One by one, the three men from the same close-knit community took their own lives.

Their deaths spanned a two-year stretch starting in mid-2015 and shook the village of Georgetown, Ohio, about 40 miles southeast of Cincinnati.

All of the men were in their 50s and 60s.

All were farmers.

Heather Utter, whose husband’s cousin was the third to die by suicide, worries that her father could be next. The longtime dairy farmer, who for years struggled to keep his operation afloat, sold the last of his cows in January amid his declining health and dwindling finances. The decision crushed him.

A barn sits in a field once worked by Charlie Utter's cousin, a farmer who died by suicide in July 2017, Tuesday, March 3, 2020 in Georgetown, Ohio. [Joshua A. Bickel/Dispatch] Joshua A. Bickel, Joshua A. Bickel

“He’s done nothing but milk cows all his life,” said Utter, whose father declined to be interviewed.

“It was a big decision, a sad decision. But at what point do you say enough is enough?”

American farmers produce nearly all of the country’s food and contribute some $133 billion annually to the gross domestic product.

But U.S. farmers are saddled with near-record debt, declaring bankruptcy at rising rates and selling off their farms amid an uncertain future clouded by climate change and whipsawed by tariffs and bailouts.

For some, the burden is too much.

Farmers are among the most likely to die by suicide, compared with other occupations, according to a January study by the Centers for Disease Control and Prevention. The study also found that suicide rates overall had increased by 40% in less than two decades.

The problem has plagued agricultural communities across the nation, but perhaps nowhere more so than the Midwest, where extreme weather and falling prices have bludgeoned dairy and crop producers in recent years.

Three farmers took their own lives in a two-year span in Georgetown, Ohio, about 40 miles from Cincinnati. Three farmers took their own lives in a two-year span in Georgetown, Ohio, about 40 miles from Cincinnati. Three farmers took their own lives in a two-year span in Georgetown, Ohio, about 40 miles from Cincinnati. Joshua A. Bickel, The Columbus Dispatch

More than 450 farmers killed themselves across nine Midwestern states from 2014 to 2018, according to data collected by the USA TODAY Network and the Midwest Center for Investigative Reporting. The real total is likely to be higher because not every state provided suicide data for every year and some redacted portions of the data.

The deaths coincide with the near-doubling of calls to a crisis hotline operated by Farm Aid, a nonprofit agency whose mission is to help farmers keep their land. More than a thousand people dialed the number in 2018 alone, said spokeswoman Jennifer Fahy.

Even the $28 billion in federal aid provided by the Trump administration over two years wasn’t enough to erase the fallout from the trade war with China, many farmers said.

It’s not the first time that Washington’s efforts to help farmers have fallen short.

Nathan Brown overcame his own depression and now advocates for better access to mental-health care for other farmers near his home in Hillsboro, Ohio. Nathan Brown overcame his own depression and now advocates for better access to mental-health care for other farmers near his home in Hillsboro, Ohio. Nathan Brown overcame his own depression and now advocates for better access to mental-health care for other farmers near his home in Hillsboro, Ohio. Joshua A. Bickel, The Columbus Dispatch

In 2008, Congress approved the Farm and Ranch Stress Assistance Network Act to provide behavioral health programs to agricultural workers via grants to states.

But it appropriated no money for the legislation until last year — more than one decade and hundreds of suicides later.

Some of the first four pilot programs awarded funding still have not seen any money.

“Farmers, ranchers and agriculture workers are experiencing severe stress and high rates of suicide,” said U.S. Sen. Tammy Baldwin, D-Wisconsin, who sponsored the bipartisan bill to fund the initiative. “Unfortunately, Washington has been slow to recognize the challenges that farmers are facing.”

Reporters spoke to more than two dozen farmers, mental health professionals and other experts across the Midwest who said the problem needs attention now.

Devastating economic events on their own do not cause suicides, experts said, but can be the last straw for a person already suffering from depression or under long-term stress.

“We like to identify something as the cause,” said Ted Matthews, a psychologist who works exclusively with farm families in Minnesota. “Right now, they talk about commodity prices being the cause, and it’s definitely a cause, but it is not the only one by any stretch.”

Case in point: After her family shuttered the dairy farm, Utter said, it relieved the immediate pressures — including those on her sister and brother-in-law, who helped milk her father’s cows daily despite their own full-time jobs.

But it created a different kind of stress for her father, said Utter, who serves as the Ohio Farm Bureau’s director for a four-county region including Georgetown.

It’s one felt by many farmers.

“When your farm doesn’t succeed or you have to sell off some property, not only are you letting you and your family down, you’re letting your family legacy down,” said Ty Higgins, spokesman for the Ohio Farm Bureau.

“‘My great-grandpa started this farm, and now I’m the one that’s causing it to cease?’ Boy that’s a tough thought. But a lot of farmers are going through that right now.”

Ohio farmer Nathan Brown overcame depression. Show Close and skip Farming was all Nathan Brown ever wanted to do growing up in Hillsboro, Ohio. He started working for a neighbor at age 12. He and his wife, Jennifer have owned their own 115 acres for the past five years. “I love growing things,” he said. Yet, at times, the father of three has been so depressed he could barely leave bed. “You spend a lot of time in the spring or fall in a tractor alone,” he said. “A little 4-foot-by-4-foot box in that tractor cab, and you get to thinking about things. It’s real easy to go to dark places.” Isolation plays a role in depression among farmers, he said. So does economic stress and self-blame. “If your farm’s failing, most guys say that’s a sign that they’re failing,” he said. “And really it’s not. You can be the best businessman in the world, and if the stars don’t align, the stars don’t align.” Brown overcame difficult times without mental-health treatment. After hearing about other farmers who died by suicide and feeling helpless while talking to a friend contemplating suicide, he works to reduce stigma and advocates for better access to mental-health care. “I just about cried,” Brown said of the conversation with his friend and fellow farmer. “Cause he was struggling so bad, but he felt that he couldn’t get help. Since that day I’ve been able to keep listening and communicating with him and keep checking on him. He’s getting better.” He’s worked with mental health agencies and the Farm Bureau to bring mental health first aid and “Question, Persuade, and Refer” training – a program to identify and prevent potential suicides – to farmers in his area. And he hopes to organize a farm-to-table dinner where mental health professionals can learn about the job farmers do and, in return, demystify their own work for the farmers. “We know there’s a stigma, so we need to build a community around this,” Brown said. “There’s nothing to be afraid of or scared of or ashamed of when it comes to mental health,” he said. “If you get the flu… you break a bone, whatever, it’s OK to go get that stuff fixed.” But somewhere along the line, he said, men especially started thinking it wasn’t okay to go get their brains fixed. Now Brown focuses on the good things, such as teaching one of his sons to drive a tractor last fall. “He got in the tractor and drove it, and I drove the combine right beside of him,” Brown said. “It’s little things like that, being able to spend time with the family.” Hide

‘It’s a problem now’

Farmers have been among the most at-risk populations for years.

More than 900 farmers died by suicide in five upper Midwest states during the 1980s farm crisis, the National Farm Medicine Center, found. During that crisis, mental-health counseling and suicide hotlines sprang up across the country. But after the crisis passed, the programs dried up.

Show caption Hide caption A barbed wire fence surrounds an old barn where Charlie Utter's cousin once kept angus cattle on Tuesday, March 3, 2020 in Georgetown, Ohio. His... A barbed wire fence surrounds an old barn where Charlie Utter's cousin once kept angus cattle on Tuesday, March 3, 2020 in Georgetown, Ohio. His cousin died by suicide in July 2017 and Charlie was left to handle his affairs after his death. [Joshua A. Bickel/Dispatch] Joshua A. Bickel, Joshua A. Bickel

The deaths subsided somewhat in the years that followed, but University of Iowa researchers found that farmers and other agricultural workers still had the highest suicide rate among all occupations from 1992 to 2010, the years they examined in a 2017 study.

Farmers and ranchers had a suicide rate that was, on average, 3.5 times that of the general population, the study found.

There are similarities between the 1980s farm crisis and the situation plaguing farmers today, said Brandi Janssen, a University of Iowa professor and director of Iowa’s Center for Agricultural Safety and Health. But the thinking around mental health has changed.

“I think it’s become more obvious to people,” she said. “Whether the rates or the numbers are higher or lower (compared with the 1980s), sometimes I don’t know if that matters. We know it’s a problem now.”

Keith Henneman's parents became advocates after his suicide. Show Close and skip All four of Julie and Phil Henneman’s children grew up working on their farm in Grant County, Wisconsin, but their son Keith showed the most interest. When Julie and Phil found other jobs in the late 1990s, Keith took it over at age 21. He set to work modernizing the farm. He kept the ground clear of weeds and nurtured their dairy cows, often playing with the young ones to calm their nerves. “He hated working for people,” Julie said. “He wanted to be his own boss.” Financially, their son was doing OK, they said, but he watched 23 of his heifers wither and die from Johne’s disease. “That took a big toll on him,” Julie Henneman said, adding Keith had worked with them since they were calves. “He knew them personally.” It wasn’t long after, in June of 2006, that Keith’s younger brother called with the news that Keith had killed himself. He’d just turned 29. Phil dealt with the police and the coroner, because Julie couldn’t. Instead, she milked the cows. “I used to love going to the farm,” Julie said. But, afterward, “there were days I would go to work and want to join him.” Eventually, the family sold the remaining cows and then the adjoining 50 acres. The next few years felt like a blur— purposeless, they said. A local meeting of The Compassionate Friends, a support group for parents whose children have died, helped them get through. After the original leaders stepped down, Julie and Phil began co-leading meetings. They also help Sue Springer, the head of the Suicide Prevention Coalition of Iowa County, teach classes on recognizing signs of suicidal thoughts. Springer, a therapist, started the coalition after her 41-year-old brother died by suicide in 2012, leaving behind three children. At community events, such as basketball games, her coalition hands out T-shirts with resources printed on the back. People have told Springer they attended a talk and used the strategies with their family the same night. “We don’t want anyone else to feel that pain,” Phil said. During classes, especially when men are present, Phil tells Keith’s story and breaks down. “For many years, men were never supposed to cry,” he said. He wants them to know, “sometimes you just have to break down and cry.” Hide

Federal, state and local governments must provide funding to help struggling farmers, said Janssen, but she cautioned that it will take more than just mental-health counseling and hotlines.

“It’s a lot more complicated than that,” she said. “It’s related to larger structures in the ag economy and climate and isolating work and rural areas that are being depopulated.”

Part of the problem, experts say, is that farmers are a tough bunch to reach – both geographically and emotionally.

Most live in rural areas far from mental health professionals. Urban counties in the United States average 10 psychiatrists per 100,000 people, but rural counties have only three per that many people, a 2018 University of Michigan study found.

Even when help is available, stigma prevents many in the largely male-dominated profession of farming from reaching out.

“In general, when men feel stressed, they pull back,” Matthews said.

Counselors have advised farmers to alleviate stress by finding a different job — something many find impossible to contemplate, said Fahy, the spokesperson for Farm Aid, which runs the crisis hotline whose calls jumped by 92% between 2013 and 2018.

"It's essential,” Fahy said, “that farmers are talking to people that understand the unique aspects of agriculture.”

‘My heart hurts so bad’

Keith Gillie rarely slept or ate in the spring of 2017.

He was stressed about the family farm in Minnesota, which he and his wife, Theresia, bought from his grandfather in the 1980s. After pouring their lives into the operation, they found they couldn’t turn a profit anymore.

The couple talked about selling the farm and their equipment.

On the last Friday in April, Theresia reached out to her marketing manager and a loan officer to come up with a plan. But before she could finalize the details, Keith had taken his own life. He died by suicide the next day. He was 53.

Show caption Hide caption Theresia Gillie's husband, Keith, died by suicide in April 2017 at the age of 53. This photo of the couple, who were married in 1984,... Theresia Gillie's husband, Keith, died by suicide in April 2017 at the age of 53. This photo of the couple, who were married in 1984, was taken in July 2016 at Dick's Last Resort restaurant at the Mall of America in Minneapolis. Gillie family photo. Courtesy/Theresia Gillie

“The day Keith died, part of me died, too,” she said. “Sometimes my heart hurts so bad that my whole body aches.”

Theresia ultimately sold the farm equipment but kept the property. She now operates the farm alone. And she speaks publicly about suicide. The Kittson County commissioner and former president of the Minnesota Soybean Growers Association has one goal in sharing her own experiences:

“I want growers to understand you're not alone in this boat,” she said. “There's others that are really struggling, too. And we’re going to find an avenue through this.”

At least 75 farmers died by suicide across six Midwestern states that same year, 2017, the USA TODAY Network’s data analysis shows.

An additional 76 farmers took their lives in 2018: Eighteen in Missouri. Eighteen in Kansas. Fifteen in Wisconsin. Thirteen in Illinois. Twelve in North Dakota.

But the trend started years earlier.

Keith Henneman of Grant County, Wisconsin, took his own life at age 29 after losing heifers to Johne’s disease in the mid-2000s.

Larry Ruhland killed himself on the Minnesota farm he operated with his wife, Barbara, in 2006 as they were working to renegotiate their contract to raise heifers for a local dairy.

“I didn’t put it together because I didn’t even think of the fact that Larry was under as much stress as he was under,” Barbara Ruhland said.

A memorial to Larry Ruhland stands near the driveway to the Minnesota farm where he died by suicide in 2006. "I didn’t even think of the fact that Larry was under as much stress as he was under,” said his wife, Barbara. A memorial to Larry Ruhland stands near the driveway to the Minnesota farm where he died by suicide in 2006. "I didn’t even think of the fact that Larry was under as much stress as he was under,” said his wife, Barbara. A memorial to Larry Ruhland stands near the driveway to the Minnesota farm where he died by suicide in 2006. "I didn’t even think of the fact that Larry was under as much stress as he was under,” said his wife, Barbara. Dave Schwarz, USA TODAY NETWORK

Matthews, the Minnesota farm psychologist, helped Ruhland through the turmoil after her husband’s suicide, and again when she lost a son to an aneurysm in 2014.

Too often, he said, he gets calls after the fact.

“It truly saddens me,” he said. “The person has committed suicide, and now I’m working with that family.”

It’s why training more people to spot the red flags of suicidal thinking is a crucial part of his mission. That includes anyone who interacts with farmers regularly: the ag management workers who set production goals, the auction folks who arrange the equipment sale, the bankers who deny the loan.

“That banker is at the kitchen table,” Ruhland said. “Those people are on the frontlines every day.”

Barbara Ruhland remembers her husband, Larry. Show Close and skip Barbara Ruhland remembers little from the days and weeks after her husband, Larry, took his life on their Minnesota farm in 2006. There were 450 cattle to feed, a crop to get in the ground, and a funeral to plan. “I went through the motions,” Ruhland said. Her husband was larger than life — 6 feet, 6 inches tall and quick with a joke. But farm life took its toll on Larry, and he’d suffered a lot of loss in his life — his father when he was 14; a brother at 19. “I didn’t put it together, because I didn’t even think of the fact that Larry was under as much stress as he was under,” she said. “So when I got the call … .” She gets emotional describing that day nearly 14 years later. Ruhland still lives on the farm where she and Larry raised their five kids and hundreds of calves over the years. It was a life she tried to resist but now won’t let go. She was training to be a nurse, he an electrician, when they met in the summer of 1971. But when his brother-in-law died, leaving a dairy farm behind, there was family pressure for Larry to take over. “I was fighting tooth and nail because I was from a farm family, and I didn’t want to go back,” Ruhland said. “I lost the battle and we moved over to the farm, and I jumped into being a farm wife.” vRuhland still has photos of better times on the farm — Larry covered in dirt, but smiling ear to ear. But by 1997 money had gotten tight and they sold their 125 dairy cows. Ruhland resumed work as a nurse for extra income. They started raising heifers on contract — buying baby calves from a big dairy, raising and breeding them, then selling them back. vRuhland still has photos of better times on the farm — Larry covered in dirt, but smiling ear to ear. But by 1997 money had gotten tight and they sold their 125 dairy cows. Ruhland resumed work as a nurse for extra income. They started raising heifers on contract — buying baby calves from a big dairy, raising and breeding them, then selling them back. They were in the process of renegotiating that contract in April 2006. “I was taking it as just one more hurdle of farming, one more thing of figuring out how we’re going to survive, how we’re going to stay on the farm,” Ruhland said. She was working full time off the farm plus going to school to get a four-year degree. Larry was on the farm alone a lot, trying to figure out a way forward. “Aside from him being very tired and very frustrated, I never picked up on the fact that he was going through this turmoil,” Ruhland said. “I think it sneaks up on farmers. They don’t take the time away to actually refresh and give themselves a chance to pull back and look at things objectively. “We all have this idea that farming is our only identity, especially men, and if it’s a family farm, there’s no way they are going to give that up.” Hide

Minnesota has added a second psychologist to split the work with Matthews. The program costs $228,000 annually.

“We don’t have anything like that,” said Jim Birge with the Sangamon Farm Bureau in Illinois. He’s heard about Matthews’ work and would love to see a in his state.

“I don’t want to see this discussion fade,” he said. “I want to keep it alive.”

‘A tough bunch’

University extensions, Farm Bureau chapters and others have started to take notice, creating crisis hotlines specific to farmers and training people in farm communities to spot signs of depression or suicidal thinking.

Iowa recently funded a program to pay for psychiatrists to provide mental health services in rural, underserved areas.

Wisconsin approved $200,000 for vouchers so that farmers could attend counseling, and the Wisconsin Farm Center offers advice on finances. It also has training on how to identify suicidal thoughts and how to help.

Nathan Brown loves farming, but there were times, he said, when depression left him unable to get out of bed. He now focuses on the good things, such as teaching his son to drive a tractor. Nathan Brown loves farming, but there were times, he said, when depression left him unable to get out of bed. He now focuses on the good things, such as teaching his son to drive a tractor. Nathan Brown loves farming, but there were times, he said, when depression left him unable to get out of bed. He now focuses on the good things, such as teaching his son to drive a tractor. Joshua A. Bickel, The Columbus Dispatch

“Farmers feel that they’re most helped by someone who understands them,” said Wisconsin state Rep. Joan Ballweg, a Republican from Markesan, chairwoman of the suicide prevention task force. “I’d like to see something that is dedicated (to farmers), like the national hotline number has a function for veterans.”

In Ohio, the state Department of Agriculture launched a campaign last year called “Got Your Back” to reduce stigma and encourage farmers to ask for help.They hand out cards with the Ohio State University Extension crisis line as well as the National Suicide Hotline and online resources.

“We want farmers to know that they are so much more valuable than their next crop,” said Higgins with the Ohio Farm Bureau.

Ashton Gebhard struggled to find mental-health care in rural Kansas. Show Close and skip Ashton Gebhard has driven hours to avoid the stigma of living with depression in a small farm town, and he’s waited weeks for an appointment in a region where therapists are scarce. The 35-year-old grew up on a farm in Kansas near the Nebraska state line. Diagnosed with depression in high school, he drove four or five hours to see a therapist because he feared seeing someone local would brand him as different. “At the time I still had a lot of personal stigma over it,” he said. To break free from farm life, he went to college, majored in finance, and lived in Omaha for a decade. In the city, mental health resources were more plentiful. When a cousin he was close with took his own life, Gebhard could attend a support group run by the American Foundation for Suicide Prevention. It really helped. But after a decade in a cubicle, Gebhard jumped at the chance to return to the farm. In 2017, his grandfather stepped back from day-to-day farm operations and let him take charge. The move back to Long Island, Kansas, meant trying to find a local therapist in a remote area. It was about a month before he could get in for an initial appointment, more than 20 miles away. Patients near Long Island commonly wait a month or longer, he said. In the meantime, Gebhard said, “God forbid something comes up.” Those hurdles can deter someone from getting treatment before they’ve even begun, Gebhard said. “The very nature of depression and mental health is such that you run into a tiny stumbling block and that’s enough to derail you completely,” he said. “And you’re like, ‘I guess there’s nothing that can be done, and I can’t be helped.’” His experiences led him to volunteer locally with the suicide-prevention foundation that had helped him in Omaha. He co-coordinates the annual Out of Darkness Walk in Hays, Kansas, and speaks about suicide prevention and awareness. To help farmers, Gebhard said, churches and co-ops where farmers already gather should host training about how to spot the signs of suicidal thinking. “I can guarantee that even the smallest town, like our town of 100 people, has at least one church,” he said. “That’s where everyone in the community is going to be, and that’s your chance to interact with everyone.” Hide

Some programs host outreach efforts at events such as Nebraska's Husker Harvest Days.

“Farmers are a tough bunch and they have thick skin and they don't want to be seen pulling up to the counselor’s office,” said Susan Harris-Broomfield, the rural health, wellness and safety director at the University of Nebraska-Lincoln Extension. “That’s not their jam. However, we have one of the largest farm and ranch shows in the nation.”

She handed out wallet-sized cards with a help-line number and other resources — similar to those distributed in Ohio.

“We were actually surprised at how many of these, especially men – farmer men – were absolutely open to taking it and they thanked us for what we were doing,” Harris-Broomfield said.

Her biggest tip: Make the conversation about stress instead of mental health. Neither their booth sign nor a survey they handed out mentions mental health.

“Stress is something we can all relate to,” she said.

Stress mixes with grief in Georgetown, Ohio, where Heather Utter’s father is adjusting to life after farming, and her father-in-law farms 1,500 acres — a combination of the land he grew up on and the adjacent property that his cousin had tended until his death.

Charlie Utter does some service work with his son, Kyle, left, at their farm on Tuesday, March 3, 2020 in Georgetown, Ohio. Utter's cousin, Steve, died by suicide in July 2017. [Joshua A. Bickel/Dispatch] Joshua A. Bickel, Joshua A. Bickel

“If you don’t farm, you just don’t understand it,” Charlie Utter said of the stress and despair to which so many local farmers have succumbed. “There’s just so many ups and downs and variables you can’t control. It wears on you.”

Charlie Utter said he regrets not talking to his cousin sooner; he knew something was bothering him in the days before his death. Family members need to watch one another closely, he said.

“If you see somebody is down, go talk to them, and don’t put it off,” he said. “If people were more educated, it couldn’t hurt. One person might catch something.”

This story is a collaboration between the USA TODAY Network and the Midwest Center for Investigative Reporting. The Center is an independent, nonprofit newsroom based in Illinois offering investigative and enterprise coverage of agribusiness, Big Ag and related issues. Gannett is funding a fellowship at the center for expanded coverage of agribusiness and its impact on communities.