Psychiatrist Shortage Means Long WaitsApril 3, 2017 |
by Sam Kennedy, Associated Press
ALLENTOWN,Pa. — Sue Drabic of Allentown knew right away something was wrong with a family member, a college student at the time.
“He was having delusional statements, like talking about saving the world,” she said, recalling the episode. “He was saying it in a way that you could tell he was serious about it.”
All Drabic wanted, as would anyone in her shoes, was help for her loved one — and right away. What she got instead was an initiation into the state of psychiatry.
“(He) had to go all the way to Philadelphia because there were no beds in the Lehigh Valley,” she said.
He came back weeks later heavily sedated, barely able to function.
Eager to have his prescription altered, she called for an appointment with a local psychiatrist only to find out the next opening was in five to six months, she said.
“It’s hard for someone to get the news that someone they care about is very ill and then to have to wait,” she said.
Eight years later, the situation is much the same. A shortage of psychiatrists in the Lehigh Valley, statewide and nationally means limited options and long waits are still the norm, according to health care professionals, advocates and patients and their families. Specialists, such as pediatric or geriatric psychiatrists, are in even shorter supply.
For those in crisis, the stakes couldn’t be higher, said Muhamad Aly Rifai, president-elect of the Lehigh Valley Psychiatric Association. These are people who might be experiencing thoughts of suicide or paranoia, and their erratic behavior can be a danger to themselves and others. Some end up in not a hospital bed but a jail cell.
“We see this all the time,” said Rifai, chief psychiatrist and internist at Blue Mountain Psychiatry in Lower Nazareth Township. “Every day.”
As bad as the problem is in the Lehigh Valley, it’s just as bad or even worse in many other places. Roughly half the country, including a swath of downtown Allentown and about 120 other parts of Pennsylvania, have been identified as mental health professional shortage areas by the U.S. Health Resources and Services Administration, meaning they have only one psychiatrist for every 30,000 or more people.
The problem is projected to only get worse in the not-too-distant future, in part because mental health disorders appear to be becoming more common or at least more recognized, and because a disproportionate number of psychiatrists are older and approaching retirement.
Forty-two percent of psychiatrists in Pennsylvania are 60 or older, compared with 27 percent of all physicians in the state, a 2013 study by the Association of American Medical Colleges found. Of three dozen physician specialties, the only other with an older workforce was anatomic/clinical pathology.
The number of new slots for psychiatry residency programs, meanwhile, has not increased in two decades, creating a bottleneck at the entry level.
Psychiatrists are often confused with psychologists, although the two are quite different. Generally speaking, psychologists are therapists who help people learn how to better cope with certain mental health or life issues. Psychiatrists, on the other hand, are medical doctors with special training in the field of brain disorders. Unlike psychologists, psychiatrists are licensed to prescribe drugs.
Sometimes psychologists end up serving as a stand-in. That’s what Fransisco Martinez, who was diagnosed with bipolar disorder in his youth, found recently when a nonprofit group that provides housing assistance told him he needed a psychiatrist’s assessment before it could help him.
“I’ve seen my therapist four times, but I still haven’t seen a psychiatrist,” said an exasperated Martinez who, at 24, has been living in a homeless shelter with his wife and three children while he waits. “We’re trying to better our situation and we’re going through the process, but it’s not me (slowing it down).”
In recent decades, society has undergone profound shifts in the way it perceives and responds to mental disorders. On the one hand, the stigma, while still real, has diminished as celebrities such as the late Carrie Fisher of “Star Wars” fame have gone public with stories of their own struggles.
But on the other hand, those with serious problems have been left to deal with them largely on their own – or perhaps, for those fortunate enough to have such support, with the help of their families and friends. Since 1955, Pennsylvania has closed the bulk of its state hospitals, reducing the number of patients from 41,000 in 1955 to less than 1,500 as of last month, according to the Department of Health and Human Services.
Many people who need help end up finding their way to the Lehigh Valley chapter of the National Alliance of Mental Illness. The nonprofit serves as both a support group and a clearinghouse of information about local resources.
“We get many calls. By far the majority are from people seeking help looking for a psychiatrist,” said Margaret Murphy, NAMI Lehigh Valley director. “Most of those people, before they call us, have made multiple phone calls . and most are told the waiting period is” months.
Cindy Porter, 69, of Wescosville believes psychiatrists are so taxed that patients such as her adult son, Mark Savary, don’t get the level of attention they need.
“It’s just treat him and street him,” she said, speaking generally about the system and not about any particular doctors. “You don’t get any follow-up. … Even when I call and say, ‘It looks like Mark is going over the deep end again,’ I cannot get a call back.”
Porter said her son, 44, used to be a highly productive welder. He began to show signs of mental illness after the 9/11 attacks on the Twin Towers, which he witnessed from his work site directly across the Hudson River.
His behavior became unpredictable and threatening, Porter and Savary said and court records confirm. His girlfriend broke up with him, he smashed multiple cars and filed for bankruptcy, losing his house.
He ended up in jail, where he was diagnosed with schizophrenia, they said. Since then, however, his diagnosis has been revised to post-traumatic stress and bipolar disorders.
Over the years Savary said, he’s been in and out of hospital emergency rooms and lock-down units. More recently, his medications have rendered him listless.
“He sleeps 24/7. He gets up and goes to meetings, but that’s no life,” Porter said. “Every day he must say it 100 times, ‘What does it all mean?’ I get so tired of hearing it.”
Savary isn’t happy with his predicament either.
“I went from hero to zero,” he said. “I used to have a good life. … It’s rough now.”
Beds but no doctors
One of the biggest providers of psychiatry services in the region is Lehigh Valley Health Network, whose facilities include a 52-bed adult inpatient center and 13-bed adolescent center, both at LVH-Muhlenberg.
And yet even there the demand for services is difficult to meet. According to LVHN’s website, only two of the network’s two dozen psychiatrists are accepting new patients.
“Even with this substantial and experienced team of providers and the number of people helped, access to all who need it remains a challenge,” LVHN spokesman Brian Downs said.
Virginia Wagner, behavioral health administrator at St. Luke’s University Health Network, sounded a similar note.
“We know the enormity of the national crisis that has been caused by the shortage of psychiatrists and we continue also to consider alternative models of care,” she said, adding that St. Luke’s continues to recruit psychiatrists and other licensed mental health providers.
Other area hospitals offer special psychiatric services. In 2015, Easton Hospital opened a 16-bed unit specifically for the inpatient psychiatric treatment of adults age 50 or older.
At its sprawling campus in North Whitehall Township, KidsPeace has one of the largest free-standing children’s psychiatric hospitals in the country, with 120 beds.
One day last month, the nonprofit had to turn away children even though only 96 of the beds were occupied, said Dr. Matthew Koval, chief medical officer at KidsPeace. The reason: Not enough psychiatrists.
Koval said the facility employs nearly a dozen psychiatrists, including himself, but still has three openings he has struggled to fill.
“We’re busy, and we’d be even busier if we had those three other doctors,” he said. “If we could recruit more, we would do more.”
Indeed, competition for psychiatrists is stiff nationwide. Hospitals are making use of nurse practitioners and physician assistants who work under the direction of psychiatrists as well as video conferencing technology that allows psychiatrists to take on ever-larger caseloads. But such “physician extenders” aren’t enough.
The physician recruiting firm Merritt Hawkins reported in 2015 that the number of prospective employers’ searches for psychiatrists over the previous year hit an all-time high after three decades of tracking. Only internal and family medicine specialists were in higher demand.
Often family doctors, desperate to help their patients and lacking timely alternatives, step in to fill the gap despite their lack of expertise, Rifai said, noting that family doctors prescribe the majority of psychiatric medications.
“They know the wait time is so long,” he said. “And they start treatment.”
For Drabic’s family member, the key to regaining his mental health was a psychiatrist who was willing to experiment with different medications and doses until finding just the right combination. But it took years to find such a doctor, she said, and then more time to fine-tune the prescription.
The past year, she said, has been a good one for her family member, who is back in college after dropping out.
“I really admire people who have mental illness and continue to stick with it and put up with all the difficulties, whether it’s the stigma or the lack of practitioners,” she said. “It can be a particularly challenging illness, especially when it hits you at a young age.”