Opinion: Missouri is the worst state in America for mental health care. Here’s how to fix it

Photo courtesy of U.S. Air Force photo by Staff Sgt. Alexander W. Riedel/Released.

When it comes to mental health care in the U.S., Missouri is the worst. According to the Henry J. Kaiser Family Foundation (KFF), an organization that determines health professional shortage areas (HPSA) in all 50 states and U.S. territories, the Show Me state was the worst at covering its populations’ mental health care needs. Only 7.2 percent of citizens’ psychiatric needs were being met, as opposed to a 26.10 percent average in the U.S. and a 31.63 percent average in Kansas.

As society progresses and more people are talking about their mental health, there have been great strides in reducing the stigma related to seeking treatment for mental health issues. More people are looking for psychologists or psychiatrists – but their search may be in vain.

When primary care physicians notice a mental health concern and try to refer patients to a psychiatrist, two-thirds of doctors report that they have trouble finding someone to refer their patients to. This is the highest rate of referral shortages of any specialty.

In Missouri, there are seven state-run psychiatric hospitals or residential facilities and 39 community mental health centers. In Kansas, there are two state hospitals and 146 community mental health centers. This raises the question: how did Missouri get so far behind, and what can it do to fix this problem?

The biggest problem in Missouri is the lack of psychiatrists or psychologists, especially in rural areas. The shortage of healthcare in rural areas is nothing new, and to combat this issue that state started the Missouri Health Professional State Loan Repayment Program. This program offers up to $50,000 to physicians and dentists that work in an HPSA community for at least two years in order to pay off their student loans. However, this is available only to primary care physicians or dentists, so psychiatrists cannot apply.

Reclassifying psychiatry as a primary care specialty is a necessary first step in raising the amount of Missourians who receive the necessary mental health care. If medical students know they will be eligible for the loan repayment program, they may be more encouraged to specialize in psychiatry and stay in the state.

Missouri also needs to create a similar program for other medical professionals. In Kansas, the repayment program is open to not only psychiatrists but also to eight other mental health care professions including licensed social workers and marriage and family counselors. In 2017, 22 percent of the people who used the state loan repayment program specialized in mental health care.

The program in Kansas also pays more. Instead of capping the amount of money one can receive at $50,000, the state continues to offer reimbursements after the required two years. If one were to work in Kansas for five years, a physician could receive up to $95,000 and other health professionals could receive up to $70,000.

Missouri is also the fourth lowest paying state in the country for psychiatrists. The average salary for a psychiatrist is $217,330 per year in Missouri compared to $233,696 per year in Kansas. A similar trend emerges in other mental health care professions.

This means that if you are a mental health professional in the Midwest, it makes more financial sense to practice in Kansas than Missouri. In Kansas, you can make more money and have a smaller loan to pay back.

In 2017, Representative Keith Frederick (R-Rolla) proposed a bill in the Missouri State House to add psychiatrists to the loan repayment program, but the bill failed. Other similar bills that would increase funding for telepsychiatry and nursing programs dedicated to mental health care also failed.

The lack of access to mental health care in Missouri is a serious crisis, and it’s one that the state can fix – yet it continues to do nothing. By expanding the state loan repayment program and increasing the number of state-run psychiatric facilities, Missouri could improve the lives of tens of thousands of its residents. It could also decrease crime, homelessness and drug abuse –  issues all stemming from limited access to mental health care.

I understand that none of these solutions will totally alleviate the problem in our state, and they will cost several millions of dollars. However, the lack of mental health care is clearly a problem in our state. When only a little more than seven percent of the population’s needs are being met, it is clear that Missouri has failed its people. Our government has a duty to at least try to fix the problem. This state needs to step up – Missourians deserve better.


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