By Mike Watkins, DTN Correspondent

Editor's Note: Throughout May, DTN/Progressive Farmer's special series "Mental Health Hope & Help" is exploring the unique mental health challenges people in rural America face, highlighting efforts to overcome stigma and looking at ways farmers and ranchers can manage their mental wellness. This is the sixth story in the series.

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Cheyenne Watson (name changed to protect her identity) grew up in a small town in western South Dakota, helping her parents work the family farm when she wasn't in school.

She spent summers with her dad in the tractor or combine planting and tending to the corn and soybean crops while also taking care of the chickens in the family coup.

"It was a great childhood; I loved every minute of my time working on the farm," she said. "I have amazing memories of those days."

And while she said her family discussed many topics at the dinner table or during family gatherings, no one ever talked about mental health beyond mentions of someone in town being "crazy."

"It just wasn't talked about, especially if anyone in our family was ever struggling with mental health," she said.

That all changed when, as a teenager, her uncle, Mike (name changed to protect his identity), who farmed in a neighboring community, showed visible signs of depression following the loss of a large crop.

She said the town he lived in, while friendly and filled with charm, was small with limited mental health resources -- plus, he believed strongly that it wasn't "a big deal" and he could "handle it himself."

The nearest mental health clinic was miles away, and transportation was a constant hurdle. He confided in his personal doctor, who helped him find some online and mental telehealth services until he could make it to a neighboring town with in-person services and resources.

WHEN IS IT TIME TO SEEK HELP?

Cheyenne's story isn't unique. For people living and working in rural areas, mental health services and resources are often sparse, and those that are available could be hours and miles away. Add in the stigma surrounding mental health and the fear of people knowing your business, and it can deter people from seeking help.

So, how do you know when it's time to seek the help of a mental health professional? And how do you go about finding that help?

Linnea Harvey, Rural Renewal Health Initiative coordinator, Department of Agricultural Education, Communication and Leadership at Oklahoma State University, said there are two things that contribute to someone's willingness to get help.

"First, stress simply becomes too much, and they have someone in their life they can say that to without being judged," said Harvey, who grew up on a farm in rural Wisconsin. "Telling someone else is the first step in seeking professional help, and if you don't have that 'someone' you feel comfortable talking to, you're less likely to seek help on your own.

"The second is that there are a lot of adverse childhood experiences in rural areas. These experiences often lead to mental health issues coupled with substance abuse. If people get to a place where they're serious about rehab or getting clean, often that's the time they address their mental health as well; otherwise, they're more likely to relapse."

SIGNS, SIGNS, EVERYWHERE SIGNS

Signs of mental illness in rural America can vary, but there are some common indicators to observe.

"The classic signs I know are decreased interest in normal activities, signs of stress in the individual and in the family members, changes in routine, decline in personal care and care of property," Harvey said.

Some signs to look for in yourself as well as those close to you include:

-- Social Isolation: Withdrawal from social activities and isolation from friends, family and community.

-- Substance Abuse: Increased use of drugs or alcohol as a coping mechanism.

-- Increased Agitation or Irritability: Noticeable changes in behavior, such as persistent anger, irritability or aggression.

-- Changes in Sleep Patterns: Significant alterations in sleep patterns, such as insomnia or excessive sleep.

-- Poor Performance or Attendance in Work or School: Decline in job or academic performance, frequent absences, or difficulty concentrating.

-- Physical Health Issues: Unexplained physical ailments, chronic pain, or worsening existing health conditions.

In her experience as the Panhandle co-director of the Behavioral Health Education Center of Nebraska (BHECN), Cate Jones-Hazledine views changes in behavior, feelings of anger or irritability and changes in sleep and appetite as signs that mental struggles may require attention.

It's the identification of these characteristics and feelings -- and their degrees of severity -- that may or may not need professional assistance.

"Everyone gets 'down' sometimes, but if this is more severe than normal, or lasts longer, that is a sign that it might be something more," she said. "And (always) any thoughts of suicide or self-harm should be taken seriously, and help should be sought immediately."

"Resources of many types are in short supply, but over the last 20 years, more mental health practices have popped up (in the Nebraska Panhandle)," Jones-Hazledine said. "We also have resources like Western Community Health Resources (Chadron), which has some family support services."

SUPPORT IS CLOSER THAN YOU THINK

If you live in a rural area, finding mental health help may require some additional effort, but there are still options.

-- Primary-care providers: They can play a crucial role in identifying and managing mental health concerns. While they may not specialize in mental health, they can provide initial evaluations, prescribe medications, if necessary, and refer individuals to available resources.

-- Local hospitals or clinics: Contact them to inquire about mental health services they provide or for a recommendation for local mental health professionals.

-- National helplines: Reach out to helplines such as the 988 National Suicide Prevention Lifeline (call or text 988, or chat online at 988lifeline.org/chat) or the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline (1-800-662-HELP) for guidance and support.

-- Support groups: Look for local support groups or online communities where you can connect with others who may be experiencing similar challenges.

-- Self-help resources: In the absence of professional therapy, individuals may turn to self-help resources such as books, online articles, videos and podcasts. These resources offer guidance, coping strategies and information about managing mental health.

-- Faith and spirituality: Religious and spiritual beliefs can play a significant role in rural communities. Many individuals turn to faith for comfort and support during times of mental distress.

-- Teletherapy and online support: Although broadband internet service can be spotty in rural areas, teletherapy has become more accessible, allowing individuals to receive mental health support remotely. Online support groups and forums also provide a sense of community and connection.

DO YOUR HOMEWORK

When seeking mental health services and resources, asking the right questions before a first meeting or session is vital to getting what you need. A few to ask include:

-- What types of mental health services do you offer? (Individual therapy, group therapy, medication management, etc.)

-- What are the qualifications and experience of the mental health professionals at your facility?

-- How long is the average wait time for an initial appointment?

-- Are there any specific areas of expertise or specializations within your practice?

-- What is the cost of services, and do you accept insurance?

-- Do you offer a sliding fee scale or financial assistance for individuals who may have difficulty affording services?

-- What is the cancellation policy for appointments?

-- How often are appointments typically scheduled and how long do they last?

-- Do you offer teletherapy or online counseling options?

-- Are there any support groups or additional resources available for individuals seeking mental health support?

WORTH THE FINANCIAL IMPACT

When having to choose between paying for a new tractor or seeing a mental health practitioner, in rural America, more often than not, the tractor wins.

"While some see the circular aspect of it, 'If I take care of myself, I am going to be a more successful farmer/rancher,' I think the majority of the individuals are going to place needs of the farm/ranch over their own needs," said Tara Wilson, associate professor, counseling, at Chadron State College and co-director of the BHECN Panhandle.

"For example, a farmer might need a knee replacement but keeps putting it off because he cannot take time away from the farm. The same is true for mental health. Often, our mental health is not as visibly seen, so they place an emphasis on the more obvious needs," points out Wilson, who is a licensed mental health practitioner and nationally certified counselor.

Despite the costs of mental health services, insurance is an option to cover some or most of the expenses -- and it is just as important to know how to navigate the process.

Self-employed individuals can deduct health insurance premiums as an adjustment to their income on their federal income tax returns. This deduction is available for self-employed individuals, including sole proprietors, partners in a partnership and more.

To qualify for the deduction, the health insurance plan must be established under your business and must cover either yourself, your spouse, your dependents or your children under the age of 27 at the end of the tax year. The insurance plan can be in your name or in the name of your business.

SELF-CARE: LEARN TO MANAGE STRESS

One aspect of coping with mental health issues involves handling stress related to life -- and in rural living, those stresses are much different than those people in urban settings experience.

But ultimately, the result -- positive or negative -- can come down to how that stress is managed.

Together, mental health professionals reflect on the kinds of things our minds say to us when we're faced with a challenging situation.

At a recent regional farming conference, Isaac Hooley, senior behavioral health clinician, Department of Psychological and Quantitative Foundations, College of Education Affiliations at the University of Iowa, facilitated a conversation about stress management with a roomful of agriculture producers and family members.

"When I shared examples like 'I have to figure this out myself,' 'It isn't anyone else's responsibility to get this done for me,' 'Work a little harder,' 'Other people are watching to see if I can be successful at this,' 'I can't let my family down,' there were lots of nodding heads in the crowd," Hooley said.

"I teach people to watch for signs that they're under significant stress -- behaviors (like isolating, over-using substances, angry outbursts, etc.), thoughts (like I mentioned above, as well as thoughts about wanting to be dead, etc.) and feelings (overwhelm, anger, helplessness, etc.). We all have some capacity to cope with challenges and some level of resilience -- and benefit from knowing our limits and when it's time to ask for help."

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For more articles in this series:

Blog:

-- Editors' Notebook: "Take Time for Mental Health," https://www.dtnpf.com/…

Stories:

-- Mental Health Hope & Help - 1: "Rural Americans Still Face Mental Health Stigma, Scarcity of Resources, But Outlook Is Improving," https://www.dtnpf.com/…

-- Mental Health Hope & Help - 2: "Farmers Urge Fellow Farmers to Reach Out When Life Overwhelms," https://www.dtnpf.com/…

-- Mental Health Hope & Help - 3: "Obstacles, Solutions Abound in Rural Youth Mental Health," https://www.dtnpf.com/…

-- Mental Health Hope & Help - 4: "Gender Differences Exist in Farmer Emotional Health," https://www.dtnpf.com/…

-- Mental Health Hope & Help - 5: "Be Mindful of a Mother's Mental Health," https://www.dtnpf.com/…

Additional resources:

For more information and mental health resources, visit our "Spotlight on Rural Mental Health" page at https://spotlights.dtnpf.com/…

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