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Rural areas face bigger mental health shortages

Columbus Telegram - 11/6/2017

Nov. 05--COLUMBUS -- The solution to the need for more behavioral health providers might have to start locally.

There is a lack of access to psychiatric and mental health services in Nebraska, much like the rest of the country, and the problem is even more prevalent in rural parts of the state.

The reasons for the shortage are many, from an inability to attract licensed providers to smaller communities to burnout experienced from having to serve a widespread area in rural counties.

The solution might come down to retaining the local talent pool as much as recruitment.

"If you want to have a large enough number of providers, you have to grow your own," said Brent Khan, co-director of the Behavioral Health Education Center of Nebraska (BHECN).

The center was established in 2009 after the Legislature passed a bill that moved behavioral health services away from institutional care to a community-based approach. Since then, the Omaha-based BHECN has been working to improve access to services across the state.

One way of doing this is increasing the number of providers.

Programs have been established as early as at the high school level to expose students to careers in the behavioral health field.

BHECN also recently received a $1.1 million grant from the U.S. Department of Health and Human Services to increase the number of behavioral health paraprofessionals in rural Nebraska. The grant will be used to provide full tuition and laptops for 70 nontraditional students each year to become community health workers and provisionally licensed addiction counselors.

Khan said the grant is an opportunity to address the shortage of mental health professionals present in 88 of Nebraska's 93 counties.

For those already pursuing careers in the mental health field, retention becomes a focus. But getting professionals to stay here is another challenge.

Khan said Nebraska is often viewed as a training ground for higher-paying jobs in other states.

Some strides have been made in meeting needs within the state. In recent years, there has been an increase in licensed behavioral health workforce areas such as psychiatrists, advanced practice registered nurses, physician assistants, psychologists and licensed independent mental health practitioners. During the same time frame of 2010 to 2016, the number of licensed mental health practitioners and licensed alcohol and drug counselors has dropped.

In Columbus, there is one new provider.

Earlier this year, Goodwill Industries of Greater Nebraska began providing behavioral health services in the community when it answered a proposal from Region 4 Behavioral Health Services.

The community had recently lost two mental health providers after Catholic Charities left and Rainbow Center closed.

Kim Buschkoetter, vice president of compliance and mission marketing for the company, said Goodwill provides behavioral health services to those with a mental illness or substance use disorder in rural areas of its 55-county territory.

"We have a lot of experience providing day rehabilitation, providing community support and working with folks who have a disability, helping them become employed," she said.

The services are based in the Columbus Family Resource Center and so far about 60 clients are receiving assistance through day rehab and community support.

Buschkoetter said having providers in rural areas is just as important as in metropolitan areas because there is a need everywhere.

"Mental illness, substance abuse disorder, a behavioral health condition covers all economic backgrounds, ethnic backgrounds and race. Probably all people can talk to someone in their lives that they know who had to deal with these kinds of illnesses," Buschkoetter said.

Still, the challenges of addressing the lack of providers in rural areas are ongoing.

Those practicing in rural Nebraska don't have colleagues nearby to collaborate with and often don't have a backup to help treat patients.

"A lot of providers experience burnout because they are the only game in town," Khan said.

The shortage combined with an aging workforce could mean more trouble moving forward. About half of the state's licensed providers are older than 50.

"If we don't backfill this, in 10 to 20 years the problem will grow exponentially," Khan said.

Trying different methods to reach rural populations could ease the challenge. One way is using telecommunications. Khan also is in favor of integrating behavioral health into primary care.

"This is a key strategy, to train and place people in primary care clinics. That is the front line," he said. "That strategy and video conference to cross distances are major ways to improve the access."


(c)2017 the Columbus Telegram (Columbus, Neb.)

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