Shortage of mental health workers in Eastern Oregon

From the East Oregonian, October 20, 2012

Sharyn Smith calls herself an extreme parent.

Pendleton Beauty

Pendleton Beauty

She quit her in-home childcare job in 2008 to raise her own son, Adam, then 4, whose behavior was so erratic she couldn’t even take him to the library. She and her husband Dan Smith had tried for a year and a half to understand his outbursts before taking Adam to psychiatrist David Conant-Norville.

“You could tell when he’d get this way, he gets a different look in his eye,”? Sharyn said. “It’s almost a feral type look.”?

Conant-Norville diagnosed Adam with bipolar, obsessive compulsive and attention deficit disorders, prescribed him medication and gave Sharyn and Dan tips for managing his conditions.

The family still has to cancel plans because of Adam’s moods, but they don’t face these trials alone. Since November, they’ve worked through their challenges with other parents of children with emotional, developmental and behavioral disorders with Special Needs Families Connect.

The support group’s 20 members offer each other peer counseling, advice and references to resources from insurance to therapists.

Smith said she speaks with someone from the group daily. Group members have monthly meetings, organize play dates for their children and babysit for each other.

“We’re kind of an extended family in a way,”?she said. “It definitely does decrease the amount of trips to the psychiatrist.”?

Conant-Norville said such support groups are one way for Pendleton to leverage its limited mental health resources. The city has three clinical psychologists, and Conant-Norville is its only psychiatrist.

But he said the community can remedy the dearth by capitalizing on the kind of tight-knit connections only small towns have, which can make it easier for people to make referrals to mental health services.

Special Needs Families Connect does this well because it’s overseen by a professional organization. Autism Society of Oregon gives classes on handling special needs children’s behavior, and trained Sharon and Winnie Brunett to lead the support group’s discussions.

Even with these resources, Pendleton is still strained by its lack of mental health professionals. Clinical psychologist Connie Umphred often puts patients on wait lists; the Smiths had to wait a month for their first appointment with Conant-Norville.

“We are full all the time,” Umphred said. “We do take new patients, but we’re very busy.”

Conant-Norville said rural areas commonly lack these resources. The shortage of psychologist and psychiatrists spans eastern Oregon; Terrel Templeman, Ph.D. and Umphred see clients from as far as La Grande and John Day at Psychological Services of Pendleton.

It’s hard to say how many of these professionals the community needs.

Conant-Norville was booked when the city had three other psychiatrists when he worked here full-time from 1987 to 1993. Even if the city had more psychiatrists, many people with mental disorders would go untreated because they don’t have health insurance, he said.

Templeman said two more psychologists would fill his and Stephen Condon, Ph.D.’s practices. Templeman will hire Heather Bacon, Ph.D. when she finishes her year-long residency at his practice and receives a clinical psychology license.

Umphred sends some clients to social workers or marriage and family counselors for therapy if they don’t absolutely need to see a clinical psychologist. This leaves her with the difficulty of deciding which patients need her professional attention.

Some patients’ needs require the expertise of a clinical psychologist, including personality disorders, gender identity issues, and underlying problems people develop from experiences such as being physically, sexually or emotionally abused as a child.

The training, continued education, and licensing clinical psychologists are required to have equip them to perform the diagnosis and assessment these issues demand. Umphred refers patients with less complex issues, such as an adolescent having a hard time adjusting to a new stepparent, to a social workers or marriage and family counselors.

Conant-Norville, who flies in from Portland twice a week and offers video appointments for patients at Mind Matters, P.C. Child & Family Psychiatry, relies on physicians to shoulder Pendleton’s psychiatric case load.

Karen Dunlap, physician assistant at Pendleton Family Medicine, said primary care doctors and physician assistants can make diagnoses and write prescriptions for psychiatric issues including depression, anxiety, bipolar and attention deficit disorders, and bereavement.

Dunlap said she refers patients to psychiatrists if she’s exhausted her treatment resources, but rarely does so because of the city’s lacking mental health resources.

“Some people will not get treatment, or they’ll choose not to get it instead of driving somewhere,” Umphred said. “Those people that do choose to find some type of treatment will further stress the limited resources we have.”

Umphred said psychologists and psychiatrists may not come to Pendleton because they want to work in a bigger city, where they may make more money and have a greater client base. Conant-Norville said he’s tried to recruit another psychiatrist to Pendleton since he started working here in 1987 to no avail.

“They don’t realize that this place has a lot to offer,” Umphred said. “Pendleton doesn’t market itself very well and I think we need to find a way to do that.”