NEWS

Psychiatrist shortage worsens court bottleneck

A shortage of psychiatrists in South Dakota is hampering efforts to address a bottleneck for court-ordered mental health evaluations in the state.

Mark Walker
mwalker@argusleader.com
James Marken leaves Walmart on Louise Avenue with his mom, Diane Marken, on Nov. 4. Marken served time in prison after threatening a police officer. Most of the time he was in prison he was waiting a mental health evaluation.

A shortage of psychiatrists in South Dakota is hampering efforts to address a bottleneck for court-ordered mental health evaluations in the state.

An Argus Leader Media investigation found mentally ill defendants were jailed for half a year or more as they waited for exams to determine whether they are competent to stand trial.

The state's mental health hospital says it is not responsible and does not have the resources to conduct all of the exams, and that's forced counties to seek out private psychiatrists to help manage a surge in criminal cases involving defendants with mental illnesses.

The problem is that few private practitioners in the state are qualified, and those who are charge more and often aren't interested in following clients into the courtroom.

“Oftentimes psychiatrists don’t want to do these evaluations because they know they will have to go to court,” Lincoln County Public Defender Cynthia Berreau said.

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Ken McFarland, former administrative officer for the Minnehaha County Commission, said the growing cost and demand led the county to partner with Avera Behavioral Health Center last year to speed up the process.

The county pays $250 an hour to have timely competency evaluations conducted at Avera Behavioral. This has speed up the process for some, but many still wait.

"I don’t know if it will be a temporary fix or not, but it was something we were forced to do because we had people sitting in jail," McFarland said.

Phyllis Arends is the executive director at NAMI in Sioux Falls

Paying private psychiatrists isn't the only challenge. Finding them is, too.

A Kaiser Family Foundation analysis this year found South Dakota has enough mental health professionals to meet only about 15 percent of the need for services in the state. There were an estimated 30 psychiatrists statewide in 2014, according to the U.S. Bureau of Labor Statistics.

The South Dakota Department of Labor and Regulations puts its estimate at just 20 psychiatrists statewide.

Based on BLS and Census data, South Dakota has fewer than one psychiatrist for every 30,000 people, one of the lowest ratios in the region.

“Unfortunately, it’s been demonstrated that people end up incarcerated or … taking their own life when services are inadequate,” said Phyllis Arends, executive director of the National Alliance on Mental Illness in Sioux Falls.

Argus Leader investigation: Locked in Limbo

It's not a new problem, Arends said, but solutions have been elusive. How do you encourage workers to go into a profession that requires advanced education that's also plagued by stigma and low pay?

Avera McKennan, which employs more psychiatrists than anyone in the state, has donated money to the University of South Dakota to help expand its psychiatry residency program, but the impact is still years off.

Tim Soundy, chair of USD’s psychiatry program, said many of its graduates stay in South Dakota or the Midwest, but other states are recruiting to fill shortages, too.

James Marken looks for a parking spot at Walmart on Louise Avenue with his mom, Diane Marken, and her dog, Pickles. Marken, who has schizophrenia, is looking to turn his life around after serving time in prison.

“Some years a lot stay. Some years a few stay,” Soundy said. “If you look nationwide, there is a shortage of psychiatrists so they get bombarded with offers. That’s one of the issues."

The South Dakota Department of Labor doesn't have any active program specifically recruiting mental health care professionals. The profession also is not address in Gov. Dennis Daugaard's workforce development iniatives.

Competency delays threaten defendants' legal rights

“This is the first time I have ever been made aware of the issue before,” said Dawn Dovre, the department's workforce planning and policy director.

Tia Kafka, a spokeswoman for the Department of Social Services, said South Dakota has made significant strides with mental health services. She cited a Helmsley Charitable Trust survey that showed 64 percent of South Dakotans said they received the mental health care they needed.

“We think overall, mental health needs are being met,” Kafka said. 

Psychiatrists per 100,000 people, 2014

Nebraska   3.2

South Dakota  3.5

Iowa  4.8

Minnesota  6.6

Wyoming  6.8

Montana  11.7

North Dakota  Data not available

Sources: Bureau of Labor Statistics, U.S. Census Bureau