No Easy Answers in Bioethics: Supporting Michigan’s Agricultural Community

MSU Extension farm stress management specialist Eric Karbowski joined the "No Easy Answers in Bioethics" podcast from the MSU Center for Ethics and Humanities in the Life Sciences to talk about the work being done in Michigan to support the well-being of farmers, agribusiness professionals, and the broader statewide agricultural community.

This episode of "No Easy Answers in Bioethics," a podcast from the MSU Center for Ethics and Humanities in the Life Sciences, focuses on work being done in Michigan to support the well-being of farmers, agribusiness professionals and the broader statewide agricultural community. Dr. Karen Kelly-Blake, assistant director and associate professor in the Center for Ethics and Humanities in the Life Sciences, is joined by Community Behavioral Health Extension Educator Eric Karbowski and Dr. Melissa Millerick-May, who holds appointments in the Division of Occupational and Environmental Medicine, Environmental Health & Safety, and Michigan State University Extension. Mr. Karbowski shares MSU Extension resources available to farmers experiencing stress, including webinars, teletherapy and other programs that help to reduce stigma still associated with behavioral health. Dr. Millerick-May discusses her ongoing work on farm safety, including tools developed in response to the COVID-19 pandemic. Both guests also discuss what led them to the work they are currently doing at MSU. Please note that this episode does contain brief mentions of suicide in the context of suicide awareness and prevention. The National Suicide Prevention Lifeline (U.S.) is available 24/7: 1-800-273-8255 or visit suicidepreventionlifeline.org.

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: "While We Walk (2004)" by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License

Episode Transcript

Liz McDaniel: Hello and welcome to another episode of No Easy Answers in Bioethics, the podcast from the Center for Ethics and Humanities in the Life Sciences at the Michigan State University College of Human Medicine. In this episode, Center Assistant Director and Associate Professor Dr. Karen Kelly-Blake is joined by two individuals affiliated with Michigan State University Extension. MSU Extension “helps people improve their lives by bringing the vast knowledge resources of MSU directly to individuals, communities and businesses.” Behavioral health educator Eric Karbowski shares ongoing work being done in Michigan to address farm stress, and Dr. Melissa Millerick-May discusses her work on COVID-19 agricultural preparedness and an ongoing project that helps keep agricultural workers and the public safe. Finally, please note that this episode does contain brief mentions of suicide in the context of suicide awareness and prevention.

Melissa Millerick-May: Hi, my name is Melissa Millerick-May. I’m an assistant professor of medicine in the Division of Occupational Environmental Medicine at Michigan State University. I also hold appointments with the MSU environmental health and safety department, and MSU Extension. And I’m happy to be here. Thank you for having me.

Eric Karbowski: Hi, my name is Eric Karbowski and I’m a behavioral health educator with MSU Extension that focuses on farm stress, working with farmers and farm families around the state, providing them some behavioral health supports and resources.

Karen Kelly-Blake: I am Dr. Karen Kelly-Blake. I’m an associate professor in the Center for Ethics and the Department of Medicine. I am also the assistant director for the Center for Ethics here in the College of Human Medicine. Welcome, Eric and Melissa, thank you so much for being with us today.

EK: Thank you very much for allowing us to be part of this.

KKB: Our discussion will broadly search on the work, Eric, you’re doing related to farm stress. And Melissa, your work on COVID-19 agricultural preparedness and other areas of interest. You’re both doing exciting and important work, so I want to make sure we touch on as much of it as possible. So, Eric, can you give us some background on what led you to joining MSU Extension and working in farm stress?

EK: Yeah, absolutely. I appreciate you asking that question. While growing up, my grandparents were farmers, and I also married into a farming community. And prior to my accepting my role with MSU Extension, I served in the public mental health system as a supervisor for over ten years. Having that experience, I’ve had the fortunate and unfortunate experience, both personally and professionally, to see the impact of mental illness on a family as well as loss of life by suicide. And so I openly share that knowing that there are a number of stigmas out there that are associated to mental health. And having that connection and that empathy with the farming community, you know, I share that experience to help embrace and support and encourage farmers to reach out and break down some of those stigmas, and access resources that are available to them.

KKB: Thank you for sharing that, Eric. That’s very important, because we do know that unfortunately there is still stigma attached to having mental health issues. So, we know that farming is a stressful occupation that is both physically and mentally challenging. What are some of the programs that MSU Extension provides to the farming community?

EK: Yeah. So currently we have three different programs that we offer to the farmers and agribusiness community. One is “Communicating with Farmers Under Stress,” and that is geared more toward the agribusiness community. And really through those four different units, we work with agribusiness community on identifying and responding to signs of stress. What are some of the strategies for maintaining or working with farmers that are dealing with stress. And then also how to help people that are in need. And through the “Weathering the Storm” curriculum, cultivating a productive mindset. We, again, there is some overlapping content, but really it’s to, what are some of those identified areas of stress that farmers are experiencing? How do you help someone in need? What are some of those supports that are available? What are some of the warning signs and symptoms of suicide, and what are some of those resources that are available? And then most recently we created a shortened program that we call “Mending the Stress Fence.” And again, it’s to help the farmers and agribusiness community identify some of the signs of stress. What are some of those coping mechanisms or strategies that we can incorporate into this toolboxes to help the farmers and farm agribusiness professionals work through maybe some of the different stresses that they’re experiencing. Also how to ask open-ended questions. And again, what are some of those warning signs of suicide and what are some of those resources that are available.

KKB: So, to piggyback on what you just said. One, could you define what you mean by agribusiness for our audience members who may not understand what that means specifically? And then, two, if you could speak a little bit more about what are some of the signs of stress that farmers, farm workers, and family members should be aware of.

EK: Yeah. So, in farming, agribusiness are essentially a lot of the different workers that maybe communicate or interact with farmers. Maybe it’s with an elevator, maybe it’s a fertilizer salesperson, maybe it’s a seed salesperson, maybe it’s a loan officer. All of these different people interact with farmers. And so we wanted to make sure that they were aware and understand what some of the signs and symptoms of a farmer that is experiencing significant amounts of stress could be, so that they are better equipped to A, identify them, but then also connect them with some of those supports and some of those resources that really might be able to help potentially save their lives. And then so some of the things that, you know, farmers that are experiencing stress, there are a number of different things that farmers, just like you and I, could experience, but maybe it’s trouble sleeping, it could be over eating, under eating. There may be some of these psychosomatic pains that are created. You know, are you having back aches, are you having some of these different things that maybe could be associated to your work, but maybe are just compounding issues that are created by the levels of stress that the farmers are experiencing.

KKB: So then, Eric, what are some of the tools and intervention approaches used when connecting with farmers to help them manage stress or behavioral health concerns?

EK: Right. Well, we know that farmers traditionally are a very independent culture. And we also understand that, you know, sometimes talking about feelings and mental health and stress don’t often come naturally, for, for farmers. And so with that, there’s no one-size-fits-all tool that comes with recovery and support. So what we’ve tried to do is incorporate a number of different tools to help create awareness to those. And some of those are the evidence-based practice motivational interviewing. Some of them are asking open-ended questions. We also, in our most recent program, incorporated the eight dimensions of wellness so that people will have the opportunity to kind of explore what really works for them. What are things that I can go to and I recognize. What are, you know, once I recognize, creating this level of self-awareness that I am experiencing stress, what, what tools work for me, where can I go, what are some of those things that I can do to kind of help control and balance some of the stress that I’m experiencing.

KKB: So could you expand a little bit more on eight dimensions of wellness?

EK: So, when, when we talk about the eight dimensions of wellness, there’s the physical, there’s the intellectual, there’s financial, environmental, spiritual, social, occupational, and emotional. Are the eight dimensions of wellness. And through that, you know, we like to give the farmers the opportunity to kind of explore what those are. And through our different programming and outreach efforts, we say, okay, you know, what are the things that you can control? What are those things that you can do to, to stay connected, to stay with, within your peers? So that, because we know that staying connected can really be beneficial in terms of, you know, decreasing stress, helping allow you to vent, connect with peers, troubleshoot, problem-solve. And so those are some of the things that we talk about when we go through the eight dimensions of wellness, as well as the impact that just being physically active can do for, for your mind and your body.

KKB: Thank you so much for that, Eric. So with the number of uncontrollable risk factors involved in farming, what resources are in place for suicide prevention?

EK: Yeah, there are a number of uncontrollable risk factors that are involved in farming. You know, the weather can be a huge factor. Just different machinery breakdowns, disagreements with family members. Those are all things that we talk about, and work with farmers on. And so one of the really exciting things that we’ve recently created is a partnership with Pine Rest behavioral health with MSU Extension. And through that, we are able to connect farmers with teletherapy supports or online counseling with master’s level clinicians. And there are a lot of really cool things about this program. One is, is that all of the farmers that are connected with a therapist, the therapists themselves have an agricultural connection. So they’re either farmers, grew up on a farm, or have some level of connection to the agricultural field. So, the farmers that have went through this program really shared that the counselors are able to empathize on a lot of different levels. Because farming doesn’t necessarily start at nine and end at five every night. And some of those different ups and downs that the farmers are experiencing, really, the therapists are able to relate with them. In addition to that, we also have some funding available, because we wanted to reduce as many barriers to accessing this program is as possible. And so currently we do have funds to help offset the costs associated for the farmers. And those are available again to help the farmers, you know, when they need them. Because we really didn’t want the farmers to be put in a position where they’re trying to decide, do I buy Cheerios for my family or do I access behavioral health supports? And so that has been a very exciting opportunity that a number of farmers across the state are really taking advantage of.

KKB: That sounds very exciting Eric, especially the teletherapy component. But could you speak briefly to the fact that we’re hearing so much and reading so much about the lack of broadband access in rural areas? I would imagine that would also impact a farmer’s ability to access teletherapy. Could you speak to that a little bit?

EK: Yeah. I think that is kind of the reality of a lot of the issues that we’re confronted with within that. Many of the farmers themselves either reside or are located in rural areas. And so, some of the workarounds that we’ve tried to do is, the nice part about this is you can really access these services from anywhere. So if there are local libraries that have high-speed Internet, if there are local areas in, in your community that you can, that you can go into and connect with on those platforms. It can be really done anywhere. This also helps support the reduction of stigmas that are associated to farmers actually driving their, their vehicle to a behavioral health office or a setup. And so I think that too they’re able to connect with that therapist in a place that they’re comfortable, in an environment that they’re comfortable. So, we don’t have all the answers to that. But I think there are some workarounds that we’ve definitely worked with the farmers on.

KKB: Oh fantastic. So, Eric, I do understand that MSU Extension was the recent recipient of two grants for farm stress. Can you share more about these efforts with our audience.

EK: Yeah, we’re very excited about the two grants that we have, and we’ve called them right now “The Legacy of the Land.” And through these different grants, really it is foundationally based on creating opportunities to support farmers. And some of the key offerings that are in this grant are farm financial analysis, farm stress resources, business management strategies, as well as offsetting some of those supports as I shared with the teletherapy, the costs associated with that. In addition to that, we have mental health first aid trainings that are becoming available, and Mental Health First Aid is an evidence-based practice that is really designed to help support individuals in their awareness and recognition of mental health. What are some of those resources that are available to them? And what can they access? And so we’re very excited about these opportunities. And in addition to that, we’re really trying to incorporate a wraparound approach. We’re involving behavioral health educators in addition to the farm financial managers. So that we’re looking at some of the farmers that maybe are going, are struggling with maybe their business, what their next business needs are, what the direction they should go. And instead of just giving them numbers, we’re also trying to say, okay, how does involve the family? What are some of those things? How are you handling your stress? And so we’re able to, for farmers that are interested, connect them with those next level supports through this, through this grant and through this opportunity.

KKB: That sounds fascinating. So, because of the rural nature of the farm industry, are there any efforts to keep farmers engaged and connected with their peers? And, I would like to, if you could, speak to the dynamic nature of that. When we talk about peers, oftentimes people are thinking about farming as a male-centric enterprise, when really we’re talking about families, and often, in many cases, we’re also talking about women who are leading those efforts. So if you could talk about how you are keeping farmers engaged and connected with their peers. However those peers are being defined.

EK: So, historically, farmers would often get together. There are often gatherings where they would, you know, connect with each other to talk about their problems, to talk about maybe their concerns to, to troubleshoot, to problem-solve. And those have kind of just gradually decreased. And so, what we’ve tried to do is create a natural support system where it originally, it originated where it was in person. But now because of, since COVID, we have transitioned that to more of an online platform. And through that opportunity, we call it “Lunch Break.” And so we encourage farmers, farm families, agribusiness professionals, regardless of gender, regardless of what their occupation or involvement in farming is, to connect with us and stay connected, to connect with some of their peers. You know, what are some of those things? And through this “Lunch Break,” we are working, we have various topics that we have field crops that provide a segment. We have beef and dairy that provide a topic. We also have financial, we call it “Financial Fondue.” We try to have fun and keep people engaged. And then I provide a “mental health minute” we call it. And so, really what that is, it’s a platform to keep people connected, to give them some, some information. But then really with the hopes are that they would continue to reach out and stay connected with their peers.

KKB: You spoke to many different resources available, and what you all are doing to engage farm workers who may be experiencing stress. Are there any other resources that people can access to learn more about farm stress?

EK: There are. Through a recent partnership with MSU Extension, University of Illinois Extension, Farm Credit, American Farm Bureau Federation, and the National Farmers Union, we were able to create a three-unit self-paced course that we call “Rural Resilience.” And through this, participants are able to access the course as many times as they, they want or may need. And some people that have been exposed to behavioral health may find some of it to, they may be able to go through the course a little bit faster than others, but, this is a great opportunity for people to identify different stress factors that are involved in farming, communicating with distressed farmers. And again, it talks about suicide awareness. What are some of those local and national resources that are available to help support the farmers that are need.

KKB: So Eric, I just want to say that you really are doing very exciting and important work. Do you have any additional closing comments you would like to make sure our audience takes away with them from this presentation?

EK: Yeah, thank you very much. I just always like to share that, know that there are a number of people that are working very hard behind the scenes to support the farmers as they support us, and we appreciate all the work that they’re doing.

KKB: Thank you so much, Eric. So we’re going to sort of switch our attention to Dr. Millerick-May. Dr. Millerick-May, I know a little bit about your research background. Can you tell us how did you come to support MSU Extension and ultimately the agricultural industry here in Michigan?

MMM: Yes, thank you. So, prior to coming to MSU, I worked in the automotive industry with a focus on preventing workplace exposures. So everything that I’ve done, both again in the industry, workplace environment, as well as my current research activity focuses on understanding workplace exposures, environmental exposures to various airborne contaminants. And, along with that, the goal is ultimately to reduce or eliminate those exposures. So, much of what I do is readily transferable to agriculture. I first began supporting MSU Extension when, several years ago, when we were trying to identify potential sources of exposure for a pathogen that was transmitted through air that causes pigs, swine, to become ill and die. And so, the goal in some of those early projects were to identify risk factors on-farm risk factors for transmission of disease. And ultimately come up with strategies to prevent pathogen transmission. So, you know, that led to continued efforts not only to support the ag industry in terms of food animal production, but then that segwayed into something that I’m also very familiar with in quite a bit of the work that I did in industry, which has to do with general workplace safety. And so I began working with Extension in the farm safety realm, helping to support our, our farmers and our farm operators. And, you know, fortunately or unfortunately, when COVID came around in early 2020, the leadership at Extension contacted me and said, hey, this looks like this may be something that’s that’s up your alley. Can you think of a way that we can, we can quickly support, support our farmers, and help them fight through this.

KKB: Well thank you so much for that. So, can you tell us a little bit about your efforts then to support the MSU agriculture community when the COVID pandemic began?

MMM: Yeah. So as I mentioned, MSU and AABI leadership contacted me right away to see if we could pull together a team, a rapid response team, to support, to support our farmers, to support our industry. And that’s really where our efforts began. So, early on in the year, we developed an e-tool that’s called MSU E CHAMP, which is the MSU Extension COVID-19 Hazard Assessment and Mitigation Plan. The e-tool was developed in a flexible format. Essentially, you know, we had to do this quickly. So it was an Excel workbook that, that we designed. And we did this as a means to support the ag community in addressing requirements not only by the state, to conduct job and task-based hazard assessments, but also to develop tailored mitigation strategies in an effort to identify risk factors that would help slow the spread or mitigate the spread of COVID-19 amongst the workforce, as well as between the workforce and the public. For public-facing operations. So it was sort of a dual purpose approach, again, to satisfy state requirements for open businesses. And early on it was for essential businesses, and then it, and then it expanded, those requirements were expanded to all open businesses to, you know, protect our workers. But again, to also protect the public.

KKB: So it sounds like you were really engaged from the very beginning in trying to ramp up a lot of resources for our agricultural community to help them be able to continue their vital work during the pandemic. So do you foresee the need to continue with this effort now that the vaccine rollout is underway?

MMM: That’s a, that’s a great question. And, in short, yes. So we just found out a couple days ago that workers, ag workers, will be able to begin scheduling for vaccinations as early as March 1st. So, that’s, that’s absolutely fantastic. That said, it’s gonna take awhile for all that want to be vaccinated to cycle through the process. And, I’m not sure if you’re aware, but in Michigan we have quite a few seasonal employees. We rely on seasonal employees on our farms. And so, as those individuals will be coming in from out-of-state, you know, it’s going to take awhile to get everybody through the vaccination process. So, between the timing of the vaccine rollout as well as, we’re hearing, we know that new and more virulent strains of COVID-19 continue to emerge. It’s really become apparent that there’s gonna be a need for increased as well as sustained efforts in support of the agriculture industry in order to protect our workforce. And again, as I mentioned previously, the public. And ultimately the supply chain. So, you know, if we don’t have, if we don’t have the workers, we won’t have food available. We know that early on in the year, I’m sure you recall, there were runs on, you know, meat products. So we couldn’t find poultry, or we couldn’t find pork in grocery stores. And there were farms where we know that COVID-19 spread through the workforce quickly and it also almost decimated those operations, and food supplies coming out of those operations. So, you know, we really, really need to protect this industry.

KKB: So, to that end, because that makes perfect sense, would this MSUE CHAMP tool have utility outside of pandemic preparedness?

MMM: So, in short, the answer to that one is yes, that’s a great question. So, much like the hazard assessments as well as the development of mitigation strategies that were required under the auspices of pandemic preparedness planning we saw for COVID-19, prior to COVID-19 there was activity already surrounding other ag-centric programs. Such as biosecurity, food safety, farm safety, emergency preparedness. Now all of these activities require a careful evaluation of an operation, in terms of risk for a given outcome or threat. Earlier on in our conversation I mentioned an airborne pathogen that was greatly affecting swine producers. Pork producers. So in the same vein, you know, they’ve, they’ve worked with, they’ve worked with this stuff before. Maybe not with respect to a human pandemic, but definitely in other aspects of their business. So development and implementation of targeted practices and procedures aimed at prevention and mitigation, as well as continual monitoring of the effectiveness of these plans that I mentioned—the biosecurity plans, food safety planning, farm safety, emergency preparedness—is really essential. So, this requires, keeping up with all of this is a full-time job in itself. These guys and women are incredibly busy. So, this requires substantial effort in terms of, of data capture and reporting, development of written programs, as well as careful training of the workforce. So, what we aim to do with our CHAMP tool, with our online tool, is to expand the tool to support these activities. Because if you think about it, there’s quite a bit of overlap in terms of the data and the operational characteristics, that are need to support those activities that I mentioned. So again, not only pandemic preparedness, like COVID-19, but also biosecurity, food safety, farm safety, emergency. You know, it’s, it’s sort of one of these, you know, let’s see what we can do to support the ag community in satisfying all of these requirements and making sure that they’re ready. What can we do to facilitate their activities? Because we know that, we know that they’re busy, and they’re, you know, it’s a lot. It is a lot.

KKB: Mm-hmm. So it sounds very complex. Can you describe for our audience your approach?

MMM: Yeah, certainly. So, one of the things, I actually helped to develop a similar tool when I worked in industry. And one of the things that I heard from plant management and support staffs that is, seems to be a common thread with those stakeholders that I’ve spoken with in the ag industry, is that what they really want is, is one-stop shopping. Or the equivalent of, you know, a 7-Eleven. They want to be able to go to one place. So they recognize the fact that a lot of the data inputs that are required to develop the programs that we just spoke about are similar. And they don’t wanna have to, to take redundant steps in order to satisfy each of those programs. So, I’ve heard loud and clear, and our leadership team has heard loud and clear, that one-stop shopping is the key. So, what we intend to do is to, to expand this CHAMP tool into a web-based web served app that’s guided by that one-stop shopping notion. Sort of the all data and insights will be held in one place type notion. That aims to provide a set of capabilities for our users to collect, visualize, and analyze their data and information from their operations. Or in the case of business consultants, agribusiness owners, and agricultural workers, to establish situational awareness, evaluate and mitigate risks, develop strategies during emergency responses like COVID-19 as well as other pending disasters, which hopefully we won’t, we won’t see one of those for a long time. And to also make smarter decisions to build organizational resilience through, you know, harmonization with assessments, and again, mitigation strategies for other biological agents, chemicals, physical hazards, you know, consisting with existing programmatic activities that they’ve got in place. Again, such as food safety, emergency preparedness, environmental stewardship, and biosecurity. And I know this is a podcast and sometimes it’s difficult to, when listening to all of this, understand how there are common threads between each of those programmatic activities. But, when you, when you really get down to the nuts and bolts of that, probably, you know, 60 to 70 percent of the data that needs to be, that needs to be collected and analyzed is common between those. So one of the things that we hope, we hope to do, or we’re targeting to do, planning to do in support of our industry within this new CHAMP app is to hold virtual training, develop webinars, online educational courses, as well as sets of curated videos, printables, modifiable templates that are translated into multiple languages and can be essentially a plug-and-play for those operations. So something that fulfills the, the perhaps regulatory or internal requirements for their programs that again, are flexible and easily modifiable. If that’s a word. Modifiable to, to their operation. So, we have been building commodity specific teams to help guide us in the development of these tools. And the, another thing that we’re going to do, because we recognize that the, that farmers, that business owners may not have staffs or access to individuals that have sort of a risk assessment, hazard assessment, exposure assessment background. And we’re going to assemble a team that can be deployed to be able to do on farm site-specific planning, and consulting for our farmers, our business owners and operators. So I’m hoping that that’s going to be, we’re hoping that that’s going to be very valuable in terms of assisting with the development and implementation of these tools. So, you know, as I mentioned, we’ll have the ability to do on farm and virtual consultations. And what we’d like to be able to do is carry them out in a “train the trainer” type format to be able to further knowledge and skill development of those individual on the farm who are responsible for these types of programming. So that this will be a tool that’s going to be sustainable, and, again, flexible for them. So, and, you know, to make sure that we’re doing a good job, what we’ll be able to do is then follow up with, with those that are interested in utilizing our tools to evaluate the ease and completeness of use, as well, you know, in evaluating those responses that will help inform us as to where we may need to, to, to tweak the systems or take it, you know, at perhaps a different direction in terms of modification of the tool with respect to ease of use. So, so far, you know, our team, we’ve been, we’ve been charging ahead full steam. As I mentioned, we’ve developed these subject matter expert teams that are commodity specific, and we’ve been reaching out to farmers and other stakeholders for their input so that we can, we can figure out how best to support them in all their activity related to this.

KKB: Fantastic. So, with that, we are at the end of our time. But can you briefly provide any final comments that you would like to provide, Dr. May, if there’s anything?

MMM: I think I’d like to echo what Eric said earlier. Please get in touch. If you need assistance, please get in touch. There are many of us working behind the scenes to support the industry. So, contact your local Extension agents. Our contact information will be available on the website for which this podcast is posted. As well as there are many resources that are that are searchable, that are easy to find from the MSU Extension webpage.

KKB: Thank you so much. So I just want to thank both of you again. You, Eric. You, Melissa. It was a fascinating discussion. Again, I just want to emphasize with our audience the important work that you are both doing, and that I wish you both the best in your continued research efforts and the work that you’re doing because it is important. Oftentimes, I don’t think people understand that Michigan is an agricultural state. And it’s important for us to support our people who are providing food for us. And the work they do is of vital importance, and it is indeed essential. So thank you both very much. We do appreciate you taking the time. And we wish you all the very best. Thank you so much.

MMM: Thank you.

EK: Thank you.

LM: Thank you for joining us today on No Easy Answers in Bioethics. Please visit us online at bioethics.msu.edu for full episode transcripts and other resources related to this episode. A special thank you to H-Net: Humanities and Social Sciences Online for hosting this series. This episode of No Easy Answers in Bioethics was produced and edited by Liz McDaniel in the Center for Ethics. Music is by Antony Raijekov via Free Music Archive.