Mental health care expanding in Creston amid state shortage

May 12--Recently, Greater Regional Medical Center in Creston gained employment of a psychiatrist. Mark Preston, MD, happens to be the only psychiatrist who is able to meet patients in person in the city of Creston.

Crossroads, a mental health center in Creston, also has services available for a variety of mental health issues. However, their psychiatrists can be seen via telehealth, or a TV screen.

Why is there only one in-person psychiatrist? There are a variety of reasons.

"There's a shortage of psychiatric providers nationwide, but there's a particular shortage in Iowa," said Pete Brantner, executive director at Crossroads.

Psychiatry

Preston recently joined the Greater Regional team with a specialty in adult psychiatry. His medical education began at Iowa State University in Ames, and he continued his education at Drake University in Des Moines and did his residency at University of Iowa in Iowa City.

He worked in private practice with his father in Des Moines, then began working for Unity Point before coming to southwest Iowa.

"I thought, well, maybe it's time for me to start to slow down and focus in on the part of my job that I like the most, and that's the relationship aspect of psychiatry," Preston said. "So, as you would guess, psychiatrists, a lot of the times, we spend a lot of time with each patient because we're trying to understand the patient's life and their stressors. So the doctor-patient relationship becomes important."

An issue for mental health care in Iowa, according to Preston, is the shortage of all forms of mental health care providers, which then leads to a deficiency in public education and awareness.

"Those providers we do have tend to be clustered around the population centers. Des Moines, Cedar Rapids, Iowa City especially," Preston said. "If I'm going to complain about the shortage of mental health providers in rural areas, maybe it's time to put my money where my mouth is, so to speak."

Historically, there has been a shortage of mental health care providers because people go into other medical fields. According to Preston, another reason is how Medicare may not reimburse for psychiatric services.

According to National Institute of Mental Health 2014 statistics, 4.2 percent of all adults had a serious mental illness. That adds up to nearly 10 million people 18-years-old or older. Half of those people were female and most were under the age of 49. Other statistics from 2014 show 18.1 percent of American adults had any kind of mental illness, and this number includes the serious mental illness numbers. That adds up to nearly 45 million adults.

In 2015, Iowa Gov. Terry Branstad closed two of Iowa's four mental health facilities in Mount Pleasant and Clarinda. After the closures, Branstad also made general statements on the possibility of closing the remaining two facilities in Cherokee and Independence.

"In Des Moines, I can tell you yeah, we see, as inpatient psychiatric beds have dwindled through the years, we see more and more severe cases, people with severe acute problems, that we didn't used to see when there were more beds around," Preston said. "And, that's because the payors, who are the state and the private insurance companies, don't like to spend money on inpatient psychiatric care."

Preston also has relation in the area. His parents have a small farm in the area, and his wife's family is from Afton, where her parents still live.

Crossroads

Meanwhile, Crossroads, located on Cottonwood Road in Creston, also has offices in Osceola and Winterset, and serves Corning, Greenfield, Lamoni and Lenox.

"I think one of the things you need to realize about psychiatric services today is very little counseling goes on by the psychiatric provider," Brantner said. "There's a little bit, but not much. They're mainly medication providers."

Crossroads provides four different providers to their patients. Two are psychiatrists and two are psychiatric nurse practitioners, which means they have been trained to prescribe psychotropic medications. Also, two providers are licensed to counsel children as well as adults.

A nurse will talk with a patient at Crossroads and take basic vitals. That nurse will then talk with the provider without the patient present. After the patient sees the provider, that patient will then talk with the nurse again if any questions were not answered.

"We want to make sure that people, when they come in, that we find out all the information that we need to find out so that they can be taken care of," Brantner said.

Crossroads also has substance abuse services available. According to Brantner, 60 percent of people who present with mental health issues have some kind of substance abuse issue, and a common characteristic is those people do not see the same provider for both issues. Brantner said health care personnel at Crossroads want to help prevent reciprocity when it comes to both substance abuse and mental illness. But, that can be difficult.

"We have decided to go with telehealth. A, because there hasn't been a lot of psychiatrists that want to come to southwest Iowa. B, psychiatric services are very expensive," Brantner said. "So, we have found that this is a more efficient way to deliver psychiatric services. ... If people maybe have a bad experience with one prescriber, or maybe they don't mesh with one, we have different options for them."

The nurses as Crossroads travel to other offices and locations, but it would be inefficient for a psychiatrist to travel because it would take away from that doctor providing care to patients.

"Not very many people are choosing to be psychiatrists because it's a specialty field. People who go to med school are choosing to get into other kinds of fields rather than the psychiatric field. So, there's a shortage of therapists in the state, too," Brantner said. "What's becoming more challenging for providing outpatient services, for example, is that we have a shortage of therapists and psychiatrists. To find them is not easy."

Crossroads facilities, which are available to see all kinds of patients, cater to 3 percent of their population coverage. That is approximately 1,600 people in a six- to eight-county area. There is no age limit for patient care, and people from across the socioeconomic spectrum visit the facility. The most common causes for care are depression and anxiety, as well as other chronic mental illnesses.

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