While Utahns debate the causes of the state’s infamously high rates of depression and suicide — is it the altitude? The culture? The number of guns? — a new report shows massive gaps in treatment of mental illness.
While more than a third of adults in some Utah communities are suffering from depression, less than half of adults with mental illness have received any treatment or counseling, according to a report released Wednesday by the Kem C. Gardner Policy Institute and the Utah Hospital Association.
“There’s been a lot of press about Utah’s suicide rate, but once you pull everything into one place, you can see just what a big problem the state of Utah has in terms of mental health,” said Laura Summers, the institute researcher who wrote the report. “The severity of the problem is worse than I thought going into it.”
Factoring in Utah adults’ high rates of mental illness and low access to care, Utah in 2018 ranked No. 51 in a national analysis of mental health measures by the nonprofit Mental Health America, the report stated.
For children, the picture was not much brighter. The JAMA Pediatrics magazine in 2016 found that Utah was one of 11 states where the prevalence of child mental health disorders exceeded 20%, and was among the bottom 12 states for the percentage of mentally ill children receiving care.
If you or people you know are at risk of self-harm, the National Suicide Prevention Lifeline provides 24-hour support at 1-800-273-8255.
Of the Utah teens who experienced a “major depressive episode” in 2015, nearly 40% did not receive treatment, according to federal numbers.
The vast majority of Utah’s counties have no child and adolescent psychiatrists, and only two counties — Summit and Kane — have an adequate number of providers, the report states. Statewide, there are six child and adolescent psychiatrists per 100,000 children.
‘WE ARE DESPERATE’
In discussion groups hosted by the report’s authors, leaders in Utah’s mental health industry and public services were quoted as saying:
"Waitlists to see a child psychiatrist are several weeks to months long throughout the state.”
“Right now, we would hire three full-time therapists if we could find them.”
“We are desperate for therapists, we have more demand than we can meet.”
The need for youth mental health services is rising; state surveys of students show rising indicators of distress, with more than 28% of adolescent girls reporting they had seriously considered suicide in the previous two years.
The lack of access to mental health care was even more pronounced for adults. From 2009 to 2015, the percentage of Utah adults with poor mental health bobbled up and down between 15.3% and 15.9%. But in 2016, that figure rose to 16.5%, and again in 2017, to 17.5%.
Meanwhile, less than 44% of Utah adults with a mental illness received care in 2015, according to federal data. The ratio of mental health professionals to residents in Utah is below the national average, and the number of mental health workers would need to double to catch up — and to keep up with the state’s steady population growth, the study found.
The shortage of mental health professionals, most severe in rural areas, was the problem most talked about in discussion groups researchers hosted, Summers said. Many patients, especially in rural areas, can’t find therapists or psychiatrists with openings; if they can, they often learn the provider isn’t covered by their health insurance, or the waitlist is too long to address urgent needs.
And by the time a patient or their loved ones recognize that professional help is needed, Summers said, the symptoms are typically so severe that the patient is in crisis. For someone in that state, it may be nearly impossible to persevere through phone call after unhelpful phone call to doctor offices and insurance helplines, or set and keep appointments that are months away.
“If you’re trying to navigate complex systems — health care is complicated, insurance is complicated — it’s hard for anyone," Summers said. "But when you’re struggling with severe anxiety or another mental health issue, it certainly compounds that issue.”
The report suggests a number of measures that could remedy the shortage: Offer student loan forgiveness and other incentives for people who join the field or work in a underserved community; adjust licensure requirements so the different types of professionals — therapists, social workers and psychiatric nurses, for example — could treat more types of patients; create advanced nursing programs for mental health care; and boost consultations online and by telephone. Schools of medicine could provide more residency slots for psychiatric students, Summers said.
Primary-care doctors also can be enlisted more effectively, said Rachel Weir, a psychiatrist with the University Neuropsychiatric Institute at University of Utah Health. Weir’s practice in Salt Lake City has a 6-month waiting list, and, like many psychiatrists, a large number of her patients were referred to her by their family doctors after relatively mild depression or anxiety symptoms worsened or didn’t respond to medication.
With extra support, primary care doctors could manage treatment for those patients, Weir said. “Some of these mild to moderate cases could be managed in primary care.”
Some health systems have enlisted psychiatrists to consult with multiple doctors; in those clinics, a single psychiatrist can help to treat up to 300 patients in a day, compared to the 12 or so patients that psychiatrists can see in a day on their own.
Without backup from a psychiatrist, Weir said, primary care doctors often are reluctant to increase antidepressant dosage or recommend certain specialized types of therapy because they don’t have a lot of experience or confidence in mental health care.
As a result, only about 20 percent of patients who receive antidepressants from their family doctors actually improve, Weir said. The rest may see their symptoms worsen, until they do need specialized psychiatric care.
Treating depression also makes care for other, physical maladies, more effective, Weir said. “If someone’s depression is not under control, they’re probably not going to be compliant with their diabetes treatment,” she said.
Even if Utah had enough mental health professionals to meet the rising demand, many Utahns could not afford their help. Private insurance plans often require expensive copays even for routine therapy sessions, and many do not cover residential treatment or inpatient hospital care.
Income is closely tied to mental wellness, with nearly a third of adults with an income less than $25,000 reporting that they suffered from some depressive disorder in 2017, according to the report. About 15% of new moms in Utah suffer from postpartum depression; for low-income moms, that number rises to 21%.
As providers become more scarce and costly, rates of mental illness are rising to crisis levels in some communities. The Glendale neighborhood in west Salt Lake City showed the highest rate of depression of any Utah community, with 38.4% of adults suffering from a depressive disorder, according to state data collected in 2017.
But more affluent neighborhoods also had staggering rates of depression, with residents of the Avenues in Salt Lake City reporting a depression rate of 37.2% and Provo’s East City Center at 36.5%. Midvale was at 34.9%, and the Hurricane and LaVerkin area of Washington County was at 34.3%.