Foot and mouth outbreak: lessons for mental health services

The 2001 foot and mouth disease outbreak in the UK was widespread and devastating. Some areas (e.g. Cumbria) were very badly hit, but all farmers were affected to some degree. Huge numbers of animals, infected and healthy, were slaughtered. Tourism was badly affected. Data from three systematic studies found elevated levels of psychological morbidity among farmers and other rural workers, especially those directly affected. Most farmers turned to family and friends (and veterinary surgeons) for support; relatively few approached health or social services, mainly because they did not see their reactions as illness. Many farmers and other rural workers prefer to use supports within their own community, or anonymous supports such as self-help materials or computer-based treatments. Mental health services should take account of these preferences by adopting an educational and consultative role in any similar outbreak. David Peck is Professor of Health Research at the University of Stirling (Highland Campus, Old Perth Road, Raigmore, Inverness IV2 3FG, UK. E-mail: [email protected]). From 1988 to 2004 he was head of Clinical Psychology Services for NHS Highland. He has special interests in mental health services in remote and rural areas and in delivering services using new technologies. Foot and mouth outbreak 271 Advances in Psychiatric Treatment (2005), vol. 11. http://apt.rcpsych.org/ income-generating activities such as tourism and haulage; this additional income rapidly ceased. Many parts of the British countryside were virtually closed by these and other official restrictions, discouraging walkers, cyclists and other holidaymakers. There were unavoidable and obtrusive signs of the culling throughout the countryside, which also deterred visitors. Thus, many rural communities suddenly lost income from their two main sources, agriculture and tourism, with knock-on effects for public transport, agricultural suppliers, catering and other local industries. Some urban areas also suffered, with the closure of zoos and nearby country parks. The economic costs of the outbreak were high. Thompson et al (2002) estimated that the losses for agriculture and the food industry were over £3 000 000 000, with similar levels of loss for the tourist industry. It has been argued that tourism was economically more adversely affected than agriculture: farming received compensation for losses, but tourism did not. Farming hardships before the outbreak Before the 2001 outbreak of foot and mouth disease, British farming, especially livestock farming, was in a parlous state (Box 1). Previous diseases that had damaged the industry included bovine spongiform encephalopathy (BSE) and swine fever. Moreover, the prices of agricultural products, especially meat and dairy, had dropped markedly in recent years. Incomes were therefore very low, especially in upland sheepfarming areas, where the average annual salary in 2001 was about £6000. Nearly a third of upland farmers had net incomes of less than zero. Many farmers also had large debts, on average £50 000. Bureaucratic procedures, especially the requirement to complete numerous official forms, were major additional stressors. Not surprisingly, farmers began to leave the industry: about 5% of the workforce had left in 1999/2000 alone. Many farmers regard farming as a way of life rather than just a job, and for them giving up farming would be particularly deleterious to mental health. Moreover, in farming, houses are often ‘tied’ to the job; therefore leaving farming could be highly disruptive to daily life. Mental health of agricultural workers The mental health of farmers had been investigated before the outbreak of foot and mouth disease by Thomas et al (2003). At that time, only 6% of farmers reported clinically important psychological morbidity, less than in the general population. Similar low figures for overall psychological morbidity in rural areas before the outbreak had been reported by Paykel et al (2000). Paradoxically, however, Thomas et al did note that farmers were more likely to feel that life was not worth living. This is consistent with the high rate of suicide among farmers; interestingly, veterinary surgeons also have high suicide rates (Hawton et al, 1998). In summary, the foot and mouth disease outbreak had devastating economic and social consequences on rural communities; farmers suffered the most, but there were also major consequences for related agricultural industries, other rural professions and tourism (Box 2). The psychological sequelae of the outbreak Several reports published in the immediate aftermath of the outbreak commented on its adverse psychological impact (Deaville & Jones, 2001; Royal Society of Edinburgh, 2002), but the data were mainly anecdotal. A survey in one rural and one semi-rural area in England investigated the general public’s views on the adverse effects of the disease outbreak; the stress and anxiety in rural communities were Box 1 The state of agriculture before the