Lack of psychiatrists hits mental health patients

WISH File Photo
WISH File Photo

LAFAYETTE, Ind. (AP) — A nationwide shortage of psychiatrists is hitting home in Indiana, where patients battling mental illness can be forced to wait months for an appointment.

More than half the state’s counties have a shortage of mental health professionals, according to the Health Resources and Services Administration. In places like Tippecanoe and surrounding counties, there is just one psychiatrist for every 57,585 residents. The federal Centers for Medicare and Medicaid Services recommends at least one psychiatrist for every 10,000 people.

The shortage has taken a toll on people like Pam Kiser, 57, of Lafayette, who quit taking medications to treat bipolar disorder and had a psychotic episode. When she tried to resume appointments with her psychiatrist, she was told she might have to wait three months.

“The system is just broken,” Kiser, now an advocate for the National Alliance on Mental Illness, told the Journal & Courier. “When you’re in a crisis, for someone with a mental illness, it’s like a person going through a heart attack. You need help now because the longer a heart attack goes, the more damage your heart has.”

The shortage stems in part from low reimbursement rates by insurance companies. A private psychiatrist will make more money by refusing to accept insurance. But even that pool of doctors is shrinking. More than 25 percent of psychiatrists are poised to retire in the next decade, and fewer Indiana medical students are entering the profession to take their place.

The situation could get worse. The federal health care overhaul makes more people eligible for mental health services, and even the number of psychologists and social workers is declining in some areas.

“It’s definitely a crisis situation,” said Jennifer Flora, executive director of Mental Health America of Tippecanoe. “The whole mental health system right now is in jeopardy.”

The situation has even affected police.

Lafayette Police Sgt. John Yestrebsky is coordinator of the department’s Crisis Intervention Team. Officers get 40 hours of training each year on how to deal with mental health issues.

But Yestrebsky said police can run into problems when trying to put a 24-hour psychiatric hold on someone, only to find that not enough psychiatrists or beds are available to accommodate the request.

“Oftentimes when the family doesn’t know what to do, they call us,” Yestrebsky said. “The CIT program is great to put that Band-Aid on it, to help de-escalate someone in a crisis. But where do you go from there if you don’t have the professional resource that a psychiatrist is?”

Hospitals and clinics are trying to adapt by recruiting constantly and even flying in temporary physicians.

Tom Gilliom, chief operating officer for Wabash Valley Alliance, said his agency employs two full-time and one part-time psychiatrist and provides one full-time psychiatrist to serve River Bend Hospital.

The alliance works with recruiting firms and constantly updates online job postings in an effort to attract psychiatrists.

“It’s been months since we had anyone who was a psychiatrist submit a request for information to find out anything about us,” Gilliom said. “And it’s probably been since last July since we actually had an interview with a psychiatrist.”

The group has enlisted has six temporary psychiatrists to work on short-term contracts. Most commute from other places around the country.

The temporary doctors cost more than a permanent psychiatrist because the agency has to pay for housing and travel. And their short-term nature can result in inconsistent care.

“I had a doctor flat-out tell me, ‘I don’t feel comfortable changing your meds because I don’t know if I will be here next month to see how you’re doing,’ ” Kiser said.


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