<figure>
 <img src="https://media.eaglewebservices.com/public/2020/1/1578414748992.jpeg" alt="Kansas community mental health centers say job vacancies for doctors and therapists sometimes stay open for years.&nbsp; Celia Llopis-Jepsen / Kansas News Service " />
 <figcaption>Kansas community mental health centers say job vacancies for doctors and therapists sometimes stay open for years.&nbsp; Celia Llopis-Jepsen / Kansas News Service </figcaption>
 </figure>By NOMIN UJIYEDIIN <a href="https://www.kcur.org/post/kansas-sees-shortage-psychiatrists-and-other-mental-health-providers#stream/0">Kansas News Service</a>TOPEKA — It typically took Walt Hill more than a year to recruit a psychiatrist to northwest Kansas. Now he doesn’t even bother.Instead, the executive director of the <a href="http://hpmhc.com/" target="_blank">High Plains Mental Health Center</a> relies on out-of-state doctors willing to work remotely, treating patients through video conference.For
 years, the center has used remote appointments with local psychiatrists
 to reach patients in far-flung corners of its coverage area, which 
spans 20 largely rural counties.But recently, Hill said, it’s 
been almost impossible to find psychiatrists and psychiatric nurses to 
do even that. He’s had to turn to providers who conference in from 
Kansas City, Texas and Tennessee.Like the <a href="https://www.npr.org/2018/03/09/592333771/severe-shortage-of-psychiatrists-exacerbated-by-lack-of-federal-funding" target="_blank">rest of the United States</a>,
 Kansas is seeing an increase in patients seeking mental health 
treatment. But the state can’t find enough doctors, nurses and 
therapists to treat them. Providers say the problem is worse in the 
state’s least-populated rural areas, where clinic jobs can stay open for
 years at a time.&nbsp;“Fewer and fewer individuals are going into 
these professions,” Hill said. “We’re seeing a demographic challenge, a 
crisis coming.”One <a href="https://data.hrsa.gov/tools/shortage-area/hpsa-find" target="_blank">measure from the federal government</a>
 suggests only nine of the counties in Kansas have enough psychiatrists,
 and they’re mostly in urban areas: Johnson, Wyandotte, Shawnee, 
Douglas, Harvey, Sedgwick, Marion, McPherson and Miami counties.There are 431 psychiatrists actively licensed to practice in Kansas, according to the state’s Board of Healing Arts. <a href="https://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&amp;selectedRows=%7B%22states%22:%7B%22kansas%22:%7B%7D%7D%7D&amp;sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D" target="_blank">One calculation</a> by the Kaiser Family Foundation estimates the state needs 53 more to meet its needs.The
 state’s community mental health centers, like the one Hill manages, 
face a particular challenge. The centers treat people regardless of 
their ability to pay. Some say they’ve had to absorb more patients since
 the state-run mental health hospital in Osawatomie reduced its 
admissions drastically.Hill said High Plains Mental Health 
Center hasn’t experienced that so much. But as reimbursement rates from 
insurance companies have stagnated, the center has had to raise its base
 fees to cover costs.The center sees 6,000 patients a year, 
about half of whom need medication. Some have to wait as long as six 
weeks for an initial appointment with a provider.“It’s 
stretched. Some people do have to take on a lot more cases,” he said. 
“That is just way too long for people to have to wait.”<h2>Hiring issues</h2>In some ways, telemedicine has helped, said Greg Hennen, executive director of the<a href="https://www.fourcounty.com/" target="_blank"> Four County Mental Health Center</a> in Independence. But it’s also made it worse.“It’s
 a very nice resource, but it’s also hampered our capacity to recruit 
because people can work from their living room instead,” he said. 
“People don’t have to relocate to deliver services.”Hennen’s 
center has been trying to recruit a psychiatrist to serve as medical 
director for two years. Only two people have applied for the job. One 
couldn’t get his license and the other decided he didn’t want to live in
 southeast Kansas.The location is a hard sell for many candidates.“We
 do have some people that are not interested because it’s an hour and a 
half to drive to Tulsa or Joplin or two hours to Kansas City,” he said. 
“They just want to be a little closer to the cultural offerings of a big
 city.”Pay is an issue, too. Neighboring states like Nebraska 
and Colorado can afford to pay medical staff and therapists partly 
because they expanded Medicaid coverage. That can mean more of their 
patients have health insurance. Oklahoma and Missouri have federal 
funding from another source: the Excellence in Mental Health Act, a 
program Kansas never applied for.The result is that other states
 have hired providers away from Kansas. Hennen said one experienced 
therapist left his center to work across the border in Oklahoma for a 
$20,000 raise.Meanwhile, he has three openings for therapists. 
And he hears regularly from schools and other community organizations 
that they’re hiring, too.“If I was actually going to answer the demand,” Hennen said, “ I could hire another five on top of those three.”For Lisa Southern, executive director of <a href="http://compassbh.org/" target="_blank">Compass Behavioral Health</a> in Garden City, hiring nurses is the challenge.She has hired nurse practitioners on a temporary basis through the <a href="https://nhsc.hrsa.gov/" target="_blank">National Health Service Corps</a>,
 which repays student loans in exchange for a few years of work. But 
it’s hard to get people to stay in southwestern Kansas. Many qualified 
nurses just end up going back home, she said.The center paid a 
recruiter $20,000 to find a qualified nurse. But in 18 months, they only
 had two applicants. Even those nurses decided not to take the job 
because they didn’t want to move.“It’s not about the agency. 
It’s not about the population we serve,” Southern said. “It is simply 
about people wanting to live in a different area than where we are.”<h2>Solutions</h2>The
 Garden City center hasn’t had any trouble recruiting therapists. That’s
 because aspiring social workers in the area can earn a master’s degree 
at the University of Kansas or Washburn University.“That is our 
saving grace for therapy staff,” Southern said. Her center has also 
offered scholarships for staff to get their master’s degrees.The
 centers that Hennen and Hill run have also paid for master’s degrees 
for nurses who agree to come back and work at their centers.In 
an effort to recruit and retain more staff, Gov. Laura Kelly raised 
salaries for employees at Larned State Hospital, a state-run mental 
health facility, in early December. The vacancy rate at the hospital is 
57% for RNs and 73% for LPNs, said a spokeswoman for the Kansas 
Department for Aging and Disability Services. The hospital does not 
track vacancies for psychiatrists or therapists. The state’s other 
mental health hospital in Osawatomie has 14 vacancies for RNs and none 
for psychiatrists or therapists.In 2017, to attract more psychiatrists to rural areas, Kansas passed <a href="http://www.kslegislature.org/li_2018/b2017_18/measures/SB32/" target="_blank">a law</a> that added psychiatry to the state’s <a href="http://www.kumc.edu/student-affairs/student-financial-aid/loan-information/loan-programs/kansas-medical-student-loan.html" target="_blank">medical student loan program</a>.
 The program helps pay for tuition and other expenses in exchange for 
the student practicing primary medicine in the state’s less populated 
counties after graduation.It’s too early to tell whether that’s 
encouraged more medical students to choose psychiatry and practice in 
Kansas, said Dr. William Gabrielli, head of psychiatry at the University
 of Kansas School of Medicine, the only medical school in the state.But
 as attitudes toward mental health treatment change, Gabrielli is 
optimistic more students will feel encouraged to do psychiatry 
residencies in rural areas.“It’s really where they do their 
residency training that helps them put down roots and that keeps them in
 those locations,” Gabrielli said.Typically, doctors are reluctant to go to rural areas because they prefer not to practice alone, Gabrielli said.“If
 you go out and be a lone practitioner in a rural part of the state, you
 have no partner,” he said. “You have nobody to help cover for you. You 
have nobody to bounce cases off of.”Plus, psychiatry is one of 
the lower-paying medical specialties, which means it’s a hard draw for 
medical students, who can rack up hundreds of thousands of dollars in 
loans. The problem is exacerbated by an aging population of 
psychiatrists who are retiring, Gabrielli said.Ultimately, he said, doctors go into the field because of intrinsic motivations.“Most
 of the people that pursue psychiatry as their medical specialty are not
 focused on maximizing their incomes,” he said. “They’re focused on 
taking care of the people.”Nomin Ujiyediin reports on criminal justice and social welfare for the Kansas News Service.&nbsp; Follow her on Twitter <a href="https://twitter.com/nominuj?lang=en" target="_blank">@NominUJ</a> or email nomin@kcur.org.&nbsp;

Kan. sees shortage of psychiatrists, other mental health providers