Much has been said about the shortage of primary care physicians, but similar forces are at play when it comes to mental health, as providers scramble to hire and retain psychiatrists, psychologists, therapists and counselors.
Primary care and psychiatry are among the lowest-paying medical fields, and education is expensive.
“A medical student leaves medical school and residency with the same amount of debt no matter their specialty, yet primary care and psychiatry are professions with some of the lowest annual salaries,” said Chuck Ingoglia, senior vice president for public policy at the National Council for Behavioral Health, in a Washington Post article. “Which one would a smart, ambitious young person choose?”
On the demand side, there is a laudable effort to encourage people to push past the stigma of mental health and seek help. Plus, health coverage has expanded under the Affordable Care Act and the expansion of Medicaid.
But a corresponding effort on the supply side has been slow in coming. Our current health care system still values specialists over primary care physicians and psychiatrists. While the Department of Veterans Affairs encourages returning troops to seek help for emotional wounds, it struggles to recruit enough caregivers. More than half of U.S. counties have no mental health professionals.
Private and public providers are drawing the same shallow pool. The number of federally funded residency slots has not increased in 15 years, according to the Wall Street Journal, despite a long-standing shortage. Some incentives have helped boost the number of doctors in areas of acute need, but a more robust approach will be needed.
Rural areas suffer the most. Spokane is the go-to place for many small communities in the Inland Northwest, and pressure for mental health care has risen.
The good news is that Providence Health Care and Fairfax Behavioral Health have teamed up to build a 100-bed psychiatric hospital, which is scheduled to open next year in Spokane. Meanwhile the state has made some investments (and the governor is proposing more), but only after being sanctioned by the courts for not providing timely evaluations and care.
Capacity issues at state hospitals spill over into local jurisdictions. The largest mental health facility in Eastern Washington is the Spokane County Jail, which is ill-suited to the task. The mental-health care crisis has been called “the new McCleary,” a reference to the state Supreme Court stepping in to ensure basic education is funded.
On the state level, leaders must guard against giving the current McCleary all of their attention. On the national level, the ramifications of rolling back health care access – whether through the ACA or Medicaid – must be thought through.
We are making strides in this country with mental health, but it’s a long journey. We can’t afford to reverse course.
To respond to this editorial online, go to www.spokesman.com and click on “Opinion.”
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