Shortage of providers can mean long wait times for mental health help

This is not a new problem. It is a product of the economy and geography, and there is no easy solution.

For years, many people trained in the medical profession tended to avoid working in the field of mental health, which was generally not as well paid or profitable for hospitals as other medical specialties .

Wisconsin has a total of 148 child psychiatrists, or 12 per 100,000 population under the age of 18, according to the American Academy of Child and Adolescent Psychiatry. That's about a quarter of the amount recommended by the academy.

And of these 148 psychiatrists, 111 are located in only four counties: Brown, Dane, Milwaukee and Waukesha.

Meanwhile, the need for mental health services has increased, making the shortage more obvious. As a result, providers struggled to keep pace, focusing more and more on prevention and early intervention to keep children with mental health issues out of emergency rooms and out-of-school settings. hospital care.

A few months earlier, when Rosenthal had called the Wisconsin Children's Hospital in the hope of getting an appointment for his son, waiting to see someone seemed like unthinkable – seven or eight months at least, she said.

But this is not an unusual experience for patients and their families, said Amy Herbst, Vice President of Mental Health and Behavior at the Wisconsin Children's Hospital, which has outpatient clinics in the United States. 'State.

"Every day, families call us all over the state to try to get an appointment with a therapist," she said.

The response to these calls is usually the same: the wait can take weeks or even months.

"We are all terribly sorry because we want to do better," said Herbst. "And we'll do better, but we're not in that position yet."

"A devastating situation"

In Wisconsin, more and more children have mental health problems, even though the shortage of providers makes it more difficult to get help.

• Nearly 40% of high school students in the state had a high level of anxiety, while about 27% suffered from depression, according to the 2017 Wisconsin Youth Risk Behavior Survey.
• More than 16% of students considered suicide, while almost 8% attempted suicide.
• In 2017, the rate of suicide in Wisconsin among children aged 10 to 17 was 6.6 per 100,000 compared to 4.3 per 100,000 in 2012, according to the Center for Disease Control and Prevention. The national suicide rate for children of the same age was 5.3 per 100,000 in 2017, compared to 3.5 per 100,000 in 2012.
• The rate of hospitalizations related to mental health among youth in Wisconsin – 7 out of 1,000 in 2015 – remains high compared to the national rate of about 1.6 per 1,000 in 2014.

The consequences of untreated mental illness can be disastrous, which makes health care providers particularly fearful about the significance of the shortage for their patients.

"We do not want access to be one of the reasons this tragedy happened," said Herbst, referring to youth suicide. "But that's really what's happening."

Even when the situation is not yet so serious, many families still struggle to find help for a child, said Joanne Juhnke, director of policy at Wisconsin Family Ties, an organization based in Madison helping families with children who have mental health problems.

"It's really a devastating situation for families," she said.

Smriti Khare, a pediatrician and primary care chair at Wisconsin Children's Hospital, said families often try to manage the situation themselves, seeking help only in times of crisis.

"The hardest thing is when you're in a room with a family and you know they need help right away," she said.

RELATED: The Kids in Crisis documentary tells kids "You're not alone"

& # 39; A long way to go & # 39;

Most Wisconsin counties have no child psychiatrist at all and those who are tired of it.

Jon Lehrmann, president of psychiatry and behavioral medicine at the Wisconsin School of Medicine, said the situation was even worse. Many psychiatrists trained to treat children spend at least part of their time helping adults, which further limits their availability.

"If we had this kind of shortage of surgeons, I think we would have a national emergency," said Lehrmann.

There have not been enough child psychiatrists in Wisconsin – or even nationally – for decades, he said.

Many health systems do not always use psychiatrists, he said, because they were not as profitable as other doctors. It's finally starting to change.

The Medical College has been working to reduce the shortage of psychiatrists in rural areas since 2017, the year it was launched in the Psychiatry Residency Programs in Green Bay and Wausau, with the goal of training and maintaining them in the most disadvantaged areas.

Eight doctors are currently enrolled in the four year Green Bay program, which is expected to grow to 16 when it will be fully recruited next year. The Wausau program will recruit 12 resident psychiatrists in 2020.

The Medical College says that setting up programs in northeastern and central Wisconsin can help alleviate the current and long-term shortage, as about two-thirds of physicians settle in the community in which they live. have been trained.

The Mayo Clinic has implemented a program similar to Eau Claire.

"We are making progress, but we have a long way to go," said Lehrmann.

Solutions will not be fast

In March, Governor Tony Evers visited Catalpa Health, an institution specializing in youth mental health care located near Appleton. There, Democrat Evers spoke with reporters and compared the shortage of mental health providers to the labor problems faced by other state industries.

Evers' two-year budget for the state would increase the number of Medicaid, which would enroll an additional 82,000 people and an additional $ 22 million every year to help schools pay for social workers, psychologists, counselors and nurses to help students with mental difficulties.

But the governor's budget requires the approval of the Republican-controlled state legislature, which has already announced its intention to withdraw many of the budget's Evers initiatives.

Senator Tammy Baldwin, a Democrat, joined Catalpa to invite Wisconsin legislators to support Evers' efforts to expand Medicaid into the state.

"Our state suffers from a very significant general shortage," said Baldwin, who called the issue "urgent priority" for those who decide budgets at the federal and state levels.

There are signs that the situation is starting to improve in Wisconsin. More and more medical students are choosing to pursue careers in psychiatry, as more and more health systems are finding value in these positions, said Lehrmann.

At the same time, many health care providers have also attempted to make behavioral health more widely available in primary care, Lehrmann added. This leads to more problems quickly, thus avoiding more intensive and expensive treatment.

For example, the Wisconsin Children's Hospital employs a behavioral health specialist in 19 of the state's 26 clinics, split between the other sites, said Khare pediatrician.

Patients are less likely to worry about stigma when they visit the usual doctor, Khare said. This arrangement also gives pediatricians more opportunities to learn about mental health from people in these specialties.

Nevertheless, it's hard not to feel inadequate as a health care provider when you can not get immediate help the patient needs, Khare said.

"We are losing so much sleep because of these kids," she said. "You worry about them."

Children's Hospital also partnered with Ascension Wisconsin and ThedaCare about five years ago to form Catalpa Health, a partnership to improve access to mental health services for youth in northeastern Wisconsin.

Catalpa has clinics in Grand Chute, Oshkosh and Waupaca and staff in about 50 schools in the area, said Mary Downs, president of Catalpa.

"The care was really distributed among the systems," said Downs. "We have everything under one roof."

Catalpa employs six psychiatric service providers – a combination of doctors and nurse practitioners who can prescribe medications – five psychologists and about 50 registered therapists, said Downs.

But that does not mean that Catalpa is safe from the problems of manpower posing a challenge to the rest of the industry. The organization is trying to prioritize urgent cases, generally leaving a few niche appointments open to patients requiring immediate attention, said Downs.

Downs highlighted the major challenge of increasing the number of therapists: Wisconsin requires licensed therapists to spend 3,000 hours in the field after graduation before being reimbursed by insurance.

Many non-profit organizations can not afford to pay therapists when they are not reimbursed, Downs said.

"A lot of people end up leaving the field because they can not get their 3,000 hours," she said.

Herbst, of the Children's Hospital, said his organization was also concerned about this requirement of therapists.

"Most people can not afford to spend their time working for a year and a half to get those 3,000 hours," Herbst said.

To help people meet this requirement, the Children's Hospital plans to launch a program this spring that will involve hiring individuals to attend a specific training program to become a full-time therapist. The Children's Hospital hopes that at least 25 people will have completed the program over the next five years, said Herbst.

But that alone will not solve the problem. More youth need to be encouraged to consider a career in mental health, Herbst said. And health care providers must continue to focus on prevention and early intervention.

"The solution can not simply be to hire more people," she said. "It never worked and it will not work in the future."

Listen to children from Wisconsin

USA TODAY NETWORK-Wisconsin will host two more free screenings of "You're Not Alone," a documentary produced in collaboration with Milwaukee PBS. Children are welcome, but please note that the film sensitively deals with difficult topics such as suicide and sexual assault.

Appleton: May 18 at the Fox Cities Performing Arts Center, 400 W. College Ave. Register on bit.ly/notaloneapc or watch live on facebook.com/postcrescent.

Wausau 6:00 pm June 4th at the Marathon County Public Library, Wausau Headquarters, 300 Saint St. Sign up at bit.ly/notalonew or watch live on facebook.com/wausaudailyherald.

Do you want to organize your own projection?

If you want to organize a screening and discussion for your school or community, you can find a free stream and a toolbox at the address jsonline.com/yourenotalone. You can also request a free DVD copy of the film.