Published on June 11, 2010

A "Perfect Storm" for Mental Health

Shortage of psychiatrists, underfunding challenges nation

The perfect storm of governmental neglect, underfunding and a critical shortage of psychiatrists is facing Americans with mental illness, according to Julie Manas, President of Genesis Medical Center, Davenport.

One recent study indicates that the United States already has a shortage of about 45,000 psychiatrists, and the shortage will only become worse as a large segment of practicing psychiatrists approach retirement age.

The storm has not missed the Quad Cities. Funding for mental health continues to decline, as does the number of psychiatrists in the region. Without the psychiatrists, it becomes increasingly difficult for health care systems like Genesis to serve the needs of patients, Manas said.

Vera French Community Mental Health Center provides psychiatrists for Genesis Health System. Vera French is actively recruiting psychiatrists to fill the need in the region, but many parts of the country are experiencing the same shortage.

"There is plenty of need in the community for our inpatient mental health beds. Our problem, and it is a problem across the country, is finding psychiatrists who can place patients in those beds and oversee the treatment of mental health patients," explained Manas. "The number of patients is increasing at the same time we are seeing this national shortage of psychiatrists."

Manas does not see improvement in the climate for mental health care anytime soon. Under the present adverse conditions, she does not expect an influx of doctors who want to specialize in psychiatry.

"One, it is a difficult specialty right now because of the shortage and the work itself. The need isn't going away but the number of doctors is declining so naturally there are increased demands," Manas said. "Two, the reimbursements for care are very low right now. Three, it takes a long time to be trained as a psychiatrist, which means a high cost of training at the same time reimbursements are low. If you are looking for a specialty coming out of medical school, you are not likely to look at psychiatry."

Manas said one factor that could improve the situation could be health care reform. Health care insurers now typically "carve out" mental health treatment with restrictions. For example, insurance companies often have special restrictions on the number of office visits a covered patient can have with a psychiatrist and restrict the number of inpatient days within a year or within a lifetime of coverage.

Mental health parity, which is being advocated as a solution to the problem, would require insurers to treat mental health as a disease. Millions more people would be able to get the same coverage for substance abuse and illnesses like bipolar disorder, major depression, and schizophrenia as they would for diabetes or cancer.

"We'll have to see what finally comes out with health care reform. Maybe patients with mental illness will have less restrictive access to the help and treatment they need," Manas added.

There are other possible solutions that have been suggested nationally.

One solution would be to shift more mental health care to primary care physicians, although there is also a growing shortage of primary care physicians. A related solution would be to allow doctors of psychology to write prescriptions.

Another solution would be to make it attractive to young doctors to choose psychiatry through forbearance or forgiveness of college and medical school loans.

Manas said training more advanced practice nurses, who in some states can write prescriptions, could alleviate some of the issues, especially in areas where the population is underserved.

Finally, telemedicine allows psychiatrists to treat patients from a distance using a highly secured connection. There are already 66 total psychiatric telehealth sites in 49 counties in Iowa.

Genesis Psychology Associates psychologist Richard Whittlesey, Ph.D., counsels his patients in the Quad Cities from Colorado, where he now lives, using an Intranet connection and screens at each end.

"We can't just turn away from the problem. Even if you close a behavioral health unit, as some hospitals have done, you are going to see the same patients in your emergency department, which ties up the valuable resources of that department and creates long waits while staff must call around to find a mental health unit that will take the patient," Manas explained.

Manas said Genesis remains determined to continue to meet the needs of the community during a challenging time for mental health care.