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Doctor Shortage: Lack of Behavioral Health Professionals Takes Toll On I.E. Residents' Mental Health

Steve Snodgrass

The Inland Empire’s severe doctor shortage affects all aspects of healthcare – including mental healthcare. KVCR’s Benjamin Purper explores the area’s shortage of mental healthcare professions in this report.

At the Riverside Free Clinic, patients are waiting for free mental health services. They’re provided by counseling students from the University of Redlands.

Most of the patients at the RFC are uninsured. Some are undocumented immigrants, others are transients. But Medina says the thing that’s common among them is low socio-economic status.

“I think the biggest thing here, and it's something that I noticed living in different areas for college and different states and everything - poverty is honestly one of the biggest contributions to the lack of resources, the lack of awareness,” says Erica Medina, a student volunteer. “A lot of our areas are resource deserts, there's nothing here.”

In 2016, a team at UC San Francisco ranked all the major regions of California by the number of behavioral healthcare professionals per capita. The Inland Empire ranked dead last, along with the San Joaquin valley.

That leads to long wait times for therapy, medication, and other mental health services – which creates desperate situations for a lot of people.

Allie Mink has first-hand experience with those people.

“We get questions every day to our website and some of the questions are heartbreaking,” Mink says. “It might be something like, my son was just recently diagnosed and I don't know what to do and I can't find resources and, you know, help me. It might be something along those lines.”

Mink is a director for the San Bernardino chapter of the National Alliance on Mental Illness, or NAMI. They’re a non-profit, not a treatment center, but they still get people coming to them because they’ve got nowhere else to go.

“That's more common than you would think,” Mink says. “I think that people think that because you have coverage, that that means that you have access. And unfortunately the two things do not go hand in hand. It's a slippery slope, a lot of times when people are looking for help they can't get, prior to a crisis, they can't get an appointment with a psychiatrist.”

NAMI has support groups and classes for people living with mental illness and their families. But when a person approaches NAMI when they’re psychotic or suicidal, the only thing they can do is refer the person to emergency services.

“We're treating mental illness like we're treating a broken arm,” Mink says.

Credit "California’s Current and Future Behavioral Health Workforce" / Healthforce Center at UCSF
Healthforce Center at UCSF
Riverside and San Bernardino Counties rank near the bottom in every occupation except Psychiatric Technicians, which Coffman says is most likely due to the presence of Patton State Hospital in San Bernardino.

Janet Coffman studies health policy – she’s one of the authors of the UCSF report.   

“What we found is that California is projected to have a pretty substantial shortage of behavioral health professionals between now and 2028,” Coffman says. “Particularly among psychiatrists and psychologists, because large numbers of them are reaching retirement age within the next decade and the pipeline of newly trained psychiatrists and psychologists isn't large enough to replace them.”

But it’s not just the number of psychiatrists and psychologists; it’s also where they choose to practice.

“We also found that behavioral health professionals were poorly distributed across the state. And that regions like the Inland Empire and the San Joaquin Valley have much lower ratios of most behavioral health professionals to population than the Bay Area and other large metro areas on the coast.”

There’s also a lack of equal representation.

“In most occupations, there's a lack of racial/ethnic diversity relative to the population of California and also an under-representation of men.”

Based on these core issues, Coffman and her team have a few suggestions for the Inland Empire. She says we need to increase the supply of mental health professionals by attracting more of them to this area, and by training more of them here. We also need to increase racial and ethnic diversity.

“We're in a bad situation and it's only going to get worse unless we really as a state make more of an effort to prepare the numbers of behavioral health professionals we need and encourage them to distribute themselves across the state in a way that provides better access.” 

Dr. Bradley Gilbert is the CEO of the Inland Empire Health Plan, a non-profit Medi-Cal and Medicare health plan in the Inland Empire.

"When I look at the statistics, we're very low for pychiatrists in terms of our base supply," Gilbert says. "We're very low for psychologists, a little better for Licensed Marriage and Family Therapists and Licensed Clinical Social Workers, relative to the California average and other counties."

But there's one occupation that's especially lacking: "a very significant child psychiatrist shortage," Gilbert says. "And the child psychiatrist shortage is nationwide, but again [the Inland Empire] is on the bad edge of supply in general." 

That makes it difficult to get treatment for children with attention-deficit and other disorders. "It's hard to get access," Gilbert says. "The access is difficult because there's just not enough.

You can learn more about NAMI San Bernardino at namisb.org, and you can read the UCSF report here.

This story was produced for the USC Center for Health Journalism’s California Fellowship.

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