Nichole Konen Giraldo lives in Walla Walla, Washington, a town of about 30,000. This past summer, she lost her husband.
鈥淵ou鈥檙e struggling, you鈥檙e sad, you鈥檙e depressed, you鈥檙e suicidal,鈥� she said. 鈥淚 mean, you have all these things going through your brain and you just need someone to talk to.鈥�
Giraldo has been searching for a long-term grief counselor for five months. She鈥檚 called everyone she can think of. Most don鈥檛 even call her back.
鈥淵ou鈥檙e left to basically just sink or swim,鈥� Giraldo said. 鈥淚t鈥檚 a crisis in this community.鈥�
Across the country, there鈥檚 a 鈥� and it鈥檚 particularly pronounced in small towns.
According to the Department of Health and Human Services, of the U.S population lives in an area short on mental health providers. Of that group, over two-thirds are in rural or partially rural places.
The challenges can be even greater for immigrants, who may experience a range of , including language, stigma and cost. Or for people with low incomes.
is a therapist in St. Maries, Idaho, which has a population of around 2,500. She said it鈥檚 especially difficult to find providers who take Medicaid.
Her clinic is one of just three in the town, and one of the few in that area to take Medicaid. For providers, she said, Medicaid requires more work and offers less reimbursement than other types of insurance.
鈥淵ou鈥檙e doing more work for less pay,鈥� she said.
Robinson has some clients who drive nearly two hours to see her, simply because she takes Medicaid.
For some rural patients, telehealth services can help bridge the gap. But internet access isn鈥檛 always reliable in remote areas. And Robinson said some patients don鈥檛 want to seek therapy over a video call.
Denise Metzger is a social worker in Coeur d鈥橝lene, Idaho. She said even though her part of the state isn鈥檛 rural, it鈥檚 still underserved. Many therapists have waitlists, especially if they serve clients with specialized needs or certain insurers.
鈥淚f you have Medicaid or Medicare, then the amount of people that you can see are very limited. I give out the same names and same numbers to pretty much a lot of the people,鈥� she said. 鈥淚n terms of children鈥檚 therapies, that鈥檚 pretty limited as well.鈥�
That shortage puts a huge burden on patients, said Cassidy Brewin, who works in behavioral health for Walla Walla County.
鈥淭hey need care now,鈥� she said. 鈥淚n the same way that somebody could walk into an urgent care if they had a physical health need and get services that same day.鈥�
Waiting for months, in other words, is not realistic.
In rural areas, Brewin pointed out that the dearth of specialized providers and facilities can strain other services, as many of those seeking care will call 911 or go to the emergency room.
鈥淚f you look at the state of Washington, at least has a partial shortage in mental health providers,鈥� she said. 鈥淭his is not something unique to our county, but I think the rural areas are struggling more than our more urban counterparts.鈥�
In the state as a whole, there are around 15 licensed mental health providers for every 10,000 people. , the number of providers is a fraction of that: around five per 10,000 people.
Though the need is clear, the solutions are less so. focus on reducing paperwork and increasing reimbursement for providers.
Others focus on simply getting more people into the field.
And that鈥檚 no easy hurdle: While the median pay for jobs in physical health care, such as , is much higher than those in , according to the Bureau of Labor Statistics, many positions still need advanced degrees. And then there鈥檚 the .
鈥淭here鈥檚 always been tremendous need and it鈥檚 a challenging field,鈥� said Teresa Claycamp, who works at Washington鈥檚 . 鈥淭he pandemic really greatly exacerbated the workforce shortage.鈥�
Some programs work to support clinicians in rural and underserved communities by providing workforce training and a chance to connect with each other.
鈥淔or me, it feels like, sometimes, a lifeline,鈥� Metzger, the social worker in Coeur d鈥橝lene, said of . 鈥淚 have presented cases for feedback from other professionals. And that has been really helpful, even if it鈥檚 just to get some validation, like, 鈥榊ep, that one鈥檚 a really hard one.鈥欌��
To pull more providers into the field, Washington鈥檚 Health Care Authority also launched a in 2021.
It highlights behavioral health careers that don鈥檛 require graduate degrees, such as substance use disorder professionals and peer counselors. It aims to attract providers who otherwise might not have considered jobs in mental health. The state has introduced a , too.
鈥淭here鈥檚 lots of different pathways in,鈥� Claycamp said. 鈥淚t鈥檚 not just this cookie cutter way of getting to a career.鈥�
Another helps pay for master鈥檚 programs for aspiring counselors, therapists and social workers. After graduating, those students must spend three years working at select community agencies or tribal health centers. In Walla Walla County, for instance, there are that would qualify.
Ryan McKown believes that strengthening the student-to-therapist pipeline is a crucial piece of the solution. He鈥檚 the executive director at , a free walk-in counseling center in Walla Walla where master鈥檚 level students treat patients.
鈥淚t鈥檚 a real challenge to go from a master鈥檚 graduate to licensed social worker, providing counseling with a full schedule, making a living,鈥� McKown said.
When their clinicals are finished, McKown said many of his students want to stay in the area. But about half end up leaving, because they can鈥檛 find jobs. Or they can鈥檛 find therapists to supervise them as they work toward their licenses.
Others choose to do telehealth, because small town life has unique challenges.
鈥淵ou know your neighbors, you run into people that you know on the street, in the grocery store,鈥� McKown said. 鈥淎nd the lack of separation between working in the mental health field and one鈥檚 personal life can also be a barrier.鈥�
Editor鈥檚 note: If you or someone you know is struggling with mental health, support is available by calling or texting the national Suicide and Crisis Lifeline at 988.
This story comes from the Northwest News Network, a collaboration between public media organizations in Oregon and Washington.