Building Bridges to Farmer Mental Health: Developing and Supporting a Mental Health Advocate Network in Rural Communities.

Farmers experience disproportionately high levels of psychological distress and suicide risk compared with the general population, yet they often face personal and structural barriers to mental health support. In response, the Building Bridges to Farmer Mental Health initiative was developed to strengthen community-based outreach in rural Kentucky by training trusted local stakeholders who regularly interact with farmers, their family members, and farmworkers to recognize signs of distress, engage in supportive conversations, and connect individuals to appropriate resources. Two cohorts of Mental Health Advocates (N = 12) from nine rural Kentucky counties participated in a 1-year training and peer-support model that included monthly cohort sessions, Question-Persuade-Refer Gatekeeper Trainer certification, farm-specific scenario-based practice, and structured referral pathways to a university telepsychology clinic. The process evaluation included attendance tracking, documentation of training completion, and structured feedback collected from mental health advocates to refine initiative content. Implementation experiences highlighted the use of trusted messengers, tailored materials, peer-network support, and practical skill-building within this initiative.