From our survey
Eight steps from knowing where patients start to mapping certified sites by drive time, front-loading payer work, and closing the loop.
A referral is a promise that someone on the other end will pick up. In much of Missouri, for depression that has not responded to treatment, that promise is harder to keep than it looks on the order screen.
Our survey gives primary care a reason to care about the gap. We commissioned a study of 443 adults across ten Midwest states, Missouri included, and asked which voice would persuade them to consider ketamine-family treatment. Their own doctor's recommendation outweighed everything else at 74 percent; family and close friends trailed at 18, a service member they follow online at 4, advertising at 2, and podcast hosts at 1. The figures are final and validated.
If your word carries that much weight, a referral that dead-ends is not neutral. It is the most persuasive voice in the patient's life pointing at a closed door. This guide is about keeping the door open.
Asked about a first stop, respondents put primary care well ahead at 56 percent, with a psychiatrist or therapist at 23 and online searching at 12; another 5 percent had no clear starting point. That puts you at the front of the line in a state where psychiatry is unevenly spread. A patient in Cape Girardeau, Kirksville, or Joplin may face a much longer path to a specialist than one in Kansas City or St. Louis, and your plan has to account for that.
"Ketamine" covers at least three things, and patients will not sort them out alone. Spravato delivers esketamine as a nasal spray; its approval is specific to treatment-resistant depression, every dose is supervised in a certified clinic, patients wait two or more hours under observation, and nobody drives home themselves that day. Clinic infusions of ketamine for depression are off label, and telehealth ketamine taken at home is a third arrangement with no one present during dosing. Write "evaluation for esketamine at a certified site" on the referral, not "ketamine"; the wording changes where the patient lands. For a sense of how a certified program describes this to patients, see Brain Recovery Centers' Spravato page.
Being close to home was a leading concern for 43 percent of respondents, and in rural Missouri that preference collides with geography. A certified site ninety minutes away costs a patient most of a day, plus a driver, for each visit, more than once a week early on.
Build a short regional list of certified sites and psychiatric practices taking new referrals. Confirm by phone, because directories go stale, and note the typical wait for a first appointment. For patients far from any certified site, name the tradeoff honestly and ask whether telepsychiatry can handle evaluation and follow-up even if dosing must happen in person.
When picking a provider, 85 percent of respondents ranked insurance first or second. For 65 percent, it would largely decide whether they pursued treatment at all; half would take the insured route with more hoops over simpler self-pay.
Commercial coverage led the payer answers at 39 percent, with Medicaid nearly level at 37, so MO HealthNet will be a common payer on your list; Medicare (23 percent) comes next, then the uninsured (9) and TRICARE (5), and respondents could pick more than one. Learn once what each major payer wants for prior authorization, and build it into the referral note: agents tried, doses, durations, reasons for stopping. A receiving site with a complete history moves faster.
Two percent of respondents were veterans or active military, 4 percent first responders, and another 29 percent family of someone in those roles. TRICARE's coverage and referral rules differ from the commercial and Medicaid plans above, so learn once what it expects before a specialty referral, and put that route on your list so a service member's referral does not stall.
Since Spravato was unfamiliar to 73 percent of respondents, the patient may lose the name before the parking lot. Hand them a card with the product name, the reason for the referral in plain words, the site name and phone number, and the date your office will check in. People do not search for drug names anyway: when 319 respondents listed the words they would search, they wrote phrases like "help with depression," "ptsd help," and "therapist near me." Without a card, the search leads somewhere you did not intend.
Have someone in your office confirm within two weeks that the receiving site has reached the patient. If prior authorization was denied, find out why; a missing medication history is fixable. If the patient never called, ask why. Five percent of our respondents admitted they would not know how to start, and a stalled referral is often a patient who got lost, not one who changed their mind.
Your recommendation moved the patient, so stay visible after the handoff: ask the receiving practice for a note after evaluation, and see the patient in follow-up. Many will keep relying on primary care for everything else while specialty treatment proceeds, and they will tell you things they do not tell the specialist.
This page offers no clinical guidance on who should be treated; the treating clinician decides that. The survey describes how people say they would seek care, not outcomes.
Every referral card should also carry one number that needs no authorization. The 988 Lifeline takes calls and texts nationwide, free, around the clock, and for a patient waiting weeks for a first appointment it may be the most important line on the card.
This publisher paid for Pollfish study 395586438 and commissioned it; the study closed June 23, 2026. Its 443 respondents, members of the public rather than clinicians, were 18 to 64 and drawn from ten Midwest states, and the results did not isolate Missouri. This guide uses top-line figures only, and because multi-select answers are shares of respondents, some sets total more than 100. Every figure has cleared the panel's final validation.