Longview News-Journal, May 14, 2009: LONGVIEW — It’s the same response Gail McBride gives day in and day out as office manager for Wendy J. Burke and Associates, a Longview psychiatry firm: “We’re not taking any new patients.”

It’s a response she doesn’t like giving.

“It’s difficult because we’re backed up,” McBride said. “They can’t understand that because they really want help, but we’re totally booked up.”

Texas faces a critical shortage of mental health professionals, and with the state’s rapid and diverse population growth, mental health experts say the shortage will continue without more state participation.

“It’s just awful,” said Longview psychologist Kathie Ramey. “If I have a patient that’s depressed and needs to see a psychiatrist, it’s nuts trying to get them an appointment anywhere in East Texas. There is a terrible shortage of psychiatrists in this area.”

The U.S. Department of Health and Human Services has designated 184 of the state’s 254 counties as mental health professional shortage areas, meaning the number of professionals needed to provide adequate care to mental health patients is inadequate. That includes Gregg, Upshur, Rusk and Smith counties.

The National Alliance on Mental Illness gave Texas a “D” and ranked it 49th nationally in its 2009 State Report Card, largely because of the lack of equitable funding for local mental health authorities and poor health insurance coverage.

In 2006, the agency gave the state a “C” and ranked it 47th in the country.

‘Very real’ shortage

“This problem is very real,” Ramey said. “Without proper mental health care coverage, many of these people can end up hurting themselves and others, then they are placed in jail where at times they don’t get the sufficient care and cost the taxpayer.”

Since 2000, the number of mental health counselors and social workers dwindled from 72 counselors per 100,000 Texas residents to 66 counselors per 100,000 residents in 2007, according to a report by the Texas Hogg Foundation for Mental Health. The same reports also states that the number of psychiatrists dropped from seven per 100,000 residents to six per 100,000 Texas residents in 2007.

Recruiting and retaining mental health professionals who are racially, culturally and linguistically diverse also has proven to be a struggle for the Lone Star State, especially in rural areas, according the same report.

Tom Tinsley, program director for Community Healthcore’s Mental Health Outpatient Clinic, said he’s not surprised by the figures.

“I’ve been working in the Longview area for about 19 years, and there is definitely a shortage in psychiatrists in the area,” Tinsley said. “Many people wait months before seeing a psychiatrist in Longview.”

Psychiatrists are the only mental health professionals who can prescribe medication. Other physicians, such as family doctors and general practitioners, can prescribe medication for chemical imbalances related to mental health, but most do not because that is not their speciality.

Tinsley said his office, which provides mental health and counseling services to residents throughout East Texas, is working overtime to treat the influx of new patients needing mental health care. He said insurance claims and additional state funds allow the group to extend coverage.

“We’re supposed to treat 1,700 adult patients on a monthly basis, but we currently treat 2,400,” Tinsley said. “Our capacity for children is 324, and we treat 600 monthly.”

Tinsley added that extra money from the state, meant to cut the number of people going to emergency rooms for mental health treatment, is tied to particular types of illnesses.

“That’s another large problem,” Tinsley said. “Adults must have schizophrenia, be bipolar or suffer from major depression before we can treat them. It really limits our ability to help residents.”

Effects on children

Local counselor and licensed clinical social worker Barbara Morgan said the regional shortage is taking a toll on Longview’s children.

“It’s very sad because the children hold these emotions in for a very long time,” Morgan said. “They’re like ticking time bombs. When they explode, it can affect everyone around them.”

Morgan said many of the children she visits with display behavioral aggression at home and school and, at times, anxiety symptoms from standardized testing, divorce and social pressures from bullying or trying to fit in.

A report released this month by the nonprofit children advocacy group Texans Care For Children ranked the state’s mental health services for children poorly, citing a lack of mental health providers and a lack in investment by the state to treat mental illnesses in children.

Texas is falling behind other states in treating the social and emotional health of young children, the report says, noting that 82 percent of children who qualify for mental health services based on a diagnosis do not receive treatment.

“It’s cataclysmic,” Morgan said. “When the mental health needs in children go untreated, they become youth at risk of entering the juvenile system, then becoming parents at risk of endangering their own children and later costing taxpayers money while sitting in jail. All this because I can’t refer a child to a psychiatrist. It’s scary and disappointing.”

Gaps in coverage

Jane N. Bolin, director of the Texas A&M University Southwest Rural Health Research Center in College Station, said the challenge of providing adequate mental health treatment goes beyond the need to build up the number of professionals in the field. She said some people, including those with insurance, simply can’t afford to pay for mental health services.

“It’s very expensive to pay for these types of services, and in many cases people don’t have the money to pay for them,” Bolin said. “Veteran Affairs and non-public insurance will reimburse providers up to a certain number of visits. After that, many are faced with the doctor visit bills and medication on their own.”

Local mental health professionals said getting paid is an issue.

“It’s just very difficult to get your money from some of these insurance companies,” Morgan said. “In Tyler, there are some agents who only take cash. It’s really sad because these people need help, but on the other hand we have to make a living, and the current plan makes that difficult.”

Slight progress

The Allegiance Speciality Hospital of Kilgore announced plans this month to expand its adult inpatient psychiatric ward by 11 beds by 2010, bringing its total number of beds to 70.

Many health officials say more needs to be done.

“Psychiatric issues are being pushed aside in this state, and they shouldn’t,” said Sherry Bustin, the CEO Allegiance Speciality Hospital of Kilgore and vice president for Allegiance’s psychiatric services for Texas and Oklahoma

“It’s going to take a lot more money and attention from the state in order to address these issues. People should not have to wait to see mental health professionals.”