Suffering in Silence

July 21, 2016 - 2:58pm

Mental health services in rural Nebraska are few. The stresses from a changing climate could make it worse.

As a child growing up in rural Nebraska, Keith Rexroth would often turn to the northwest to see a storm brewing near his hometown of Sidney, Nebraska.

These days, the storms have changed. They usually come from the Four Corners and his nearly 40-square-mile farm is largely affected by the unpredictable weather. Rexroth, now 65, makes more money off of his crop insurance than he does from harvesting wheat. He gets $7 per bushel of wheat in crop insurance. He would have to spend a total of $8 to harvest.

“I’m faced with the emotional flip-flop of, ‘I’m here to grow this stuff, but the economics say it’s almost better to get hail,’” Rexroth said.

Stories similar to Rexroth’s have sprouted up all over the state. Experts say the climate in Nebraska will be radically different in 50 years and as annual temperatures rise and new heat records are set, water will become scarce.

For farmers, a change in the weather can mean withering crops, withering income and along the way, withering mental health.

“Your funeral is going to depend on what the weather is doing,” Rexroth said.

Those fortunate enough to have access to an expert often avoid treatment due to stigma. And in many of the vast counties that don’t have a single mental health practitioner, community members turn to the two familiar pillars they know they can rely upon.

Their religion and each other.

Keith Rexroth sits in a coffee shop in Sidney, Nebraska. Instead of turning to mental health professionals or religious organizations, Rexroth primarily relies on talking with other farmers to relieve the stress of his profession. (Photo by Allison Hess)


There’s a stereotype common in rural communities that in hard times, no matter the circumstance, farmers just pull themselves up by their bootstraps.

Samara McPhedran describes the assumption as “the tough and self-sufficient rural man, isolated, suffering in silence against great personal and environmental adversity.”

She said this idea is harmful and largely based in stigma. McPhedran, a researcher at Griffith University in Queensland, Australia, who has studied mental health in rural workers, said seeking help or showing any signs of a crack in the armor in rural communities can be seen as weakness.

Learn more about Nebraska's Changing Climate in a series of multimedia stories produced by students in the College of Journalism and Mass Communication at the University of Nebraska-Lincoln.  The students' reporting was part of a class taught by professor of practice Matt Waite. 

In Nebraska, the physical toll of what McPhedran called environmental adversity--drought and water shortage, primarily-- has bled into people's lives, and no amount of bootstrap pulling can solve deteriorating mental health. At best, those in rural communities must put on a brave face and toil in silence. At worst, they turn to self-harm.

“It goes in cycles, Rexroth said of his own mental health challenges. “Due to medical and physical challenges, sometimes you say, ‘I don’t want to do this anymore.’”


Throughout and after Nebraska’s 2012 drought, which experts deemed on par with the Dust Bowl of the ‘30s, rural counties in Nebraska saw spikes in the suicide rate. An analysis of suicides by local health department - the state Department of Health and Human Services does not release suicide data for small counties to avoid identifying individuals - showed that in 2013, the rate of suicides in Banner, Box Butte, Cheyenne, Dawes, Deuel, Garden, Kimball, Morrill, Sheridan and Sioux counties jumped by 12 suicides per 100,000 people.

In 2012, suicides in Fillmore, Gage, Jefferson, Saline and Thayer counties rose by 29 deaths per 100,000 people.

“Some days were on the fringe of stepping in front of a bus,” Rexroth said. “You wonder, ‘Is it worth it?’”

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Suicides in rural Nebraska counties spiked after the 2012 drought, analysis of data from the Nebraska Department of Health and Human Services shows. Chart by Reece Ristau.

When farmers do seek mental health counseling, they’re often left in the dark. A June 2015 Nebraska Behavioral Health Workforce report found as of 2014, there wasn't a mental health provider in 48 of Nebraska's 93 counties.

Such a lack of access to mental health counseling is concerning to mental health experts, who say rural mental illness goes untreated as a result.

“As you get more rural, it becomes so much more challenging to maintain those types of professionals,” said Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations and a former state senator. “We don’t have the numbers of trained psychologists and mental health practitioners.”

For many farmers, burdened by the stress of poor farming conditions and with seemingly nowhere to turn, they look to their communities for support.

Steven Sugden stands with his sons his sons in front of his farm near Adams, Nebraska. (Photo by Allison Hess)

Steven Sugden, a farmer in Adams, Nebraska, began farming when he was in high school and went full time in 2005. He has experienced many stressful farming periods due to weather, particularly in the last four years.

“It’s hard on the farmers, but I think that it’s even harder on the families,” Sugden said.

Sugden’s form of community support comes from coaching his son’s little league baseball team.

“It takes my mind away from the farm, even if it’s only for an hour or two,” Sugden said. “There are still nights that I lie awake at night and just think.”

Others anonymously seek help to combat their stress. Jerry Albright, director of the Interchurch Ministries of Nebraska, helps run a program called the Rural Response Hotline. In the last quarter of the year alone, the organization has received 865 calls and acquired 71 new clients, most with concerns about mental health.

“The cost of land is to account for a lot of that,” Albright said. “Many farmers rent their land, and land prices have gone up while the farmers’ return has gone down.”

Jerry Albright, the Executive Director of the Interchurch Ministries of Nebraska, sits in his office in Lincoln, Nebraska. He and his organization run the Nebraska Rural Response Hotline, which serves as an outlet for the farmers during stressful times. (Photo by Allison Hess)


Mental health experts in the state are trying to change things on two fronts: access and stigma.

Richard Bischoff, professor and chairman of the University of Nebraska-Lincoln’s child, youth and family development department, has been implementing what he calls tele-mental health services to rural communities. The system is similar to Skype, where patients go to their local hospital to receive counseling from a mental health expert on video.

Nearly all of the people with knowledge of the mental health crisis in rural communities say overcoming stigma is the most important and most challenging problem at hand. Brent Anderson is the executive director of Cirrus House, an organization that works to provide quality of life and independence for people living with mental illness in the Nebraska Panhandle. Anderson said it’s important to understand that mental health is like any other illness.

“Seeking help if you’re depressed is no different than going to the doctor if you have high blood pressure,” Anderson said. “It’s something you can get help with.”

Rexroth has participated in his own counseling, which he said helped.

“Going through a counseling program turned my head around,” he said.

More often though, he turns to those closest to him.

“‘Hi, how you doin’ really does mean something out here.”

Every Thursday morning, Rexroth can be found at his local coffee shop, chatting with other farmers about the problems they’re facing, from family to the weather to the things that keep them up at night.

“You have those that you can count on, be it friends or family members, that you can talk about certain things,” he said. “That is your social, that is where you learn - that is also where you vent.”

It’s how they get by.

Editor's Note:  This article was written by University of Nebraska-Lincoln students Reece Ristau and Allison Hess. This story and the other student stories linked above are part of a reporting project on climate change in Nebraska produced as part of a class taught by professor of practice Matt Waite. This article is an effort by NET News to highlight the students' reporting on this important issue. 

Jerry Albright, the director of the Interchurch Ministries of Nebraska, discusses the increased stress levels of farmers throughout Nebraska. Video by Allison Hess and Reece Ristau.



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