Psych Crisis: Mental health care providers adapt to staff shortages

Adam Andreassen: Demand for behavioral health has never been higher.

Last edited 2:11 p.m., Feb. 28, 2023

Before the COVID-19 pandemic hit, an estimated 1 in 5 adults suffered from a mental illness, affecting 51.5 million people in the United States.

That estimate from the National Institute of Mental Health has steadily increased since 2019, and with the growing demand for health care services comes a shortage in mental health care professionals. Officials at area clinics and hospitals, such as Burrell Behavioral Health, Eustasis Psychiatric & Addiction Health and Citizens Memorial Hospital, say they are working creatively to meet the needs of the region.

“Demand for behavioral health has never been higher,” said Adam Andreassen, chief operating officer for Brightli, Burrell Behavioral Health’s parent company, via email. “This is related both to reduced stigma as well as to the predicted multiyear effects following a pandemic.”

Further compounding the situation, he said, is that nurses are in demand across the industry, not just within mental health.

According to data from the Health Resources and Services Administration, there are more than 6,000 designated areas with a shortage of mental health care professionals in the U.S., meaning those areas have a shortage of mental health care providers relative to their population. This shortage is particularly pronounced in rural and underserved communities, with Missouri ranking third on the list, behind California and Texas.

In Missouri, the HRSA estimated in September 2022 that only 12.2% of the population’s needs are met with health care services, and that 159 practitioners are still needed in order to remove the state’s shortage designation.

“Our most notable local shortages relate to counselors and nurses. We have added approximately 100 additional counselors in southwest Missouri since 2017, and the demand keeps growing,” Andreassen said, noting the shortage also extends across clinics.

Eustasis Psychiatric & Addiction Health CEO Breanna Jain agreed.

“I need more counselors,” she said, noting these are in addition to the nine advanced practice providers and psychiatrists recently hired that she and the team are onboarding through April.

Jain, a psychiatric and mental health nurse practitioner herself, said Eustasis aims to have more practitioners than administrators in order to serve their patients and have started doing more group counseling of eight to 10 people as one way to help offset the demand.

Another strategy to increase the number of mental health care providers is through strengthening community relationships, Andreassen said. Through partnerships with area universities and colleges, he said Burrell can train and hire future workers.

“More long term, we have an agreement with Missouri State University to bring a doctorate in psychology back to Springfield in the near future,” he said, noting Burrell employs 150 licensed clinicians and 75 medical psychiatric prescribers, while it also works with hundreds of providers in schools.

Eustasis’ Jain added there aren’t enough psychiatrists in the profession, either.

“You really need that MD with that oversight and experience to be weighing in on best practice guidelines,” she said.

Eustasis has 135 employees, Jain said, and about 40 open positions, including doctors, nurses, psychologists and therapists.

At the moment, however, there are more students seeking psychiatry residencies across the nation than there are open spots, according to a 2022 Physician Specialty Data Report by the Association of American Medical Colleges.

Pushing patients toward telehealth and crisis call lines has been a solution for many areas where psychiatrists are unavailable or have a monthslong wait time. Burrell has expanded its crisis line to be a crisis and resource line, due in part to the $5.3 million American Rescue Plan funding from the city of Springfield.

“Our crisis line team is now trained and equipped to answer questions for nonmental health and non-911 appropriate calls, including housing, security, car or utility bills, transportation and much more,” Andreassen said, noting the crisis line is available 24/7 for those in a behavioral health emergency.

Burrell also opened a rapid access unit in 2020 to provide 24/7 assistance to patients with immediate mental health or addiction needs.

At Eustasis, telehealth is available only for established patients.

“Virtual is a great tool, but it is not a total solution,” Jain said. “Health care providers have to see our patients."

However, Jain said at Eustasis they strive to see patients on a walk-in basis for those who are in a crisis.

“We immediately triage and stabilize, then get patients counseling with our psychologists on a regular basis,” she said.

Prior to opening Eustasis, Jain worked in a hospital setting and saw patients who were poorly managed or not managed at all.

“People were waiting for months for appointments, going to the ER because they didn’t know what to do,” she said.

Eustasis’ model, a psychiatry walk-in clinic, similar to urgent care but for mental health needs, has proven timely since opening in 2018.

“We saw nine patients our first weekday, and now we serve 400 patients a day from here to Arkansas,” Jain said.

With an expansion in progress to include a walk-in only clinic and a separate clinic for appointment-based psychology and counseling in Springfield, Jain hopes for more private clinics to adopt this model on a national level. Eustasis also operates clinics in Ozark and Rogers, Arkansas.

In Bolivar, Citizens Memorial Hospital is expanding its services with the opening of the CMH Behavioral Health Transitional Clinic.

“Patients are sometimes in crisis and need to feel supported by having quicker access to behavioral health services,” said Michael Calhoun, CEO of CMH, in a news release. “This clinic will have an important role in helping patients receive the care they need quickly while awaiting an appointment with a CMH behavioral health provider.”

The mental health clinic with one provider will care for patients ages 6 years and older who are unable to have an immediate appointment scheduled with a CMH behavioral health provider.

Another inpatient treatment facility in Springfield, the Marian Center at Mercy, is benefiting from ARPA funding.

“Mercy Hospital Springfield will be using ARPA funds for the expansion of our behavioral health program in our Marian Center, currently an inpatient facility that will make space for our intensive outpatient program,’ said Kyle John, Mercy’s vice president of behavioral health services, via email.

The $150,000 in ARPA funding will go toward a $1.1 million project budget for more natural light, friendlier environments and brighter features, while ensuring patient and staff safety remains paramount, officials said.

“With mental health facilities, there is always an increased level of patient and staff safety built into projects that we don’t see with other types of health care construction,” John added.

Jain knows there are multiple barriers that still prohibit patients from accessing behavioral and mental health care, and by more clinics offering in-patient services, she hopes more people understand the importance of treating urgent cases in a timely manner. She uses an example of someone who is in cardiac arrest: “Do you tell them to go swimming and walk the track? You need to get people out of the emergency first,” she said. “People really have to shift their thinking that mental health is medical.”