The coronavirus pandemic has created widespread fear and economic anxiety across Texas, and mental health experts and advocates say rural areas — which already had fewer providers and higher rates of suicide and drug overdoses — could see more severe mental health impacts than the state’s urban areas. They are predicting a lingering wave of trauma and depression even after the pandemic’s immediate effects recede and lockdowns lift.
But it’s not all bad news. Although the pandemic has aggravated existing problems, the speedy rollout of telemedicine may prove to be a boon for rural residents who urgently need mental health care.
“There’s a lot of bad things happening right now because of COVID-19,” said Andy Keller, president and CEO of the Texas-based Meadows Mental Health Policy Institute. “But in some ways, people in rural Texas have better access to health care than they’d ever had before. All the barriers to them accessing physicians across the state have been lifted.”
In April, Gov. Greg Abbott temporarily waived restrictions on telehealth, allowing mental health care providers and local mental health authorities to broadly expand services and collect reimbursement for online appointments more easily. The state also implemented a mental health hotline in March that offers free over-the-phone support and provides resources and information to callers who need help.
At Texas Tech University — which has long been a pioneer in telemedicine — Sarah Wakefield, chair of the Department of Psychiatry at the school’s Health Sciences Center, said she’s seen a “huge spike” in telemedicine appointments since the pandemic began.
Although mental health care can be easier over video calls, Keller says calling in with a cellphone can be just as helpful and doesn't require an internet connection. That’s especially important for rural areas, where another barrier to adequate treatment is lack of broadband access. About 440,000 of the half-million Texas households without access to broadband are in rural Texas.
Barbara Vinson is a Seguin resident and the founder of the Guadalupe County chapter of the National Alliance on Mental Illness, where she runs support groups and therapy sessions. When in-person meetings were canceled, she urged members to continue checking in regularly online or by phone.
“The technology part is difficult for some people out here, it’s so new,” Vinson said. “Some people don’t have laptops, they just have flip phones they paid $50 for. So technology is an issue, but they get through it. And with time they’ve gotten more comfortable.”
Vinson regularly calls and emails members to stay in touch. If someone tells her they are having a crisis, she counsels them through it and then offers additional resources. And while she can’t say for sure if there have been more distress calls than usual, the Facebook page she runs has gained dozens of new followers in the past three months.
Now, more than ever, Vinson says her neighbors in Seguin and its outlying areas are hungry for information about mental health resources.
The pandemic has almost certainly exacerbated existing anxiety or depression diagnoses and brought on new ones, said Alison Boleware, a director for the National Association of Social Workers in Texas. Social workers and therapists in the state have their hands full with an influx of both old and new patients.
Experts are anticipating rising cases of depression and suicide, addiction and overdose; Keller calls these the “diseases of despair” that are aggravated by unemployment and economic stagnation. For every 1% increase in unemployment, the Meadows Institute estimates about 60 more people in Texas will die from suicide annually while 100 will die from drug overdoses.
And for rural Texans, the stigma of seeking help for mental issues can also be a significant obstacle. Some Texans still view mental health issues as a moral failing, Boleware said.
“We know there are still some pockets of Texans who might not feel as open to seeking mental health treatment or might not feel comfortable because of how it's viewed in their communities,” Boleware said. “In rural areas, there is a ‘pick yourselves up by the bootstraps’ mentality.’”
That’s something Catherine, who asked not to be identified by her last name, knows all too well. The 45-year-old technical writer was diagnosed with clinical depression as a teenager and said her isolation after stay-at-home orders heightened her anxiety and increased her feelings of loneliness. She lives alone and worries frequently about her teenage daughter and her elderly parents, who live in different parts of the state.
And living in Denison, a town with 20,000 residents about 75 miles north of Dallas, has not helped, Catherine said.
When she lived in New York years ago, “no one would bat an eye if you talked about your therapy at dinner. Whereas here, the opinion would be, ‘What’s wrong with you?’” Catherine said.
In March, Catherine was able to make online appointments with her psychiatrist, who is based in Sherman. She also got a prescription for a new anxiety medication to help control the panic attacks she’s had during the pandemic.
Catherine has had two telehealth appointments since then and says she now prefers them over in-person appointments; for one, she doesn’t have to see anyone in the waiting room.
For now, experts are hopeful for telehealth’s potential to improve mental health care in rural Texas. Keller said that if Abbott’s emergency telemedicine waiver becomes permanent, providers can continue expanding coverage and hopefully reach the historically underserved communities they haven’t been able to penetrate before.
“Bad things happen, and we figure out how to deal with them," Keller said. “This pandemic has been a disruption that in some ways has forced people to do what they should have been doing all along.”
How to get help
National Suicide Prevention Lifeline: 800-273-8255
Texas COVID-19 Mental Health Support Line: 833-986-1919
Disclosure: Meadows Mental Health Policy Institute for Texas and Texas Tech University have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.