According to federal labor statistics, there are more psychiatrists working in Illinois than most states, with the bulk of that service concentrated in the Chicagoland area. But mental health providers say there are major gaps in service across Illinois, especially downstate.
Zach Medlyn, 27, of Champaign did not start hearing the voices until about seven years ago, when he was a student at the University of Illinois.
“I started thinking that there were secret messages in my emails that people were sending me, that I could decode them and read their thoughts," Zach said. "I started thinking that people were reading my thoughts. I imagined that my friends were all talking to me in my head. I thought that I was the chosen one, chosen by God to lead people to justice in the apocalypse.”
Zach started showing signs of depression when he was 18, but he said his schizophrenia began taking shape when he was in college. He had been diagnosed with ADHD and was taking Adderall.
Over the last few years, he says he’s talked with gods, demons, angels, and ghosts, and has had visits from extraterrestrials.
“Now I believe that I hear from the voice of God himself, and I believe that he got me to stop smoking and he’s been getting me to stop drinking so much, and make more friends, all kinds of stuff," he explained. "Sometimes I get the voice of the devil, too, but I’ve learned to distinguish which one’s which.”
"If I hear a voice that says to go kill yourself, that would be from satanical," he added.
After giving school a try at the U of I and Southern Illinois University in Carbondale but not graduating, Zach is now living at home in Champaign with his family. He has been hospitalized several times since his diagnosis, and is focused on getting better. He said he has support to do that through religion and his family.
“We’re very proud of you," Zach’s mother, Debra, told him at their home. "You could have found an easier way out, and you’ve taken the high road.”
Debra has become a real advocate for her son, even participating in the local chapter of the National Alliance on Mental Illness. In 2007, she tried to schedule a visit for Zach to see a psychiatrist at Carle Hospital in Urbana, and was told it would be three to four months before a doctor could see him. Before that could happen, he had a crisis and needed to be hospitalized.
“If he’d seen the doctor earlier when I first called or when I was starting to explain the things like rolling around on the roof are dangerous, then it wouldn’t have escalated to the point of him being hospitalized," Debra said.
Debra started looking for a psychiatrist for her son in major cities, where there were more of them on staff, and shorter wait times. According to the U.S. Bureau of Labor Statistics, around 60 percent of Illinois’ psychiatrists are based in the Chicagoland area.
Zach ultimately went with a psychiatrist three hours away in the St. Louis area. If Zach were to start seeing a psychiatrist at Carle today, he would have to schedule as a new patient, and the hospital said it is currently booking first-time psychiatric patients six months out.
“Since my experience at Carle, that has only expanded over time," said Arthur Traugott, one of 10 psychiatrists at Carle Hospital.
Traugott has been with the hospital for more than 40 years, and he says the long wait times are, "primarily because of a shortage of other psychiatric services in the community. Our program here at Carle has continued to grow over the years, but has not kept up with the demand for our services. ”
According to a report by the Association of American Medical Colleges, more than half of psychiatrists are at least 55 years old. That means they’re getting closer to retirement. The records also show the number of psychiatrists dropped slightly over a five year period. Traugott has one solution.
“I keep working in retirement," he explained. "That’s what I’ve been doing.”
While there is a concern about shortages with these providers, the number of U.S. medical student seniors “matched” into psychiatry residencies has gone up in the last couple of years.
But even with more people entering the field, mental health providers in Illinois say insufficient funding and low Medicaid and Medicare reimbursement rates are making it difficult to keep up care.
Community Elements, the mental health center in Champaign County, has been forced to cut back on its services in the last decade. It has gone from having seven psychiatrists (some who were part time), to what it is today, which is a full-time and part-time psychiatrist.
Wait times for an initial visit with a psychiatrist can take at least six months. Community Elements CEO Sheila Ferguson said her agency is doing the best it can with the money that is available.
“We wouldn’t be able to do it without some funding from our state," Ferguson said. "So that’s what’s been really critical is in the last few years as the state has cut funding we are now at a point where if they go to this next budget session and cut, it could really jeopardize the current level that we have. ”
Ferguson said problems with funding have also made it difficult to recruit psychiatrists to Champaign County. Carle Psychiatrist Arthur Traugott said that is a problem that goes beyond physicians in his field.
"Other things that are being put into practice are the use of mid-level practitioners in psychiatry, psychiatric nurses who have had special training in the field," Traugott said. "However, we have been trying to recruit at Carle, and we find them very difficult to entice them to come to this community.”
That can lead to a shortage of mental health care providers, which too often, leaves patients like Zach Medlyn in the Emergency Room for mental health care.
“When he was ill, we needed somebody then," Debra said. "We couldn’t wait weeks and months. The Emergency Room was not what Zachary wanted to do. He wanted to see a psychiatrist.”
With the shortages in mental health care, some agencies are more selective about who can see a psychiatrist. For example, at Frances Nelson Health Center in Champaign, Nancy Greenwalt, who oversees the clinic, said patients can’t just call to schedule an appointment with the clinic’s part time psychiatrist. They instead have to be referred by a primary care doctor.
“Our psychiatrist does consulting with all of our primary care providers," Greenwalt said. "She has for a long time, but what we’ve done recently is we have a monthly meeting where providers can bring in cases, our psychiatrist can meet with all the primary care providers, and that way we can meet some of the need, some of the more manageable cases at the primary care level.”
Greenwalt said that staves off long wait times, which at Francis Nelson are typically three to five weeks for an initial visit.
Daniel Yohanna served as the president of the Illinois Psychiatric Society. He said that kind of model where different physicians are communicating is a good idea.
"Most people who have mental health problems get depression, anxiety, substance abuse disorders are in primary care – more than 85 percent," Yohanna said. "A small percentage who are severely ill and require more of a system care should be treated within the mental health system within the states.”
The shortages in mental health care are particularly noticeable in rural communities, like in Mason County in western Illinois where the hospital there has had trouble recruiting a psychiatrist. According to federal data from the early ‘90’s that the government continues to use, more than half of the nation’s counties have no practicing psychiatrists, psychologists, or social workers. All of those communities are rural. Harry Wolin is the administrator at Mason District Hospital, which serves a county of fewer than 15,000 people. That is much less than Champaign County, but Wolin said the two communities share a common challenge – attracting psychiatrists.
"Recruitment into a rural area is very challenging because of the unique nature; it’s finding someone who enjoys the lifestyle of not having a mall on every street corner, and living in a community where there aren’t the sorts of amenities that typically are found in urban areas," Wolin said.
So, the hospital looked for other ways to provide that care. Enter tele-psychiatry. A psychiatrist meets with a patient through a remote video connection. It is sort of like Skyping with your doctor. The Mason District Hospital uses this technology for both children and adults. Wolin says it’s more expensive because of the equipment, Internet connection, and extra staff to be in the room during a session, but he says it’s worth it.
“Very important to the community, very expensive to the hospital, but in balance that’s why we’re here is to meet the needs of the community,” Wolin said.
Telepsychiatry is covered by Medicaid, but not all private insurers. A bill in the Illinois legislature seeks to change that. The mental health center in rural Douglas County serves a diverse community, including Latinos and the Amish. It lost all of its funding from the county, and now relies on 95 percent of its support from Medicaid reimbursements. Mental Health Executive Director Jan Aten said her agency used telepsychiatry for children, but stopped a couple of years ago.
“I think that you lose a lot of opportunities to recognize symptoms and emotions when you don’t have a person-to-person meeting. And that’s my opinion, but it’s also what our parents of our clients," Aten said. "They were frustrated. They didn’t feel the connection with the psychiatrist.”
Aten said the Douglas County Mental Health Center did away with telepsych, referring patients to other providers, even volunteering to drive them if transportation is an issue. She does have an adult physiatrist who came out of retirement, and works at the mental health center 14 hours a month. She actually picks him up from Champaign and takes him to the mental health center 30 minutes away. That doctor is nearing 70 years old, and will eventually have to stop working, which is something Aten has thought about as she looks at continuing psychiatric care.
“I will make every effort to find a psychiatrist that is willing to come in and meet our patients face-to-face," she said. "It’s probably inevitable that eventually we will have to go to the telepsychiatry, but that is an absolute last resort for us.”
Meeting the needs of community while balancing cost and care is something many health care providers are struggling with as the demand for mental health service continues to grow.