STEWARTVILLE, Minn. – The last few years in the dairy industry have been challenging and down-right burdensome for many, causing a lot of additional stress for producers. Because of this, mental health has been a topic more people in the dairy community are bringing forward.
    “My belief is we need to be better neighbors,” Cynthie Christensen said. “In rural America, we have to turn toward mental illness like we do if someone had a heart attack or a Hiemlich situation or if someone’s in the ditch. We help each other. With depression and stress, we tend to turn away from each other.”
    Christensen is trying to change that by volunteering through the Minnesota division of the National Alliance on Mental Illness. The long-time farmer and president of the Houston County Farm Bureau is also a psychiatric nurse and a licensed therapist with her own teletherapy business for sessions in person, through video streaming or via phone. She presented “Harvesting Hope: Helping Our Neighbor,” which includes the QPR program to Land O’Lakes employees and dairy producers Nov. 6 in Stewartville.     
    QPR stands for question, persuade and refer. The national program is an evidence-based emergency mental health intervention to help reduce suicidal behaviors. It is intended to offer hope through positive action. It comes from the QPR Institute in Spokane, Washington. The goal of the institute is to have QPR be seen as the mental health equivalent of CPR, cardiopulmonary resuscitation.
    “This whole program and the thought of suicide and helping someone stay alive who is having suicidal ideation is huge and it’s frightening,” said Hayley McHale, community health educator for NAMI Minnesota. “We want to teach with this program that no matter how small of a step you take, by offering someone hope you can essentially persuade them to stay alive by giving them hope to seek out options.”
    The first part in QPR is question. Christensen gave examples to ask people such as: Are you doing OK? How is it going? Do you ever wish you could go to sleep and never wake up? Do you feel like you want to harm yourself? I’m worried about you, and I’m wondering if you are thinking about suicide?
    “If you have the instinct something is wrong, just ask the question however you are comfortable,” Christensen said. “It’s just having the courage to ask the question. And, if you’re wrong, you’ve taught them that if they get in trouble, you’re a person they can talk to because you asked the question.”
    Christensen said questions not to ask include: You’re not suicidal, are you? You wouldn’t do anything stupid, would you?
    “We have to have the courage to ask when we first get that first instinct and not wait,” Christensen said. “We’re all very private and think it’s not our business, but we have to get over that.”
    The next step in QPR is persuade. It is persuading someone to stay alive. Listen to them, do not be judgmental, do not argue, do not give advice, tell them you are sorry for the situation they are in and offer hope. After this, ask: Will you go with me to get help? Will you let me help you get help?
    “The fact you’re there and worried about them gives them hope,” Christensen said. “You have to add those personal touches to give hope. Connection is huge. Sometimes it can be hard to get someone help. You have to be persistent.”
    The third step in QPR is refer. In this step, it is important to find the person resources to help them. If possible, include the individual in this decision. Get others involved such as family, their doctor or therapist, or a person from their faith community. There are also helplines to call, including the 24/7 Minnesota Farm and Rural Helpline, 833-600-2670, or by dialing **CRISIS.
    “It’s the one number people should put in their phone,” McHale said. “You can call throughout the state to be able to access your county’s crisis team. If you’re able to call that number, you need to stay with the person who is having suicidal ideation and the mobile crisis team will arrive. It is comprised of counselors and social workers who come in and do an assessment with the individual and refer them to the proper help.”
    If needed, a person helping may also dial 911.
     In her presentation, Christensen said 47,173 deaths were attributed to suicide in the United States in 2017, and for every suicide there are 25 attempts. According to 2015 reports, male farmers, ranchers and other occupational managers had a suicide rate of 32.2 per 100,000 people, which is higher than the U.S. suicide rate of 13 per 100,000 people reported in 2014.
    “The suicide rate is higher in the greater Minnesota than in the seven-county metro area,” Christensen said. “It’s good we talk about this.”
    Unique stresses on the farm – long hours, isolation, volatility in agricultural prices, weather, farm succession, working with family and land prices, among others – contribute to this higher rural suicide rate.
    There are also barriers for people to get the mental healthcare they need. Health insurance deductibles for small business owners are sometimes high and can be financially detrimental. There might be limited access to healthcare in certain rural areas and a fear from the farmer that his or her treatment will not be confidential. Christensen also said men have a harder time asking for help, because they say they do not have time or want to admit something is wrong.
     Christensen said there are suicide clues and warning signs people can watch for.
    “The more signs, the more serious it is,” Christensen said.
    Christensen gave examples of direct verbal clues such as saying to a friend, “I’m going to kill myself.” Or, to a spouse, “Why don’t I just shoot myself and let the bank have this place?” An example to a banker is, “If you foreclose, you’ll be seeing my obit next week.”
    “If you’re not aware of how much somebody’s struggling, you might not interpret it as the sign it is,” Christensen said.
    Examples of indirect verbal clues Christensen gave included: “Don’t be surprised if I die in a tractor rollover.” “Is this enough medicine to kill someone?” “You’ll need to look after your mother when I’m gone.”
    Behavioral clues include sudden changes in behavior like not attending events a person had never missed in the past such as a morning coffee gathering or church service. Another example is if someone used to always answer the phone but no longer does and only texts instead, Christensen said.
    “Social isolation is one of the biggest clues of someone being in trouble,” Christensen said.
    Other behavioral clues include feeling of hopelessness or helplessness, a sudden interest or disinterest in religion, and more use of alcohol, drugs or CBD products.
    Situational clues might be being denied credit, a relationship ending, a family death or anytime there is a big change or loss.
    “When someone is struggling with depression, they don’t want to be a burden to their family,” Christensen said. “If they feel like they can’t perform like they would like to and they feel they would be a burden to their family or better off without them, that’s really devastating. Our mind can begin to convince ourselves of things that are not true in these times of stress. When you’re stressed and not thinking clearly, you can make that story seem more real.”
    That is why Christensen said it is so important to check on neighbors and friends.
    “Farmers are a particularly challenging group because they’re so independent,” she said. “To ask for this kind of help takes so much courage. But, we need to have conversations, we need to normalize it and make it OK because committing suicide and losing one single farmer is not OK. There’s nothing more important on the farm than a farmer. It stops without a farmer. We need to get that thought out there that the farmer is the most important thing on your farm.”