From farmworkers to new mothers to first-time therapy patients — Kansas City mental health providers saw an increase in the number of people who sought counseling in 2020.
Because of pandemic restrictions on in-person meetings, provisions in COVID-19 relief bills made it easier for patients to access health care virtually, and in many cases patients still have their telehealth appointments covered by insurance.
Now that the country is easing out of the pandemic, the insurance waivers that covered telehealth and teletherapy could expire by the end of the year. There’s a call to keep the services going. Several federal bills with bipartisan support are trying to make telehealth a permanent part of U.S. health care, especially because it can help those in rural areas access health care.
That’s something Dr. Tiffany Ruffin, a psychologist at Truman Medical Centers in Kansas City, Missouri, supports.
“Knowing that insurance companies are supporting us providing telehealth services makes a huge difference, of course,” Ruffin said. “As insurance companies have become more flexible and willing to provide that and back it, it makes it much easier to provide to more people.”
Republican Sen. Jerry Moran of Kansas issued this statement about the Protecting Rural Telehealth Access Act, which he co-sponsored: “Even after the pandemic ends, our health care system should bolster telehealth services as a reliable option to serve patients and help expand health care options and availability for rural America.”
Proposed federal legislation regarding telehealth
- The Protecting Rural Telehealth Access Act permanently waives geographic restrictions so patients can be treated from their homes, among other changes to the Social Security Act that would protect telehealth. The bill is sponsored by U.S. Sens. Jerry Moran (R-Kansas), Joe Manchin (D-West Virginia), Joni Ernst (R-Iowa) and Jeanne Shaheen (D-New Hampshire). It’s currently in the Senate Committee on Finance.
- The Telehealth Modernization Act, introduced in the House in February, extends Medicare’s coverage of telehealth and is co-sponsored by 25 Democrats and 30 Republicans, including Reps. Tracey Mann (R-Kansas), Jake LaTurner (R-Kansas) and Vicky Hartzler (R-Missouri). It’s currently in the Ways and Means Committee and the House Committee on Energy and Commerce.
- The Protecting Access to Post-COVID–19 Telehealth Act of 2021, introduced in the House in February, makes telehealth accommodations permanent and is co-sponsored by 27 Democrats and 15 Republicans, including Mann and Rep. Sharice Davids (D-Kansas). It’s currently in the Ways and Means Committee and the House Committee on Energy and Commerce.
Increased accessibility and flexibility for patients
Right now, Ruffin said about half of her one-on-one therapy sessions are online. At the beginning of the pandemic, nearly all of her appointments were virtual.
Telehealth has given patients more flexibility for attending their appointments, which can reduce the number of no-shows and cancellations, Ruffin said.
If a patient is sick or needs to pick up their child from school, for example, they can still attend their appointment virtually, even if they had originally planned to come in person. Patients who have just had a baby don’t have to worry about breastfeeding or finding child care to attend their appointments, Ruffin said.
When appointments are virtual, it’s also easier for patients to disengage with the process of therapy if it makes them uncomfortable, Ruffin said.
“One of the selling points is being able to say to someone, ‘You don’t have to put in that investment of getting in your car, driving, finding parking, sitting in the waiting room, being anxious — all of that is gone,'” Ruffin said. “And reminding them that they can feel a little more empowered, if it’s something that makes them incredibly uncomfortable.
“And I think for some people, that definitely alleviates some of that initial anxiety that can be a barrier to getting connected to that very first appointment that takes so much courage to get to,” she continued.
The shift back to in-person has been patient-driven, Ruffin said. Patients can choose if they’d like to continue with virtual appointments or come to the clinic in person.
Jewish Family Services also saw teletherapy as a benefit for patients, especially those who may have transportation issues, a disability or young kids, said Molly McGurk, director of mental health services at Jewish Family Services.
The group provides counseling and mental health services to patients in the Kansas City metro area, regardless of faith, and is the lead agency in the Greater Kansas City Mental Health Coalition.
But Ruffin and McGurk agree that telehealth is not a great option for those without reliable internet access or a private space for appointments.
Resources if you are in a crisis
All of these services are available for free 24 hours a day, seven days per week.
- Call 1-888-279-8188 if you are experiencing a behavioral health emergency. The hotline is run by Comprehensive Mental Health Services, based in Independence, Missouri.
- Text “HOME” to 741741 to text with a crisis counselor through the Crisis Text Line.
- Call the National Suicide Prevention Lifeline at 1-800-273-8255. You can also web chat with counselors.
Working to overcome the technology barrier
Gladys Carrillo, director of program services for the National Center for Farmworker Health, said a lot of their work during the pandemic focused on helping health centers around the country, including in Missouri, connect with patients.
NCFH is a private, not-for-profit corporation based in Texas that focuses on improving health care access for farmworkers and their families. Rural workers often have less access to the internet, which means they have less access to telehealth. And there’s the added challenge of digital literacy, Carrillo said.
“Agricultural workers already have a number of barriers and challenges to access health care anyway, just given the nature of the work that they do. And especially if they’re migratory workers, they tend to be very mobile and move around quite a bit,” Carrillo said. “Implementing telehealth services was really a benefit to health centers, to be able to continue to reach the population and provide services.”
NCFH has worked to help health centers continue to provide services to agricultural workers throughout the pandemic. But ensuring that patients have access to technology continues to be a barrier.
Carrillo said there has been an increase in the need for mental health services in particular.
“I’ve known mental health is a need, period, already,” Carrillo said. “It’s still very stigmatized and not talked about as openly as it should be. So I feel like the pandemic kind of put a spotlight on it.”
Jewish Family Services has also seen a lack of technology as a barrier to services and launched its Tech Connect program in June 2020 that focuses on connecting older adults with internet services, providing them with a tablet and training them how to use it.
McGurk said the transition to telehealth was more difficult for children than it was for adults.
“The adults have transitioned wonderfully to teletherapy, they actually prefer it,” McGurk said. “It’s the little ones where it’s more challenging.”
Because of this, families were some of the first at Jewish Family Services to return to in-person visits.
Kansas City providers managing waitlists, stress on therapists
At Truman Medical, Ruffin said she’s seen a lot more people talking openly about their mental health during the pandemic, which has led to an increase in people willing to try therapy for the first time. But the downside is that high demand can mean waitlists.
McGurk said every clinic she’s aware of currently has a waitlist for patients. In 2020, Jewish Family Services’ therapy services increased by 50%, with over 4,000 individual therapy sessions.
It hired additional staff to keep up with the demand for mental health care providers and is continuing to add more, McGurk said. The organization is also in the process of launching support groups for people who are on the waitlist.
With the increase in wait times for therapy appointments, some people are turning to apps like Talkspace and BetterHelp.
Ruffin said some patients are likely better suited to use therapy apps than others.
Someone “needing some quick support here and there might be a better candidate than someone who’s really wanting to work on some deeper issues that might be more of a commitment,” Ruffin said.
Pandemic burnout can also lead more people to reach out for mental health care. But providers are impacted by the demand.
Jewish Family Services reduced the workload for their therapists by 10% because of the stress of the pandemic, McGurk said.
Ruffin said she’s felt very supported by her colleagues, but it can be hard to take the advice she often gives to patients about making sure they practice self care.
Both McGurk and Ruffin said they’d like to see teletherapy remain an option in a postpandemic world.
“Most people, I think, like the idea of it,” Ruffin said. “And then there have come some decreased barriers for many, and then other additional barriers for other people.”
Tips for finding a therapist
From Dr. Tiffany Ruffin, a psychologist at Truman Medical Centers in Kansas City, Missouri.
- Talk with your doctor if you have one and ask for a list of mental health professionals.
- Reach out to a community mental health organization that can connect you with a therapist. In Kansas City, these include the Greater Kansas City Mental Health Coalition, Metro Council of Community Behavioral Health Centers and Jewish Family Services, among others.
- Psychology Today allows you to search for therapists by ZIP code and accepted insurance providers, among other factors. The database is not comprehensive since providers must list themselves on the site, but it can be a useful starting point.
- Contact your insurance provider for a full list of therapists who are in your network.
- Try not to get discouraged. Finding a therapist who works for you is worth the effort and time. If you see a therapist for a few sessions and don’t feel like it’s a good fit, don’t be afraid to keep looking.