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A farmer is shunned by his local community due to the effects of depression and fails to look after his animals properly. In his isolation he attempts suicide. Chris Coates (left) tells Graham Hopkins how joining the farmer in the fields helped him regain his self-respect

Craig Marston (not his real name), a farmer from a well established farming family, was referred to the national lottery-funded Rural Emotional Support Team on its first day of existence. He was in serious trouble. His erratic behaviour and history of mental health problems had seen his family exclude him. Also, like the agricultural community at large, he had refused support from health or social services.

“Farmers are very proud people who have their own culture,” says Chris Coates, co-ordinator of Rest. “Because of the isolated manner of their work, they don’t want outside help. They value and respect each other, so once shunned by that community where does (Marston) get that respect from?”

It was this lack of respect that Coates set about restoring. Marston was due in court facing possible imprisonment for, among other things, cruelty to animals and non-payment of fines. “When we went to find him,” says Coates, “we didn’t know where he was in this village. People just said ‘Oh the lunatic - he’s up the road. What do you want to do anything for him for? - he’s a pest.’ They’d made their judgments. But we hadn’t.

“He wouldn’t comply with Trading Standards - and incurred fine after fine,” adds Coates. “But they lost the plot also. All Trading Standards could see was that he was not doing what he had been told. The RSPCA turned up one day and shot his animals - some of them in front of him. But these animals were also his friends, his company. He attempted suicide.”

Coates, while attempting to convince Trading Standards, RSPCA and the police to  view Marston differently, set about gaining Marston’s respect. Coates’s own agricultural background helped as did his willingness to work the fields - and know what he was doing. “We talk his language,” he says. “One day I used a word - I think it was ‘therapeutic’ - and he just looked at me as if I was talking Swahili. You’ve got to talk to people at their level - in a way they understand.”

The court case was very humiliating for Marston - his name and photo made the paper. “This just isolated him more and more,” Coates recalls. But despite the loss of his house and what little livelihood he had, previous suicide attempts and the killing of his animals, Coates was convinced that Marston should stay out of care and in his caravan.

“We stood for hours with him in the fields - in the freezing cold. We spent time with him. We weren’t going to bring police in and arrest him as had happened before. We spoke to police and said ‘hold on - this is the real situation, not what had been said by villagers.’

“We want him to have the life he wants. However, there are boundaries to this. We said he’s got to start talking to Trading Standards - not shouting at them. And keep his appointments. He has to face up to his responsibilities. Sometimes that means going back to his caravan upset. And that’s the risk we take - what’s he going to do when he’s there? Especially when he looks out on an empty field.

“But we give him reassurances,” continues Coates, “we say that we will be back tomorrow - we are his friends, we’re not going to judge him. We’d have hours of crying and extreme upset and threats to kill himself and so on. But we were there. We were there to listen to him.”

The risk of keeping Marston in the community, for Coates, diminished quite quickly. “We talked to him like a human being for starters,” he says, “and we explained what the symptoms he displayed were. And so we looked at ways he could cope with that and, importantly, what he can do to help himself.”

It certainly wasn’t a one-way furrow being ploughed: “He has tested us,” admits Coates. “He’ll say he wants this and he wants that. And sometimes we’ll say ‘yeah, fine’. Other things we’ll say ‘no’. But we explain what we won’t or can’t do and we won’t leave until he understands why. He understood we knew what he was going through because we were speaking the same language as him.”

The reason Marston hasn’t made any suicide attempts since Rest has been involved is clear to Coates: “We have given him back his self-respect by showing him respect - which is something nobody else has really done.”

Case notes:

PRACTITIONER: Chris Coates

FIELD: Co-ordinator of the Rural Emotional Support Team (Rest)

LOCATION: South Staffordshire

CLIENT: Craig Marston (not his real name) is a 63 year-old farmer from a large and well-established farming family.  He has been variously diagnosed with severe depression and schizophrenia.

CASE HISTORY: Marston was admitted to a psychiatric hospital about 20 years ago.  Shunned by his family, he later resumed farming, but this failed.  Three years ago he bought a house with some land and began to take in sheep.  However, he had clearly lost the rationale for farming and began buying old ewes that he felt sorry for.  Unable to afford to keep them properly, they began dying.  He didn’t dispose of them properly. Neighbours reported him and over 18 months a case was built up to prosecute Marston for cruelty. He moved into a caravan - which even his sheep stayed in.  Nobody recognised the mental health problems.  

DILEMMA: The loss of his animals and licence to farm could undermine attempts to encourage Marston to take responsibility for himself.

RISK FACTOR:  Marston has attempted to take his own life in the past and events could prove too much for him if left in the community.

OUTCOME: Although banned from farming for 10 years, Marston’s quality of life continues to improve with strong support from Coates and his team.

Arguments for risk

- For the first time Marston has been actively engaged by a mental health support service and has been responding positively.

- Marston’s positive response was, in part, a reaction to the non-traditional health or social services model of support being offered, and, crucially, because he felt that Coates, given his rural background, understood his situation.

- Coates and his team were not prepared to judge Marston on his history or the picture painted by family and neighbours.

- Since Rest’s involvement with the case, Marston has kept appointments. Therefore, Coates was confident that he was taking responsibility.

- Having managed to achieve the support of the main players - police, Trading Standards and the RSPCA - in viewing Marston’s situation as a whole, including his mental health needs, Coates successfully eased the array of pressures that caused Marston’s anxiety and fears.

Arguments against risk

- Farmers have one of the highest suicide rates in Britain (which was the case even before BSE and Foot & Mouth) - a fact that is underlined by their work and lifestyle being characterised by isolation and stress.

- Marston had been shunned by his family and friends. He had lost his farms, most of his land and his house in order to pay debts. He had nothing except his animals and his farming - but then both of these were taken away from him. He had made an attempt at suicide previously and talked about taking his life.

- His experience of health and social care support had been a very negative one. Sectioned and admitted to large psychiatric hospitals he received no support once he was discharged. If he raised mental health issues he feared being “carted away and locked up again”. This might cause him to consider a more drastic option.

Independent comment

The earlier mental health experiences that Craig Marston suffered are reasonably common, writes Dr Eric Davis.

Craig Marston displays a classic profile of a farmer who is at moderate to high risk of suicide due to a range of clinical and actuarial (for example, age, race and sex) variables. He is also at higher risk because he is male, white, unmarried and living alone. In addition his recent job loss and depression add to this risk.

Chris Coates’s team has done a very good job of assertively engaging Craig Marston. The Rest team met Marston on his own territory, as opposed to Marston having to leave his community and enter a psychiatric environment, such as a day centre or hospital.

Also, the credibility of Coates and Rest with their rural background, will have helped in the rapport-building with Marston. The practical nature of the support is important. Although a mental health problem has been identified, Coates and colleagues have successfully encouraged Marston to face up to his responsibilities. This maintains and augments flagging levels of self-respect. Because Marston has valid goals to aim for, this will, in turn, be expected to help counter clinical depression, and its deadly counterpart hopelessness, virtually a constant feature in completed suicides.

The Rest team should continue their excellent inter-agency liaison work, judging by their record of work with Trading Standards, RSPCA, and the police.

Dr Eric Davis is consultant clinical psychologist, East Gloucestershire NHS Trust.