Rose Jeter posed a question to her Facebook friends last summer: Why did they think struggling farmers were turning to suicide?

She wasn't surprised by the answers they offered: the constant stress, the reliance on unpredictable Mother Nature, the inability to set their own prices, the fact that you could work tirelessly and still make little.

They were all familiar to Jeter, the daughter of a farmer who married into the Jeter Farm family and works for Homestead Creamery.

But she was surprised to receive private messages from some farmers who said they had contemplated taking their own lives.

“These were people that I knew,” Jeter said.

Amy Johnson, a family nurse practitioner who farms with her husband in Bedford County, responded to Jeter's post and said she was interested in talking more about the issue. Since then the two women, who knew each other through Virginia Farm Bureau Young Farmers, have been working to raise awareness of farm stress and create spaces for conversations about mental health.

They join a growing number of people in the region and state — from academics to farmers to the state's commissioner of agriculture — looking to shine light on an issue that often remains hidden in the shadows.

A 2016 report from the Centers for Disease Control and Prevention indicated those working in the farming, fishing and forestry sector had the highest rate of suicide by occupational group.

Last year, the agency retracted the report, because of errors in coding for some occupational groups.

Though the study served as the impetus for some people working to address farm stress, they say its retraction does nothing to minimize the significance of the problem.

“At the end of the day, does it matter if it's the highest percent or not?” Jeter said. “It's happening.”

Raising Awareness

Jeter first took an interest in farmer mental health a decade ago when she was working as a cooperative extension agent, her first job out of college. She got a call about a farmer who might have been suicidal.

“I knew enough to know that they didn't need to talk to me about that,” Jeter recalled. “They needed to talk to a mental health professional.”

But when Jeter searched for resources to point the distressed farmer toward, she couldn't find much. The experience prompted her and others at Virginia Tech to publish a brief guide of their own.

The CDC report was a “kick in the butt” for Jeter, making her reflect about what she'd done to raise awareness of farm stress in the years since.

“I wanted to make sure I didn't let time go by again,” she said.

Jeter and Johnson started by drafting and submitting policies to their local chapters of Virginia Farm Bureau. Those policies later were adopted at the state level.

The policies voice support for the Farmer and Rancher Stress Assistance Network, in addition to training on farm stress for mental health professionals practicing in rural areas and seeking grants to fund workshops for farmers in crisis that would address mental health and financial restructuring.

The American Farm Bureau Federation, the national organization, adopted one policy that cites similar goals.

Ben Rowe, national affairs coordinator for the Virginia Farm Bureau, said in an email that the policies serve as a “guiding document when we participate in the legislative process during the General Assembly Session, and in Congress.”

More Than An Occupation

Life as a farmer is stressful. It's a simple fact. Commodity prices are out of farmers' control and their product's quality is dependent on the whims of the weather. For farmers, the work is not just an occupation, but part of their identity.

As economic conditions have worsened, members of the agriculture community have experienced an increase in life stressors, which impact a person's mental health and sometimes even their physical health, said Kim Niewolny, an extension specialist and associate professor at Virginia Tech who also serves as director of the Virginia Beginning Farmer and Rancher Coalition and AgrAbility Virginia.

Perhaps the most obvious life stressor is making financial decisions that will support the farm both today and into the future, Niewolny said. Many farmers work land that has been in the family for decades, creating an added pressure to succeed.

That stress can extend beyond the primary operator of the farm and into the family. It can also endanger the safety of farmers, as they might take risks or cut corners, feeling as if they don't have the time or resources to take necessary precautions. Or perhaps they're just so physically and emotionally taxed that they forget a step or safety measure.

It's a problem that academics like Niewolny are looking to address. She and an action team focused on farm safety, health and wellness were recently recommended to receive a grant from the Southern Risk Management Education Center for what Niewolny described as a project seeking to reduce human and financial risk to Virginia farmers. They will focus specifically on new and transitioning farmers, military veterans and historically underserved populations.

The grant application was made in Virginia Tech's name, but the action team also includes representatives from Virginia State University, Virginia Cooperative Extension, Virginia Farm Bureau Young Farmers, the Farmer Veteran Coalition of Virginia and AgrAbility Virginia.

Niewolny explained the team's three-prong approach: workshops and a dinner theater program for farmers, professional development for the educator community and webinars that will help farmers and providers work through decisions, based on real-life scenarios.

The farm dinner theater is an intervention developed by Deborah Reed, a University of Kentucky professor, who will assist in bringing the program to Virginia.

Farmers will be recruited, likely through extension agents who already have relationships in the community, to write and perform a script at a community dinner. It's a chance for farmers to share their own experiences with farm stress.

“We need to help build capacity to talk and address and identify the issues,” Niewolny said. “This is more of a community development approach that we're really excited about.”

Though Niewolny said she was glad the action team's proposal was accepted, it's just one 18-month grant. There is more work to do.

A Safe Place To Open Up

As a sixth-generation dairy farmer, Courtney Henderson knows something about tradition. But there's one thing the 23-year-old from Botetourt County wants to do differently than her predecessors: talk more openly about farm stress and mental health.

“Mental health to me is something that's been ignored in the agriculture industry for a very long time,” she said. “You're always taught to kind of keep that to yourself. If you're dealing with it, deal with it and go on.”

Given the struggles that many in the agriculture industry — dairy farmers particularly — are facing, Henderson said the issue deserves more attention and farmers need a safe place to open up.

Henderson created that outlet for herself shortly after graduating from Virginia Tech in May. She rounded up young women in agriculture and suggested they meet every so often to get off the farm, vent their frustrations and share perspectives. It's nothing formal, more of a social hour, Henderson said. But it's a space that didn't exist for these women before.

Henderson believes her generation is more open to talking about the sensitive topic of mental health.

“The older generation has always been taught hush hush, keep to yourself. This generation is tired of the hush hush. I'm tired of it,” she said. “It's nice when I get together with that group because I can get out and talk.”

Awareness, Affordability and Access Are Priorities

The first time Amy Johnson delivered a talk on mental health to a room full of farmers, she was nervous. She didn't know how they'd respond to words like depression or suicide. They can be difficult for anyone to hear and discuss, but particularly farmers, often the strong, stoic types.

“To walk into a room and say the word ‘suicide’ —`We're going to talk about suicide' — that stops people in their tracks because we don't talk about that,” Amy Johnson said.

But that's exactly the mindset she's seeking to change. With a professional background in medicine and personal background in agriculture, Amy Johnson is uniquely suited to do so.

“I like to say I talk real,” she said. “I break it down. I'm not afraid to meet folks where they are.”

Amy Johnson knows what they're going through. Her father almost lost the Highland County farm she grew up on several times. The stress has kept her husband, W.P. Johnson, from sleeping in the past. Last year he even lost a friend to suicide.

“Farmed every day of his life, and just couldn't handle it anymore,” said W.P. Johnson, who also works off the farm for the USDA Farm Service.

Though others in the agriculture community knew of the man's death, W.P. Johnson said nobody talked about it — farmers just aren't built that way.

“We talk about the weather,” he said. “We'll talk about the weather for days.”

W.P. Johnson said he feels it's become more acceptable to talk about mental health in the “mainstream world,” but his world has been slower to adjust. He believes it could take generations. That makes it essential to start the conversation now, as his wife is doing.

Maybe W.P. Johnson's children, to whom he hopes to pass his farm , will grow up in a world where they aren't shy to speak up about their struggles — assuming he can keep the farm going long enough to hand it down.

“I still got to get through tomorrow before I can ever give it to them,” W.P. Johnson said.

The talks Amy Johnson has given to agricultural organizations have been well-received so far, resulting in questions, stories and even pleas for help.

“Those are truly the scary ones because you think, well if they weren't here today what would they be doing?” she said.

Farmers face myriad barriers to mental health services, Amy Johnson explained. There's a stigma attached to admitting a problem or seeking treatment. There's a lack of access to resources in rural areas. There's an affordability issue — the family nurse practitioner noted that farmers are an underinsured population.

Work needs to be done to address affordability and access, Johnson said, but her focus now is awareness.

When milk cooperatives started including phone numbers for suicide hotlines with milk checks, Amy Johnson said farmers were forced to acknowledge the problem.

“That was kind of a in your face, this is a problem type thing,” she said. “It made people realize that we really can't just turn our back on it. We have to talk about it.”

Being Willing To Talk Openly About Mental Health

Josh Fleenor fell into a depression after losing his job managing a beef cattle farm in Prince Edward County.

He felt betrayed, as the owners hadn't let on about their financial problems, and he'd just made it through a difficult season with the cows. Many calves were lost to illness. To make matters worse, his housing was tied to the job, and his wife had a baby on the way.

Fleenor, 39, said he'd been taught all his life that if he worked hard, he'd achieve success. He was the first in his family to graduate from college and was dedicated to the farm. Yet Fleenor still struggled.

“That didn't mean I was a failure, necessarily. I can see that now,” he said. “But at the time I didn't see that at all.”

Fleenor said he began to heal when he finally admitted to himself that he had a problem and began to open up about it, starting with his wife. The birth of his daughter also helped.

Fleenor watched TED talks and read up on depression and mental health, learning everything he could about it. Now, he's taking graduate courses in psychology online through Purdue University Global.

Fleenor is still a cattle farmer. He ended up buying the farm he previously managed. Fleenor is a strong advocate for talking more openly about mental health. He said farmers need to let go of the “machismo BS and quit being Mr. Tough Guy.” There's nothing tough, he said, about suffering in silence.

A Crisis Hotline for Farmers

As commissioner of the Virginia Department of Agriculture and Consumer Services, Jewel Bronaugh meets with a variety of commodity groups. And at seemingly every meeting, someone calls for help for farmers, citing their stress or a friend's loss of life.

The issue of farm stress is directly tied to economics, Bronaugh said. And this is a time when farmers are struggling financially.

“When you go through these tough economic times those incidences of stress and depression and suicide tend to go up,” she said. “It's happened before.”

Bronaugh knew she needed to do something. She'd heard about a crisis hotline for farmers in Colorado and is now working to bring a similar hotline to Virginia. In Colorado, Bronaugh said, cards printed with the hotline number said something general, along the lines of “times are hard, you need to talk about it, call this number.” It was a simple invitation to talk.

“I would very much like to get a hotline up and running in the state of Virginia so that if someone is in a dire situation, they can call the hotline, they can talk to someone who not only understands the cues of stress generally but also understands the language of a farmer,” Bronaugh said.

The commissioner is currently putting together a task force, which includes Niewolny. It will also have representatives from Virginia Farm Bureau, cooperative extension, the Department of Behavioral Health and Development Services and the Virginia Agribusiness Council.

Understanding the Financial Squeeze Many Are Facing

In January, cooperative extension agent Cynthia Martel traveled to Michigan State University so she could be trained to provide workshops on farm stress.

Martel, who specializes in dairy and is based in Franklin County, estimated there were 100-some people at the training, with more than 20 states represented, illustrating the scale of the problem.

The average person doesn't understand the financial squeeze many farmers are experiencing, which can lead to stress and health problems, both physical and mental. But Martel does. For some it's a struggle just to put food on the table, a sad irony.

“They can hardly afford to go buy it themselves in the grocery store,” Martel said. “And they're the ones who produce it all.”

Martel attended the Michigan State training with Jeremy Daubert, a dairy extension agent serving Rockingham County. Since then, the two have been organizing local workshops on farm stress for farm families and people who work with agricultural producers, like veterinarians or loan officers.

The workshops cover a variety of topics, Martel explained: identifying signs of a farmer in distress, explaining how stress can cloud judgment and lead to accidents or injuries on the farm and sharing calming strategies.

Martel said she tries to emphasize to farmers that they need an outlet, someone to talk to. Often, she said, the best person to reach out to is “their neighbor, their fellow farmer.”

It can help farmers to realize they're not alone and their problems are not unique. Local extension agents are resources, too.

Additionally, Martel said she'd like to find therapists and mental health professionals who are willing to offer an initial consultation or a one-hour session with a farmer for free. She also plans to organize a brunch for spouses of farmers so they can better identify symptoms of stress or depression.

Martel didn't expect mental health would become a key focus of her work as a cooperative extension agent. But as times have changed, so has the job.

“We have to make the changes to go with that to help our farmers out,” she said.