Texas mental health care shorted

Dr. Candace Ackerman, clinic director for Flourish Counseling and Mental Wellness Center, said she began her Lakeway- area practice in January to fill a shortage of mental health care providers in Lake Travis.

“One of the reasons I did open is because of a low saturation level [of mental health providers] in the area,” the licensed psychologist said. “We’ve been able to have a lot of quick success because there isn’t a lot of mental health providers [in the region]. We’ve even been able to pull patients from Marble Falls.”

Ackerman’s reasoning is justified, as Texas has the fourth-lowest number of psychiatrists per 100,000 residents in the U.S., with 4.1 psychiatrists per 100,000 residents, according to physician consulting firm Merritt Hawkins’ 2015 North Texas Regional Extension Center report. 

“There’s an increasing awareness among our leadership that this is an issue that has been ignored for far too long,” said Greg Hansch, National Alliance on Mental Illness-Texas public policy director.

Resources in Central Texas

Austin has 10.5 psychiatrists for every 100,000 people, with the national standard set at 25 psychiatrists for every 100,000 people, Ackerman said.

However, Austin and Travis County residents are probably “[some] of the most fortunate in Central Texas” because of the variety of mental health care  resources that exist in the area, said Karen Ranus, executive director for the Austin affiliate of NAMI.

“I think you can put a little circle around Austin, Travis County and even if you move a little farther beyond that [as an area with mental health care options],” she said.

Rural areas

Although mental health care options in the more densely populated portions of Central Texas are prevalent, the region provides some challenges to those seeking treatment in its more rural areas, according to Merritt Hawkins. Out of the state’s 254 counties, 185 counties have no general psychiatrist, including the Central Texas counties of Blanco, Burnet, Caldwell, Fayette, Lee, Llano and Mason, its report stated.

“Spicewood is a perfect example,” Ranus said. “If you have an individual that’s living way out in the country, they don’t have access to transportation. You’ve got rural areas that are dealing with higher levels of poverty and lack of [health] insurance. So you start taking all of those into account and it becomes very challenging [to access mental health resources].”

According to an April 2016 Hogg Foundation brief, “The Mental Health Workforce in Texas Continuing Challenges & Sensible Strategies,” half of Texas psychiatrists accept private insurance as opposed to nearly 90 percent of Texas physicians in other fields, and only 21 percent of Texas psychiatrists accept Medicaid patients compared with 37 percent of Texas physicians in other fields.

Local offerings expand

“A crop of new psychiatric hospitals has emerged” in the Austin and Travis County area to assist current treatment options, Ranus said.

The Guy Herman Center for Mental Health Crisis Care, 6600 E. Ben White Blvd., Austin, is set to open early 2017. The 16-bed facility will provide short-term emergency psychiatric care, including individuals taken there by law enforcement who are in mental health crisis.

Housing First Oak Springs is set to open at 3000 Oak Springs Drive, Austin, in spring 2017 to house homeless people living with mental illness and/or substance abuse.

Cross Creek Hospital, 8402 Cross Park Drive, Austin, opened March 2, 2015. The 90-bed facility offers adult psychiatric services to treat depression, anxiety, schizophrenia and substance abuse and added treatment for adolescents and children in 2015.

Statewide shortage

Merritt Hawkins cites a statewide trend that  indicates although primary care doctors are anticipated to be in short supply, the steepest shortage may be among psychiatrists.

This shortage can be attributed to an aging psychiatrist population—with 60 percent of Texas psychiatrists being age 55 or older—the small numbers of medical school graduates who choose psychiatry residency programs and the continued negative stigma of mental health issues, Merritt Hawkins’ 2015 report states.

“There is a potential in the near future to have more psychiatrists leaving the specialty per year than entering,” according to Merritt Hawkins.

The Texas Legislature, through the help of sponsor Sen. Charles Schwertner, R-Georgetown, passed a student loan repayment program—Senate Bill 239—during the previous legislative session. The program encourages recent medical school graduates to focus on underserved geographic areas, or Health Professional Shortage Areas, by offering school loan repayment assistance for certain mental health professions.

“The purpose [of SB 239] is to try to get more folks in the door to get into this field,” Ranus said.

Three new medical schools are slated to open in Texas—including The University of Texas, Dell Medical School, the South Texas School of Medicine in McAllen and Harlingen, and The University of the Incarnate Word in San Antonio.

Part of the issue in growing the number of psychiatrists in the state corresponds to retaining them after they finish medical school, Hansch said.

“The state doesn’t have enough residency slots for people who go to medical school in Texas to stay in Texas and do their residency here,” he said. “So people will go out of Texas and do their residency out of state.”

What can be done?

Integrating primary health care providers to better coordinate mental health treatment is a possible solution since most adults with a mental health condition also have one or more chronic physical conditions, according to the Hogg Foundation brief.

Other possible improvements include increasing treatment reimbursement rates for doctors, advocating peer support services, expanding physician internship and residency slots in-state and broadening the use of technology to connect a patient with a mental health professional, the brief stated.

The state’s recent increased mental health focus may account for more people accessing mental health care, reduced wait lists for treatment and more community centers, Hansch said.

“Texas in the past few years has come a long way in bolstering resources that are dedicated to the public mental health system,” he said. “[However] there’s a need for more resources for the public mental health system.”