Mental health patients drowning in shallow pool of providers

This article was originally published in El Paso Matters on June 16, 2022. 

A sense of relief overcame Jorge when he finally landed a job in March 2021 after being out of work for 10 months during the pandemic — a time in which he also went without mental health treatment.

A recent graduate of the University of Texas at El Paso, Jorge, 26, previously accessed free services at the university as a student. With a job and benefits, he figured he could get back on track managing his bipolar disorder and the depression that hit at the height of the COVID-19 pandemic.

He’s still waiting. Twelve out of the 14 therapists covered by his health insurance are overwhelmed and not taking any new clients. The other two are taking in patients but with month-long wait times.

“I can still remember that a therapist told me she would not be able to take on clients until this year. I spoke to her in April of last year, and I thought, ‘No way. What can I do about it?’”

Mental health providers were already in short supply before the pandemic, but increased demand for services has since left more and more people like Jorge frustrated and without the help they desperately need.

Officials in El Paso and Juárez say they’re working to increase the pool of mental health providers in the region — including growing our own professionals in the field – and to remove negative stigmas around mental health conditions.

Building Blocks to Address Shortages

El Paso has 97 mental health providers for every 100,000 residents as of 2020, according to Healthy Paso del Norte data. While the rate has slowly increased from 47 providers per 100,000 people in 2013, it is still well below neighboring Doña Ana County’s 307 to 100,000 ratio.

Healthy Paso del Norte is part of the Paso del Norte Health Foundation, which provides population data and community health information for the region, including El Paso and Hudspeth Counties in Texas, and Doña Ana, Otero and Luna Counties in New Mexico.

Breaking down the numbers, El Paso had 67 licensed psychiatrists and 92 licensed psychologists in 2021, according to the latest data available from the El Paso Behavioral Health Assessment report conducted by the Meadows Mental Health Policy Institute.

Tracy Yellen, CEO of the Paso del Norte Health Foundation, said some of the efforts to alleviate the shortage include working with the University of Texas at El Paso and Texas Tech University Health Sciences Center El Paso to build the psychiatry residents and psychologist internship programs to have more locally trained professionals who are ready to enter the workforce.

The program, called the El Paso Psychology Internship Consortium, has small cohorts of about four students per class with at least one student remaining in El Paso to practice as a licensed psychologist. In the 2021- 22 program, three of the four students remained in the region.

“Creating these building blocks to building providers is so important and we’re finally seeing some results around (those) investments,” Yellen said.

Enrique Mata, founding executive director of the new Paso del Norte Center at the Meadows Mental Health Policy Institute, said other efforts include improving service availability and empowering primary care providers to know when and where to refer patients for mental health help.

“When you go see a primary care provider they can respond to questions about the mental health of the individual and in the family and help connect and coordinate with referrals in the community,” Mata said. “Whether it’s the need to talk with a mental health professional or coordinate care with psychiatry.”

For his part, Jorge hopes all that happens sooner rather than later — and that employers and insurance companies offer and help pay for those services.

At the start of the pandemic, he worked for a nonprofit that helped pay rent and utilities for those who’d lost their jobs or had reduced incomes. Seeing people suffering through those difficult times further impacted his mental health, he said.

During the agency’s training sessions, he remembers employees were instructed to handle people with a mental health condition by referring them to a suicide help line.

“Things like this opened my eyes to see that surely there’s a lot of stigma but also that a lot of people just don’t understand it,” he said. “I’m not too sure how much the pandemic affected my mental health.”

On one hand, he said, being isolated in 2020 helped him fend for himself never before.

“On the other hand, I can’t help but wonder how much progress I would have made if I had been able to get therapy while I was working.”

A Strained Health System in Juárez

The problem is much steeper in Juárez.

Within the public mental health services provided by the state of Chihuahua there are 0.13 psychiatrists per 100,000 population, according to the  network of healthcare organizations known known by its Spanish acronym as ROTMENAS — Network of Organizations Dedicated to Prevention and Treatment of Neurological and Mental Disorders and Substance Abuse.

These rates are lower than in 2011, when there were 0.83 psychiatrists per 100,000 people.

The network has been focusing on the shortage of mental health services for more than five years, according to its 2017 strategic report. It points out that these rates are significantly lower than the 2.08 recommended by the World Health Organization and as is the case in other countries with medium to high incomes.

Diana’s Journey For Help

The lack of providers — and a complicated system of referrals — left Claudia back in April trying unsuccessfully for three weeks to have her 21-year-old niece, Diana, admitted to Juárez’s only psychiatric hospital, Hospital Civil Libertad.

Claudia was told her niece could only be admitted there with a referral from the Mexican Social Security Institute. The two went to Social Security Clinic No. 68 and waited in the emergency room for four days before Diana was admitted to the clinic’s psychiatric wing.

By that time, Diana had attempted suicide twice. She tried a third time when she managed to leave the hospital after being admitted.

Two years earlier, Diana had been diagnosed with severe depression. When her parents separated, she sought therapy at the University of Ciudad Juárez where she was a student. She was referred to a private therapist who referred her to a psychiatrist.

Her mother partially paid for psychiatric sessions at a private hospital. With some financial help from her boyfriend, she paid for consultations at $40 per session.

Overwhelming Challenges

The overwhelming challenge is clear when you consider that the Hospital Civil Libertad is the only psychiatric center in Juárez, which has a population of more than 1.5 million.

It only has room for 36 patients, said psychologist Ana Julia Robelo, and there are only two psychiatrists employed there, data from the Chihuahuan Mental Health Institute shows.

In 2019, there were 3,120 medical consultations at the psychiatric center, which dipped to 1,921 in 2020 during the pandemic, data shows. In 2021, consultations sprung back up to 2,137.

While schizophrenia continues to be the main mental illness treated at the Hospital Civil Libertad, consultations for post-traumatic stress disorder doubled and services for mixed anxiety depressive disorders increased by 61%.

“The majority of the little funding available for healthcare was allocated for the (COVID) pandemic. There was a tremendous lack of medicines, and I’m not just talking about in the public sector but also in the private sector,” Robelo said.

People couldn’t find antipsychotic drugs and mood stabilizers at pharmacies. Those already diagnosed before the start of the pandemic couldn’t fill prescriptions or attend any type of therapy, Robelo said.

The Hospital Civil Libertad limited the number of inpatients, but also the access to professionals that could diagnose a clinical condition and recommend the appropriate treatment.

With these limitations in the health system, cases of depression, anxiety, PTSD and bipolar disorder increased.

“Not only are we working with new cases, but also with a backlog of cases throughout the medical system because we don’t have enough psychiatrists to cover such great demand,” Robelo said.

Part of the challenge is that much of the funding and resources allocated to mental health services go to addiction services.

“(Addiction) is a disorder that also needs to be addressed, but many times too much emphasis is placed on this type of problem. Everything else is sidelined because it’s not as serious as addiction,” said Oscar Esparza, a psychologist and professor at the University of Ciudad Juárez.

Getting Help Is Not Easy

Claudia, the woman who had difficulty getting psychiatric help for her niece, believes a big part of the problem is that mental health conditions are still not taken seriously — even by other medical professionals.
She claims Diana was often met with disbelief by medical personnel even as they presented a letter of referral written by a psychologist from the Center for Psychological Care SURÉ.

“The stigma is pretty strong. Even other patients looked at her and said she had nothing wrong with her,” Claudia said. “We saw people who were intubated, with physical problems and the psychiatric patients didn’t get care.”

Even among her family, Diana faced the stigma. Her parents didn’t believe what she was going through was a real illness and that she should be able “to control her own thoughts,” Claudia said. That’s why she stepped up to help her niece, she added.

Available Programs and Resources

In El Paso, there are programs available to address a variety of mental health issues including crisis and counseling services.

Emergence Health Network offers crisis and suicide prevention, mental health community trainings, outpatient clinics and counseling services among others.

Celeste Nevarez, chief of clinical services with the network, said the agency is also focusing on preventive care to help people address mental health needs before they reach a crisis.

“I don’t want to dismiss or minimize the acute calls that we are definitely seeing as well, but I’m happy with the increase in the number of preventive care calls we are seeing,” she said.

Yellen, of the Paso del Norte Health Foundation, said the organization began working toward reducing mental health stigmas in the region about 10 years ago through the Think Change initiative. The initiative provides grant funding for area mental health programs and caregivers and works to make mental health approaches more holistic.

“There’s a whole network of providers, nonprofits and others that are convening frequently and a lot of it was building relationships, but also looking at systems,” Yellen said.

That cross-agency collaboration aims to better allow primary care doctors to make referrals or get recommendations from psychiatrists for treatment options.

In the public sector in Juárez, the Chihuahuan state government offers mental health services through the Hospital Civil Libertad, therapy through the Mental Health Integral Center and prevention programs subsidized by the Ciudad Juárez Health Sector and the Undersecretary of Social Development. The state also offers addiction services in three primary care centers.

The municipal government offers a variety of mental health services through the Instituto Municipal de la Mujer, the Instituto Municipal de la Juventud de Juárez and at the Municipal Community Centers.
In addition, there are close to 20 nonprofit organizations that offer mental health services to address issues such family therapy, marriage counseling, addiction services and prevention, gender and family violence and suicide prevention.

But even with these low-cost options, addressing mental health conditions is still inaccessible for people with the lowest incomes.

Both Robelo and Esparza agree that a huge weight has been put on nonprofit and religious organizations to fulfill the need for mental health services in Juárez.

“Lots of civic associations care for the mental health of Juarenses in different ways, such as treatment and prevention. There are lots of people making an effort to provide the care that the government and hospitals are not,” Esparza said.

In order to address these shortages, groups like ROTMENAS have pushed for better health policies and for mental health conditions to be part of the public agenda. There’s currently a pending initiative that sits in Congress to modify article 7 in the Health State Law.

The initiative seeks to change the requirements and handling process of inpatients that suffer from mental illnesses and implement the changes suggested by the network of mental health providers and experts.

In February of this year, members of the organization presented a human rights handbook for people with mental health conditions at the state’s congress. Padilla explained that the organization worked on the handbook to serve as a manual to create better health policies.

“The idea is to make this an official document. In other words, to have government entities acknowledge it, accept its significance, adopt it and distribute it,” Padilla said. “We want to take the necessary steps to put mental health issues before the decision-makers to continue to create public policy that truly benefits residents.”

The full article is available online here.