When Karla Buchanan and her husband adopted their 16-year-old daughter last year, they knew she had some serious problems.
The now 17-year-old girl suffered from attention deficit hyperactivity disorder, autism and cognitive delays, and she needed treatment and medication.
Buchanan, who serves as the local affiliate leader of the National Alliance on Mental Illness, said they first started looking for therapists and psychiatrists in Kokomo, but they didn’t have any luck.
At St. Joseph Hospital, no psychiatrists were available to see her daughter, she said. At Community Howard Regional Health, where Buchanan works, staff determined they couldn’t offer the girl comprehensive treatment because of her complex condition.
When they turned to the Kokomo Family Psychiatric Center, Buchanan said, they were told their daughter needed to see a therapist before getting access to a psychiatrist who could prescribe medication, and there was no guarantee the psychiatrist would take her case.
They didn’t have any more success after calling hospitals and mental-health centers in Indianapolis for help. They were all booked up. Everywhere they looked, it was a two-month wait or longer to get in to see a psychiatrist.
“I called everyone, and no one could meet her needs,” Buchanan said.
After searching for three months, she said they finally were able to get their daughter into Four County Counseling Center in Logansport, but it was still a three-week wait to see a counselor, and another month to see a psychiatrist.
Buchanan said it would have been even longer, but the counseling center expedited her daughter’s case because of her special needs.
Buchanan’s struggle to find mental-health treatment in Kokomo isn’t unique. It’s a story that plays out all too frequently due to a severe statewide shortage of psychiatrists.
“Most people who seek treatment need to be seen now,” she said. “They may not be in crisis when they first start looking, but they will be after waiting two months to see someone.”
A Psychiatric Drought
In Kokomo, there are six psychiatrists serving the city and surrounding counties. Community Howard employs three, St. Joseph has two and the Kokomo Family Psychiatric Center, which is a private practice with eight therapists and counselors, employs one.
Compared to the rest of Indiana, that’s pretty high. But even with more psychiatrists per capita than other areas of the state, people who need to see a psychiatrist in Kokomo still often wait months for an appointment.
“The services are here, but getting into them is the problem,” said Ken Gardner, a clinical therapist at the Family Psychiatric Center. “The services that we provide in Kokomo are solid, but in this area, the demand far exceeds the supply.”
Jill Snyder, executive director of the Mental Health Association in Kokomo, said the number of psychiatrists and mental-health workers in the city needs to increase dramatically in order to meet the need for treatment.
“In a town this size, with this many problems, we probably need to double the amount of psychiatrists,” she said. “There’s not enough staff, there’s not enough doctors, there’s not enough personnel. The bottom line: there just isn’t enough people. Unless you’re in a crisis, you’re going to have to wait.”
It’s even worse in rural parts of the state.
According to the U.S. Department of Health and Human Services, 62 of Indiana’s 92 counties are designated as “mental health professional shortage areas.” That means there’s less than one psychiatrist per 30,000 residents.
In Howard County, Indianapolis and the area in between, there’s just over one psychiatrist for every 10,000 residents.
The state in total currently has 344 psychiatrists. Dr. David Diaz, assistant professor of clinical psychiatry at IU School of Medicine, said that’s not even close to meeting the demand for mental-health services in Indiana.
“This state could easily absorb 100 more psychiatrists without blinking,” he said.
Although people suffering from a mental illness in Kokomo can usually get in to see a therapist to talk about their issues in a couple of weeks or less, it’s only psychiatrists or psychiatric nurse practitioners who can prescribe psychotropic medications that treat mental illnesses.
Mental Health Association’s Snyder said talking to a therapist can help for something like mild depression, but for people with chronic, debilitating mental illnesses, medication is often the only solution.
“You’re talking about people who are going downhill quick,” she said. “Sometimes people get so low that it’s hard to get them out of that deep pit.”
For those people, waiting months to see a psychiatrist to receive medication can sometimes mean the difference between life and death.
All mental-health professionals agree: Indiana needs more psychiatrists. But that likely won’t happen. In fact, the shortage probably is going to get even worse.
The Drought Deepens
Dr. Alan Schmetzer, professor emeritus at Indiana University School of Medicine, said the average age of Indiana’s psychiatrists is 55 years old. In the next decade, more than 100 of them are set to retire, drying up the already shallow pool of psychiatrists in the state.
How many psychiatrists is Indiana producing every year? Around six, Schmetzer said. How many are staying in-state? Around two.
“Not only are we not turning out enough psychiatrists. The ones that we do produce are leaving the state,” he said. “I don’t think the current figures show how bad of a situation we’re going to be in. The number of psychiatrists is going down dramatically in Indiana.”
Indiana University School of Medicine is currently the only college offering residency programs in the state for students going into psychiatry.
When Schmetzer began teaching at IU in the 1970s, he said there were 12 residency slots open for students. But cuts in federal funding for psychiatric programs over the last decade have sliced that number in half.
IU professor Diaz, who serves on the university’s residency training committee, said there might be hope if Indiana could attract more psychiatrists from outside the state, but that’s tough to do given the national shortage — and a preconceived notion that Indiana isn’t very exciting.
“A lot of people think of Indiana as cornfields and a few traffic lights,” he said.
In Indianapolis, which employs the most psychiatrists in the state and has the best chance of attracting new ones, there are currently 10 job openings for psychiatrists, Diaz said. They’ve been empty for months.
“It’s just hard to attract people from out of state,” he said. “Indiana isn’t a glamourous place to live.”
A Solution?
With little chance the psychiatric shortage will get any better in the coming years, clinical therapist Gardner said medical professionals need to begin looking at other solutions to ensure people who need psychotropic drugs can get them.
He said medical doctors could be a big part of that solution and help alleviate the huge backlog of patients waiting to see a psychiatrist for medication.
Although family medical doctors are technically allowed to prescribe psychiatric medication, many don’t, Gardner said. They don’t feel comfortable giving out drugs for medical problems outside their field of expertise, he said, and the liability involved with prescribing the incorrect medication is too risky.
But by taking the initiative to receive specific training in mental health, Gardner said, a family’s medical doctor, who already has a more intimate familiarity with their patients, could accurately diagnose a mental illness and write up a prescription rather than refer the patient to a psychiatrist.
IU professor emeritus Schmetzer said in theory that could work, but most medical doctors are just as busy as psychiatrists. The extra training and additional work just wouldn’t be feasible.
“It’s not the doctors’ fault. They’d love to treat everybody,” he said. “But they have to attend the people they’re already seeing.”
Whatever the solution is, Schmetzer said, it needs to happen soon.
With 44 million adults suffering from a mental illness in the U.S., and 90 percent of suicides being committed by people with mental illnesses, the inability to see a psychiatrist can be life threatening.
“Will a person still be alive for treatment if they have to wait two months get an appointment?” Schmetzer said. “Two months might be too long.”