Mental health workers face low paid and stressful schedules | News

The number of professionals in the field of psychiatry has been declining over several decades, according to Anthony S. Ragusea, clinical psychologist board-certified at Evangelical Community Hospital.

Ragusea said there were several reasons for the drop, ranging from low pay to stressful hours with stressful cases.

“Part of the problem is that medical students don’t want to go to psychiatry,” Ragusea said. “It was never a top specialty in medicine and it was looked down upon. You don’t get a lot of special treatment as a psychiatrist. You work arduous hours with difficult and complicated patients. It tends to be hard work and not enough money compared to other specialties.

According to, “Psychologists and psychiatrists can provide psychotherapy. However, most psychiatrists treat patients primarily by prescribing medications, while psychologists rely primarily on talking and/or behavioral therapy. Some states now grant psychologists prescribing privileges once they have completed the required education and training.

This story is part of The Daily Item’s year-long look at mental health issues in the Valley that have been exacerbated by the pandemic, according to local and national studies and experts.

Discourage Psychiatrists are generally no longer trained in psychotherapy. Psychiatrists have been reduced to “mostly 15-minute medical checkers” who prescribe and manage drugs, Ragusea said.

“If they’re smart, they know the effectiveness and usefulness of drugs is limited, but that’s the only tool they’re allowed to use because they’re not really reimbursed for doing psychotherapy with drugs. patients,” he said. “It’s discouraging for many psychiatrists. As a result, the average age of the psychiatrist is getting older and older.

A growing need for services and a decreasing number of providers have created this problem. Efforts to improve the fall appear to have failed, he said.

“The way we’ve adapted to this is increasingly relying on other professionals to fill that gap,” Ragusea said. “That means primary care doctors. It can also mean medical assistants. These may be psychiatric nurse practitioners who specialize in psychiatric treatment. This is how we tried to compensate for this load.

The problem, he said, is that while there are enough nurse practitioners, they don’t have enough training, and comfort levels in prescribing psychotropic drugs can vary widely.

Many doctors don’t have the “breadth of knowledge” or greater experience in psychology to understand that some problems aren’t best treated with medication, Ragusea said.

“When the only tool you have in your toolbox is a hammer, everything looks like a nail,” Ragusea said. “Most people who seek mental health services see their primary care physician first. Because of this, it puts them on the path to medical treatment for their problem. This skews the whole course of their treatment.

‘Very frustrating’

Jacqueline Kieffer, 33, a US Army veteran from New Berlin, was diagnosed 15 years ago with a personality disorder that went untreated for years. She found medicine helpful, but the turnover of mental health professionals presented additional challenges.

Keiffer found services quickly when she first sought help in 2014, but said the longest time she had seen the same psychiatrist was four months. Right now, she’s waiting for another new psychiatrist.

” It is very frustrating. They need to know your whole story, at least a good glimpse of it,” Kieffer said. “What works for you, what are your stressors, stuff like that. So if I start having episodes, I can get it treated.

Not all doctors and patients will work together seamlessly, she said.

Sometimes she says she feels she has to “take what I can get” from the professionals because she needs someone to prescribe her medication.

“I like a stable, happy life with my medication,” Kieffer said. “We are not apart, we are together. I need the doctor to follow me.

Kieffer, who with her husband had her first child Kylie in April 2020, said she realized she needed to control her mental health issues as a mother. She said she wasn’t taught growing up to manage her emotions or deal with her mental health issues.

“I’m not alive for me anymore, I’m alive for her,” Kieffer said. “God gave me this little beauty and said ‘there, that’s your goal.’ Sometimes, if I feel like I have no purpose at all, it’s her. I brought her into this world. I’m responsible for her.

Her daughter will have the “best possible future,” she said.


When patients can’t access care, it causes problems, Ragusea said.

“It adds to the burden on our penal system,” he said. “Severely mentally ill patients who cannot get treatment often end up being arrested. They are arrested for substance abuse and drug-related problems. They are arrested for violent crime or non-violent crime. They are arrested for homelessness. They end up getting in trouble, they end up getting arrested, and they become the problem of our incarceration system, which does a terrible job of treating people.

While some mental health professionals in the prison system are excellent, Ragusea said that’s often not the case.

“It’s not a system designed for care,” he said. “It’s a system designed for punishment or humiliation, not empowerment, which is what people with mental illness need.”

Other consequences are not so obvious. Those without access to care may be more likely to miss work and lose their jobs. They may be at greater risk of having medical problems and more likely to rely on social and disability services. They may be at higher risk for more serious consequences such as suicide, he said.

“Short End of the Stick”

Evangelical does not have an emergency psychologist on staff and uses a telepsychology program for immediate needs. It may take some time to find a placement for longer-term psychiatric help, he said.

“There are no psychiatrists locally, depending on how you define locally,” Ragusea said. “There is a psychiatric nurse practitioner at Shamokin. To get a psychiatrist, you must go to Geisinger, which has limited access, or Williamsport, Harrisburg, or State College.

Reimbursement rates for psychiatric hospitals are lower than for other medical specialties, so psychiatric hospitals receive very few people without insurance. If you have insurance, you could be there for a limited time, Ragusea said.

“Mental health care has the final say on reimbursements. It’s a tiny percentage of what insurance companies pay,” Ragusea said. “We don’t value mental health care in this country, we don’t prioritize it. If you pay practitioners more, you will interest more people in this type of work and you will also get better care.

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