BISMARCK -- For Carie Moore, a Rocklake, N.D., farm manager and president of North Dakota Agri-Women, the inability to go into fertilizer plants earlier this spring on top of suddenly juggling farming responsibilities with the online education of her children was a lot to handle.
Additionally, the social aspect of the farming community felt diminished when 4H events began to be canceled here and across the country, she said. "Those are my getaways where I get away from the farm, from the kids and everything. Those are my growing and learning opportunities, and those have been literally ripped away."
Moore said the pandemic has had many consequences, adding to the stress that farmers usually feel. "It's affecting markets and what you're going to put in the ground and what your fertilizer is going to cost," she said. "Regardless, we have to feed the world. If we aren't, who is?"
Two of the phrases that Lindsey Kringlie, mental health counselor in Fargo, frequently encourages clients to practice saying are, “I need help” and “no.”
While North Dakotans can be resilient, Kringlie said it is important for them to reflect daily on their own mental health needs. “We tend to have that ‘Midwestern nice’,” Kringlie said. “We don’t want to burden or get in the way of anybody else.”
Throughout the state, mental health professionals have been helping clients maintain their mental health as they cope with economic, health and other challenges, including the COVID-19 pandemic and responses to it. For many providers, this means moving online to utilize telehealth sessions with clients.
Jada Hofland of Reeder, N.D., past president of the North Dakota Mental Health Counselors Association, is one of three mental health counselors in a 100-mile radius and has become increasingly busy over the previous months as more residents seek assistance.
Hofland said the anxiety in western North Dakota is more centered around the unknown of what could happen, given that the area has not seen as much exposure to COVID as other parts of the state and the country and are not witnessing the consequences as much.
"I cannot stress that enough, how important telehealth is, especially in a state where there are so many rural communities," Hofland said. "This makes it possible that they don't have to spend all day getting resources."
Dan Cramer, psychologist and regional director of the South Central Human Service Center in Jamestown, said while some clients may have been reluctant to try the virtual component of therapy at first, a vast majority have found it to be as beneficial as seeing a therapist in person.
Cramer said having a virtual means of seeing a mental health professional expands the reach of resources for clients. "We've seen clients get hooked up more broadly across the state, whereas it used to be confined by how far you can drive,” Cramer said. "What we know about telehealth is for a lot of people, it’s just as effective.”
For many clients with pre existing anxiety or other mental health conditions, added stressors now can include social and physical isolation, a sense of uncertainty and the prolonged nature of the pandemic
Andrew McLean, department chair of psychiatry and behavioral science at the University of North Dakota, previously was involved with disaster-related mental health projects. “I think one of the differences between pandemics and other disasters is the uncertainty," McLean said. "That's part of the frustration, wondering when will this stop, when will we get back to our normal way of doing things?"
Cramer said experiencing multiple stressors at once can lead to a physiological impact in some circumstances, such as inability to sleep, headaches and changes in blood pressure.
“We know the more stressors we have, the more impact they tend to have on us functionally,” Cramer said.
While he thinks the majority of people will not have traumatic long-term mental health effects, McLean said those who already experienced underlying mental health conditions such as PTSD might and that there might be a continuing demand for therapy via phone or computer.
“What’s going to be really interesting is what happens when this settles back down,” McLean said. “I think the public is going to demand that some form of that (teletherapy) continues.”
As both a mental health professional and a client herself, Kringlie said the use of virtual therapy has been beneficial and it can give her own clients a way to discuss the safety concerns they have surrounding COVID-19 without worrying about possible exposure.
“From a client’s perspective, it’s been an excellent experience,” Kringlie said. “I recommend all counselors do their own self-care and for counselors to see their own counselors. Counseling is the best gift anybody could ever give themselves.
"When it comes to that work station, at the end of the day, shut that computer off,” Kringlie said. “I ask myself the same questions I ask my clients: What am I going to do for myself today? Do I have a balance? What areas am I overstimulated in and what areas am I needing more in?"
Aside from utilizing telehealth services, many North Dakota mental health providers have extended hours into the evening to offer more availability. Natalie Reiter, secretary of the North Dakota Mental Health Counselors Association, said insurance providers have been willing to approve the use of virtual services in North Dakota and she hopes to see that continue.
“I think one of the biggest stressors is there’s so much ambiguity,” Reiter said. “A unique thing North Dakotans are experiencing on top of the pandemic is particularly the impact of the last field season.”
Factoring in ag sector
In rural states like North Dakota, farming communities have seen particular strains on mental health due to economic factors both in conjunction and independent from COVID-19. According to a recent study conducted by the Centers for Disease Control and Prevention, farmers are among the occupational groups with the highest risk of suicide.
President Mark Watne of the North Dakota Farmers Union said the financial impacts of the trade war between the United States and China on top of the pandemic have put farmers in positions of seeing increased depression and anxiety.
"The outlook for a successful year has dropped simply because of the pandemic on top of the trade war," Watne said. "Farmers are eternal optimists, but you can only be an eternal optimist for so long."
North Dakotans with severe mental health needs can reach the 211 hotline or their local human service center for assistance.