Editor’s note: If you or someone you know is suffering from mental health problems, support is available by calling or texting the national Suicide and Crisis Lifeline on 988.
In small towns, like Walla Walla, Washington, it can be difficult to find behavioral health providers.
Susan Shain / NWPB
Nichole Konen Giraldo lives in Walla Walla, Washington, a city of about 30,000 people. Last summer she lost her husband.
“You’re struggling, you’re sad, you’re depressed, you’re suicidal,” she said. “I mean, all these things go through your brain and you just need to talk to someone.”
Giraldo has been searching for a long-term grief counselor for five months. She called everyone she could think of. Most don’t even call her back.
“You just have to sink or swim,” Giraldo said. “It’s a crisis in this community.”
Across the country there is a behavioral health provider shortage – and it’s particularly pronounced in small towns.
According to the Department of Health and Social Services, about a third of the U.S. population lives in an area lacking mental health care providers. Of this group, more than two-thirds live in rural or partially rural areas.
The challenges can be even greater for immigrants, who may face a range of difficulties. cultural and structural barriersincluding language, stigma and cost. Or for people with low incomes.
Alyssa Robinson is a therapist in St. Maries, Idaho, population about 2,500. She said it’s especially difficult to find providers who take Medicaid.
Her clinic is one of three in the city and one of the few in the area with Medicaid. For providers, she said, Medicaid requires more work and offers less reimbursement than other types of insurance.
“You do more work for less pay,” she said.
Robinson has clients who drive nearly two hours to see her, simply because she takes Medicaid.
For some rural patients, telehealth services can help bridge the gap. But internet access is not always reliable in remote areas. And Robinson said some patients don’t want to do video call therapy.
Denise Metzger is a social worker in Coeur d’Alene, Idaho. She said that while her part of the state is not rural, it remains underserved. Many therapists have waiting lists, especially if they serve clients with specialized needs or certain insurers.
“If you have Medicaid or Medicare, the number of people you can see is very limited. I give the same names and numbers to a lot of people,” she said. “In terms of therapies for children, it’s also quite limited.”
This shortage places a huge burden on patients, said Cassidy Brewin, who works in behavioral health for Walla Walla County.
“They need care now,” she said. “The same way a person could access emergency care if they had a physical health need and get services the same day. »
In other words, waiting months is unrealistic.
In rural areas, Brewin pointed out that the lack of specialized providers and facilities can strain other services, as many people seeking care will call 911 or go to the emergency room.
“If you look at Washington State, each Single county there is at least a partial shortage of mental health providers,” she said. “It’s not something unique to our county, but I think rural areas are struggling more than our more urban counterparts. »
Statewide, there are about 15 licensed mental health providers per 10,000 residents. In Walla Walla Countythe number of providers is only a fraction of that figure: about five per 10,000 people.
If the need is clear, the solutions are less clear. Some strategies focus on reducing paperwork and increasing provider reimbursement.
Others simply focus on getting more people into the field.
And it’s not an easy hurdle: Even though the median salary for physical health care jobs, like registered nursesis much higher than those of behavioral health careaccording to the Bureau of Labor Statistics, many positions still require advanced degrees. And then there is the burnout problem.
“There’s always been a huge need and it’s a difficult area,” said Teresa Claycamp, who works at the University of Washington. Health Care Authority. “The pandemic has really made the labor shortage significantly worse. »
Some programs aim to support clinicians in rural and underserved communities by providing workforce training and a chance to connect with each other.
“To me, it feels like a lifeline sometimes,” Metzger, the Coeur d’Alene social worker, said of one of these programs. “I presented cases to get feedback from other professionals. And that’s been really helpful, even if it’s just to get some validation, like, “Yeah, this one is really hard.” »
To attract more providers to this area, the Health Care Authority of Washington also launched a public awareness campaign in 2021.
It highlights behavioral health careers that do not require advanced degrees, such as substance use disorder professionals and peer counselors. It aims to attract providers who otherwise might not have considered jobs in the mental health field. The State introduced a behavioral health apprenticeship programAlso.
“There are many different paths,” Claycamp said. “It’s not just an easy way to get into a career.”
Another Washington State Initiative helps fund master’s degree programs for future counselors, therapists and social workers. After graduating, these students must spend three years working in selected community agencies or tribal health centers. In Walla Walla County, for example, there are three agencies this would be admissible.
Ryan McKown believes that strengthening the student-therapist pipeline is a crucial part of the solution. He is the executive director of Blue Mountain Health Cooperativea free walk-in counseling center in Walla Walla where master’s level students treat patients.
“It’s a real challenge to go from having a master’s degree to becoming a licensed social worker, providing counseling services with a busy schedule and making a living,” McKown said.
Once their internships are over, McKown said many of his students want to stay in the area. But about half end up leaving because they can’t find a job. Or they can’t find therapists to supervise them while they work toward their license.
Others choose to use telehealth because living in a small town comes with unique challenges.
“You know your neighbors, you meet people you know on the street, at the grocery store,” McKown said. “And the lack of separation between mental health work and personal life can also be a barrier.”
This story comes to you from the Northwest News Network, a collaboration between public media organizations in Oregon and Washington.
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