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'Filling in the gap': Why she launched a Conway mental health clinic during COVID-19

Sun News - 11/9/2020

Nov. 9--CONWAY, S.C. -- Starting her own counseling practice during shutdowns wasn't easy at first. Alfreda Small even wondered if it was the right time, a question on minds of many new business owners this year.

But Small said she knew it's what she needed to do. In Horry County, which she said has a real lack of mental health services and awareness about what's available, she felt like she had to get going to help as many people as she could.

"I feel like I am filling in the gap," Small said. Her goal is to be an advocate for mental health care in her community, because "it can be really, really scary not knowing what's going on with you."

Finding clients during COVID-19 shutdowns was one of the most difficult challenges Small faced. The pandemic also scrambled her plans to stick with private pay, instead of accepting insurance, as people's disposable income dried up and Americans tightened their belts for fear of being unable to work for long periods or losing their jobs.

Small quickly moved to become impaneled with big insurance companies like BlueCross BlueShield and United Healthcare. From there, patients began flowing in as she got referrals from her clients' health insurance providers. She also got more patient referrals from colleagues and other mental health professionals who were booked up due to the surge and requests for counseling services.

She also had to adapt to offering telehealth services, but she said she ultimately came to prefer it, as it made counseling more accessible for her clients, who no longer had worry about transportation barriers or time constraints during the coronavirus pandemic.

"They can access it on their phones, so anywhere, which is very good," said Small, who is based in Conway but serves people throughout the county. "In the future, depending on how COVID goes, I would do all of these services online."

Telehealth also made it easier for patients to talk to her at home or after school, without fear of their classmates seeing or hearing them get pulled aside by a counselor and getting made fun of or being called "mental" because they needed help.

Spike in anxiety, depression

Counseling didn't just change for Small on the business side.

The COVID-19 pandemic saw sharp increases in reports of anxiety and depression as people grew isolated at home during shutdowns and fear rose of catching a potentially deadly virus the world knew little about. Prescriptions for antidepressants and anxiety medicine also grew rapidly this year.

Small said she saw all these issues firsthand with her teenage clients struggling with at-home learning.

"Increased depression because you can't see your friends, you're isolated," she said. "There's some uncertainty and anxiety ... and adjusting to the hybrid model and virtual school. A lot of kids don't adjust well, and sometimes they already are dealing with anxiety and this brings more."

Some of these issues are also acute in Horry, where Small said she watched how some struggled to stay involved with school due to issues like lack of technology, which is exacerbated lack of motivation. She said it just "all builds up."

Even with the strong need among some people to get mental health support, a need heightened by the pandemic, Small said she's still seen stigma in Horry County against getting help.

"Receiving mental health services is not a bad thing. Having a diagnosis of depression is not bad," she said. "For instance, you can go to church and be religious and still seek therapy."

No matter what, though, anyone who needs help should seek it out, Small said.

"It's important now because I feel like the stress is at the highest level that it probably could be," she said. "This is new and we're all going day to day just trying to figure out what to do. So if you feel like you're struggling, please reach out to someone, a counselor, a friend, because there are people out there to help."

More details about Small Counseling and Wellness can be found at www.facebook.com/AlfredaLPCA.

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