Farming is a complex, stressful job that leads to higher rates of depression, anxiety, and suicide compared to other workforces and the general public (Bjornestad et al., 2021; Miller & Rudolphi, 2022). Some risk factors associated with suicide in this population include poor physical health, past injuries, maladaptive coping strategies, financial difficulties, and increased access to firearms (Bjornestad et al., 2021; Daghagh et al., 2019). A recent study assessing suicide characteristics of farmers and non-farmers found that 33% of farmers and ranchers who committed suicide were found to have a precipitating physical health condition (Miller et al, 2022). A systematic literature review was done in 2020 to explore the risk for depression and suicide among United States’ (U.S.) primary farm operators and their family members. The review concluded that people who are engaged in farming should be screened for depressive symptoms (Reed & Claunch, 2020). We also know that the mental health of a farmer affects the whole family unit. One study by Rudolphi & Berg (2023) found that among the farming community, there were strong associations between the mental health of parents and their children, as well as between parents’ depressive moods and financial debt.

This population also faces barriers to accessing healthcare, especially mental health services. Some reasons for this are the lack of mental health services in rural areas, the time-consuming nature of farming, availability of affordable and appropriate health insurance for self-insured farmers, and the stigma surrounding mental health conditions in the rural and farming communities (Bjornestad et al., 2021). Farmers may also not seek out mental health services due to an inaccurate perception of their own mental health. In a recent study researchers found that when farmers were asked to rate their mental health, they tended to rate it as good or excellent, but when screened for mental health conditions, over 60% met the criteria for depression and anxiety disorders (Rudolphi & Berg, 2023).

Currently there are many resources and programs aimed at addressing farmer mental health. Many free online resources can be found through state and national agricultural organizations. Additionally, many of the programs designed to address farmer mental health are free online or have waiver options (Younker & Radunovich, 2021). In a systematic review of mental health interventions for farmers, researchers concluded that due to the complex nature surrounding farmer mental health, there is a need for multifaceted educational interventions targeted at farming communities, professionals who work closely with farm communities, and health professionals (Younker & Radunovich, 2021).

Farming is a dangerous job that poses a high risk of injury and illness. Farmers are also an aging population, with the average age being 56 years old (U.S. Bureau of Labor Statistics, 2022). Due to elevated age and physically demanding, dangerous work, farmers are likely to suffer from an acute or chronic condition that requires the attention of an occupational therapist (Hildebrand et al., 2019). Occupational therapy practitioners (occupational therapists and certified occupational therapy assistants) are rehabilitation specialists who use a client-centered approach to address skills needed to participate in meaningful and purposeful activities, also known as “occupations”. The Occupational Therapy Practice Framework (OTPF) is a document prepared by the American Occupational Therapy Association (AOTA) which describes the role and the purview of the occupational therapy profession. According to the OTPF, the occupation of health management includes symptom management related to mental health needs (American Occupational Therapy Association, 2020).

While adults are traditionally referred for occupational therapy services to address a physical limitation, it is also within occupational therapy’s scope of practice to address a patient’s mental and emotional health as it pertains to meaningful occupational participation. This junction provides a space for occupational therapy practitioners who are seeing farmers for physical dysfunction to assess and address mental health and wellness within their treatment sessions. Even though it is within occupational therapy’s scope of practice to address client mental health needs, many occupational therapy practitioners may not feel equipped to use these skills and may not understand how to integrate mental health interventions into their practice (Gutman, 2011).

The aim of this study was to evaluate outcomes of an educational program directed toward addressing farmer mental health within occupational therapy practice. This was done first through the development and delivery of a training session tailored to occupational therapy practitioners and occupational therapy students in a variety of forums. The session intended to (1) raise awareness about risk factors for mental health conditions related to farming, (2) promote the use of assessments to identify mental health needs, and (3) provide practitioners with strategies and resources to address farmer mental health. Second, the usefulness of the training was evaluated through pre- and post-training surveys that assessed self-reported changes in self-efficacy to address farmer mental health within occupational therapy practice.

A total of 119 participants (39 OTPs and 80 OTSs) completed the pre-training survey and 119 participants (46 OTPs and 73 OTSs) completed the post-training survey. OTPs were asked if they currently addressed farmer mental health in their practice and if they did, how did they address it. Thirty-seven OTPs answered the question with the majority (76%) reporting that they did not address farmer mental health in their practice. Of the nine OTPs who reported that they did currently address farmer mental health in their practice, four practitioners specified the following settings: specialized nursing (SNF) and long-term care (LTC) facilities, inpatient rehabilitation, inpatient psychiatric unit, and community programs. Six OTPs specified ways they address farmer mental health. One OTP reported tying in agricultural leisure activities to address quality of life in the SNF and LTC setting. One OTP reported addressing farmer mental health following traumas. One OTP reported addressing substance use. One OTP reported addressing mental health with older farmers and ranchers.

There was a significant increase (p ≤ 0.001) in confidence in addressing mental health with the farming population for both OTPs and OTSs (Table 1). In the pre-training survey, 18% of OTPs and 39% of OTSs reported being not confident at all in addressing farmer mental health. 38% of OTPs and 39% of OTSs reported feeling slightly confident while 11% of OTPs and 1% of OTSs felt very or extremely confident in addressing farmer mental health before the training. In the post-training survey, the number of OTPs and OTSs who reported feeling very or extremely confident increased to 42% and 28% respectively with no participants reporting feeling not confident at all.

There was a significant increase (p ≤ 0.001) in confidence in screening/assessing a farmer for mental health concerns for both OTPs and OTSs (Table 2). In the pre-training survey, 21% of OTPs and 41% of OTSs reported being not confident at all in screening/assessing a farmer for mental health concerns. 33% of OTPs and 36% of OTSs reported feeling slightly confident while 13% of OTPs and 2% of OTSs felt very or extremely confident in screening/assessing a farmer for mental health concerns before the training. In the post-training survey, the number of OTPs and OTSs who reported feeling very or extremely confident increased to 61% and 41% respectively with no participants reporting feeling not confident at all.

There was a significant increase (p ≤ 0.001) in confidence in ability to provide appropriate community resources to a farmer struggling with mental health for both OTPs and OTSs (Table 3). In the pre-training survey, 23% of OTPs and 38% of OTSs reported being not confident at all in providing appropriate community resources to a farmer struggling with mental health. 44% of OTPs and 43% of OTSs reported feeling slightly confident while 16% of OTPs and 5% of OTSs felt very or extremely confident in providing appropriate resources. In the post-training survey, the number of OTPs and OTSs who reported feeling very or extremely confident increased to 42% and 42% respectively and one OTP reported feeling not confident at all.

When asked on the post-training survey how likely they were to address farmer mental health in their practice going forward, 22% of OTPs and OTSs reported being extremely likely to address it. Additionally, 43% of OTPs and 60% of OTSs reported being somewhat likely to address farmer mental health in their future practice. Only one OTP and one OTS reported being extremely unlikely to address farmer mental health in their future practice.

In the post-training survey, ten total OTPs and twenty-nine OTSs provided feedback on what additional resources would help them feel more confident to address farmer mental health in their future practice. Two OTPs and one OTS felt that the training provided sufficient resources, while one OTP requested “any and all” resources. The remaining respondents specified additional needs, which were grouped into seven categories: resources for farmers, practice scenarios, occupational therapy-specific resources, training access, exposure to the farming population, raising other professionals’ awareness, and further education and training for occupational therapists. The most requested resources were for farmers and practice scenarios. See Table 4 for specific data related to additional resources.

There is an opportunity for occupational therapy practitioners to be involved in the mental healthcare of farmers through mental health screening and intervention, as well as dissemination of mental health resources. Physical health conditions are often addressed by occupational therapists throughout the rehabilitative process. While occupational therapy practitioners address physical dysfunction in patients, it is also within their scope of practice to address the mental health needs of patients. There is an opportunity for occupational therapy practitioners to assess and address farmer’s mental health needs during the physical rehabilitation process with potentially less mental health related stigma. Additionally, farmers are more likely to engage with mental health interventions if they feel their practitioner understands the specific stressors farmers face and can provide tailored interventions to meet their needs (Hagen et al, 2019).

The aim of this pilot study was to develop and evaluate an educational training on addressing farmer mental health in occupational therapy practice. The training was evaluated by comparing pre and post training survey data between two groups, OTPs and OTSs. The results from this comparison indicate that both groups significantly increased their confidence in addressing farmer mental health, assessing farmers for mental health concerns, and providing appropriate community resources to a farmer struggling with his/her mental health. Additionally, when asked at the end of the training how likely they were to address farmer mental health in their practice going forward, 65% of OTPs reported that they were somewhat or extremely likely “to address it compared to 76% of OTPs who reported that they did not currently address farmer mental health in the pre-training survey. Overall, the majority of respondents in both groups reported that they were somewhat or extremely likely to address farmer mental health in their practice with only one respondent from each group saying they were extremely unlikely to address farmer mental health in their practice. When asked what resources would be most helpful, respondents generally reported a desire for resources for occupational therapists and for farmers, specific to practice settings and geographic regions. Some respondents reported that having some sort of role play scenario or case study to work through would have helped them to feel more confident in addressing farmer mental health. These items should be considered in future programming of this nature. It is important to note that five OTS respondents felt they would benefit from access to the resources and information from the training. All participants, as well as the general public, have access to the presentation slides as well as handouts detailing assessments, financial resources, and further education programs covered in the training on a public webpage. The educator discussed how to access these resources at the end of every training session, however, this result indicates that more time may need to be spent directing participants to resources or providing participants with a physical handout of how to access resources.

Farmers have higher rates of suicide and mental health conditions like anxiety and depression compared to other workforces as well as the general public (Bjornestad et al., 2021; Miller & Rudolphi, 2022). It is within occupational therapy’s scope of practice to address the mental health needs of farmers as it pertains to their engagement in meaningful and purposeful occupations (American Occupational Therapy Association, 2020). This pilot study evaluated the efficacy of a one-hour mental health training provided to occupational therapy practitioners and graduate students on addressing farmer mental health within occupational therapy practice. Results from the study indicate that occupational therapy practitioner and student self-efficacy in addressing farmer mental health increased after the training session. Future research on occupational therapy’s role in the prevention and treatment of farmer mental health conditions as well as farmer perception of occupational therapy intervention should be explored.