Earlier this year, the nonprofit Mental Health America found that Idaho had the third-highest rate of mental illness and substance abuse in the country and ranked 39th for its access to mental health care. It ranked the state 50th out of 51, including the District of Columbia, for its combined higher prevalence of mental illness and lower rate of access to care.
While some mental health resources are becoming more available in parts of the state, connecting rural patients to them can be challenging. Mental health experts across eastern Idaho say that new collaborations and remote treatment options are helping to close that gap but are still far from providing all the services needed.
"I think we're years away from getting to the point where's plenty of every position around here," Nelson said.
In a 2018 Post Register article, local experts said the state's psychiatrists shortage will continue to worsen in the next 10 years because the average age of psychiatrists in the state is 53 years old, and there aren't enough new psychiatrists joining the field.
Dr. Cristina Sanchez-Jaquez is one of three psychiatrists treating patients at Pearl Health Clinic in Idaho Falls, which specializes in outpatient meetings and therapy sessions. Her schedule includes 10 or more patients per day, the majority of whom are recurring clients. The clinic sees more than 150 people each day.
"My schedule is usually completely full. There's an incredible demand around here," Sanchez-Jaquez said.
Sanchez earned her degree in the Dominican Republic and had worked in Texas and Connecticut before coming to Idaho in 2016. That's a fairly normal journey at Pearl — the majority of the psychiatrists and psychologists at the center are not Idaho natives.
The lack of schools for mental health providers in Idaho caused a dilemma for Idaho clinics. Many small clinics cannot offer the salaries to consistently attract top talent away from other places around the country, and the lack of medical schools makes it difficult to provide in-state doctors to all the patients who need it.
Pearl Health Clinic is attempting to combat that by launching a partnership with the state's first medical school, the Idaho College of Osteopathic Medicine. Pearl Executive Director Zak Warren said the clinic will begin hosting residencies for doctors from the Meridian-based school later this year.
"We're working to connect the dots that will keep those experts local. The hope is that doctors who have their training here can find a career path for themselves in southeast Idaho," Warren said.
Getting people in the middle of a crisis to an inpatient room across the state isn't easy. Idaho Falls-area patients who had used public transportation or medical routes to attend meetings lost a resource when Targhee Regional Public Transportation Authority closed earlier this year. Dave Holcomb, a therapist for Lemhi Valley Social Services in Salmon, said his organization usually relied on off-duty police officers and ambulances to get patients to Idaho Falls.
"They're pretty much treated like a criminal and kept in the back of a police car if and when we can get the sheriff's department to go," Holcomb said.
Nelson agreed that many rural patients are brought to the center in emergency vehicles and rely on friends and family members to take them home once their two-week stay is completed. Many of those families choose to pay for a hotel and spend the night rather than trying to drive back to central Idaho or western Wyoming in one day.
Telehealth technology has continued to expand its reach in many mental health clinics, allowing doctors to treat patients remotely. The Behavioral Health Center has as many psychiatrists who teleconference into their appointments from Arizona or New York as actually work in the building.
Over the last year, Sanchez-Jaquez has started using telehealth to meet with more of her patients remotely. All the initial appointments at Pearl still need to be done face to face, but allowing for remote evaluations makes it easier for patients who live as far away as Salmon to schedule and attend their follow-up meetings with her.
"If we have clients that literally can't make it into a city easily and have a crisis, they can still get help. We can still find ways to see them," Sanchez said.
Pearl Health Clinic requires at least one meeting every six months for a recurring client, and Sanchez-Jaquez said most of her patients come back around once a month.
Sanchez-Jaquez also is a certified child psychiatrist, a field with an especially dramatic shortage across the state. There are 22 child and adolescent psychiatrists in Idaho, a tenth of the rate recommended by the American Academy of Child and Adolescent Psychiatry.
The distribution of those resources is also uneven. In Idaho, there are no inpatient acute care centers for children younger than 13 further east than Meridian and those programs can be especially demanding for the families of the children who spend their time there.
"Typically, the programs they would go to require parents to be there in-person every other day. That's very taxing for families that live hours away from the hospital," Nelson said.
Some rural areas of eastern Idaho have worked to organize and expand their mental health resources. Launched in 2009, the Teton Valley Mental Health Coalition is a nonproft collaboration between the therapists and counselors near Driggs to improve their ability to help the county's mental health patients.
Teton County currently has one psychologist and no in-person psychiatrists, but the coalition's Executive Director Adam Williamson said he was happy with the resources it has been able to provide over the years.
"At some point, we're going to saturate the community with resources and meet the need. That hasn't happened yet," Williamson said.
One of the biggest tools the coalition has launched is a series of subsidized counseling sessions. Every county resident can attend at least one free counseling session, regardless of what medical coverage they have, if they’re feeling suicidal or in any other crisis. Residents have increasingly taken advantage of that service — the coalition had 92 subsidized counseling sessions in 2015 and 255 last year.