Mental health workforce shortages hit rural areas hard
May 27, 2018 | By Michaela Gibson Morris
School shootings and the opioid overdose crisis have spotlighted the need for a robust mental health system across the country.
A new report from Ball State University in Indiana highlights a severe shortage of mental health professionals in rural areas. Nearly all the mental health professionals in rural areas surveyed for the report said they were not able to meet the mental health needs of people in their community and said it was difficult to recruit and retain qualified professionals. The lack of access meant rural residents end up traveling 25 miles or more to get to specialty care or a psychiatrist.
“As we deal with mental health professional shortage areas across America, we have to look to other ways to improve mental and behavioral health care in our rural communities,” said the study’s lead author, Cathy D. Whaley, director of the Northeast Indiana Area Health Education Center.
The study interviewed providers in Northeast Indiana, but the results are in line with the experiences of North Mississippi mental health professionals in the public and private sector. The shortage of psychiatrists – medical doctors who specialize in mental health – is acute in Mississippi, said Russell Chumley, psychiatric assessment coordinator at North Mississippi Medical Center Behavioral Health Center in Tupelo. Ideally, there should be one psychiatrist for every 10,000 residents.
“There’s one psychiatrist for every 100,000 in Mississippi,” Chumley said.
The shortage extends to clinical psychologists, licensed therapists, social workers, nurse practitioners and registered nurses needed to staff inpatient centers like North Mississippi State Hospital in Tupelo, said Dr. Paul Callens, the hospital’s administrator. The jobs are demanding, the caseloads can be large and salaries are not competitive compared to other states, more affluent urban areas and other health care sectors.
“We need to be better able to compete,” Callens said.
Because of low reimbursement rates, mental health providers often have to make do with fewer social workers, therapists and other staffers.
“There was a parity law passed, but it’s not being enforced,” Chumley said. “We need more (professionals) but there’s not enough funding to cover them.”
Higher caseloads in the community setting mean it’s harder for people who need care to be seen quickly, Callens said. It’s bad for patients, but it’s also extremely frustrating for providers.
“You can compensate for lack of money if you can get buy in,” Callens said.
If professionals don’t feel they are making a difference, it’s hard to turn down positions that can pay $40,000 more a year, Callens said.
“They want to make a difference, but they’ve got responsibilities, too,” Callens said.
The Mississippi Department of Mental Health’s goal is to help Mississippi by improving their mental health, quality of life and ability to participate in the life of the community.
“We cannot achieve our goal without a strong, dedicated workforce,” said Diana Mikula, ahead of a workforce forum earlier this year. “We know there are challenges with a shortage of behavioral healthcare professionals in our state and we are optimistic this partnership will open new doors and opportunities.”
The Department of Mental Health has struggled with a 48 percent turnover rate during the first year for direct care workers, who oversee the daily living activities of people in the inpatient and residential programs, said Adam Moore, the department’s communications director.
The starting salaries of direct care workers is currently just under $16,000 a year, but those workers are due to get a $2,300 annual increase starting June 1 as part of a realignment to address an extremely high turnover right.
“We know that a large number of our direct care staff members work multiple jobs to provide for themselves and their families,” Moore said. “Our goal is to see a decrease in the turnover rate as this realignment is implemented.”
At the same time mental health providers are struggling to adequately staff, the need is growing.
“In Mississippi, it’s estimated that 725,000 people struggle with mental illness at some point in their lives,” roughly a quarter of the 2.9 million people living in the state, Chumley said.
Although Mississippi hasn’t been hit as hard by overdose deaths as other states, the need for substance abuse treatment is tremendous, Callens said.
Untreated and undertreated mental health issues have real consequences, Chumley said. Thirty-seven percent of students with a mental illness drop out of school. Suicide is the 10th leading cause of death, surpassing traffic deaths and homicides.
“We know it’s a growing issue,” Chumley said.