Demand for mental health resources soared in central Illinois during the COVID-19 pandemic, and many area organizations felt the pinch of a strained system. However, as most press on with life as they know it under the new "normal," the demand for mental health resources continues to tick upward.
Dr. Samuel Sears is the consult psychiatrist for OSF Saint Francis Medical Center in Peoria, as well as the director of physician services for the Behavioral Health Service Line. He said the unfortunate reality is there’s currently a great mismatch when it comes to the need for mental health services and the people available to provide that care.
“And that's something that's really built up over many decades of decisions that have been made at a federal and state level that have really kind of made mental health services kind of a second-class citizen in health care a lot of the time,” Sears said.
Politicians on both sides of the aisle have contributed to the current state of mental health resources available, said Sears. While politicians often acknowledge the importance of mental health, he said the policies put forth often don’t support that perspective.
“There have been significant funding cuts for many years to community mental health agencies across the U.S.,” Sears said. "You can reach back all the way to the Reagan administration, as block grants were removed from community mental health funding, with a move toward a fee for service model that kind of started the erosion."
With less and less federal and state funds available, organizations have had to start consolidating their efforts just to stay afloat. Sears recalled times not long ago when mental health care was reimbursed at a significantly lower rate than physical health care.
“An initial psychiatric assessment done by a primary care provider would actually be reimbursed higher than the rate at which a mental health practitioner doing that initial assessment would actually be paid,” Sears said. “In what other areas of healthcare would you actually have a specialist get paid less than a general provider for the same exact scenario?”
The reimbursement disparity is one challenge, but the shrinking number of psychiatrists presents another.
“We are still retiring as psychiatrists faster than we're making new psychiatrists come out,” Sears said. “I can tell you that my workforce across OSF, about 40% of my workforce for psychiatrists is of retirement age or older, but continuing to work to be able to support their communities right now, because there isn't really somebody to take over for them when they do retire."
This makes recruitment of utmost importance at OSF and Carle Health alike.
Mary Thompson is the president of Trillium Place, the behavioral health service line under Carle Health. The organization currently serves 10,000 clients annually between its inpatient and outpatient programs. Thompson said Trillium is still grappling with the effects of the COVID-19 pandemic, and demand across the board for all of their programs continues to rise.
However, Trillium has recently seen growth within their psychiatry residency program at the University of Illinois College of Medicine Peoria.
“We were afforded some funding to open up a fifth…slot in our program,” Thompson said. "So, each year has four students or four positions coming in, and we have increased that this year to five."
That means that there will be a total of 20 psychiatry residents at any given time practicing in the Greater Peoria area. However, the next piece of the puzzle is retention. Thompson said Trillium already is making progress.
“Two of our graduates from this year from 2023 are remaining in the area…and then I've also been able to recruit a 2024 grad who's going to continue with us when she completes her graduation,” Thompson said. “And we're working on recruiting the two of the remaining four residents to stay here. So, what we're starting to see is an increased interest in remaining locally.”
Thompson attributes support from the Gilmore Foundation as one of the reasons why the residency program has had a bit of an outlier year in terms of retention levels. She said she's also seeing a greater amount of federal investment in mental health initiatives.
“We had grants to support our Young Minds Project, $2 to $3 million … and then funding to increase that residency slot,” Thompson said. "And then we also have a lot of grant funded programs on the community side to reach people in our community. And I think it's really a recognition that there's an increased demand for behavioral health services and not enough resources."
Thompson noted that Trillium is by no means overstaffed at this point.
“But adding these two stabilized our services immediately and then positioned us well to continue filling in the remaining needs that we have,” she said.
While some psychiatrists are choosing to call Peoria home, psychiatry is a field that often tends to cluster around big cities and coasts. Thus, Dr. Sears noted that recruiting to central Illinois often poses a difficult challenge. He said the question is no longer does that area need a psychiatrist, but rather how many extra psychiatrists does that area need?
“When people have options to go everywhere, trying to bring somebody into central Illinois with our lovely winters that we have in Illinois, with a lack of services, lack of other providers often, which inherently is going to mean greater time spent working, less ability to take vacations…that makes it all the harder to bring in more people,” Sears said.
And while residency programs offer a direct path to employment for some, they can also present a barrier to entry for others.
“When you graduate from medical school, you're a doctor. You have your options of what specialty you're going to go into,” Sears said. “Well, when you select psychiatry, you're selecting a four-year residency, so four years of greatly diminished earnings, for the same cost to get there. And then you are going to be one of the lowest paid specialties in medicine, period.”
Sears added that often folks come out of medical school with over $200,000 of debt. And while the field of psychiatry has made great gains within the last decade, there’s still a clear imbalance when it comes down to dollars and cents. Sears said when he graduated his residency, he made half of what someone graduating with a residency in radiology made, regardless of the same four years of post-medical training they each received.
“They're making literally double what I make with the same cost of schooling to get there,” he said. "Simple economics tells you a lot of people are going to make the choice, I'm going to make twice as much money."
But it doesn’t all come down to the dollar. Sears said the reason why people enter psychiatry in the first place is because they have a passion to serve their communities.
“I can tell anybody that if you want one of the most rewarding careers you could ever have, working in mental health is the place to be,” Sears said. “If you want to make money, it's the last place you want to be. But at the end of the day, there are rewards a heck of a lot bigger than financial.”
Still, until the fundamental difficulties of how mental health care is paid for, the rate at which it's reimbursed, and the affordability of medical school are addressed, it's hard to determine whether passion can conquer the growing need for services year after year.
