Rural Indiana, including Grant County, lacks mental health practitioners.
“Right now it’s basically (me) and Grant-Blackford Mental Health as far as prescribers in the area,” said Trina Greenwald, a psychiatric mental health nurse practitioner who operates a clinic in Marion. “I’ve been here five years and haven’t found (a prescriber to join me) yet.”
Officals at the Indiana State Department of Health plan to change that. The department has created a new incentive to bring psychiatrists, alcohol substance use counselors and practitioners in related disciplines into Indiana regions experiencing high numbers of opioid deaths.
Counties who will be part of the program include Grant, Blackford, Dearborn, Fayette, Franklin, Henry, Jay, Randolph, Switzerland, Union and Wayne.
The program will be administered by the ISDH Division of Chronic Disease, Primary Care and Rural Health.
Officials will award grant money for professional college loan repayments to qualifying graduates in mental health and addiction-related disciplines, as well as for some primary care physicians. There will be 30 awards given each year for four years.
Meanwhile, Greenwald has hopes to attract more professionals to her clinic.
“I do have a student that graduated that may be joining me this spring and a second maybe next year,” she said.
Greenwald’s daughter will also be graduating soon and will join her in the spring of 2020.
“If you can’t find them you just have to raise them,” she said.
While a joke, it does seem like raising them has been a necessity in Grant County.
“Let’s face it, there’s not a lot of things to attract people to Grant County right now,” she said. “Typically people go for larger communities.”
Greenwald started her practice by splitting time between Grant County and Kokomo, but the need was so strong in Grant County she was forced to stick to working in Marion.
“Most of my patients from Kokomo followed me and I still get referrals from (there),” she said.
Greenwald also has patients travel from Fort Wayne, Peru and Muncie as well. Her practice, the Serenity Clinic, is booked anywhere between three to six months in advance for new patients looking to receive a prescription.
“We have several agencies for counseling such as Life Center Counseling, several independent places, Indiana Wesleyan University and Family Service Society,” she said. “But we don’t have a lot of psychiatrists or psychiatric nurse practitioners that can prescribe medications.”
According to the U.S. Health Resources and Services Administration, 46 of Indiana’s 48 rural counties don’t have enough mental healthcare providers.
“Our biggest problem right now with drug addiction is people are so into getting people clean then leave and don’t treat the mood disorders (which caused the problem in the first place),” she said. “If you get someone off their drugs and they’re back to feeling anxious and not sleeping, then they will turn back to drugs.”
Grant-Blackford Mental Health is also having difficulty finding employees at all levels, according to Paul Kuczora, CEO of the agency.
“The real economics of the matter in behavioral health care is reimbursing our state according to (wage) rates in 2010,” Kuczora said. Prior to 2019, the rates had been set in 1994.
Kuczora said the pay is not enough for young people who are looking for wages that are not static, especially with the high student loan rates graduates face today.
“While we have some great people doing valuable work for modest compensation, we’re always looking,” he said.
Grant-Blackford has had to put more time into supervising practitioners who are still in school but are working at its health clinic. The catch is this takes valuable time away from professionals providing needed services to patients.
It’s particularly difficult for Grant-Blackford to take in new patients who are needing prescriptions.
“We’ve tried some pretty creative things with waiting times, but it’s not just a matter of seeing a prescriber, it’s a matter of getting started with care,” Kuczora said. “It might mean a scheduled appointment to let our professionals begin to understand the situation, it’s not a case where a pill alone will be a sufficient response.”
The state hopes its new incentive program will be enough to address the issue facing rural counties.
“Access to treatment is a critical component of our effort to reduce the burden of the opioid epidemic,” said Ann Alley, ISDH Chronic Disease Director. “This program will help save lives by increasing access to mental health services and removing barriers to recovery.”