Tamsin Fisher is a research associate at Keele University, Staffs.
Daniel James is a GP partner in Bury St. Edmunds, Suffolk.
Richard West is a GP partner, in Bury St. Edmunds, Suffolk.
Jordan Tsigarides is a senior research fellow, University of East Anglia, Norwich, Senior Clinical Fellow in Rheumatology, Cambridge University Hospitals, Cambridge and Chief Medical Officer, Revolve Labs Ltd, Cambridge
Carolyn Chew-Graham is Professor of general practice research, Keele University, Staffs.
Do you serve a farming community? Do you ‘make every contact count’?
Agricultural workers account for approximately 470,000 people living and working in rural communities across the UK,1 around 104,000 of these are farmers.2
A Farm Safety Network survey of 450 farmers identified that 92% of farmers under 40 years of age believed that poor mental health is the leading hidden problem facing farmers today.3 Self-harm and suicide are commonplace within rural communities such as farming and other types of agricultural work.4 Office for National Statistics (ONS) figures show there were 84 recorded suicides in agricultural workers in England and Wales in 2020.5
Evidence suggests that marital problems, access to means (poison and firearms), loneliness and geographical isolation are risk factors for suicide in farmers.
Evidence suggests that marital problems, access to means (poison and firearms), loneliness and geographical isolation6 are risk factors for suicide in farmers.7 Other risks include finances significantly higher standards of food production (meat and non-meat produce) compared to overseas counterparts.8 Farmers may suffer moral injury9 due to blame attached for climate change and the ‘anti-meat agenda’.10 More recently, the announcement that inheritance tax will be applied to farm businesses from 1st April 2026.11 Whilst the rate of tax was adjusted in the November 2025 budget, the threat to farm businesses remains.
Access to healthcare for farmers can be a challenge due to stigma associated with help-seeking, but also rural inequalities, such as poor public transport and a lack of local, convenient healthcare services, and limited mental health training for health care providers.
Gender disparity within these communities is also prevalent with males being subjected to stigma and gender stereotypes (stoic men)6, with the fear of being perceived as weak and unmasculine being a barrier to seeking help.
In the ethnographic work conducted as part of the FARM-SP study,12 people in farming communities in the West Midlands have reflected on the multiple challenges they face. They avoid using the terms depression or anxiety. Farmers acknowledge that their peers might be struggling with ‘stress’ related to their working conditions and other external pressures and describe how they help other people to seek support – mostly from farming organisations, services which often have a presence in livestock markets. Primary care was not felt to be accessible to people in farming communities and farmers were worried that their difficulties would not be understood by primary care clinicians. Where NHS checks were offered at livestock markets, they focused on physical health such as blood pressure and weight with advice on smoking and alcohol.
Farmers and farming organisations we have spoken to have reflected on recent suicides in their networks and suggested that we will see more suicides as April and the inheritance tax changes, approach.
Primary care was not felt to be accessible to people in farming communities and farmers were worried that their difficulties would not be understood by primary care clinicians.
One clinician-led response to these challenges is the Rural Minds project,13 developed in partnership with farmers, agricultural organisations and rural charities. The project emerged directly from concerns raised by farming communities about rising distress and suicide, alongside a perception that primary care does not always feel accessible or attuned to the realities of agricultural life. Rural Minds focuses on improving clinicians’ understanding of how mental distress in farmers is expressed, often through physical symptoms, exhaustion or “stress”, rather than through conventional mental health language.
The principal output of the project is a virtual reality learning module, primarily aimed at GPs and primary care clinicians, designed to build confidence in recognising risk, asking the right questions and responding in ways that feel credible and culturally safe to farmers. A shorter, farmer-facing version has also been developed to support farming communities themselves, and to be used by farming and mental health charities as an outreach tool to raise awareness, reduce stigma and encourage earlier conversations about mental health within rural settings.
Whilst farmers may not present to general practice consultations with mental health difficulties, our work suggests they do want to be asked how they are feeling and be offered advice and support.
So – if a farmer does consult – do ask – “How are you? How are you feeling?”
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