Stretching psychiatric care in rural Pennsylvania

Just 10 psychiatrists are available for every 100,000 people in Pennsylvania, and they tend to cluster in urban areas. Some don’t accept insurance.

Vickie Caffrey is the director of medical services at for the outpatient department of Behavioral Health Associates, a nonprofit health care foundation in Weissport, in the Lehigh Valley. Ask her what she’d do with unlimited resources to improve things for patients, and she’s quick to answer.

“I’d hire five more psychiatrists,” she said.

Right now, only one works with her organization. He splits his days between the Weissport facility and other agencies and hospitals. Years ago, Caffrey said, there were none in the area.

Rural areas on the whole have fewer psychiatrists, but often see a 
greater need. Rural Pennsylvanians have fewer financial resources than urban ones, according to a 2007 report from The Brookings Institution. The area has been losing union jobs for years, and long distances can make people feel isolated. Those factors, in turn, can aggravate symptoms.

It can take patients anywhere from three to six months to
 get their first appointment with a psychiatrist, said Caffrey. In the meantime, she
 can refer them to a crisis center or other mental health agencies in
 the area, but she said those, too, are strapped for resources.

“You know that they’re in a situation where they really need the help 
immediately,” she said. “And if you don’t give it to them, hopefully things will be
 OK, at least for a while, until you can get to them, or they can find  
somebody else.”

Mary, who has bipolar II disorder with major depression, 
lives in rural Susquehanna County near the border with New York. She began accessing care 30 years ago.

“It was actually my son, who was 10 at the time, saying, ‘I want my 
mom back.'” She said. “You start looking for help.”

There’s only one psychiatrist Mary can see in her area. And although, overall, she has had good experiences with care in Susquehanna County,
 last summer Mary was in crisis and had to wait longer than she would 
have liked to see a psychiatrist for a medication change.

“It’s difficult,” she said. “You rely on friends, you rely on the network you set up.”

Mary got through her crisis after the right adjustment. But some people 
see their situations escalate.

“One of the unfortunate aspects of shortages could be that somebody’s 
minor or modest problem could become intensified and become a more major 
problem,” said Dr. Richard Silbert, a professor of psychiatry at
 Commonwealth University.

Alternatives do exist for people in crisis, he said, including community mental health clinics and general practitioners. But a psychiatrist is more knowledgeable about prescribing the right medication.

Silbert said it’s hard to attract and retain psychiatrists in rural
 areas.

“Many psychiatrists find it more advantageous to work in a large,
 metropolitan area like New York, Philadelphia or Washington, D.C.,” he said.

Psychiatrists often select areas with easy access to 
universities and an urban lifestyle. And while fewer people are entering 
the profession and many existing psychiatrists are nearing retirement, 
Silbert said, the shortage is most acutely felt in rural areas.

He’s interested in telepsychiatry — where patients can talk to a psychiatrist through a secure video chat — as part of a potential solution. While telepsychiatry is on the rise in Pennsylvania, Silbert
 conceded that “it can’t meet every need.”

“There is some concern that telepsychiatry would lose some warmth or
 human contact,” he said.For now, Vickie Caffrey said she wouldn’t advise anyone with a
 mental health problem to move to Weissport.

“All those things you’re so used to in the city, it’s just not available
 here,” she said.