In Hays County the shortage of mental health resources is especially dire, as a Seton Community Needs Assessment performed in 2013 found there was one full-time psychiatrist dedicated to patients in Hays County for every 21,460 residents.

The U.S. is facing a crisis in which a large portion of the population is suffering from mental illness yet current resources severely miss the mark to serve those with such health conditions, according to physician search and consulting firm Merritt Hawkins.

Terry Jackson, community liaison for Oceans Behavioral Hospital—which opened at 1106 S. I-35, San Marcos, in August—said  Hays County is “horribly, horribly underserved” in terms of mental health care availability.

“There is an enormous lack,” she said. “There is a lack of providers. Folks may realize they need mental health help, and they can call for a psychiatrist and there can be five to six months’ wait even to get in to see the psychiatrist. There is a nationwide lack, but it certainly hits our area as the population increases.”

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.

Rural areas

According to a needs assessment performed by Seton Health Care Family in 2013, Hays County residents reported 3.5 poor mental health days each year, compared to the national standard of 2.3 days per year.

In all, the study identified behavioral health services as the fourth highest priority need for Hays County.

This situation is not unique to Hays County as other areas that are rural, or have been rural and are quickly developing, face similar shortages of mental health services.

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,” said Karen Ranus, executive director for the Austin affiliate of NAMI. “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

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

“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. “There’s [still] a need for more resources for the public mental health system.”

Among the resources available to residents of Hays County and surrounding areas is the Scheib Center, 1200 Bishop St., San Marcos. The center has offered mental health  care services to the community since 1998.

Oceans Behavioral Hospital began admitting patients in August 2015. The 24-bed facility will provide inpatient treatment for people ages 55 and older who experience such psychiatric symptoms as depression, suicidal thoughts, homicidal thoughts, delusions, hallucinations or an inability to manage daily activities. A typical stay in the hospital is about two weeks as the patient reaches mental stability, Jackson said.

In an effort to expand access, Oceans opened a mental health outpatient service aimed at patients ages 18 and older.

Jackson characterized the service as “intense.” Qualified patients are able to see a psychiatrist as soon as they are admitted to the facility and participate in up to three group therapy sessions each day for up to four days per week.

Jackson said Oceans’ inpatient services will be covered under Medicare parts A and B. The company is working with major insurers such as Humana and Blue Cross Blue Shield to gain coverage for those who do not qualify for Medicare as well as the outpatient services.

Statewide shortageLead2-DYK

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.”