Rural Wisconsin continues to face shortages in mental health care

By Benita Mathew

Counties in Wisconsin are facing severe shortages in mental health services, but rural areas in the state continue to fall the most behind. In fact, a report by the Wisconsin Policy Forum found that more than 75 percent of Wisconsin’s rural counties face a “significant shortage” of psychiatrists. However, the shortages expand beyond psychiatrists alone. Wisconsinites struggle to find access to therapists or money to cover mental health care costs, leaving many people’s mental illnesses untreated in rural communities.

“Most mental health care providers including therapists, psychologists, and psychiatrists cluster in urban areas, but we have the most data on psychiatrists,” said John Eich, the Director of the Office of Rural Health. “That’s why it seems like they are the ones with the highest shortages,” The lack of services in rural areas, Eich said, has become more concerning as cities turn to police and overcrowded ERs to handle people in need of treatment.

“Usually what happens is it becomes a police problem,” Eich said. “The police don’t know what to do about it either. They don’t have any more resources than anyone so they do what they can.”

In addition to struggles in accessing proper care, many people do not have sufficient reimbursements to cover the expensive costs of care. Many residents in rural areas are economically disadvantaged, according to Dr. Joseph Holt, the Director of the Wisconsin Academy of Rural Medicine (WARM). “And since mental health is still not valued as high as physical health, treatments are not reimbursed the same way,” Holt said.

Meanwhile, the opioid epidemic has only increased the need for mental health services in rural areas, said Elizabeth Goodsitt, a Communications Specialist at the Wisconsin Department of Health Services. More people are seeking addiction treatment, according to Goodsitt, but the lack of providers in rural areas only highlight the need for behavioral health specialists. In an attempt to remedy the problem, the DHS recently issued new grants totaling approximately $300,000 to fill “high need, high demand” positions in rural hospitals, including substance abuse counselors-in-training.

To address the shortages of specialists, communities are turning to primary care physicians to handle people’s general mental health concerns, Holt said. WARM is one initiative aiming to increase the number of physicians in underserved areas of the state. The program admits students from the UW School of Medicine and Public Health who intend to complete their residencies and practice in rural cities. Students in the program receive general mental health and psychiatry training, regardless of which field they want to practice in. “We want to give all our students a general mental health care training because just one primary care doctor makes a difference in these rural areas,” Dr. Holt said.

WARM hopes to build a network of psychiatrists and physicians who will stay in-state upon completion of the program. “We try to admit the right people whose hometowns are near needy areas — that way, there’s a chance they will go back after they graduate,” Dr. Holt said.

Goodsitt hopes there will be more efforts to retain providers who will practice in rural areas. One current initiative Wisconsin has is a special loan forgiveness program for psychiatrists who agree to practice in rural areas. In addition, the Department of Health Services created the Graduate Medical Education Initiative, which provides grants of up to $75,000 to residents in various fields such as psychiatry. Priority for the grants is given to residents in rural communities.

“These programs are important because research and experience tell us that graduate medical education programs for residents who select people with current or prior ties to Wisconsin are much more likely to stay and practice in the state,” Goodsitt said.

However, more needs to be done if the demand for physicians is to be met. According to a news release from the Wisconsin Council on Medical Education and Workforce (WCMEW), almost half of Wisconsin’s primary care physicians are expected to retire by 2035. The number of new primary care physicians will only increase by four percent statewide by 2035 despite new programs in place such as WARM. There are also shortages in the current workforce with less than 10 percent of the state’s physicians practicing in rural areas, according to the news release.

“The demand for physicians will be six times higher than the demand,” Holt said. The crisis is going to get worse all across the state.”

The supply of psychiatrists is not expected to significantly increase either. The psychiatrist workforce in rural areas is expected to retire earlier than in urban areas. According to Wisconsin Policy Forum’s report, the psychiatrist population in rural areas is, on average, older than psychiatrists in metropolitan areas.

State programs need to increase tremendously to combat the loss of the workforces, Holt said. However, programs should expand at the community level as well, according to Eich. “Many grassroots initiatives can be used with community leadership,” Eich said. Leaders can be trained to recognize warning signs and provide support.

“What people need are early screening to identify warning factors and treatment options all along the spectrum from there might be a problem or there is definitely a problem,” Eich said. “There just aren’t many treatment options either with someone in town or a bed to stay at if someone needs to be admitted. There’s just not the places to deal with it.”

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