Suicide, depression on rise in rural Michigan, but psychiatrists are scarce

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For Upper Peninsula mother Katie Sinclair, the memories are still painful.

Her then 10-year-old son, Jacob, had struggled for years with mental health issues that stretched back to kindergarten. Diagnosed with depression, he suffered panic attacks. He had outbursts at school. He would stab himself with knives, and when they were removed from the house, with pencils or paperclips.

In late 2017, he told a psychologist he wanted to cut his throat. He referred Jacob to UP Health System-Marquette, where doctors ordered inpatient psychiatric care. But there’s no in-patient psychiatric beds for children anywhere in the U.P. So Katie and her husband, Jacob, drove him nearly 250 miles from their home north of Escanaba to a hospital in Milwaukee, Wisc.

He was discharged after five days, with instructions for follow-up care. But it would be nearly two weeks before the Sinclairs could get an appointment with a psychologist for Jacob.

“We struggled mightily finding follow-up care in our area,” Katie Sinclair said. “I was frustrated. I was worried. I was crazy.”

A 2018 public health survey found the U.P. had just eight psychiatrists – and two child psychiatrists – to serve 300,000 people in an area twice the size of Massachusetts. That’s about one-third the ratio for the entire state. Seven of 15 U.P. counties have no psychiatrist.

And that shortage parallels broader mental health care gaps across rural Michigan, which has the lowest percentage of all types of mental health workers in the state.

In Presque Isle County in the northeast corner of the Lower Peninsula, there were 4,260 persons in 2018 to every behavioral health worker – a category that includes psychiatrists, psychologists, licensed social workers, counselors, marriage and family therapists and substance abuse providers. That’s 10 times higher than the state average of 400 persons per behavioral health worker. In the U.P.’s Ontonagon County, there were nearly 3,000 persons for every such worker.

“It isn’t just a need for psychiatrists,” said Julie Hautala, CEO of Gobebic County Community Mental Health in the U.P.’s western fringe.

“It’s also social workers. The demand for outpatient treatment has just skyrocketed. There really is a high demand for services but a lack of resources.”

According to a survey of 77 primary care physicians in the U.P., nearly 90 percent identified “long waiting lists” for psychiatric care for their patients. Another 70 percent said they did not have a psychiatric provider to which they could refer. More than a third said transportation to psychiatric care was an issue for their patients.

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