Psychiatrists shortage leaves patients struggling
By ISABELLA ALVES
Feb. 17, 2018
IDAHO FALLS, Idaho (AP) — If you break your arm, or catch a cold, a trip to the doctor's office will fix most woes. But what happens when the doctor isn't there to fix an arm, or help heal a cough?
That's the conundrum across the country that people with mental illnesses are facing. If you were to look at a green to red color-coded map of the United States depicting the number of child psychiatrists per capita, you would be looking at a bleeding red map.
The entire nation, with the exception of Washington, D.C., is in a child psychiatrist shortage, which is especially true in eastern Idaho. There are only five child psychiatrists per 100,000 people in Idaho, when the recommended amount is 47 per capita to be considered a mostly sufficient supply, according to the American Academy of Child and Adolescent Psychiatry.
Idaho is one of the worst states for child psychiatry access; the only state that's worse is Wyoming at four child psychiatrists per capita, according to the academy. The situation isn't any better for adults.
The crisis is only getting worse because child psychiatrists on the whole are part of an aging population. In Idaho, the average age of psychiatrists is 53 years old, and without any new psychiatrists joining the field the number of psychiatrists will continue to plummet, said Matt Larsen, psychiatry department chairman for Eastern Idaho Regional Medical Center.
Larsen predicted that the psychiatrist shortage will continue to worsen in the next 10 years. In a state that ranked fifth nationally for suicide in 2015, the declining number of mental health professionals is a major problem, according to the Suicide Prevention Action Network of Idaho.
In a region famed for its proud independent nature, sky-high mountains and rural lifestyle, the Mountain West has some of the highest suicide rates in the nation, Larsen said.
People have chalked the high suicide rates to isolation, easy access to firearms and an independent culture. Combined with the psychiatric care shortage, it creates a perfect storm.
Marci Crook, social worker at Madison Memorial Hospital in Rexburg, said on average its emergency room sees at least one patient a day who has attempted suicide, and she said she thinks it's only getting worse.
Crook said the education surrounding suicide prevention and mental health has been neglected, and contributes to the high suicide rates. She said Idaho lacks resources for treating and educating people about mental health.
Larsen had a similar feeling; he said it's obvious the state's mental health needs aren't being met.
"There aren't enough training spots (for psychiatrists)," Larsen said. "I'm glad Idaho is getting a medical school, but if Idaho can't get more residencies, then we're going to have more MDs that can't get a job."
In 2016, Idaho started the Suicide Prevention Program as a way to combat the state's high suicide rates and educate people about mental health.
Idaho has plans to open up Behavioral Health Crisis Centers in each of its seven health districts, the first one opened a few years ago in Idaho Falls.
Molly Brazier, medical supervisor at the Behavioral Health Crisis Center, said, in her experience, the mental health environment in eastern Idaho is much worse than other areas of the nation. She has worked in Seattle and Cleveland.
"We tend to prioritize individual liberties over what people need," Brazier said. She said people who are incapacitated aren't taken to the ER nearly as often as they should be, but instead are thrown in jail.
"What they (law enforcement) define as a danger to themselves is different than what mental health care workers would," Brazier said.
The crisis center is helping with this; it offers an area for law enforcement to drop people off who are in mental health crisis instead of in jail or the ER.
But even with the crisis center open, there are still times the Behavioral Health Center at EIRMC struggles to keep up.
"Some weeks, some months, we have enough (bed space) and suddenly, on one night, we get all these calls," Larsen said. "Then suddenly we're full."
Larsen said he gets calls from Utah, Montana and Wyoming for beds at the center. The trick is finding the right type of bed for the patient.
The center has beds for short-term and long-term stays divided by gender. So if all the short-term beds for women are full, and they get a call from a woman needing a short-term bed, they will have to transfer her to another facility. There is also a higher demand for short-term beds than long-term beds.
Larsen said no one who shows up at the center gets turned away, even if it's full. The center will make sure the person gets the resources they need, even if it can't be the one to help them.
But after patients are discharged from the center, there aren't enough outpatient resources. Wait times to get into a psychiatrist in the community can be months, Larsen said.
"It makes it easier to go back into crisis," Larsen said. "They were stabilized and then go back into that environment with all that stress."
Larsen said that he thinks there would be fewer people in mental health crisis if there were more outpatient resources available.
Stefanie Jones experienced this firsthand when she tried to find help for her children. She has been trying to find a place where she can get testing for her teens to figure out their mental illness, so they can get the help they need.
Luckily, Jones is personal friends with a psychologist at the Behavioral Health Center, and reached out to them for help. She said without her personal connections, she might not have been able to find the resources she needed.
"We definitely need more child psychologists and psychiatrist," Jones said. "There's lot of counseling here, but there's not a whole lot of people with advanced training for adolescents in this area."
But for the Hispanic community in Idaho Falls, an already slim resource is getting even thinner.
"I don't think there are enough resources for the Latino community as far as therapists," Lily Ponce said.
Speaking Spanish isn't enough, Ponce said. It's also important for a therapist to understand the Latino culture. Ponce said she has a friend in the community who is struggling to find a therapist who knows her culture.
"They come from a different country where there is no education (about mental health) and they're educating their children in that way," Ponce said. "Those children are the ones suffering now from mental illness, but they're not educated in it because there aren't resources in Spanish to teach them how mental illness is a real thing."
There are a lot of mental health workers in the community, but part of the problem is trying to find the right level of expertise to get the right help, Larsen said. It's also important to have social connections as a safety net for mental illness.
People want to feel wanted, and people attempt suicide when they start to feel like a burden, Larsen said. It's important to have social connections, know your neighbor and practice good self-care to stay mentally healthy.
"While there is a shortage, there's always help, there's plenty of people who care and plenty people who are trained how to help," Larsen said. "So just ask."
Information from: Post Register, http://www.postregister.com