Building a St. Louis referral map for patients new to the idea

A patient in University City and a patient in Belleville can live twenty minutes apart, sit in the same traffic on I-64, and face completely different paperwork for the same depression treatment. If you refer across the St. Louis metro, you already know the river changes more than the view.

What you may not know is how little your patients bring to that referral. We commissioned a poll that reached 443 adults on both banks of the Mississippi and eight more Midwest states, and 73 percent of them, close to three in four, drew a blank on the word Spravato. A slim 6 percent could explain the drug; for 21 percent the name rang a faint bell and no more. Final validation moved a few figures by a point or two; the gap stayed that wide.

So an esketamine referral here is rarely a patient request you sign off on. It is a route you draw for someone who cannot see the map.

Start from where patients actually show up

Asked to name a first destination if they wanted ketamine-family treatment for low mood or trauma, 56 percent of respondents would book with their usual primary care office. A psychiatrist or therapist drew 23 percent and a web search 12 percent, while 5 percent could not name any starting place. More than half of the demand lands in primary care first, so your practice is the on-ramp whether or not you built one.

Build the list before the patient needs it

The worst moment to learn which nearby sites can give esketamine is mid-visit with a patient who just failed a third antidepressant. Do it once and keep it current.

Sort by payer, because patients do

Of everything we listed, insurance was the factor our respondents most often ranked first or second, at 85 percent, with closeness to home trailing at 43 percent. Coverage would settle or strongly steer the decision to start treatment for 65 percent.

Hold the payer mix in your head as you build the list. Respondents could pick more than one, so the shares overlap. Employer or other commercial plans headed the list at 39 percent; Medicaid trailed by only two points at 37; TRICARE made up 5, Medicare 23, and those with no insurance 9. A map of commercial-friendly sites only leaves out a large share of the people this survey describes. For each site, note whether it sees MO HealthNet, Illinois Medicaid, and Medicare patients, and what record of prior medication trials each plan expects.

Give service families their own line

In this sample, 2 percent were veterans or serving military themselves, 4 percent were first responders, and 29 percent were a parent or other relative of someone in one of those roles. Those families sit in your panel even when the service member does not.

TRICARE has its own coverage and referral rules, unlike the commercial and Medicaid plans elsewhere on your map, and the patient may not know which steps apply. You do not need to master that system. Add a line saying where to send the question, and ask whether the appointment is for the service member or a relative.

Hand the patient the vocabulary

Because so few people know the name, the words you use in the room are the words they will type into a phone that night. Our survey collected 319 answers about what people would search when looking for help. They wrote "depression medicine alternatives," "ptsd treatments," "help with depression." Nobody typed a brand.

That is why a handwritten card beats a verbal mention. Write both names, esketamine and Spravato. Write "FDA approved for depression that did not respond to other antidepressants; given in a certified clinic." Write the site you are referring to. A patient who searches "ketamine St. Louis" without that card will find infusion clinics and telehealth services first, and may never learn that you described a specific, supervised product. Some practices also add a patient-facing page, such as Brain Recovery Centers' overview of how Spravato is given, so the evening search lands on the right thing.

Explain the three things before the internet does

Esketamine is a nasal spray the patient takes under supervision at a certified site, then stays at least two hours for monitoring, and does not drive until the next day. It never goes home with them. Generic IV ketamine for depression is an anesthetic being used off label. Ketamine prescribed over telehealth for home use is a third arrangement, with no one in the room.

Close the loop

A referral to a site the patient has never heard of, for a drug they cannot name, is fragile. Book the follow-up before they leave. Ask the receiving site to confirm first contact. If a prior authorization is denied, find out whether a documentation gap caused it, which is fixable, before telling the patient it was a no.

None of this is clinical guidance about who should be treated. Eligibility belongs to the treating clinician and the history in front of them, and no consumer survey substitutes for it.

Keep one number on your map that belongs to every patient regardless of payer or zip code: 988. By call or text, from any state, it connects a person in crisis with a trained counselor around the clock at no cost. Say it out loud when the history calls for it, and write it on the same card as the referral.

Methodology

This site's publisher paid Pollfish to run the study, which it fielded on its consumer panel (study ID 395586438). When fieldwork ended on June 23, 2026, 443 members of the public aged 18 to 64 had responded, from ten states running from Minnesota and Wisconsin down to Oklahoma. It did not survey physicians or patients in treatment, and it did not isolate the St. Louis metro. We cite top-line percentages, with no subgroup results. Questions allowing several picks can add past 100. Pollfish validated the panel before we drew these figures.