Texas Strives To Lure Mental Health Providers To Rural Counties
In her third year of medical school, Karen Duong found herself on the other side of Texas. She had driven 12 hours north from where she grew up on the Gulf Coast to a panhandle town called Hereford.
"Hereford is known for being the beef capital of the world," she says, laughing. "There's definitely more cows than people out there."
It's even named after a breed of cattle. Out here, there aren't many people who provide mental health care. In fact, there aren't any psychiatrists. That's the reason Duong went there — she's studying psychiatry as a medical student
at the University of North Texas Health Science Center. This assignment showed her just how severe the state's mental health care shortage is.
"You have a patient that comes in and they need immediate care or something more acute, and then you tell them that the soonest they can get in for an appointment is six months from now," Duong says. "It's not really what we want to tell our patients."
Medical student Karen Duong worked in Hereford, Texas, with Dr. Akinyele Lovelace, an instructor with the University of North Texas Health Science Center's rural medical education program.
Hereford is one of many areas in Texas lacking adequate access to mental health care.
Of the 254 counties in Texas, 185 have no psychiatrist, according to Travis Singleton, who tracks physician shortages for Merritt Hawkins, a Texas-based consulting firm. "That's almost 3.2 million [people]," he says.
The shortage goes beyond Texas. In the past year, Singleton's firm has been asked to recruit more psychiatrists nationwide than ever before.
"While we knew the demand was high, I don't think anyone expected it to that extent," he says.
Supply issues have crept up on psychiatry, Travis says. "You have less and less residents wanting to go in this specialty in general, and then you have those that actually do practice medicine not necessarily in the most optimal settings for us."
So how do you persuade students to become psychiatrists, social workers and psychologists and then be willing to work in rural areas?
Republican state Sen. Charles Schwertner is trying cash. He sponsored a law that, starting in 2016, will help around 100 medical health professionals repay loans if they go to work in underserved areas. Schwertner says the investment will pay off.
"Where we don't have those services for mental health patients, they wind up cycling back through our jails and our emergency rooms," he says.
There are a number of loan repayment programs for students focused on mental health across the country. They're "at least somewhat successful," says Sita Diehl, director of state policy and advocacy with the National Alliance on Mental Illness.
But she doesn't think they go far enough.
"The most successful strategies are to find young people within the rural community. They know the community, they have an investment in the community," Diehl says. "Otherwise the turnover rates in these loan repayment programs are pretty high."
For medical student Duong, it's also important to address the stigma of seeking and treating mental health care.
"Even I have some family members who aren't supportive of me going into psychiatry," she says. "There are people out there who don't think mental illness should be considered a diagnosis."
But Duong says she's now committed to working in a rural Texas town, despite some sacrifices.
"It doesn't compare," she says, "having all these luxuries in a city versus being able to go out there and really make a difference in your patients' lives."
This motivation is exactly what Schwertner is looking to spark with the state's loan repayment program.
This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News.
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Transcript
RACHEL MARTIN, HOST:
Across the country, psychiatrists are in short supply. In Texas, nearly 3 out of 4 counties have no psychiatrist at all. In these vast rural areas, the wait time to get mental health care can be months. KERA's Lauren Silverman reports on one lawmaker's idea to address the issue.
LAUREN SILVERMAN, BYLINE: In her third year of medical school, Karen Duong found herself on the other side of Texas, 12 hours from the Gulf Coast where she grew up in a panhandle town called Hereford.
KAREN DUONG: Hereford is known for being the beef capital of the world. There's definitely more cows than people out there, so (laughter).
SILVERMAN: It's even named after a breed of cattle. Out here, there aren't many mental health care workers. In fact, there aren't any psychiatrists. That's the reason Duong was there. She's pursuing psychiatry as a medical student at the University of North Texas Health Science Center. And this assignment showed her just how severe the mental health care shortage is.
DUONG: You have a patient that comes in and they need immediate care or something more acute and then you tell them that the soonest they can get in for an appointment is six months from now or eight months from now. It's not really what we want to tell our patients.
SILVERMAN: Hereford is one of many areas in Texas without adequate access to mental health care. Travis Singleton tracks physician shortages for the consulting firm Merritt Hawkins. He says 185 counties in Texas out of 254 have no psychiatrist, affecting about 3 million people. Singleton says his firm has been asked to recruit more psychiatrists nationwide in the past year than ever before.
TRAVIS SINGLETON: We knew the demand was high. I don't think anyone expected it to that extent.
SILVERMAN: Here's what he thinks is going on.
SINGLETON: You've got supply issues that have slowly but surely crept up on psychiatry. It's sort of this one-two punch. You have less and less residents wanting to go in this specialty in general. And then you have those that actually do practice medicine not necessarily in the most optimal settings for us.
SILVERMAN: So how do you persuade students to become psychiatrists, social workers and psychologists in far-flung places? Republican state senator Charles Schwertner is going to try cash. Starting in 2016, a program he sponsored will help around 100 medical health professionals repay loans if they go to work in underserved areas. Schwertner, who's a doctor, says the investment will pay off.
CHARLES SCHWERTNER: Where we don't have those services for mental health patients, they wind up cycling back through our jails and our emergency rooms.
SILVERMAN: There are a number of these loan repayment programs for students focused on mental health across the country, says Sita Diehl.
SITA DIEHL: It's at least somewhat successful.
SILVERMAN: Diehl is with the National Alliance on Mental Illness, and while she likes the programs, she says they need to go further.
DIEHL: The most successful strategies are to actually find young people who actually come from the rural community because they know the community. They know the culture. They have an investment in the community. Otherwise, the turnover rates in these loan repayment programs are pretty high.
SILVERMAN: For student Karen Duong, it's also important to address the stigma of seeking and treating mental health care.
DUONG: Even I have some family members that aren't supportive of, you know, me going into psychiatry, and there are people still out there that don't think mental illness is - should be considered a, you know, diagnoses.
SILVERMAN: Duong says she's now committed to working in a rural Texas town, despite some sacrifices.
DUONG: It's just so rewarding that that doesn't even compare, like, having all these luxuries in the city versus being able to go out there and really make a difference in your patients' lives.
SILVERMAN: This motivation is exactly what Senator Schwertner is looking to spark with the loan repayment program. For NPR News, I'm Lauren Silverman in Dallas.
MARTIN: This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News. Transcript provided by NPR, Copyright NPR.
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