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Rachel Harrison, of rural Dallas County, Missouri, lives with Schizoaffective Disorder and says her psychiatrist works in three counties each week.A critical shortage of mental health workers is making life difficult for both patients and providers across Missouri, particularly in rural areas. In this series, we hear their stories to learn about the extent of the crisis, and investigate what's being done to address it. Hear the series by selecting individual stories below.

Salaries, Limited Graduates, Rural Culture Leading to Mental Health Shortage

Jennifer Moore

Until a few years ago, Addie Blankenship saw herself as a relatively healthy mom of three. She didn’t recognize that she was exhibiting symptoms of Obsessive Compulsive Disorder—a mental condition that leads to obsessive thoughts and compulsive actions.

“So I would spend hours and hours washing things. Or I would have a thought that something may be on my clothes, so I would change my clothes every time I’d have a bad thought, which sometimes was 10 times a day. Sometimes more,” Blankenship said.

That was by day. By night, as her husband and kids slept, she spent hours checking and re-checking to make sure windows were locked, candles were extinguished, and the stove was turned off. 

“When I was at my lowest, I would just sit in the bathroom, sometimes hitting my head on the bathroom 

Credit Jennifer Moore / KSM
From her office in Springfield, Blankenship helps people across the Ozarks find resources and learn more about mental health.

wall. Because I just wanted the thoughts to stop,” Blankenship said.

Her mother, a nurse, took her to the Emergency Department in a Springfield hospital.

A doctor there told her he thought she had OCD, but that she’d need a psychiatric evaluation. The first opening was in two weeks.

After the psych evaluation, she had to wait two more weeks for the results, she said.  At that point, she says she was begging God to take her life.

“The therapist was relatively easy to get into. But the psychiatrist had like a two month wait. And he was the only one who could get my meds straightened out,” Blankenship said.

Credit Jennifer Moore / KSMU
Dr. Paul Thomlinson is acting CEO of Burrell Behavioral Health in Springfield, Missouri.

Blankenship’s story is not uncommon; wait times for mental health care in Missouri are often even longer in rural counties, where the shortage is most acute.

Dr. Mike Neitzel is the deputy director of the Missouri Department of Mental Health.

“If you look at psychiatrists, in 70 of the 114 counties there is no licensed psychiatrist. And then if you look at licensed psychologists, about half of the counties in Missouri do not have a licensed psychologist,” Neitzel said.

One reason for the shortage of psychiatrists and psychologists, Neitzel said, is that it’s hard to convince an urban-trained professional to relocate to a more rural area.

There are cultural reasons, and reasons of convenience—and sometimes, Neitzel said, the professionals have already had children by the time they finish residency, and don’t want to move their families.

A high turnover rate in Missouri’s mental health workforce isn’t helping matters.

And, of course, there’s the issue of salaries, Neitzel said.

“The salary that you can pay in some private agencies—which tend to be clustered in your urban areas or around academic health centers—that salary’s significantly higher than can typically be afforded in smaller clinics or in smaller communities in the rural areas,” Neitzel said.

And then, there are those Missouri institutions, like medical schools, that train and award degrees to these highly specialized individuals. Each institution usually has a cap on how many psychiatrists or psychologists it accepts each year.

Dr. Paul Thomlinson is the acting CEO of Burrell Behavioral Health in Springfield.

“The shortage has, I mean, just from the most objective data we have, certainly the shortage has gotten worse from the standpoint of the number of psychiatrists that are coming out of medical school and residencies. You know, people getting licensed as psychiatrists—that has been declining,” Thomlinson said.

Another contributing factor, Thomlinson said, could be that more people are seeking treatment.

“There’s a generational effect that’s happening. People are growing up with, perhaps, less stigma about seeking care. So we are certainly seeing people who are accessing care perhaps more than some of the stoic, older generations who may have had more stigma related to mental health access,” Thomlinson said.

Since embracing her treatment, Addie Blankenship is feeling well. She’s the director of the Hope Center at NAMI Southwest Missouri, where she helps others navigate their own mental health journeys. She says the most frequent question she’s asked by clients is, "How am I supposed to wait?"

“Because of these waits, people use substances they shouldn’t. And because of these waits, people do commit suicide. And because of these waits, you know, people are suffering,” Blankenship said.

Most of Missouri’s 114 counties are already limping along without adequate numbers of mental health workers. And yet, according to data from the Missouri Economic Research and Information Center, unless something changes, the state will experience a shortage of nearly 500 mental health counselors, more than 500 psychologists, and 230 psychiatrists through the year 2022.

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