The people in agricultural occupations are mostly “salt of the earth” who strive to be productive even when “the going gets tough.”
As the two most recent “Farm and Ranch Life” columns have indicated, some farmers, ranchers and farm workers aren’t readily willing to seek behavioral health assistance when needed, but resistance to behavioral health care services is declining within this stalwart population.
Emails, phone calls and letters to me from men and women engaged in agriculture verify that stigma about seeking help is diminishing within the farming population, but the task of finding appropriate and acceptable behavioral health care is often daunting. It’s too difficult, some say, which leads them to avoid necessary care.
It’s not uncommon to have to wait three months or longer to see a psychiatrist or other specialists in medical and behavioral health care. Such delays run counter to appropriate services that deserve A+ grades.
A+ agricultural behavioral health services are:
•Attuned to the needs of the agricultural population because the providers understand farming, which gives them credibility with farmers and ranchers, and they have training about unique issues that accompany agriculture, such as farmers’ strong agrarian drive and the effects of exposures to harmful substances such as farm insecticides, certain herbicides and fungicides, on neurological and behavioral functions
•Accessible within acceptable driving distance, by telehealth, through farmer-friendly crisis telephone and email services or on-farm visits by trained professionals and paraprofessionals such as the Lifeline program in the outback of Australia, FarmNet in New York and the Minnesota Department of Agriculture program for stressed farmers there
•Available at times when needed and which accommodate farmers’ schedules, such as on weekends and rainy days
•Affordable – many individual health insurance policies for farm families are more expensive than group rates and health insurance provided by off-farm employers, so farmers sometimes opt for high deductibles and avoid seeking professional services because of costs
•Not necessarily reportable to data collection agencies such as the federal Centers for Medicare and Medicaid Services (CMS), which tabulates all claims submitted by providers for reimbursement by federal and commercial insurers for their services
The CMS keeps track of the diagnoses on all claims submitted for insurance reimbursement, as well as many other data that are useful for tabulating health care costs and for other purposes, such as regulating insurers from overcharging. Life and disability insurance companies, as well as health insurers, can access the CMS data.
Many farm families have found that a diagnosis of recurrent depression or other chronic health conditions can increase their premiums for insurance policies. This circumstance was even more problematic for many farm families prior to passage of the Affordable Care Act (ACA), which established that all insurers who agreed to abide by the ACA would not exclude coverage for chronic health problems and preexisting conditions.
Desire for privacy from government statistics and possible increases in health insurance rates explain why some farmers who can afford necessary health care sometimes pay for services out-of-pocket so that no claim is issued by the provider for reimbursement by a health insurer.
The Farm and Ranch Stress Assistance Network (FRSAN) that I wrote about last week as a possible provision of the next federal farm bill would obviate many of the problems that deter agricultural producers from seeking behavioral health assistance. The FRSAN is called the Stemming the Tide of Rural Economic Stress and Suicide (STRESS) Act in the House proposal and FARMERS FIRST in the Senate version.
If approved federally, FRSAN would make behavioral health services available to all agricultural producers in states and regions that successfully compete to establish agricultural behavioral health services similar to other employee assistance plans (EAPs).
EAPs are free and confidential counseling services that are usually limited to five or fewer sessions with a contracted behavioral health care provider. The provider is a licensed behavioral health care professional or company that keeps records only of the number of people who seek assistance with personal or family matters.
EAPs have a proven track record of helping the people they serve to work through personal maladjustments, to become happier and more dedicated employees who miss fewer days of work and contribute to greater productivity. EAPs are offered as a benefit by a growing number of businesses.
What to do if the FRSAN doesn’t become available is a serious problem in areas where A+ services aren’t available. I have to tell these people who contact me for assistance to ask their family doctor for a referral, or to contact their state professional associations like their psychology, counseling or psychiatry associations for information about providers who best fit their needs.
Or, they may approach health care specialty clinics such as those offered at medical schools. State-funded medical schools, in particular, seek to help their state residents who lack access to quality care.
I feel unable to help sufficiently sometimes, but not as bereft as the farmers seeking help. Overall, however, the understanding and provision of agricultural behavioral health care are gradually improving.
Dr. Mike Rosmann is a psychologist and farmer in western Iowa. Readers may contact him at firstname.lastname@example.org