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SALT LAKE CITY — While the country fights its mental health crisis, the Beehive State is poised to suffer in the skirmish, a new report says.
Suicide has become the leading cause of death for young Utahns ages 10 to 24. Meanwhile, the demand for mental health providers in the state is growing at a pace that the current shortage can’t keep up with, according to the report released Wednesday by Kem C. Gardner Policy Institute in partnership with the Utah Hospital Association.
Utah has the fifth-highest suicide rate, more people with lifetime depression and fewer mental health professionals compared to nationwide averages, according to the report.
“Utah must more than double its current workforce over the next 15 years to keep up with population growth and move its mental health provider ratios closer to the national average,” researchers said.
The number of Utah adults suffering from poor mental health grew from 15.8% in 2009 to 17.5% in 2017, according to the report — now accounting for nearly 1 in 5 adults.
Data also showed 14.9% of boys ages 15-17 and 28.5% of girls “seriously considered attempting suicide” between 2015 and 2017. But almost 40% of youth ages 12-17 with depression received neither treatment nor counseling, researchers say.
“Most counties have no access to a practicing child and adolescent psychiatrist unless they travel to a different county for services,” the report states.
There are only six child psychiatrists for every 100,000 children, putting Utah in the bottom three states nationwide for children’s access to care. Current providers face long waitlists.
Mental health experts in Utah also agreed that “there are not enough long-term or intermediate beds in the state” for people with severe mental health issues. Instead, they are often admitted into hospitals and emergency rooms, a more “expensive care option” with “limited mental health services available,” the report states.
For Anne DeTevis, whose adoptive teen son suffers from depression, the shortage of access to care is a constant worry.
DeTevis and her husband adopted their 15-year-old nephew and niece after they were taken away from their mother by the Division of Child and Family Services, she said. They adopted the teen in January 2018 and soon after, he started talking about committing suicide “and it’s just been horrible since,” she said.
According to DeTevis, the teen won’t speak to therapists and he’s spent three short stays in the University Neuropsychiatric Institute after suicide attempts, but Medicaid “will only pay for a few days and then they’ll just send him home.”
The family says the physical effects of his suicide attempts will be treated during those short stays, but not the underlying problems.
The family wants him to receive inpatient treatment where he’ll be prevented from harming himself, but facilities won’t accept him long term, she said.
DeTevis is “terrified” for his safety. “Just the worry that we have that he’s gonna hurt himself. I’ve had a constant headache,” she said.
Causes of the shortage
In a state often hailed for its achievements and innovations in health care, what is causing its shortage of mental health services?
According to the report, each of Utah’s counties has fewer mental health providers than the national average. And the newly expanded Medicaid program will stretch the providers even more thin.
“While expanding Medicaid will help alleviate some of the unmet mental health needs the state is currently experiencing, it will place more people into a system with an existing shortage of providers,” according to the report.
Cost is another barrier. Funding for Utah’s public mental health system is split between different systems, “making it difficult to consistently deliver coordinated care,” researchers said. Additionally, commercial health insurance often offers limited coverage of mental health services, sometimes preventing people from seeking help.
“Even if health insurance covers mental health services, there are still applicable co-pays, deductibles, and out-of-pocket costs. For example, the cost for private counseling or therapy can range from $50 to $240 for a one-hour session,” researchers said.
“Commercial health insurance typically only covers 70% of the cost of these sessions if they are provided by a network provider and are for a diagnosed psychiatric disorder.”
Meanwhile, costs are rising, making services more inaccessible to members of the population who tend to be most at risk. Adults with incomes lower than $25,000 experience higher rates of depression and poor mental health, according to researchers.
Meeting the demand
How can a state that’s falling behind rise to meet mental health demands?
Researchers held discussion groups with Utah’s mental health community, including representatives from Intermountain Healthcare, Local Mental Health Authorities, University Neuropsychiatric Institute, Utah’s Community Health Centers, Utah Department of Health, Utah Department of Human Services, and NAMI Utah.
The keys to fighting the crisis in Utah include incentivizing more people to become providers, integrating mental and physical health services in a “timely manner,” continuing to expand the use of telehealth and tele-psychology services, and using consistent health screenings to allow for early interventions, the report states.
“There is a need for broader system collaboration and coordination given the number of different entities providing mental health services across the state. This would help ensure that necessary services are provided at the right time, in the right place, as well as avoid duplication of services among different systems,” researchers wrote.
The groups also said the state should continue public education efforts to remove stigmas surrounding mental health disorders. They suggest increasing the availability of mobile crisis services and increasing funding for school-based mental health providers. The state should eventually create a system for mental health e-consultations, the groups say.
To help address the shortage of providers, the discussion groups emphasized the need to help universities increase mental health program slots; provide incentives for students to remain in-state after school; and incentivize local workers to earn mental health degrees.
In the future, the groups said Utah should offer state-funded loan forgiveness and tuition reductions for those working in rural areas and increase or reinstate retirement benefits for public mental health providers, among other incentives.
Several measures are already being taken in Utah to improve its availability of mental health help, researchers said. Among them:
- The University of Utah Pediatric and Behavioral Health Faculty is starting a Child and Adolescent Mental Health certificate program for physicians, nurse practitioners and physician assistants.
- The state is launching five new Mobile Crisis Outreach Teams that will be located throughout the state.
- Additional funding was approved during the 2019 Legislature to increase resources for the SafeUT Crisis Line and youth suicide prevention programs.
- Funds for four new psychiatry resident slots at the University of Utah each year for the next four years were approved during the 2019 Legislature.
The Utah Department of Health offers suicide prevention help at utahsuicideprevention.org/suicide-prevention-basics. The national crisis hotline is 1-800-784-2433.
- Utah County Crisis Line: 801-226-4433
- Salt Lake County/UNI Crisis Line: 801-587-3000
- Wasatch Mental Health Crisis Line: 801-373-7393
- National Suicide Prevention Lifeline: 1-800-273-TALK
- Trevor Project Hotline for LGBTQ teens: 1-866-488-7386