Long wait times for access to mental health care persist in Ohio

CLEVELAND, Ohio (WOIO) -Mental health care is at a breaking point in Ohio, with patients and providers in a desperate situation.

Adding to the need of those with pre-existing conditions, there are now additional people with pandemic-triggered mental health issues, and a whole new wave of people finally seeking out mental health care now that stigmas are disappearing.

But there simply aren’t enough mental health care professionals out there to help everyone when they need it.

“I didn’t feel OK, but i just brushed it aside like it was nothing,” said 18-year-old Justice Gluck.

He is one of an alarming number of teenagers now recognizing that they’re facing a serious mental health crisis.

“You just keep going lower and lower until you’re going to be in danger,” he said.

“By third year of high school something was really wrong that I couldn’t fix,” said his mom, Amber Chapman.

Dr. Ellen Casper, a clinical psychologist, said the number of phone calls coming in to her practice demonstrate how much demand has escalated.

“Our referrals and need for appointment over the last two to three years have probably tripled,” she said.

Dr. Leo Pozuelo, Director of the Center for Adult Behavioral Health at the Cleveland Clinic, said they are grossly understaffed for the current need.

A 2019 internal examination showed they were already having trouble meeting the demand before the pandemic.

“Just to keep up with the current demand back then, we were short 45 outpatient providers,” he said.

Some new behavioral health patients at the clinic can’t get appointments until the end of the year.

At University Hospitals, they are able to get certain child and adolescent psychiatry appointments scheduled within one month.

But for general adult counseling, there’s a 4-6 month waitlist.

They’re expanding recruitment for providers to help bridge the gap.

At Bellfaire, they used to see about 150 referrals per month, and a wait time of about six weeks.

Currently, they’re experiencing a 33% increase in referrals and a wait time extended to 10-14 weeks.

Currently, the wait time for counseling is six to nine months at systems like Metro, and two to three months for psychiatric medication appointments.

Across the area, patients are running into these roadblocks.

Casper is afraid of what people are doing while they wait to get help for their mental health.

“They are having difficulty coping and they might resort to coping mechanisms that are very unhealthy, and certainly worrisome,” she said.

“There’s a tendency to self-medicate, so there’s potential for alcohol/substance abuse. And there’s really a cascade of events that can happen if we don’t address that mental health in a timely fashion,” Pozuelo said.

Faced with being waitlisted, some patients are getting desperate.

“If you talk to our ER docs, they’ll tell you that the uptick that’s come in now for young adults, teenagers with stress, it’s skyrocketing. So people are seeking the help, but sometimes the only urgent access they have is the emergency room. It is not the best setting to talk about mental health,” Pozuelo said.

This overwhelming demand has been taxing on an aging mental health care provider population.

Pozuelo said psychiatrists are the third oldest group of clinicians.

Many are choosing to retire, further adding to the current understaffing among mental health professionals.

“We’ve unfortunately had to close psychiatric beds, which are a valuable commodity, because we have a shortage of psychiatric nurses,” he said.

People like Gluck were forced to think outside the box and are now working to get well using innovation born out of the current log jam of mental health patients.

Getting on a months-long waitlist for a therapy appointment was not a safe option for Gluck.

“I just knew that we needed something asap, like now, yesterday, immediately,” said Chapman.

Gluck found SparkRx, an app that provides daily lessons, and explanations for how his depression was affecting him.

“It helped me regulate my emotions, maybe not to a high degree, but it helped enough that I could recognize when I’m doing something that’s overreacting,” Gluck said.

He found comfort, structure, and routine in the daily maintenance of his mental health.

It’s help on-demand.

“You can do it on your bed, while you’re chilling waiting for food to cook, anywhere you want,” Gluck said.

He calls it a gateway or a bridge to more help.

Pozuelo calls technology like new mental health apps and websites a game-changer for providing access, while they remain so understaffed.

“Many health systems, ours included, are looking at some of these, what are the products out there, what’s the quality of people they’re using? So that if we decide to put that in our portfolio of offerings for our patients, we know it’s good people, it makes sense, it has data, and that it keeps people well,” Pozuelo said.

The use of virtual visits, which were brought on as a temporary fix during the pandemic, is now being extended as a way to get to more patients seen when demand is so high.

Pozuelo said pre-pandemic 10-12% of mental health appointments at the Cleveland Clinic were virtual.

At the peak of the pandemic, 85% of appointments were virtual.

Now, it’s still at 80%.

Dr. Casper and her team of more than two dozen associates have extended their hours and have continued their virtual appointments beyond the pandemic, to address the exponential increase in demand.

“Doing it two-dimensionally is still very effective,” she said.

In this landscape, Casper said those seeking mental health appointments need to be more persistent and think outside the box, or outside their zip code.

“They might have to travel a half-hour away or an hour away to seek help in a smaller community,” she said.

Casper said she doesn’t see the need subsiding or the staffing levels boosted to the point of relieving the backlog any time soon.

“This is the barometer that we’re at right now and I think it will be this way for a while,” she said.

Recruitment is another key piece to a long-term solution.

Pozuelo said they’re seeing leading indicators in their residency program that the pipeline is filling up again.

“Before we’d get 400-500 applicants for eight positions, now we’re getting 700-800,” he said.

Leaders in the field are encouraged to see people freer to come forward seeking help, but recognize it’s created a log jam.

With the help of an app, and therapy, Gluck is in a good place, graduating from high school and working toward mental wellness.

“It’s up and down. It’s never a steady day. This littlest thing, which Spark helped me with, can spiral you down into something really bad,” he said.

But, it was that initial touchpoint, he said, that helped him turn the corner.

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