Credit: Matthew Almon Roth via Openverse

From clinicians to psychiatrists, New Jersey is in need of more mental health professionals. Meanwhile,  the demand for services from people experiencing mental health issues remains high as residents continue to feel the emotional toll of the COVID-19 pandemic.

“For psychiatry and psychiatrists, the American Psychiatric Association, the New Jersey Psychiatric Association, the Association for Academic Psychiatry and the American Association of Chairs of Departments of Psychiatry, have all been advocating for the last five to 10 years … about the growing mental health crisis that we’re faced with today,” said Dr. Stephen M. Scheinthal, the chair for the Department of Psychiatry at Rowan University’s School of Osteopathic Medicine and the president of the New Jersey Association of Osteopathic Physicians and Surgeons.

Adding muscle to medical slots

Now legislators looking to add more mental health professionals statewide have allocated a combined $9.62 million in the new state budget to expand training programs to meet the demand.

Of that $9.62 million, $4 million will go to the Psychiatry Residency Expansion Program and will be available to existing accredited New Jersey psychiatric residency training programs that have maximized Medicare funding. The Department of Human Services will disburse the money to the selected training programs, who must apply for the funding and use it only to add  four-year residency training positions to existing psychiatry resident-training slots.

Residents must also learn to deliver services at standard reimbursement rates to people who are uninsured or underinsured and who receive assistance from the human services department.

The remaining $5.62 million will go toward the Mental Health Professional Capacity Expansion Initiatives as part of a grant to the Department of Human Services. Of that amount, $4 million will go toward adding 10 medical residency positions, $800,000 for four new adolescent and child psychiatry fellowship positions and $100,000 to promote new residency positions in the state, specifically reaching out to students who are underrepresented in medicine.

Data from the Kaiser Family Foundation shows that from Sept. 29 to Oct. 11, 2021, 28.6% of New Jersey adults reported symptoms of anxiety and/or depressive disorder, compared with 31.6% of adults in the United States. This same data says that among New Jersey adults who reported experiencing symptoms of anxiety and/or depressive disorder, 19.5% reported needing counseling or therapy but did not receive it in the past four weeks, compared with the U.S. average of 26.9%.

Doctors ‘aging’ out

The importance of addressing the need for mental health services was great even before the pandemic.

“There were some decisions that are complicated but were made almost two decades ago that cut the number of psychiatry residency slots in the country. And in doing so, we are now in the situation that we’re in, where you have more psychiatrists retiring than are graduating from residency programs,” Scheinthal added.

Dr. Angelica M. Diaz-Martinez, an associate teaching professor at Rutgers University in Piscataway and the director of clinical training at The Graduate School of Applied and Professional Psychology (GSAPP), also weighed in on the problem.

“There is a shortage of psychiatrists, especially those who work with children. However, adding residencies and psychiatric fellowships does not address the shortage in all areas of mental health, particularly masters and doctoral-level clinicians who are licensed to see individuals, groups and families,” said Diaz-Martinez. “The funding does need to support other mental health providers as well.”

This shortage of mental health providers puts a strain not only on people needing help for mental health treatment  but also on the providers themselves.

Dr. Diaz-Martinez said mental health professionals were also simultaneously experiencing the pandemic while juggling work, home schooling, caretaking of elderly parents and medical issues. “Therefore, it is not just the ‘extra’ caseload, but there is also the need for mental health providers to be able to find support as well to decrease the likelihood of burnout. With the increase in demand and low reimbursement rates —  to name just a few of the obstacles — it can be taxing for mental health providers everywhere, whether in individual practice or working at a hospital or community-based agency to be able to fulfill the need immediately.”

Diploma delays

One of the areas contributing to the shortage, according to Diaz-Martinez, is the delay at the state licensing board for recent graduates waiting for their their license to practice. Diaz-Martinez said it was unclear why the response has been slower than usual, but it is a key area that needs to be reviewed and addressed immediately.

“When you get down to it, the faster these graduates can get through the licensing paperwork and become licensed, the sooner they are serving the public and helping to fill the need for mental health providers in the state,” Diaz-Martinez commented.

The crisis in the lack of counselors is not unique to New Jersey, according to Scheinthal.

Nationally, fellowship programs are not filling up, and part of the problem is the loan debt that students have after leaving medical school. Scheinthal said the average medical student is coming out with debt of $350,000 to $400,000. “…That’s a mortgage,” he noted.

Drowning in debt

Scheinthal added that students are not looking to do extra training because they’re feeling that they’re drowning in debt. “And so that’s driving some of the decisions and I think one of the things the New Jersey Association of Osteopathic Physicians and Surgeons has been advocating for is loan repayment for residents who make a commitment to stay in New Jersey.”

Medical residents have left the state for more lucrative loan repayment options, according to Scheinthal.

In the Legislature, a bill introduced in February would create a loan redemption program for licensed mental health professionals who provide mental health counseling services within the state. The legislation, sponsored by Assemblyman William F. Moen, Jr. (D-Camden), was referred to the Assembly Higher Education Committee, but has not moved in months.

Dr. Salvatore Messina, an assistant professor of psychiatry at Rowan University School of Osteopathic Medicine, stayed at the school after recently graduating in part because he qualifies for Public Service Loan Forgiveness at Rowan.

“Of courses, after medical school, there is … just a lot of debt,” he said. “My wife is also a physician and so she had to take loans, and it’s reasonable that we both paid loans. And so that burden just sitting there … besides all the things you normally have to pay in life, like rent or your mortgage …  It’s just an extra very large payment amount each month.”