By Dr. Jon Ulven
During a cold, clear winter evening, Tom considers many worries as the television fails to grab his focus. With his wife in the other room and the kids upstairs, his mind entertains its usual topics. “Will the farm make it? Will the family farm end with me? Is this the year? I wish my marriage was going better. I don’t talk to my kids like I used to.”
Tom hurts, both physically and mentally. As he sits in his well-worn chair that supports a body worn by the profession of farming, his mind fills with “shoulds” that part of him wishes were “musts.”
“I should make that appointment with the bank, get my back looked at, lose some weight, finish the basement project, open up to my wife and drink less.”
Tom gazes out the window as his mind quickly moves to thoughts about dying and wishing it was all over. He feels alone in this house full of family. He feels guilty and ashamed he feels this way. His mind has been here before
If this story resonated with you personally or made you think of a family member or friend, I hope you keep reading. In my work as a licensed psychologist in the Upper Midwest for the past 19 years, I am seeing unprecedented demand for behavioral health services that is linked to the significant distress caused directly and indirectly by the COVID-19 pandemic. I am thankful for the opportunity to write to the farming community that I grew up in about the topic of suicide and behavioral health care.
The Scope and Nature of the Problem
A survey study of thousands of Americans by the Centers for Disease Control and Prevention (CDC) at the end of June 2020 found that almost 11 percent had “seriously considered suicide” in the previous 30 days. This same study found that the rate of depressive disorders had increased by 3.5 times at the time of the survey.
People are hurting and our winter in the Upper Midwest is coming. The impact of the pandemic is unfortunately adding to an already alarming trend. A 2018 report by the CDC revealed that the rate of suicide has increased by 40 percent in the past two decades in the US. This CDC study also found that farmers ranked among the highest risk occupations for suicide. Most of you reading this article have been impacted by someone who died by suicide. In my clinical work, the primary focus of my care is increasingly working with patients to reduce their risk of suicide.
Why Do People Die by Suicide?
Thomas Joiner, PhD, a psychologist and professor, has dedicated his professional career to understanding suicide. Hundreds of studies throughout the world have led him to the following three factors that he believes are necessary to die by suicide.
- The person at risk believes they are a burden to others. They begin to believe that people would be better off without them.
- They feel socially rejected, not included, left out.
- People at risk of suicide have acquired the capacity to harm themselves through experiencing repeated emotional and/or physical pain in their lives.
In addition, people at risk of suicide often have sleep problems, nightmares and agitation at the time of a suicide attempt. Humans are biologically wired not to harm themselves or others, so it takes a lot to cross over this wiring to make an attempt. People who make suicide attempts are most often experiencing emotional and/or physical pain that they can’t make go away by other means. They don’t want to die. They want pain to stop
What to Look For in People at Risk
- Talking about wanting to die or kill oneself
- Talking about feeling hopeless or having no reason to live
- Increased use of alcohol or drugs
- Extreme mood swings
- Withdrawing or feeling isolated
- Acting anxious or agitated; behaving recklessly
How to Talk with People You Are Concerned About
The Columbia Lighthouse Project offers a helpful guide and screener to “Ask, Care and Embrace” friends and family at risk of suicide. We need to create a culture where we can ask each other questions about suicide when we know that someone is noticeably different. Asking the following questions can be very hard to do, but these questions have saved many lives. I encourage you to practice these questions and use them when you need to.
- Have you wished you were dead or wished you could go to sleep and not wake up?
- Have you actually
If someone acknowledges that they have been seriously considering suicide, I liken this to someone saying that they have chest pain. It could be indigestion or it could be a heart attack on the way. The person needs to have their situation evaluated. If you have immediate concerns, call 911. The police or local sheriff’s department team are trained to check on the welfare of individuals.
In less urgent situations, primary care teams throughout the Upper Midwest have often expanded their teams to include behavioral health staff, and your primary care provider is trained to evaluate risk of suicide. If needed, primary care makes referrals to a behavioral health provider. Suicide risk is fortunately a very treatable condition, and there is often associated anxiety and depression that are also very treatable. One development that has emerged during the pandemic is that we now have the ability to do video visits through your smartphone. I can literally have a therapy appointment with a farmer who has the GPS on and is sitting in the tractor! This technology change affords more privacy, which for some is helpful due to the lingering, unfortunate stigma of mental health.
Additional Resources For Farmers
- Suicide Prevention Lifeline (1-800-273-8255). This service is free and available 24/7. Trained staff will talk with you about your concerns, ask questions about your risk, and offer suggestions for help.
- Crisis Text Line – text HOME to 741741. Crisis Counselors will respond to help you manage the moment you are in and offer suggestions for assistance.
- Behavioralhealthbridge.org is a free website developed by UND’s Center for Rural Health and Sanford to offer helpful information for people with common behavioral health conditions.
- Substance Abuse and Mental Health Services Administration’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders.
In this significant time of change and adversity, I would like to challenge you this holiday season and winter to consider three things:
Examine your willingness to reach out if you are hurting.
Take more social risks with the people of your community to genuinely ask how people are doing. Develop skills to ask tough questions about suicide.
Humans aren’t equipped with venom, fangs, or armor to survive. We have made it this far because we are social and look out for each other. This pandemic is reminding us in powerful ways that we need each other.