The 2020 derecho and the COVID-19 pandemic are still affecting Iowa’s farmers and farmworkers in more ways than one, according to the American Farm Bureau. Supply chain disruption, labor shortages and the high cost of rebuilding resulted in two out of three farmers and farmworkers reporting negative impacts on their mental health.

With mental health stigma and limited access to care in rural areas, many rural Iowans may be fearful to speak up and reach out for help. But with doctors and patients across Iowa turning to telemedicine since the start of the pandemic, accessing mental health care is getting easier. And with more open conversations about mental health happening, people are beginning to understand that it’s OK to seek help.

We sat down with two Iowa health experts, Dr. Azeza Uddin, UnityPoint Health (UPH) Behavioral Health Service Line Medical Director, and Jami Haberl, Executive Director of the Healthiest State Initiative in Iowa, to talk about how telehealth is changing mental health care in Iowa for the better, and why it should continue post-pandemic.

Telehealth helps break down mental health stigma

Growing up on a farm, Haberl knows rural Iowa well and is familiar with challenges agricultural workers are up against, especially during the pandemic.

“We grew up in a small town where everybody knew everyone’s business,” she explains. “And you can imagine because of the stigma, my dad, a 65-year-old farmer, would fear going to see a therapist because everyone in town would know he’s there. But the great thing that’s happened with COVID-19 is that people are talking more openly about mental health, and people have greater access to telemedicine. They can access care from the comfort of their home. Because of that, they don’t have to worry about anyone knowing they are seeing a therapist – it’s more private and discreet.”

But according to Haberl, one thing that can’t remain private is talking about mental illness in ways that are supportive and open, which will help people get to the stage where they feel comfortable reaching out to a therapist for help. She says the Iowa Healthiest State Initiative’s Make It OK program is working with rural partners to open up the dialogue through trainings and education opportunities.

The Healthiest State Initiative partnered with HealthPartners Make It OK program in 2019 to bring a vast toolkit of resources, stories of recovery and access to ambassadors to help Iowa employers start conversations around mental health and end the cycle of stigma.

“We have to address this issue, and we’re working to bring voices and perspectives of farmers themselves to the table, helping encourage them to openly talk about their mental health,” says Haberl. “This work includes reaching out to organizations agricultural workers connect with, such as rural banks and seed companies, to help build a strong network to spread the message further.”

Telehealth can help meet the increased need for mental health services post-pandemic

One way to continue to help Iowans in rural communities with limited resources connect to the behavioral health and medical treatment they need is to make sure telemedicine continues post-pandemic, says Haberl.

Dr. Uddin agrees. She has seen patients regularly via telehealth for many years and feels it’s an effective optional service that needs to remain – pandemic or not.

Dr. Uddin says that the feedback she’s received from patients who’ve used telehealth visits is positive, and without them, people would have to travel far to see a provider face to face, which often isn’t doable.

And it’s no secret, according to Haberl, that essential workers, such as those in agriculture, meat processing and other industries in Iowa, are the hardest hit by the pandemic. Yet this same population may have barriers to seeking care, such as long work hours, that make it difficult to take time off to go to a clinic. That’s where telehealth can play a huge role in increasing access to health care services for these individuals, she explains.

“Having telehealth available helps employees, no matter what industry they’re in, get access to care without having to interrupt their lives or jobs,” Dr. Uddin explains. “It helps them manage their mental health in ways that might not be possible otherwise.”

Across UnityPoint Health locations in Iowa, telehealth appointments more than doubled during the pandemic, reaching a peak of over 5,000 appointments monthly by the end of 2020.

During the pandemic lockdowns, connecting via a video visit or telephone call was the only way providers at UPH and across the country could deliver care. But now these services are consumer-driven, and they’re becoming more popular because patients no longer need to wait as long to get an appointment, says Dr. Uddin.

And many patients have embraced telehealth because of the convenience and the ability to access it from the comfort of their home. “For both fully insured and self-insured employers, telehealth is a huge benefit – helping their employees deal with the elevated levels of stress, anxiety and fear brought on from the pandemic,” says Haberl.

Consumer demand and broadband internet will drive the future of telehealth

One of the greatest hurdles for Iowans when it comes to telemedicine is a lack of broadband internet access. Iowa ranks 45th in the nation for broadband access and 49th for internet speed.

The growth and success of telehealth hinge on providing access to high-speed internet, helping expand health care in rural communities where doctors are in short supply.

Iowa legislators recognize that access to broadband internet isn’t a luxury but instead a critical component to everyday infrastructure – driving the future of the economy, education and health care.  Governor Kim Reynolds signed legislation in 2021 that would authorize up to $100 million a year over five years to bring universal broadband access to Iowa by 2025.

And it’s not only access to high speed internet that will increase telemedicine access in Iowa.

There has to be consumer demand to irreversibly change the frontier of health care in Iowa, adds Dr. Uddin. Only then will policies be rolled out that make it permanent.

“States and insurance companies have to recognize the importance of telehealth and see it in the same way as in-person visits,” says Dr. Uddin. “Employers need to care about this, because otherwise, especially in rural areas, their employees may have difficulty finding care. Because of this, I see employers continuing to advocate for and help drive health care systems to provide telehealth and then telling payers to reimburse for these services long term. It’s already happening, and it needs to continue.”

UnityPoint Health is one of the primary care systems in HealthPartners UnityPoint Health fully insured and self-insured health plans, available to small and large Iowa employers. UnityPoint Health provides health care to nine regions in Iowa through a broad network that includes 20 regional hospitals and 440+ clinics staffed by over 33,000 team members.

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