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Claire Hettinger is the 2019 Illinois Humanities Engagement Fellow for the Midwest Center for Investigative Reporting.  Have a story idea, question or tip? Reach her at claire.hettinger@investigatemidwest.org. 

With farmers facing increasing stress and depression, Midwestern states and national farm groups are making more efforts to better provide services to alleviate the high rate of suicide among the agriculture industry. 

Yet in rural areas, this care is more of a challenge. 

Rural hospitals -- often the primary source of health care services in these areas -- are closing or merging. Since 2010, 23 hospitals have closed across the Midwest -- a loss of nearly 1,000 beds, according to the North Carolina Rural Health Research Program. 

An Institute for Nonprofit News investigation by 12 news outlets across seven states found that rural Midwest hospitals have reduced services or merging with larger health systems in an effort to deal with financial and regulatory pressures. 

Only two of those Midwestern hospitals were in Illinois, but accessing mental health services in rural communities remains difficult. Some groups have decided to address the situation themselves. 

For example, the organization GROW sets up meetings over Zoom, a video conferencing app, to help those in rural areas experiencing mental health issues.

And more than a dozen farm bureau managers in Illinois have taken mental health first aid classes that help people recognize signs of distress.

Harry Brockus -- the chief executive officer of Carle Hoopeston and Carle Richland in Central Illinois, a collection of hospitals that serves 41 mostly rural counties -- said there is a physician shortage across the country and recruitment to rural areas is an even bigger challenge. 

“We do not offer the amenities that physicians are looking for,” he said, “such as shopping, schools and different entertainment venues.” 

Other challenges in rural areas, such as transportation, housing and access to healthy food, can make rural healthcare costs inefficient and unaffordable, Brockus said. 

This has left rural America in a bind when it comes to care for mental health.

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“The cold hard facts about mental health and rural America is that more than 60% of rural Americans live in mental health professional shortage areas,” said Dennis Mohatt, vice president for behavioral health at the Western Interstate Commission for Higher Education during a 2018 webinar by the National Institute for Mental Health on mental health and rural America. “More than 90% of all psychologists and psychiatrists and 80% of Masters of Social Work, work exclusively in metropolitan areas. More than 65% of rural Americans get their mental health care from primary healthcare provider, and the mental health crisis responder for most rural Americans is a law enforcement officer.”

Adding to the problem of access is the high rate of suicide in rural communities. The agriculture industry has the fourth-highest rate in the country, according to a January Centers for Disease Control and Prevention study

“What few Americans picture is a farmer or a rancher with serious depression,” Mohatt said. “They don't think about the stress associated with a changing rural economy where a single tweet on trade by the President can tank soybean prices across the Midwest. They don't think about someone driving 150 or more miles to access care, let alone a psychiatrist or a psychologist or a different mental health professional driving a circuit to deliver care like the circuit riders of the past.”

Wait times

In the rural areas that Carle hospital serves, patients do come from as far as 150 miles away for service, said Heather Hintz, director of behavioral health at Carle. 

Wait times can be a problem. 

“It is not uncommon to wait three to six months for services,” Hintz said. 

The hospital is working to hire more psychiatrists and fill vacant positions, she said.  

In the meantime, Carle is taking steps to reduce wait times, Hintz said. Carle has started hosting mental health first aid courses and providing telepsychiatry and virtual visits. It’s also creating a psychiatry residency program.

“Our goal is to provide resources and get people to reach out for help,” Hintz said. 

Both telepsychiatry and virtual visits are with a licensed provider and are confidential.

Telepsychiatry can be done from a doctor’s office while virtual visits can be done on a personal cellphone or computer from a person’s home, said Virtual Visits manager Haley Miller.

Online therapy services through Carle are covered by many insurance companies. If they are not, appointments cost $49, she said.

Miller said people are typically seen within a week of scheduling a behavioral health appointment.

Filling in the gaps

One group that hopes to help fill in the gap is GROW, a national community-based mutual help mental health organization for recovery and prevention that has a chapter in Champaign County.

It provides free remote access to meetings through Zoom, which can be done over video or just through audio, said Chris Stohr, a National Coordinator of GROW In America. Zoom is available on computers and smartphones. 

People can contact the GROW secretary at karen.shan@growinamerica.org or 217-352-6989. The secretary will then send an invitation Zoom link. 

Stohr said he encourages people to seek peer-to-peer support or mutual health groups as part of their road to recovery. He said the limited access to doctors, psychiatrists and therapists can be a problem for people. 

Sometimes, groups like GROW are a better part of treatment, he said. For one, those in distress can build relationship. And, two, groups like this can aid in treatment in ways that professional help may be lacking, Stohr said.

“You're not going to be able to call up doctor so and so and say I've had a crisis here and I need help,” he said, “but you can do that with mutual help” peer.

Farmer mental health

Carle, the hospital, is reaching out to farmers through Mental Health First Aid courses, Hintz said. So far, the programs have trained more than 300 people throughout Central Illinois. 

One of those people is Jim Birge, the Sangamon County Farm Bureau Manager. He said he attended the event because he’s recognized the difficult times farmers are living through, especially in recent years. 


Jim Birge, Sangamon County Farm Bureau manager. Photo credit: Sangamon County Farm Bureau

A decrease in cash flow for farmers, many difficult seasons in a row and the trade war -- all of it increases farmers’ stress levels. 

“We’ve seen an increase in depression and suicide come along with that,” Birge said. 

Birge, who had a friend die by suicide a few years ago, has gone a step further. He organized a training in his own county. 

On Dec. 12, eleven people who work with and around farming learned how to spot signs of mental distress, Birge said. He hopes to have more in the future.

Birge said he thinks farmers lack the knowledge of how to get care for mental health concerns. Many people haven’t dealt with that part of the healthcare system before, he said. 

The second barrier to mental health care is overcoming the stigma and shame that people believe comes with getting mental health care, he said.

“If you have troubles with your foot, you go to the doctor,” Birge said. “It is the same with your head. There is a medical reason that your head isn’t working, and it may be a simple reason.” 

At the Carle training, “we were taught different skills and approaches to work with the individual and to not be judgemental,” Birge said. 

They also were taught to help people access the help they need, which can range from just being there to listen to long-term professional help, he said.

“Sometimes, it is a matter of having someone to confide in and tell them your thoughts: if they are having imminent thoughts of suicide or if it is just things haven’t been going right,” he said. 

It is difficult to talk yourself out of the problem but having someone else to confide in is helpful, Birge said. 

“Some people think, ‘I don’t know how to deal with this and I don’t know what to do’,” Birge said. “But you can break it down into smaller problems until you have the problem taken care of.” 

He encourages people to reach out and talk to someone. Speaking with someone is better than speaking with no one, he said. Clergy and pastors often have training in these matters as well so reaching out to someone can be really helpful, he said. 

“We have the means to intervene and we should do something about this,” Birge said. 

This story was updated on Feb. 18, 2020, to clarify the difference between telepsychiatry and virtual visits and to correct that telepsychiatry is only done in a provider's office.

Claire Hettinger is the 2019 Illinois Humanities Engagement Fellow for the Midwest Center for Investigative Reporting.  Have a story idea, question or tip? Reach her at claire.hettinger@investigatemidwest.org. 

Sky Chadde, Gannett Ag Data Fellow, contributed to this report.

Seeking a Cure: The quest to save rural hospitals is a collaborative project including the Institute for Nonprofit News and INN members IowaWatch, KCUR, Bridge Magazine, Wisconsin Watch, Side Effects Public Media and The Conversation; as well as Iowa Public Radio, Minnesota Public Radio, Wisconsin Public Radio, The Gazette (Cedar Rapids, IA), Iowa Falls Times Citizen and N’west Iowa REVIEW. The project was made possible by support from INN, with additional support from the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems. For more stories visit hospitals.iowawatch.org