South Dakota News Watch-Elena Tittel
Mt. VERNON, S.D. – About 20 miles from Mitchell sits a 100-year-old barn. Merely driving by, it looks like nothing out of the ordinary: just one of many such farming landmarks off of I-90 surrounded by fields of crops and tall grass.
That barn belongs to Colleen Stegenga, a licensed clinical social worker and therapist who runs Embracing Change Counseling Services.
Stegenga grew up on a cattle farm about 5 miles from where she currently lives. When one of her family members who ran the family farm had a health crisis three years ago, she and her siblings came together to help out.
“It was a crazy few weeks because it was planting season, the cows still needed to be milked and he still had bills to pay. And so that’s when I started to realize farmers have a lot of stuff they have to deal with,” Stegenga said. “I got a really brief snapshot when I was working with my family. Like how do these people do this?”
Shortly thereafter, she decided to put more focus into helping the agricultural community by transforming an old barn into a safe place offering mental health services. Once the clinic opens in August, she hopes to later incorporate horses, mini highland cows and babydoll sheep.
Work on the farm never ends.
“(People tell me) how do I keep going? I’m not sleeping, the bank is telling me I have to come up with more collateral and I don’t know what I’m going to do,” Stegenga said.
Karl Oehlke, a physician assistant on the Avera Behavioral Health team, said there is a longstanding history of stigma surrounding mental health among not just agricultural communities but Midwesterners in general.
Because some farmers feel pressure to tough it out, they may fear being recognized while using in-person services such as seeing a live therapist, attending an alcoholics anonymous meeting or even picking up a psychiatric prescription at the local pharmacy.
“I heard a number of folks say that their primary care providers are the same person they see at church or go to a basketball game at the high school with,” Oehlke said. “They’re quite comfortable talking about a plan for cholesterol or diabetes or a broken arm. But divulging that they are having issues psychiatrically is even harder in that situation.”
However, many of those who feel comfortable going in person often can’t.
South Dakota currently has a statewide mental health care provider shortage. Of the state’s 66 counties, only four – McCook, Minnehaha, Turner and Lincoln – do not have a geographic shortage of mental health care providers. Those four counties instead have a population shortage. A population shortage refers to a shortage of providers within a defined geographic area for a specific group of people, such as those who are low-income or face cultural or social barriers.
For patients of Stegenga’s who cannot easily get to her in-person offices, have fear of being recognized or cannot step away from work, she has found virtual services – whether a phone call or a video chat – to be just as successful.
“I do have people that just step out into their car on their lunch break, and we can do therapy that way,” Stegenga said. “You don’t have to leave work, or for my farmers and ranchers, ‘Hey, if you’re in the field, just get your phone propped up, and we can talk,’ so it is really helpful.”
Dr. David Newman, chief medical officer of virtual care at Sanford Health in Fargo, North Dakota, said the health center’s virtual care system took off in 2021 after receiving a $350 million virtual care investment.
In 2025, patients who used the virtual services saved an estimated $41 million by reducing the need to take time off from work and pay for travel-related expenses.
For patients of Horizon Health and Monument Health – two other large health care systems in South Dakota – in-person and virtual services are also available.
Telehealth appointments are not the only virtual behavioral health resource. Those wanting immediate support from a mental health professional can utilize 24/7 hotlines such as 988 (formally the National Suicide Prevention Line) and the Farm and Rural Stress Hotline (800-691-4436).
South Dakota News Watch is an independent nonprofit. Read, donate and subscribe for free at sdnewswatch.org. Elena Tittel’s internship was funded with support from the Nonprofit Newsroom Internship Program created by The Scripps Howard Fund and the Institute for Nonprofit News. Contact: elena.tittel@sdnewswatch.org.