He was a farmer. A well weathered looking man in his fifties. Gnarled hands clutching his hat, muddy boots on his feet.

It was as if the stereotypical farmer our lecturers back in the big smoke had told us about was sitting in front of me. I could hear them saying “Men in the country don't come to the doctor until they absolutely have to”.  “They'll only come in when they're sick of their wife's nagging” or “Farmers don't talk about their feelings, they think it's an unmanly thing to do. That's why there's such a high rate of suicide in the country”. I expected this consultation to play out along those lines.

Male farmers in Australia die by suicide at more than twice the rate of the general employed community.

The reasons for this seem fairly straightforward.

Farming is hard work, physically and mentally demanding. It is a livelihood of huge financial instability, dependent on the totally uncontrollable events of Mother Nature. It is socially isolating. Many farming communities around in Australia are in decline. Their populations are ageing, young people are moving away to the cities. Things are hard, and compounding that is a lack of mental health services in the bush and easier access to weapons and poisons. Finally there is the fundamental issue of the attitude among Australian men that it is a sign of weakness to seek help.

Presented like this, it seems the best solution will be to address this harmful attitude.

We need to encourage more male farmers to access mental health services.

There is no point simply increasing the availability of mental health services in rural areas if these men are not going to use them anyway, right?

But thinking like this may well be a major mistake.

A 2015 study found 43 per cent of Queensland farmers who died by suicide from 1990 to 2008 had had contact with a mental health professional. That is, nearly half had decided to seek help.

This brings me back to our patient. “How are things going?” my GP supervisor asked. Expecting an answer about millimetres of rain in the past month or the price of wheat I was jolted out of the world of textbook answers and big city experts. “I've been feeling pretty good. There was a hard patch over Christmas when none of the kids came home, but I've been doing what we talked about. Going fishing with Harry when we get the chance. It's great to have someone to talk to.” 

What had just happened to my stereotype? It was evaporating in front of my eyes.

Assuming male farmers do not even access mental health services is a harmful assumption to make because it results in a tendency to ignore whether appropriate services are available in the first place.

The study mentioned above raises the important issue of whether those men who make contact with a mental health professional but still commit suicide actually got the help they needed.

The authors question whether a young, newly trained mental health personnel straight out of the city is the right person to help the farmer who decides to seek help.

In the case of our patient, a trusted family GP was the perfect person to talk to about his mental health, highlighting the vital role GPs can play.

As such it is essential all medical students receive adequate mental health training during their studies, and that this training should continue throughout their careers. It is also essential that other mental health services are tailored for rural people.

Luckily such services are being introduced and strengthened, and this needs to continue.

The Shed Online is one such example, a website designed to provide an easy way for men who might otherwise be socially isolated to connect with other like-minded people and discuss a wide range of topics of interest, as well as being a source of health and lifestyle information.

Local Men’s Shed groups also exist around Australia and have been established in many rural towns.

More, however, could be done to ensure mental health personnel who work in the bush have the training and understanding required to be able to develop a good relationship with rural men, including by increasing the number of people from rural backgrounds that go into these professions.

The assumption that the fundamental reason for the increased rate of suicide among male farmers is their reluctance to seek help also means a tendency to ignore the potential of tackling the factors that make farming such a stressful livelihood in the first place have a large role to play.

Strengthening programs to support farmers in the wake of catastrophic events like drought and floods is vital, as is helping farmers to build businesses that are better able to cope with such events.

Increasing access to further education and employment in rural areas is a crucial way to strengthen rural communities, increasing their capacity to support their residents.

The higher rate of suicide among male farmers is much more than an issue of these men not wanting to seek help.

While it does play a role, addressing the problem requires considerably more than addressing this one aspect.

It is essential that more is done to address the factors that make farming such a demanding profession and to ensure appropriate services are available to these men.

Due to their ability to build strong, long-term relationships with their patients rural GPs have a large role to play.

If you or someone you know requires assistance, contact Lifeline on 131 114 or Beyond Blue 1300 22 4636.