When people reach out in need of mental health care, they’re likely experiencing some sort of crisis.
“And the longer they have to wait to see a provider, the more susceptible they become to struggling with the mental health issues they have and/or suicidal ideations,” said Kirsten Belaire, director of behavioral health at Mt. Carmel Veterans Service Center. “Immediate access, especially with our veteran community, is critical because it might be the first time the patient is reaching out, and they don’t have the coping skills they would get from a clinician yet.”
In the Colorado Springs area and nationwide, a shortage of mental health care providers is making it difficult for patients to find available appointments, said Moe Keller, director of advocacy for Mental Health Colorado.
“It’s a national problem; it’s a state of Colorado problem,” she said. “There’s a workforce shortage across the entire mental health spectrum, with rural areas much more impacted than urban ones.”
It found there were 9.1 practicing psychiatrists per 100,000 people in the Colorado Springs metropolitan area, which was 37 percent below the national average at the time.
Mike Ware, CEO of the El Paso County Medical Society, told the Business Journal’s sister publication, the Colorado Springs Independent, in January that the shortage has worsened locally due to the area’s population growth and an increase of recently retired psychiatrists.
“It’s gotten pretty extreme,” he said.
Colorado needs 131 more psychiatrists to achieve the desired population-to-psychiatrist ratio of 30,000 to 1 to be removed from the nonprofit Kaiser Family Foundation’s Mental Health Care Health Professional Shortage Areas list.
The state has about 30 percent of the number of psychiatrists — trained medical doctors who can prescribe medication — needed to serve its population, according to the nonprofit.
Keller said a lot of mental health professionals are leaving the industry because of their own mental health.
“It is a very emotionally straining career,” she said. “After a few years, you’ll find that people are starting to cut back. Then, they might even leave the profession and do something else because their emotional stability gets affected.
“They get tired and too drained — burned out,” she said. “This is true of workers in all the human services sectors, whether it’s foster care, or it’s running group homes, people get worn out.”
Wage growth also hasn’t kept up with demand, Keller said, adding the nonprofit has heard it from all mental health providers, but particularly psychiatrists and psychologists.
“One psychiatrist said he was being paid currently by a private insurance company the equivalent to what he was being paid in 1984,” she said. “With Medicaid and Medicare, the federal government also provides very low reimbursement rates for mental health and substance abuse disorders.”
As a result of the low reimbursement rates, mental health providers are starting to no longer accept clients’ insurance, either federal or private, Keller said, which limits the “affordable” options for people.
“We know [in Colorado] that about 50 percent of mental health workers, especially psychiatrists, but also psychologists and licensed clinical social workers, do not take Medicaid patients, nor do they take private insurance,” she said. “That’s part of the problem, but it’s not the whole problem.”
Another issue keeping providers from taking any type of insurance is the “onerous” paperwork, Keller said.
“I had a physician tell me yesterday that he took Medicaid patients but what he decided to do was not even bill Medicaid because he lost the money when he had to fill out the paperwork,” she said. “He said he just wrote them off as pro bono.
“It was easier, faster and more cost effective for him to do Medicaid patients free of charge than it was to actually bill for the service — that’s how bad the paperwork was and still is. And it’s not much better with private insurance.”
Keller said there’s also the issue of private insurance companies narrowing the number of practitioners in their networks to control their costs, “which creates a wait list and problems for access as well. They may only have one psychiatrist when they used to have four, or they might only have three psychologists when they used to have seven — that kind of thing.”
Additionally, Keller said there have been issues of family primary care practices adding a licensed clinical social worker to their team but private insurance refusing to pay for services from the mental health provider.
“The private insurance will not allow that doctor to bill for the services that the social worker gives because they’re not in their network, and they don’t want to open the network to add any more people,” she said. “You put all this together, and we’ve got a shortage.
“And it’s really compounded in rural areas, simply because the professionals or their families don’t want to live there.”
The area’s five military bases and its veteran population nearing half a million is exacerbating the mental health provider shortage in El Paso County, Keller said.
“There is a bigger need for mental health and support groups here, not just for the military members and veterans, but for their families as well,” she said.
In 2016, there were 175 veteran suicides in Colorado, according the U.S. Department of Veteran Affairs. That year the state’s suicide rate was 42.9 per 100,000 while the national rate was 30.1 per 100,000.
Belaire said Mt. Carmel as well as other agencies with mental health services in the Springs are helping fill the workforce gap by providing other avenues for people needing help.
“I’ve also heard from a lot of veterans that they don’t want to necessarily go to civilian providers because they feel like civilian providers don’t understand them and don’t understand the military culture,” she said.
At Mt. Carmel’s counseling center, military members, veterans and their families can receive support treatment services for a variety of issues or conditions, including depression, anxiety, trauma, relationship struggles, post-traumatic stress disorder and life transitions.
Bob McLaughlin, chief operating officer for the nonprofit, said all they ask for is a $10 donation to help cover costs.
“That’s far less expensive than the average copay,” he said. “When we started this [in 2016], you could walk in and get care immediately, which was great news. Now that it’s grown, there’s a little bit of a wait.”
The uptick in clients is partly due to the provider shortage, McLaughlin said, but it’s also a result of the military addressing the stigma around mental illness.
“The stigma is going down and people are more apt — whether they’re active duty or they’re a transitioning veteran — they’re willing to come forward and say, ‘I need help,’ which is great,” he said. “And what we’re doing here at Mt. Carmel is we’ve created a place where more people will come because they feel comfortable.
“The issues have always been there with our military veterans and their families, but now, they know or feel they can get help for one reason or another.”
Meanwhile, Sherri Sharp, vice president of behavioral health at Peak Vista, said there likely is a correlation between the mental health provider shortage and El Paso County’s teen suicide rate.
“I’m sure [the shortage] isn’t helping it,” she said. “There’s a serious shortage of pediatric mental health providers everywhere, and that’s not good when a community has a problem like that.”
In Colorado, suicide is the leading cause of death for youths ages 10 to 17, according to El Paso County Public Health. The suicide rate in El Paso County among those under the age of 18 has increased from seven suicides in 2014 to 15 in 2016.
Keller said Mental Health Colorado regularly receives inquiries from parents seeking mental health resources for their children.
“Sometimes they want [at-home care] and very rarely will a private provider pay for that,” she said. “If they do, it’s going to be a few days to a week or longer before that help can be provided. And when someone is facing a crisis, they need that help now.”
Solutions to shortage
Mt. Carmel uses interns to help expand its service capabilities as well give the interns experience working with the military community, Belaire said.
The interns come from Denver University, UCCS, the University of Northern Colorado, Regis University, Denver Seminary and Colorado Christian University.
“What our program is attempting to do is make behavioral health more accessible by creating a future cohort of clinicians that are effective with our military community,” she said.
Since the intern program started three years ago, it has expanded from the four it started with, Belaire said, adding it now has about 30 to 40 interns each year.
“We have found so far that we have a pretty high satisfaction rating from the interns and our clients,” she said. “I think that’s due to the fact that whether the interns have served or not, because they’re becoming more culturally competent with the military, the people they see feel understood and feel like they’re in good hands.
“The program is getting those interns that military experience and helping them then start their professional careers, and hopefully alleviating the provider shortage some.”
Both Keller and Sharp said their organizations also are working on solutions to address the workforce gaps, including student loan repayment programs.
“There’s a certain time commitment with those, depending on which program they’re part of, to stay in a designated place, such as a federally qualified health center like Peak Vista,” Sharp said. “There are also some that are rural-specific.”
Keller said the nonprofit also is trying to address the shortage in rural communities by expanding broadband capabilities for telehealth services.
“We found if you have broadband and you have access to a professional through the broadband in your home there’s a huge spike-up of the number of people that will actually seek treatment, especially with men,” she said. “If they can talk to their counselor at home, there isn’t the stigma.
“They don’t have to worry about their neighbors or somebody else seeing their car or knowing that they’re going to get treatment,” she said. “It’s private; it’s personal.”
Mental Health Colorado also is continuing to work with the private sector in addition to legislatures to get insurance networks opened up, increase reimbursement rates and limit the amount of paperwork, Keller said.
“If they were able to provide better reimbursement rates, we would see more providers willing to take individuals who have private insurance, and Medicaid,” she said. “Untreated mental health is a cost that hits not only the family with the individual who can’t get service, and therefore cannot function as a productive member of society, but it also affects businesses in terms of their bottom line when that person has to miss work and/or eventually be replaced.
“When individuals don’t receive the care they need, it really impacts so many more people than just them — that’s why we need to address this shortage.”