“Lacking the rural empathy”; Irish farmers' and stakeholders’ opinions on current mental health services and preferences for support

Farmers face increased mental health risks such as depression and burnout, yet are less likely to seek professional help, compared to the general population. The reliance on informal support and a lack of rural health services may explain their reluctance to seek professional help. We examined Irish farmers' and stakeholders' descriptions of mental health services and preferences for an intervention. We conducted 17 online interviews with farmers, one online interview and 3 online focus groups with 11 farming stakeholders. Interviews and focus groups were conversational and semi-structured, covering perceptions of available mental health services and preferences for a help-seeking intervention. We analysed data using reflexive thematic analysis. We identified four themes: 1) reliance on informal support, 2) negative perceptions of available mental health services, 3) preferences for tailored mental health support, and 4) farm-centric logistics. Themes 1 and 2 illustrate how farmers prioritise seeking informal support, and how existing health services are ill-suited for farmers. Themes 3 and 4 describe ways that health services and interventions can tailor supports to farmers schedule, communication style, and emotional needs. Our results provide community-informed guidelines for improving current and future mental health service provision for farmers. Irish farmers seek and rely on mental health supports that are most accessible and accommodating for them; and therefore, currently rely on informal family and community support networks. In order to effectively support farmers, mental health services should be community-based to accommodate farmers’ specific cultural and occupational needs. These include accommodating erratic schedules, avoiding stigmatising language, and employing or working with farming community members to support each other.