Mental health shortages and solutions (2024)

According to the 2023 Colorado Health Access Survey, around 13% of Mesa County residents who needed mental health care did not receive it.

Around half of those respondents said cost was a deterrent to treatment, but nearly 75% said it was because they could never get an appointment.

Similarly, Mesa County has been designated a high-need health professional shortage area for nearly two decades.

“Even when you’re in the field, it’s hard to know where to start,” Counseling and Education Center Executive Director and Therapist Hali Nurnberg said. “If I don’t know, no wonder nobody else knows.”

She added that the lack of available mental health professionals not only prevents a substantial amount of people from receiving needed care but potentially impacts the effectiveness of treatment for those able to receive it.

“We need more options for people so they can have a choice … right now it’s like, ‘Oh, you got an appointment, you’re lucky; good for you, keep that appointment.’ What happens if you don’t like them?” Nurnberg said. “Can you have some choice in being able to shop around?”

According to Nurnberg, many people interested in becoming a counselor or social worker cannot financially support themselves through all the required education: high school, a bachelor’s degree, a master’s degree and clinical hours. She also said completing clinical hours is challenging because of a supervisor shortage, notably among social workers.

Mental health shortages and solutions (2)

Nurnberg added that online therapy services, while helpful for some people and a notable force behind reducing mental health stigma, have exacerbated the shortage. She said it’s grown difficult for physical providers to compete with the ability to work virtually and customize your caseload while receiving a full salary with benefits.

In theory, these online services make therapy more accessible to a wider population, but Nurnberg said that isn’t always the reality.

“A lot of those programs don’t do well with high-risk individuals, people who have suicidal ideation or complicated family situations,” Nurnberg said. “Some do alright, but a lot of them just don’t serve those populations, so we’re left with fewer clinicians supporting our community and truly invested in our community.”

Aside from the general shortage of providers, few options exist between outpatient therapy and inpatient treatment/hospitalization. Having a middle ground provides more options, especially for those who might need the wrap-around services offered inpatient but are unable or unwilling to forgo their work and other life responsibilities for an extended amount of time.

One example is intensive outpatient treatment (IOP), a daytime treatment program where clients can return home at night. IOPs and similar models typically offer a case manager, medicine provider, peer support and extensive therapy (much like inpatient), but they allow clients more independence and connection with the outside world.

SOLUTIONS AND INITIATIVES

One partnership between the local mental health office, Foundations for Families, and the online therapy service Charlie Health allows teens and young adults to access its virtual intensive outpatient therapy program in an accessible, confidential and safe environment.

According to Foundations for Families Co-Owner Aaron Jimenez, programs like Charlie Health’s IOP enable locals to receive needed mental health treatment without waiting months for a therapy appointment or having to be hospitalized. He added that having the choice is especially beneficial to youth because they are more vulnerable.

“For a parent, I could absolutely see (the reasoning), ‘Well, this is the only option. We wait six months and (someone could) make a horrible decision that’s based in mental health, hormones and the emotion of the moment, (so) maybe hospitalization is the place,’” Jimenez said. “Then, of course, that brings along stigma that will stick with a child their entire lives and unfortunate experiences that will stick with the child their entire life.”

However, Jimenez said that because the IOP is virtual, it isn’t guaranteed that the adolescents utilizing it have a safe or confidential environment to fully engage. He added that the virtual aspect of the program makes it difficult to ensure clients are actually participating and engaging with the needed mental health services.

In response, Foundations for Family partnered with Charlie Health to provide a space that allows adolescent clients to speak freely and privately, while still ensuring engagement and safety through case manager supervision (from a separate area). Clients can even obtain a ride from the program case managers to and from the IOP if transportation is a barrier.

Other initiatives are more focused on addressing the shortage of mental health professionals, such as the CEC’s internship and supervision program. The program offers students seeking their master’s degrees in counseling or social work with the internship necessary to earn their degree; it also provides the opportunity to complete post-graduate, supervised experience hours.

Mental health shortages and solutions (3)

The CEC currently boasts four supervisors who mentor and monitor up to 16 interns and trainees at a time. Upon completing the program and supervised hours, trainees are eligible to work as a counselor or social worker, depending on their academic path; if they continue working with the CEC, they qualify for student debt relief via the Colorado Health Service Corp and Public Service Loan Forgiveness Act.

Nuremberg said that although it will take the course of multiple years, the additional licensed therapists and social workers could make a notable impact on the shortage of providers and supervisors. Meanwhile, providers are increasingly hiring peer support employees to supplement staffing shortages.

Colorado’s Department of Health Care Financing and Policy defines peer support as individuals who use their lived experience to provide patients with empathy and practical solutions. These individuals can also work in addiction recovery if they get a specific certificate, but otherwise, the only requirement is a high school diploma or GED.

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According to Nuremberg, there has been a recent influx of paraprofessionals because Colorado’s Medicaid program began reimbursing providers for the service, which could lessen the costs of staffing and the burden of recruiting highly educated individuals.

Nurnberg said that there is a lot of pessimism around fixing the mental health care shortage, nationwide and locally, but she said anyone can contribute to the effort by supporting the CEC and similar resources.

“Sometimes people who want to help don’t know that they can; we think of mental health being too big of a problem, but there are agencies, communities and people who are working on that problem in this community,” Nuremberg said. “Supporting those agencies and those people is a way to help solve some of the mental health crises that we have in our community.”

“Every person has some power to impact this change.”

Mental health shortages and solutions (2024)
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