Minnesota built a rural therapy program for farmers struggling to cope. Can it be replicated?
Minnesota’s state legislature has invested in a unique, heavily utilized Rural Mental Health Outreach program. Other states are interested.
When Pam Uhlenkamp separated from her husband earlier this year, she knew the person to call.
As a farm business management instructor, Uhlenkamp mentors farmers one-on-one. When she notices they’re stressed, she refers them to the man who’s been the go-to counselor for Minnesota farmers for decades. The morning after the separation, she called him, and, by the afternoon, she sat opposite Ted Matthews.
“Today sucks. Tomorrow is going to suck. The next three weeks are going to suck,” Uhlenkamp remembered Matthews telling her in their first session.
This story is part of a yearlong project exploring the ways farmers and farming communities tackle mental health and is supported with a grant from the Solutions Journalism Network.
“He was very honest with me,” she said. “Sometimes in life you kind of need the two-by-four across the head that says, ‘Yep, this is awful and this is the reality.’”
The approach worked for Uhlenkamp, who credits Matthews with improving her mental condition. Farmers struggling with stress have turned to him, too. Matthews takes calls at all hours, including weekends, though he said he’s so passionate for the work that he barely notices the hours he puts in.
“I’m in my office before 7 every morning, five days a week and then on Saturdays I’ll see people who can’t see me during the week, and I’ll take calls on Sundays,” Matthews, 73, said. (During one 45-minute interview, six people called him, he said.)
Handling the growing number of farmers who seek counseling as climate change and trade wars uproot their lives requires working around the clock, he said. A January study by the Centers for Disease Control and Prevention found that farmers are among the most likely to die by suicide, compared to other occupations. USA Today and Midwest Center for Investigative Reporting found that hundreds of farmers in Midwestern states have died by suicide in the past few years.
With more farmers needing help, the Minnesota legislature decided last year to pay for another counselor to assist Matthews. After he worked for more than 20 years alone, Monica McConkey, 49, joined the Rural Mental Health Outreach program in October.
Farmers are among the most likely to die by suicide, compared to other occupations.
The program has become so successful that other states are calling Matthews and McConkey for training sessions and advice on how to start something similar. Matthews said he’s trained farm bureaus and county extensions in several states, including Pennsylvania, Texas and Iowa.
Wisconsin Farm Center recently introduced a pilot program that partially mimics Minnesota’s through a 24/7 hotline and telehealth services with a counselor named Jessica Beauchamp, director Jayne Krull said.
However, she said, the farm center would love to have a continuous program like the one in Minnesota, which her team looks to as a resource.
“Through our 24/7 line and Jes, we’re pretty much trying to emulate what Ted and Monica are doing,” Krull said.
But Minnesota’s system isn’t an easy one to replicate, Matthews said. His hours are extremely irregular and almost always more than the average 40 hours a week.
Matthews credited the lack of red tape for the program’s success.
“There’s just no way you can have a bureaucratic system where you’re answering to this person and answering to that person,” Matthews said, “so they pretty much leave me alone.”
Minnesota state representative Jeanne Poppe, a Democrat who chairs the Agriculture and Food Finance and Policy Division committee, said Matthews and McConkey are more like state contractors than employees.
“Being kind of an independent contractor gives them a little more freedom and flexibility,” she said. “That works hopefully for them. It definitely works well for us.”
Another reason for the success, Matthews and McConkey said, is that they both understand farm life.
“If they’re seeing a therapist or a counselor that they feel like just doesn’t get it,” McConkey said of farmers, “they don’t go back.”
It’s difficult to quantify the program’s success, but the number of people Matthews counsels has increased over the years.
During his first year in the 1990s, he said he saw 30-35 people. In fiscal year 2020, he’s counseled 20 farm families, 15 couples, 40 individuals and eight farm business management instructors and their families, according to the program’s year-end report.
Poppe said she has anecdotal evidence from farmers that the program has been successful.
“Some have expressed that they were on the verge of considering end-of-life actions and found some support this way,” she said.
“If they’re seeing a therapist or a counselor that they feel like just doesn’t get it, they don’t go back.”
Because of this, the legislature has continued to fund the program, she said. This fiscal year, the budget was upped to $250,000 so McConkey could be hired. Prior to that, the budget was $113,000, according to data provided by the Minnesota Senate.
“The need for the second person came about as a result of more difficult times on the farm,” said state senator Bill Weber, a Republican, who chairs the senate’s agriculture committee. “They were seeing an uptick in the number of people that were requesting the services, whereas for the most part, Ted had been able to handle the numbers prior to that.”
For Uhlenkamp, Matthews’ counseling works so well because he gets people to consider the things they can control. In his office, he allowed her to sit, cry and ask questions.
“He doesn’t necessarily offer you, like ‘I think this is what you should do, this is the advice I give you,’” she said. “Instead, he questions you to challenge your thinking to change that thought process, to change it from negative thoughts to positive thoughts. Do you really think it was your fault, or is it out of your control? And if it’s out of your control, then how do you control the things that you can?”
After another session with Matthews, she felt she occupied a very good place mentally for the next couple weeks, she said.
“It’s because I constantly think about the words that Ted says,” she said. “He’s really good about saying them three, four, five times within a session to make you think about it, so when you leave, you still think about those words.”
“Farmers don’t call up psychologists.”
Matthews first started working with farmers in 1993 when he was the director of mental health at Federal Emergency Management Agency in Minnesota. A farm business management instructor reached out to him and asked if the organization worked with farmers.
“I said, ‘Well, we work with everybody,’” Matthews said. “Then I looked on our books and no farmers had called before that. That’s when we recognized that farmers were not really being listened to.”
Rural mental health first gained national attention during the Farm Crisis in the 1980s, experts said. National Farm Medicine Center study found that 913 male farmers died by suicide in Wisconsin, Minnesota, North Dakota, South Dakota and Montana from 1980 to 1988, according to a 1991 New York Times article.
Suicide rates among farmers remained steady in the following years. Between 1992 and 2010, 230 farmers in the U.S. died by suicide, according to a University of Iowa study.
Matthews eventually started working with the Farm Business Management program and originally received funding from Otto Bremer Trust. Eventually, a Farm Business Management leader worked with the Minnesota government to get it funded by the state.
“Then I looked on our books and no farmers had called before that. That’s when we recognized that farmers were not really being listened to.”
Because several people in the Minnesota House and Senate are farmers themselves, they supported funding the program, Matthews said.
“They recognized that farmers don’t call up psychologists, farmers don’t call up clinics,” he said.
Originally, Matthew’s services were only for those in the Farm Business Management program. But because many people can’t afford it, his work eventually expanded to all farmers.
Matthews said a major reason why the program works is because Democrats and Republicans both support it. He, however, avoids any political talk because he thinks it could jeopardize farmers seeking help from him.
“I really don’t like to get into the politics of things because people twist it to Democrat and Republican and all I think about is the farmers,” he said.
“That will slam the door on you as fast as you can possibly imagine.”
McConkey’s great grandparents on both sides of her family started their own farms. Her parents and brothers still operate their family farms, and she helps occasionally, she said.
It’s because of this, she said, she’s able to relate to the people she counsels.
Before starting with the Rural Mental Health Outreach program, McConkey worked with rural communities for 25 years in the behavioral health field. The first 12 years were spent providing counseling services to at-risk youth and their families. After that, she worked various administrative roles and supervisory roles in both an outpatient mental health setting, as well as an inpatient psychiatric setting.
But when she was offered the job working with Matthews, she knew it was a perfect fit.
“I feel like, in a sense, I’ve come back home,” McConkey said.
Before his FEMA job, Matthews worked four years as a medic in the Air Force and then several years at a hospital clinic as a counselor.
Although Matthews did not grow up on a farm, his father worked in the mining business, where workers often striked. Eventually, he said, that helped him understand all the ebbs and flows of the farming industry.
When he started working directly with farmers, he needed several conversations with people in the Farm Business Management program, the Minnesota Department of Agriculture and farmers themselves to fully understand their work.
Matthews said one of the biggest differences with farmers is that their job isn’t just an occupation. It’s a way of life.
Thomas Gauvain, The Midwest Center for Investigative Reporting
“It’s not as simple as saying, ‘Well if you’re losing money, why don’t you try something else?’” he said. “Because for almost every farmer that I’ve ever worked with, that will slam the door on you as fast as you can possibly imagine.”
McConkey and Matthews both said that because farms are often passed on through generations, being the person to lose it causes tons of stress.
Farmers’ work also relies entirely on weather and markets, making their work extremely unpredictable. Events like the COVID-19 pandemic and the trade war with China have made their work especially challenging.
More so than most, the job also includes a lot of family interaction. This frequently creates family and marital strain, Matthews and McConkey said. The wife—and sometimes the husband—are often working off the farm in order to support the business, which can be an added stressor.
Matthews said farmers are working longer than they used to and have more land to manage than in years’ past. Some will often work into their 80s, which means the farm isn’t passed down until the son or daughter is in their 50s or 60s. This can create a power struggle, he said.
“It’s not as simple as saying, ‘Well if you’re losing money, why don’t you try something else?’”
Because farming is different from other occupations, Matthews and McConkey said they take different approaches. One of the main things they stress is focusing on what can be controlled, such as spending time with family, rather than what can’t be controlled, such as the weather.
In his sessions, Matthews homes in on family, which he said many farmers say is very important to them.
“If family is that important, what are you doing to strengthen that?” he said he asks them.
McConkey said she’s starting a new online course to help engaged or newlywed couples learn farming basics, finances, communication and farm stress. Having early discussions about communication and problem-solving is extremely important, she said.
“I think a lot of couples go into farming just really not being prepared for the toll it’s going to take on their marriage,” McConkey said.
“My goal is to work with them until they don’t need a service.”
Like Matthews and McConkey, Beauchamp, a rural mental health therapist in Wisconsin, answers calls at all hours. She’s seen people as early as 7 a.m. and as late as midnight, she said.
Wisconsin farmers can receive free telehealth counseling with Beauchamp through Wisconsin Farm Center’s new pilot program, which is partially based on Minnesota’s services. Before, people could get in-person counseling through the farm center’s long-standing voucher program, but they’re limited to three free sessions. The new telehealth services, however, are unlimited.
“My goal is to work with them until they don’t need a service,” Beauchamp said.
Also, a 24/7 Farmer Wellness Hotline has been established for people who need immediate care. The workers on the hotline are licensed mental health counselors, program director Krull said.
They were trained for about a month by Matthews and McConkey, she said.
The program is also offering “Question, Persuade, Refer” virtual training sessions, which is meant to help people identify mental health crisis situations and refer them to the correct care.
“I think a lot of couples go into farming just really not being prepared for the toll it’s going to take on their marriage.”
Because this is just a pilot program that started this summer, Krull said these services are only available for one year. Then the state of Wisconsin will assess how effective the changes have been.
So far, no other state has the exact same set-up as Minnesota, but Matthews and McConkey are frequently visiting other states to provide training on how to work with farmers. The pandemic has stalled this, though.
Like Wisconsin, some states have a voucher program or a hotline. In Nebraska, farmers have access to both a hotline and a voucher program, with up to five free sessions.
Illinois currently doesn’t have anything similar to Minnesota, but Matthews has done training sessions with the Illinois Farm Bureau. The state is hoping to have a hotline devoted just to farmers soon, according to the state’s farm bureau.
But there are two reasons for why other states haven’t replicated the Minnesota program, Matthews said.
The first is because bureaucracies typically don’t like having a program where the control is mostly left to one person, he said. The program functions because the state allows him and McConkey to work the way they see best.
“The reason it got to the point it is now is because it started so small,” Matthews said. “Because it was funded that way, nobody was asking me for all of those things that most large bureaucracies asked for and by the time it became as big as it is now, it was already developed.”
The other reason is Matthews’ passion for the work.
“You have to find people who are self-starters,” he said.
His family is supportive of his work, but it has taken a toll: Although his adult children often visit him, he hasn’t been able to journey to Arizona to see them in several years.
McConkey added that the work can be stressful at times, but she tries to practice what she tells her own clients — to take time for themselves. She hikes, reads and gardens.
As for Uhlenkamp, she’s experienced tough days since her separation. But Matthews has given her more confidence to work on what she can control.
Recently, because of the pandemic, she went into her office for the first time in a while.
“Big day for me,” she texted Matthews.
“Be safe, I’m your biggest cheerleader,” she said he texted back.
Without him, “I honestly think I would be an absolute emotional wreck,” she said. “I just honestly don’t know where I would be if I didn’t have Ted as a support system.”