Psychiatrist shortage leaves many in area without help
Aberdeen American News - 10/6/2018
Oct. 06--Aberdeen police officers are responding to mental health calls on a daily, sometimes hourly basis.
To Dave McNeil, chief of the Aberdeen Police Department, that's a reflection of the demand for mental health professionals, including psychiatrists.
But good luck getting a timely appointment with a psychiatrist in northeastern South Dakota if you're not already a patient.
On Friday, the wait to see Aberdeen's lone psychiatrist was nine weeks, according to information from Avera Health.
In other parts of the state, like Sioux Falls, the wait could end up being a few months, said Susan Kornder, executive director of Northeastern Mental Health Center in Aberdeen.
That's because psychiatrists -- medical doctors trained in treating mental health with medicine -- are tough to find these days, said Avera St. Luke's Hospital CEO Todd Forkel.
That's from both the standpoint of patients and health care providers.
Leading up to the retirement of Sanjeevi Giridhar in June, Northeastern Mental Health advertised for a new psychiatrist for 18 months, with no luck.
Northeastern's certified nurse practitioner, Rhonda Fliehs, continues to see patients who need psychiatric help. Certified nurse practitioners are able to do so under the supervision of a psychiatrist, Kornder said. She could not disclose who is supervising Fliehs.
Fliehs' schedule is full, and she's unable to take on new patients.
Avera St. Luke's has the same problem. It employs the only psychiatrist in Aberdeen, Xiaolin Deng.
It continues recruitment efforts as well, but without success, Forkel said.
That means Deng's patients often have a long wait before being able to get an appointment.
Sanford Health does not offer psychiatric services in Aberdeen.
The increase in mental health calls that McNeil has noticed is only a problem in that supply can't meet demand. A decrease in the stigma surrounding mental health has more people reaching out for help. That's a good thing, he said.
But the wait for some people to get help isn't.
There are a number of factors both Avera St. Luke's and Northeastern have identified that make it difficult to recruit psychiatrists to the Aberdeen region:
* It is a rural area.
* There's a high demand all over the U.S., and there are not enough people going into the field.
* Those who do practice psychiatry can live and work anywhere they choose.
* Agencies like Northeastern Mental Health will treat people who can't pay, and that often means a less-attractive salary.
The increasing need has to be met somehow, and that's something Avera St. Luke's and Northeastern Mental Health, as well as those on the front lines, are trying to figure out.
A mobile solution?
Police officers are specifically trained to identify people struggling and in crisis. Some officers have completed a higher degree of training through an additional crisis intervention program, McNeil said.
But even with that response, there's one thing that's lacking: follow-up.
With the help of police chaplain Jon Droege, that could soon change. The police department hopes to develop a mobile crisis team. It would be made up of officers, chaplains and mental health professionals on call 24/7 to address people in crises -- often without handcuffs or hospitalization.
The team would go into the field to assist with mental health calls, Droege said.
"Officers do a great job of responding, but what's lacking is the follow-up and connecting those people to resources," he said.
The police department is in a good position to launch the program. But the other organizations have identified some challenges, McNeil said. Those include budget restraints, logistics and personnel.
Both Sioux Falls and Fargo, N.D., have similar teams, and Droege will rely on those cities to help establish Aberdeen's while addressing the challenges. He said those teams have seen some success without having to commit or take people in custody.
According to a report by South Dakota Public Broadcasting, the mobile response team in Sioux Falls went to 47 calls last year, and not one of them required hospitalization.
State law gives mobile crisis teams the ability to intervene in crises situations. They also govern the confidentiality of records, give officers the authority to place severely mentally ill people in a mental health or detoxification facility with priority, and more.
For now, though, in an emergency situation, people are connected with crisis lines, such as Northeastern Mental Health's.
"If imminent danger exists, (the person is) taken to (the Avera St. Luke's) emergency department or sometimes held in the jail for evaluation, depending on the situation," Kornder said.
There's access to making an initial call for help through the crisis hotline by dialing 211, which is "a really, really easy point of contact that will help a person through the process," Droege said.
The hotline is available around-the-clock.
Into the future
From a clinical standpoint, the future is in technology.
Although not ideal, telemedicine is likely where Northeastern Mental Health is headed, Kornder said. Telemedicine differs from online counseling services because of the standards, rules and regulations it has to meet.
While it can work, telemedicine is not as personal as meeting with a psychiatrist, and developing that personal relationship is important, she said.
If patients feel like they don't know their psychiatrists, they are less willing to trust them. That's especially true in patients with paranoia and other symptoms. Additionally, psychiatrists often rely on body language.
But the unfortunate reality is telemedicine will be needed to keep up with client's needs, Kornder said.
Some will see that as a positive, especially in smaller communities where others are more likely to see patients go in and out of offices, she said.
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