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Growing from the Seeds of Hope by Michael Rosmann, Ph.D., Kathy Schmitt, M.S. and Jim Meek, M.Ed. Abstract: This article reviews the Sowing the Seeds of Hope Regional Program from its beginnings to its current functioning capacity. Initially presented at the 2005 Conference of the National Association from Rural Mental Health, this article recently was published in Rural Mental Health. The article describes current essential services delivered by the SSoH State Partners, SSoH Program Outcomes and recommended future directions. The full citation for the article is the following: Rosmann, M., Schmitt, K., Meek, J. (Fall 2005). Growing from the Seeds of Hope. Rural Mental Health, 30 (4), 3-7. Sowing the Seeds of Hope: Providing Regional Behavioral Health Supports to Agricultural Population by Michael R. Rosmann Abstract: In 1999, project leaders from seven states (i.e., Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota, and Wisconsin) began to share ideas and resources for providing behavioral health assistance (i.e., mental health counseling and addiction services) to stressed farmers, ranchers, farm workers, and their families. The seven states are among those most impacted by farm crisis of the 1980s and again by low commodity prices and disasters such as droughts and floods in the 1990s. Project leaders conferred in monthly telephone conference calls and by 2001 began meeting in semi-annual face-to-face meetings to formally agree on a mission, program components, and management structure. Administrative functions were transferred from the Wisconsin Office of Rural Health and Wisconsin Primary Healthcare Association to AgriWellness, Inc., a regional nonprofit corporation founded to provide technical assistance, grant writing, training of service providers, and other administrative supports. The Sowing the Seeds of Hope program has become a model for the provision of behavioral health supports for the agricultural population, including development of farm stress telephone hotlines, provision of confidential and affordable outpatient mental health and substance abuse counseling, training of professional providers in agricultural behavioral health, training of indigenous farm and rural residents as outreach workers who can respond to disasters of all types, and weekend educational retreats for farm residents. The program has achieved economy of scale by sharing expertise across state boundaries and the formation of regional administrative structure. Yet, many challenges exist, the greatest of which is obtaining ongoing permanent support for the increasing numbers of uninsured and underinsured people involved in agriculture. The citation for this article is the following: Rosmann, M.R. (November 2005). Sowing the Seeds of Hope: Providing Regional Behavioral Health Supports to the Agricultural Population. Journal of Agricultural Safety and Health, 11 (4), 431-439. Farm Pesticides and Depression by Michael R. Rosmann, Ph.D. and Lorann Stallones, M.P.H.,Ph.D. Article: Many health care practitioners, even those in agricultural areas, are not aware that organophosphate and carbamate insecticide poisoning can lead to depression. There are established links between acute poisoning from organophosphate compounds and increased risk of suicide. Most of our common agricultural insecticides (e.g., Dursban, Lorsban, Aztec, Dyfonate, Thimet, Amaze, Furadan, Broot, to name but a few) contain one of these substances. Acute exposures to organophosphates and carbamates produce headache, nausea, muscle twitching, diarrhea, excessive salivation and sweating, difficulty breathing and severe exposures can lead to pulmonary edema, seizures and death. Some researchers have suggested when the depression that results from acute poisoning is treated with selective serotonin reuptake inhibitors (e.g., Prozac, Zoloft, Paxil, Celexa and Luvox) there may be an increased risk of suicide. Suicide is a serious issue in the agricultural population. In some areas farmers have been reported to be at higher risk of suicide than other working populations and than the general public. Exposures to organophosphate and carbamate insecticides, depression and suicide are aptly documented in a video entitled “Green Blood Red Tears,” available from Ag-Culture Media Project, 11503 Main Street, Middletown, KY 40243. These matters are getting attention in the scientific literature as well. Recent studies have suggested that the depression associated with an acute pesticide poisoning persists long after the initial episode. An excellent resource to address acute poisonings is "Recognition and Management of Pesticide Poisons" by J. Routt Reigart, M.D., and James R. Roberts, M.D., M.P.H. The book is available from the United States Environmental Protection Agency, 401 M Street Southwest (7506C), Washington, DC 20460. It can be ordered by calling (703) 305-7666. The manual is available in electronic format on the Internet at www.epa.gov/oppfead1/safety/healthcare/handbook/handbook.htm. A number of laboratories offer tests for red blood cell acetylcholinesterase enzyme and plasma pseudocholinesterase levels. Depressions in plasma pseudocholinesterase and/or red blood cell acetylcholinesterase enzyme activities can be biochemical indicators of excessive organophosphate or carbamate absorption. The test is not widely available in all hospital and clinic laboratories. Many small hospitals and physician clinics may need to send out blood samples for analysis because they do not have the equipment to conduct the test locally. An important consideration that is often overlooked and hard to accomplish is the establishment a baseline cholinesterase level. The reference range is wide and many persons may experience a drop from baseline and still be within the normal range, so additional testing is required to determine if the cholinesterase level is continuing to drop, stabilizing, or rising. It is important that health care providers have adequate information to provide education regarding the signs and symptoms related to working with these cholinesterase inhibiting chemicals. Many times farmers are not aware of the problems associated with exposures to these chemicals. Exposures can be through ingestion, inhalation and skin contact. Health care providers should be able to recommend personal protective equipment and steps that users of the chemicals can take to minimize exposures. Health care professionals need to ask questions about what types of chemicals have been used, and what types of personal protective equipment are being used. When prescribing medication for depression, clinicians should assess whether there has been an acute pesticide poisoning in the past which may have lead to the depression and should monitor these individuals closely for suicidal ideation. These are important considerations in the treatment of depression in individuals who have experienced an acute pesticide poisoning. Personal protective equipment is available from several suppliers, such as Gempler’s, Inc., P.O. Box 270, 100 Countryside Drive, Belleville, WI 53508, telephone: (800) 382-8473. Behavioral Health Access for Farm and Ranch Families by Michael R. Rosmann Abstract: This paper was presented at the Fifth International Symposium: "Future of Rural Peoples, Rural Economy, Healthy People, Environment, Rural Communities,” Saskatoon, SK, October 19 – 23, 2003. The paper summarizes the work of seven state partners, along with AgriWellness, Inc. in delivering behavioral health services to farm and ranch families and other persons involved in agriculture who are in need of assistance. A brief history of the Sowing the Sowing the Seeds of Hope program is included in the paper, along with accomplishments during the four years of its existence. Behavioral Health Supports for the Agricultural Population by Michael R. Rosmann Abstract: This article appeared in Rural Roads. It summarizes the work of AgriWellness, Inc. and its Sowing the Seeds of Hope partners in Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin. The citation for the article is the following: Rosmann, M. R. (October, 2003). Behavioral health supports for the agricultural population. Rural Roads, 1(2),10-12. Agricultural Behavioral Health: In Critical Need by Michael R. Rosmann Abstract: Farmers, farm workers and ranchers comprise a special rural population whose behavioral health care needs are seriously underserved. This review describes the rural agricultural population, economic and demographic factors affecting the well-being of this population and identifies their unique behavioral health risks. A number of barriers to effective care are identified, along with recommendations for ameliorating these circumstances. The author recommends that the critical health care needs of the rural agricultural population should be addressed as a matter of national security. Additionally, the author suggests significant collaborative efforts that need to be undertaken at the federal, state and rural levels to build a safety net of supports. The establishment of a national center for agricultural behavioral health is recommended. This article is a chapter in Partners in Agricultural Health, B. Duerst (2003). Madison, WI: The Wisconsin Office of Rural Health. Farmers Need Better Behavioral Health Care by Michael R. Rosmann Abstract: Guest editorial which appeared in Iowa Farmer Today on June 21, 2003. Sowing the Seeds of Hope --Model for Practice: Mental Health and Mental Disorders--in Rural Healthy People 2010: A Companion Document to Healthy People 2010, by Larry D. Gamm, Linnae L. Hutchison, Betty Dabney and Alicia M. Dorsey (eds). Abstract: The Sowing the Seeds of Hope program is featured as a model for practice in Rural Healthy People 2010: A Companion Document to Healthy People 2010. The program is a collaborative effort of project leaders in seven predominately rural states: Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin. Project leaders are establishing an integrated regional network of behavioral health care supports for the rural agricultural population. The citation for the article is the following: Gamm, L. D., Hutchison, L. L., Dabney, B. J., & Dorsey, A. M., (eds.). (2003). Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 1. College Station, Texas: The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center, 175-178. The article is available online at: http://www.srph.tamushsc.edu/rhp2010/Model/focus/mental.htm. Begun in 1999, the Sowing the Seeds of Hope project was designed and initiated by the Wisconsin Office of Rural Health and Wisconsin Primary Health Care Association and supported by grants from the U.S. Department of Health and Human Services Office of Rural Health Policy and Bureau of Primary Health Care. Since 2002 administrative support is provided by AgriWellness, Inc., a 501(c)(3) nonprofit organization. Sowing the Seeds of Hope activities also are supported by grants from the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration, private foundations and contributions. Agricultural Behavioral Health by Michael R. Rosmann Abstract: This is a guest editorial which appeared in the November 2002 issue of the Journal of Agricultural Safety and Health. The behavioral health risks of persons engaged in agriculture are less well understood than occupationally related medical illnesses, injuries and fatalities. A good case can be made that the behavior of persons involved in agriculture is the least understood component of their safety. Behavioral health and safety of those involved in the production of food and fiber warrants dedicated focus from scientists, educators, policy makers, funders and the providers of health services. The editorial proposes how these issues can be addressed. The Health Care Crisis Among Wisconsin Dairy Farmers by the Program on Agricultural Technology Studies Abstract: This University of Wisconsin - Madison program in Agricultural Technology Studies documents that 18% of Wisconsin dairy farmers are uninsured and 23% are underinsured (for a total of 41%). New farmers (i.e., started farming in the past five years), smaller farms (i.e., average herd size of 49 cows) and families with children under the age of 18 were more likely to be uninsured. Medium-sized farms (i.e., average herd size of 75 cows and total farm receipts of more than $100,000) and older farmers (i.e., 58% of Wisconsin dairy farmers are older than 55 years of age) were most likely to be underinsured. A farm health task group in Wisconsin is looking at various solutions to the health insurance problem: 1) Changing Medicare/Badger Care guidelines so depreciation is not included in income when determining eligibility for the program; 2) Developing health insurance risk sharing pools that include farmers, other self-employed persons and small business owners; 3) Creating incentives for federally-funded community health centers to extend their care to uninsured and underinsured farm families; and 4) Encouraging rural churches to develop parish nurse programs so basic health care services can be offered in churches. Seeds of Hope: Caring for the Mental Health of Iowa's Farm Population by Margaret Van Ginkel, Jim Meek, Diane B. Patton and Michael R. Rosmann Abstract: The Iowa Concern Hotline, the Iowa State University Extension Rural Mental Health Initiative and Ecumenical Ministries of Iowa are linking together to create a network of mental health services for Iowa's farm and rural families. AgriWellness, Inc. provides administrative services and technical assistance to the Iowa network of services. A Vision for the Behavioral Health Care of our Nation's Agricultural Population by Michael R. Rosmann Abstract: This is the Victor I. Howery Memorial Award acceptance speech, given at the National Association for Rural Mental Health Conference on August 27, 2002 at Santa Fe, New Mexico by Michael R. Rosmann. In this speech, Dr. Rosmann proposes his vision of behavioral health for the nation's agricultural producers. Sowing the Seeds of Hope: Creating a Mental Health Response for Wisconsin Farm Families in Distress by Roger T. Williams and Kathy Schmitt Abstract: It’s been a tough “row to hoe” for Wisconsin farm families. Most farm families have experienced financial distress for the past 15+ years: plummeting land values in the mid-1980s were followed by a severe drought in 1988; major feed shortages in 1989; low milk prices in the early 1990s; drought in 1992; floods in 1993; feed shortages in 1994; intense heat in the summer of 1995; a cold, wet spring in 1996; low milk prices in 1997; low beef, hog, corn and soybean prices in 1998-99; extremely low milk prices in 2000; and a cold, wet spring followed by dry conditions in 2001. This state of “chronic, prolonged stress” for Wisconsin farm families made it easy for our state to join in a federally-funded Sowing The Seeds Of Hope project to respond to the mental health and support needs of farm families in distress. The Sowing The Seeds of Hope project offered an exciting opportunity: to be part of a seven-state Midwestern project that involved each state developing the mental health and support services they needed for their farm families and to learn from each other through monthly teleconferences and occasional face-to-face meetings. The challenge became one of determining what constellation of services would be most helpful for Wisconsin farm families in need and mobilizing the people and groups that could help launch a statewide project. Sowing the Seeds of Hope: Overview of Best Practices of Agricultural Mental Health by Michael R. Rosmann Abstract: Seven states (Wisconsin, Minnesota, Iowa, North Dakota, South Dakota, Nebraska and Kansas) share resources and a common administrative structure to offer culturally specific mental health services to underserved farm and ranch families. This workshop reports the “best practices” of five projects in the region: The Wisconsin Provider Survey, the Counseling Outreach and Mental Health Therapy Project in Nebraska, the South Dakota Rural Mental Health Network, the collaborative work being done in North Dakota and the administrative coordination provided by AgriWellness, Inc. Sowing the Seeds of Hope: In Critical Need by Michael R. Rosmann Abstract: Low commodity prices, escalating farm expenses, farm consolidation, long hours of work in isolation and bad weather are factors that have created chronic prolonged stress for farm and ranch families. Sowing the Seeds of Hope (SSoH) was established on a pilot basis in 1999 to provide prevention and mental health services to farm families in seven of the most severely affected states: Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin. In the short time that the SSoH project has been in existence, more than 14,000 farm residents have participated in outreach events; at least 5,850 farm residents participated in community education and more than 4,500 farmers and family members have been linked with SSoH service providers for mental health counseling. Affiliated crisis hotlines have responded to more than 21,000 calls in the seven states. The SSoH program has been featured in Successful Farming, Rural Mental Health, and on ABC and CNN television programs. Rural Mental Health Paper for the Iowa Consortium by Michael R. Rosmann Abstract: Commissioned by the Iowa Mental Health Consortium, this paper was written in preparation for the Iowa Mental Health Forum October, 31, 2001. The paper summarizes rural mental health trends, needs of the population, availability of the model nationally, availability of the model in Iowa, empirical support for the model, barriers in general and barriers specific to Iowa. Putting the Farmer in Charge of his own Recovery by Dan Wilson Abstract: This article reviews, in brief fashion, the Farm Wrap Program in northwestern Minnesota, which attempts to connect the farmers with an array of helping services. This article first appeared in Rural Mental Health. The reference is: Wilson, D. (2001). Putting the farmers in charge of his own recovery. Rural Mental Health, 26(4), 23-24. The Ongoing Farm Crisis: Health, Mental Health and Safety Issues by Roger T. Williams Abstract: This article reviews efforts by the Wisconsin Farm Center, the Wisconsin Sowing the Seeds of Hope partner, to respond to health, mental health and safety issues of Wisconsin farm families. This article was first published in Rural Mental Health in the fall, 2001 issue. The reference is: Williams, R. T. (2001). The ongoing farm crisis: health, mental health and safety issues in Wisconsin. Rural Mental Health, 26(4), 15-17. Implementing a Crisis Counseling Program in a Large Rural Area: Iowa Recovers 2004 – 2005 by Michael R. Rosmann, Ph.D. and Lila P.M. Starr, LBSW Abstract: The Iowa Recovers Crisis Counseling Program was implemented in 75 of Iowa’s 99 counties after 69 tornadoes and 110 flash floods damaged homes, businesses, farmlands and affected the lives of more than 4,000 Iowans in late May – early June 2004. The Crisis Counseling Program was funded by the Federal Emergency Management Agency and the Center for Mental Health Services in a grant to the Iowa Department of Human Services, which contracted with AgriWellness, Inc. to deliver the services. The project ended in June 2005. Outreach workers who are familiar with the culture of rural Iowans provided the crisis counseling assistance. The project demonstrated the effectiveness of having a Ready Reserve of trained outreach workers who are geographically dispersed throughout a large rural area and who can be available on short notice to assist with the emotional toll that can accompany a disaster. Full citation for this article is the following: Rosmann, M.R. and Starr, L.P.M. (Winter 2006). Implementing a crisis counseling program in a large rural area: Iowa Recovers 2004 – 2005. The Dialogue, available at www.mentalhealth.samhsa.gov/dtac/dialogue/winter2006.asp Be Prepared: Disaster Behavioral Health Services in Rural Areas by Michael R. Rosmann, Ph.D. ABSTRACT: The effects of disasters on behavioral health can be significant. Often, people who experience a serious disaster have more difficulty coping with the emotional trauma of the event than the property damage and economic consequences caused by the event. This article describes how disaster behavioral health responses can be planned at state and local levels to enable rural communities to be better prepared for unforeseen events. The full citation for the article is the following: Rosmann, M.R. (Winter/Spring, 2006). Be prepared: Disaster behavioral health services in rural areas. Rural Mental Health, 31(1), 22-27.
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