Rural doctors and nurses have warned that the foot and mouth outbreak could leave stressed farmers without access to adequate support, as surgeries in affected areas are closed and home visits cancelled.
Doctors fear farmers already reeling from the impact of BSE will suffer serious mental health problems as the crisis continues. A Devon GP has counselled three suicidal farmers in the past week, while helplines for stressed farmers have been inundated with calls.
There are now 183 confirmed cases of across the country, with 935 farms under restriction and 116,000 animals already slaughtered.
The department of health and Wales' chief medical officer Dr Ruth Hall have issued emergency guidelines about working in affected areas to all primary health care professionals via their health authorities and local health groups.
They are:
• Park vehicles at farm entrances rather than taking them on farmland;
• Disinfect vehicle wheels before your journey;
• Give farmers advance notice of visits;
• Vehicles should cross straw soaked in disinfectant when entering or leaving farms;
• Wear wellington boots and disinfect them leaving or entering a farm.
Devon GP Dr Asad Al-doori was forced to close his branch surgery in Winsford last Wednesday after several cases of the disease were confirmed.
He has visited affected farms to counsel suicidal farmers. "I've dealt with three serious cases of farmers contemplating suicide in the past week, as well as five seriously depressed families and another nine or 10 people who were just extremely upset."
But because Dr Al-doori has visited infected farms he has been barred by the Ministry of Agriculture, Fisheries and Food officials from visiting any other farms for five consecutive days.
He said: "I had to deal with a suicidal farmer on the phone because there was a suspected case on his farm. The health authority has provided me with a locum in case there is an emergency on another farm."
Farmers have the highest occupational suicide rate in the UK, with 79 farm owners and managers, horticulturists and farm workers in England and Wales killing themselves in 1999.
Nurse Jon Munsey, community mental health team leader for Torridge, north Devon, said the macho culture of the farming community meant many people in desperate need did not ask for help.
"Unfortunately, suicides have always been high as most farmers have access to shotguns," he said.
Carolyn Davies, director of the Rural Stress Information Network, said: "People are breaking down in tears on the phone. They're shell-shocked.
"We're speaking to the benefits agency to see whether they can arrange crisis loans - at 0% interest - for all workers affected by the outbreak."
Community psychiatric nurses fear that restrictions on home visits will lead to vulnerable patients deteriorating. Phil Brace, charge nurse at the mental health resource centre in Ystradgynlais, near Swansea, said there had been a 20% reduction in home visits locally.
He said: "Even routine visits are essential as we're the only people checking up on farmers in isolated areas. They may forget to take their medication because they're stressed about their farms and become more depressed. But it's difficult to adequately assess the risk of suicide without seeing them."
Health visitor Alison Allen, south-west chairwoman of the Community Practitioners and Health Visitors Association, said: "Some of our local members are feeling fairly desperate as they are married to farmers. So they can't get out to help their patients and are worried about their own farms."
Powys GP Dr John Wynn-Jones, director of the Institute of Rural Health, warned health services could not cope if more staff were barred from visiting patients. "They're aren't enough doctors to provide cover in north Wales.
But Dr Nicol Black, consultant in communicable disease control health said only essential home visits would be approved. "Just going to check up on granny Smith to see whether she's ok is not really justifiable," he warned.
