Tom Silbernagel spent many nights at his kitchen table, looking out the windows at a failed dream.

He started his hog farm in south-central North Dakota in the 1970s. It was an exciting time, and consignment sales promised large profits.

But breeding problems, hard winters and low livestock prices in the 1980s eventually took their toll.

Rather than wait for the market to force him out of business, Silbernagel left on his own. He sold the farm in 1989 after 17 years of long, intense workdays.

The change was overwhelming, and Silbernagel suffered bouts of depression and low self-esteem. He wondered if he had a future beyond farming.

"You feel like you didn't make it," he said. "Farming is not just a job - it's a way of life. But we weren't making any money, and leaving was the right choice, the only choice I could have made."

Rural communities across North Dakota face similar struggles of survival.

Profound social and demographic changes over the past three decades in rural areas have led to America's silent farm crisis - the staggering number of deaths by suicide, said Jacque Gray, assistant professor at the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences.

The suicide rate among rural farmers and ranchers in the United States is nearly double the national average.

During downturns in the farming economy, such as the Great Depression in the 1930s and the 1980s high farm debt, the rate rises to three or four times the average.

In 10 rural North Dakota counties with populations less than 2,500 each between 1999 and 2003, the suicide rate was 16.46 deaths per 100,000 population, according to data from the N.D. Division of Vital Records. The suicide rate in urban counties was 12.74 - almost 25 percent less. More than 60 calls flooded the state's crisis helpline on a July morning after rain storms swept over many of the northern counties, said Sue Helgeland, executive director of the Mental Health Association in North Dakota.

Callers included both men and women, many living in rural areas where severe weather damaged hundreds of thousands of farmland acres, Helgeland said.

As harvest begins across much of North Dakota, producers already seeing molds and disease from drowned soils still could encounter more crop loss, said Duane Berglund, an agronomist with the North Dakota State University extension service office.

"Farmers in these dire straits may feel they have nowhere to turn for help," said Michael Rosmann, executive director of Agriwellness, a rural health outreach program based in Iowa. "They take their lives as a last act of desperation to secure life insurance payments for their families."

North Dakota's suicide rate for all ages is 30 percent higher than the U.S. average, and ranks 13th in the nation, according to the National Center for Health Statistics. Suicide is the state's No. 2 cause of death for 10- to 34-year-olds, behind accidents.

Between 1999 and 2003, 385 suicides accounted for 1.3 percent of deaths in North Dakota, according to data compiled by the North Dakota Division of Vital Records.

Rural men in all age groups have about twice the suicide rate of urban males in Midwest states. The more rural their residence, the more likely men are to commit suicide, Rosmann said.

According to the 2000 census, 8.2 percent of North Dakota's population works in agriculture - down from 11.7 percent in 1990.

Billings County ranked second for the state's highest suicide rates - 43.27 deaths per 100,000 population - between 1999 and 2003, according to data from the Division of Vital Records.

About 72 percent of residents in the western North Dakota county work in agriculture. Two the county's 32 deaths in the five-year period were suicides.

Eddy County ranked highest, with six suicides and a rate of 43.86 deaths per 100,000 population.

Because the U.S. economy no longer depends on agricuture, farming communities have sustained continuing loss - loss of land, political power, livelihood and social unity, Rosmann said.

"Losing the family farm is the ultimate loss," he said. "You are giving up heritage to which your parents contributed ... it's a very empty feeling."

It took Silbernagel a long time to recover from losing his farm.

Despite the pain, he never considered suicide. His strength came from his 15-year-old daughter, he said, who wouldn't let him give up.

After signing the sale papers, he moved his family to Bismarck. He had never worked outside farming, but eventually found a job that returned him to his roots.

As an administrator with the Agricultural Mediation Service, he helps resolve financial stress and personal disputes for North Dakota farmers and ranchers.

He has worked directly with some 400 families, many struggling with the same decision he made more than 16 years ago. Client numbers have fallen in recent years, he said, because of the state's declining farming population.

But someone always needs help, he said, and mediators often refer clients to mental health services.

"I have seen a lot of tears," Silbernagel said. "There is a lot of underlying emotion. Anytime you deal with someone's livelihood, it's stressful."

The lack of health care services in rural areas is a leading aggravator - and perhaps the most troubling, Gray said - in America's farm crisis.

In 1997, more than 75 percent of U.S.-designated Mental Health Professional Shortage Areas were non-metropolitan. As of last year, 95 percent of North Dakota had a federally desgnated shortage of mental health providers.

Nearly half of the 65 million U.S. farmers are clinically depressed, Gray said, but most never receive treatment.

Stigma about seeking help for mental health problems causes many farm men to feel they should be self-reliant, she said.

Men in seed-company hats pulled low over their heads arrive for counseling sessions at local health clinics, hoping they won't run into anyone they know, Gray said.

"When your truck is parked in front of the mental health clinic, everyone knows what you're going there for," Gray said.

Mental health integrated into primary care clinics would increase patients' anonymity, she said, but a lack of providers prevents such resources in rural areas.

Mental health care providers must be supervised for at least a year by a licensed practitioner before receiving their own license, Gray said. Most providers work in urban areas, and graduates typically set up practice where they receive their license, she said.

"It takes a long time to change people's views," Gray said. "Younger farmers are more willing to get help, but often times the only people they can talk to are a pastor or a friend - people who are not trained in agricultural stress."

In place of nearby clinics, crisis hotlines have provided 24-hour mental health advice, Gray said.

The North Dakota Mental Health Association launched the 2-1-1 HELP-LINE last February. Helgeland, who oversees the hotline's operation, said states with established crisis lines have stabilized, and sometimes decreased, suicide rates.

Improved mental health, Rosmann said, leads to better farming.

"Agriculture people see good health as a tool to make themselves more efficient," he said. "People want help to make their farming more viable."

Farmers attend educational seminars throughout the winter, Rosmann said.

They call county extension service agents with crop questions, and use crisis hotlines during high stress periods, he said.

Calls this year to the 2-1-1 HELP-LINE have already doubled last year's number, said Chet Pulver, education coordinator for the Mental Health Association. The hotline now receives about 300 to 500 calls each month, he said.

"We know they use these resources when they are available," Rosmann said. "More mental health care would not be any different."

He suggested that agricultural agencies could earmark savings for rural health care during periods of high crop prices, when farmers receive less federal subsidies.

"We need a solution because the problem is not going away," Rosmann said.

With 1.5 million rural elderly people, an age group at highest risk for suicide, the country's crisis could worsen, he said.

Silbernagel is proof that life exists after farming.

Farmers slowly are becoming more open to selling their land, he said, but pride can be the toughest challenge.

"It doesn't have to be the end of the world," he said. "It wasn't for me."

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