellness in the Woods. They have a telephone “warmline” staffed with people who have been successfully treated for a variety of mental health issues and are gifted at helping people get started toward their road to recovery. In Governor Tim Walz’s frequent emails, he posts Wellness in the Woods’ Peer Support connection telephone number.
Their support number is 1-844-739-6369. They are available from 5 p.m. to 9 a.m. every day of the year, You can have twenty-minute conversations with the counselors on the warmline. They are not a substitute for medical help, like the kind I have been receiving for over forty years, but they may help you get your story off your chest, and serve to develop a friendly voice in our community.
In Minneapolis, Fairview Health Services Psychiatry Clinic’s telephone number at Fairview Riverside Hospital’s outpatient clinic is 612-273-8700 Extension 2. The wait time may vary, but if you stay on the line and wait for the operator of the clinic, you can make an appointment.
However, the best thing you can do is contact your health insurance company, if you have one, and ask for a referral.
My interest in mental health started with my own situation when I was in high school and being beaten by several students who tried to throw me out of a second story window.
However, in 2011, MN Senator Kari Dziedzic came to me at a retirement party for outgoing State Senator Larry Pogemiller at a nice restaurant in northeast Minneapolis. She said that she saw the incredible progress I’d made over the years and asked me if I would be interested in serving on the Hennepin County Adult Mental Health Advisory Council.
I was, made a three minute speech before the board of commissioners, and was appointed out of a group of more than forty candidates. I served for three years and was elected as the Council’s vice chair, among physicians, nurses, social workers and other consumers of health care.
If you are feeling like there is no hope ahead of you, please know that there is hope. Upsetting days can be behind you with a little conversation and taking medication which calms and soothes your mind. If the medication doesn’t work after trying it for a while, there are other medications which can be substituted. It took a while to find the right ones for my body.
Please don’t let the notion of “stigma” get to you. Nobody outside your family has to know about what you are doing for your health — and then again, you may find the help you receive to be so good that you offer your story, just as I am offering my story.
My family has not farmed in more than three generations. They are legal and medical professionals, firemen and police officers, laborers, bartenders, tour guides and consultants. I am a teacher and assist foreign doctors and engineers learn how to speak English more proficiently.
Please take your mental health as seriously as you take other elements of your health. Strive for balance and harmony. Do not let the darkness or fear of what others may think of you consume you, as your greater health will lead you to greater abilities of making good decision and to greater prosperity.
I wish you the very best!
Wes Davey, whose comment appeared before mine and who came from a farming family, made important points about President Donald Trump. Mr. Trump is not friendly to people with health concerns. The Affordable Care Act, which too often is referred to as Obamacare, thereby alienating a huge segment of the population, helps people with substance abuse concerns, depression, and anxiety.
As the president has shown himself to be incompetent in creating a helpful environment for farmers, those of you who have in the past voted as Republicans may want to reconsider and vote for Joe Biden this time around.
The U.S. Chamber of Commerce is not at all enamored by Trump’s trade wars and immigration policies. Many Republicans are turning to Joe Biden this year to assure that Mr. Trump, whose ability to speak in intelligent and complete sentences is in question, is not re-elected.
Please, if you have a farm that has been adversely affected by Mr. Trump’s trade wars or immigration policies, consider voting for Mr. Biden. Please write to the White House and Joe Biden, and to your members of Congress and Senators, with ideas that can help your business. Mr. Trump’s mind is in the 18th and 19th centuries where mercantilism and and the notion of divine power of the leader of our nation is in question. He doesn’t have the character or the training to be our president, and it should be left to others who are far more advanced in their training.
Getting back to health: if you or anyone you know consumes alcohol on a frequent basis, you may like to know that alcohol is a depressant and can make stress and depression worse for you. We often get involved with high levels of alcohol consumption when we are young, and relate that we are “social drinkers.” This may be causing difficulty for you or a loved one.
There are many programs to help with easing the amount of alcohol we drink. As I have chronic kidney disease, not related to consuming alcohol or other substances, I cannot drink even beer — although I like to go to a place called Acadia Cafe in south Minneapolis near where I live where the sign reads, “No Crap on Tap.” I consume ginger ale or Sprite, or even water — at the bar where I sit and chat with Al, Sam, Juliana, or Ted, the barkeeps and owners. They don’t mind at all that I don’t drink alcohol, as long as I am paying for meals and other drinks. No one seems to notice or care that I don’t drink alcohol — and I enjoy plenty of conversations with others who come to this bar/restaurant.
So, if you are drinking alcohol and it is noticeably interfering with your mood and behavior, please take a break. Drink something else that is not a depressant. You’ll feel better, and your relationships will improve!
With best wishes!
Here is a link to a few videos and telephone numbers which may help rural Minnesotans cope with stress and depression.
https://mnhealthycommunities.org/mental-health-in-rural-minnesota/
The material which I read states that farmers are far more likely to commit suicide while on the job than other occupations. This can be avoided with initial help and then by talking about ways to manage either your life or your business, or both.
Remember that many colleges and universities have online classes. In the 1990’s I was a student senator at University of Minnesota’s College of Continuing Education and Extension. The college is now called College of Continuing and Professional Studies. During my brief time as a senator, I desired to put together a survey to determine the needs of rural and farming communities. I quit as too many of the students on the student senate had in mind that it was a popularity contest and had little insight or interest in actually achieving anything. I believe students these days, who are working on Minnesota Student Association, have a more mature outlook.
The bottom line is this: There are all kinds of opportunities a person can get involved with and make a happy income. Maybe farming is not for you anymore; maybe it is and you need ideas on how to improve your business’ reach. Continuing education is the answer to many people’s call for assistance.
In any case, if you are having difficulties, or if anyone in your family is having difficulties — emotional difficulties — please take this seriously and do not forget that help is available for you.
Please review https://mnhealthycommunities.org/mental-health-in-rural-minnesota/ and get together with others in your community to share common concerns.
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