Editor’s note: If you or someone you know is struggling with their mental health, support is available by calling or texting the National Suicide and Crisis Lifeline at 988.
Nicole Coenen Giraldo lives in Walla Walla, a town of about 30,000 people. This summer, she lost her husband.
“You’re in pain, you’re sad, you’re depressed, you’re suicidal,” she said. “I mean, with all these things going through my head, I just need someone to talk to.”
Giraldo had been searching for a long-term grief counselor for five months. She calls everyone she can think of. Most people don’t even call her back.
“It’s basically sink or swim,” Giraldo said. “This community is in crisis.”
There is a national shortage of behavioral health providers, especially in small towns.
According to the Department of Health and Human Services, approximately one-third of the U.S. population lives in areas with a shortage of mental health providers. Of this group, more than two-thirds live in rural or partially rural areas.
The challenges can be even greater for immigrants, as they may face a variety of cultural and structural barriers, including language, prejudice, and cost. Or for low income people.
Alyssa Robinson is a therapist in St. Maries, Idaho, a town of about 2,500 people. She said it’s especially difficult to find a provider who accepts Medicaid.
Her clinic is one of only three in town and one of the few in the area that accepts Medicaid. For health care providers, Medicaid requires more effort and reimbursements are lower than other types of insurance, she said.
“You’re doing more work for less pay,” she said.
Robinson has some clients who drive nearly two hours to see her just because they receive Medicaid.
For some patients in rural areas, telehealth services can help fill the gap. However, Internet access is not always reliable in remote areas. Robinson also said some patients do not want to receive treatment via video call.
Dennis Metzger is a social worker in Coeur d’Alene, Idaho. Although her area is not rural, she said it is still underserved. Many therapists have waiting lists, especially if they serve clients with special needs or certain insurance companies.
“If you’re on Medicaid or Medicare, the number of people you can see is very limited. I give most people the same name and the same number,” she said. “Even when it comes to treating children, it’s pretty limited.”
Cassidy Brewin, who works in behavioral health in Walla Walla County, said the shortage is putting a huge strain on patients.
“They need care now,” she said. “Just like you can go to the emergency room if you have a physical health need and get services the same day.”
In other words, waiting for months is not realistic.
In rural areas, Brewin said, many people seeking care call 911 or go to emergency departments, which can put a strain on other services due to a lack of specialized health care providers and facilities. He pointed out that there is.
“If you look at Washington state, every county is at least partially lacking in mental health providers,” she says. “This is not unique to our county, but I think rural areas are suffering more than urban areas.”
Statewide, there are approximately 15 licensed mental health providers for every 10,000 people. In Walla Walla County, the number of providers is a fraction of that, about 5 per 10,000 people.
While the need is clear, the solution is less obvious. Some strategies focus on reducing paperwork and increasing provider reimbursement.
Some companies are simply focused on getting more people into the field.
And it’s not an easy hurdle. According to the Bureau of Labor Statistics, although the median salary for physical health care jobs, such as registered nursing, is much higher than behavioral health care jobs, many positions still require an advanced degree. And then there’s the issue of burnout.
“It’s a challenging field because there’s always great need,” said Teresa Claycamp, who works at the Washington Department of Health. “The pandemic has really deepened the labor shortage.”
Some programs work to support clinicians in rural and underserved areas by providing employee training and opportunities to connect with each other.
“For me, it feels like a lifeline sometimes,” Ms. Metzger, a social worker from Coeur d’Alene, said of one such program. “I presented the case to get feedback from other experts, and that was very helpful, even if it was just to get validation like, ‘Oh, this is a really hard problem.’ Ta. ”
To get more health care providers into the field, the Washington State Department of Health Services also launched a public awareness campaign in 2021.
We focus on behavioral health careers that do not require a graduate degree, such as substance use disorder specialist or peer counselor. This is aimed at attracting health care providers who might not otherwise have considered working in the mental health field. The state has also introduced a behavioral health apprenticeship program.
“There are a lot of different routes,” Claycamp said. “It’s not just this run-of-the-mill way to build a career.”
Another effort in Washington state helps aspiring counselors, therapists and social workers pay for master’s degree programs. After graduation, these students must work for three years at a community agency or tribal health center of their choice. For example, in Walla Walla County, there are three eligible agencies.
Ryan McCann said he believes strengthening the student-to-therapist pipeline is a key part of the solution. He is the executive director of Blue Mountain Health Cooperative, a free walk-in counseling center in Walla Walla where master’s level students treat patients.
“It’s really hard to go from being a master’s graduate to being a licensed social worker, providing counseling with a full schedule, and making a living,” McCann says.
Many students want to remain in the area once their clinicals are finished, McCann said. However, about half of them end up quitting their jobs because they cannot find a job. Or they can’t find a therapist to supervise them as they work towards getting their license.
Some people choose telemedicine because of the unique challenges of living in a small town.
“I know my neighbors and sometimes I run into people I know on the street or at the grocery store,” McCann said. “Inability to separate work in the mental health field from personal life can also be a barrier.”
