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Mental health provider shortage felt across state

St. Joseph News-Press - 11/12/2022

Nov. 12—Jordan Jackson was 13 years old when she was diagnosed with anxiety and depression. She was being bullied and having suicidal thoughts in middle school. Her parents sought out help, but it never lasted long.

"By the time that I turned 18, I had already gone through four different therapists," Jackson said. "I would get started with someone, and then I would get about like a year, at most, in with them, and then they would leave. And so then I would have to start all over."

Jackson was prescribed anti-anxiety medication, but she had to drive 40 minutes from her hometown of Odessa, Missouri, to see a psychiatrist. On top of that, appointments were difficult to schedule.

"If I needed to change my dosage at all, I would have to wait for six months," Jackson said. "That was also hard, just trying to find a medication balance, and so I actually, for several periods of time, ended up not taking any because it wasn't doing anything for me."

Natasha Johnson had a hysterectomy in 2020 and fell into depression. She knew she needed help and tried calling organizations covered by her insurance but never heard back.

As if perfect timing, a mental health support group was started at Johnson's church. She said if not for that group, she wouldn't have pursued any help.

"I probably would have just stayed the way I was, honestly," Johnson said. "I probably would have just tried to convince myself that I didn't have anything wrong like I had been my whole adult life."

These are just two stories of residents who have struggled to find adequate mental health care. According to the Rural Health Information Hub, 112 out of Missouri's 114 counties are designated as mental health professional shortage areas. The only two that aren't are in the St. Louis region and are designated as partial shortage areas.

Show me the numbers

According to data from the Missouri Department of Mental Health, 1,966 people received treatment for mental illness at a certified state provider in Buchanan County in the fiscal year 2021. The Family Guidance Center is a certified agency through the Missouri Department of Mental Health Division of Behavioral Health. Co-CEO Kristina Hannon said a shortage of professionals is causing long wait lists at local agencies.

"When we have this significant shortage of behavioral health workforce, people come in and walk in and say, 'I need help,' and we sometimes have to say, 'We agree you need help, but we don't have anybody to help you,'" Hannon said. "As a social worker, that's a very frustrating thing to say."

According to the Kaiser Family Foundation, Missouri needs 159 more practitioners to remove the designation of being a mental health professional shortage area. Currently, the number of available professionals only meets 12.2% of the statewide need.

Dr. Jeanette Simmons, deputy director for the Division of Behavioral Health with the Missouri Department of Mental Health, said the shortage in the state is fairly significant.

"It is impacting our ability to provide services to those who need it most," Simmons said. "So, there's a large shortage of clinicians, whether that's psychologists, psychiatrists, social workers, definitely nursing."

Hannon said at the Family Guidance Center, wait times depend on each individual's situation. She said if someone has a substance use condition or is under the age of 18, there is currently no waitlist. If someone has a serious mental illness, he or she might be rerouted to a psychiatric provider because case managers and therapists might be unavailable.

Hannon said she's seeing more psychiatrists aging out of the field than people going into it. She's been trying to hire a psychiatrist at Family Guidance for two years with no success. She needs a psychiatrist to be able to hire more nurse practitioners.

"I have been approached by nurse practitioners whom I have not even recruited, who want to come work here, but I can't hire them because I don't have a psychiatrist who will collaborate with them," Hannon said. "Every time I have to turn away a nurse practitioner, that's 250 people, ballpark, that we can't provide care to."

The American Association of Nurse Practitioners lists Missouri as a restricted practice state. Laws limit the ability of nurse practitioners to engage in different elements such as diagnosing patients or prescribing medications unless supervised by and having a collaborative agreement with a licensed physician.

Hannon said if Missouri had full independent practice authority for nurse practitioners, like in states such as Kansas, Nebraska and Iowa, the Family Guidance Center could hire nurse practitioners to practice independently and serve anywhere from 750 to 900 more people.

Rural impact

The shortage of mental health professionals isn't just a statewide issue but also a national one. Missouri and other nearby states, including Kansas, fall in the middle of the numbers compared to the rest of the country. The region has an average of 32.3 psychologists per 100,000 people, according to a study done by Good Therapy.

That same study states, "Shortages are more likely to occur in rural areas due to lack of funding and infrastructure."

Hannon said it's difficult to recruit help to Northwest Missouri when metro areas like Kansas City are so close.

"While our salaries are equivalent to Kansas City, they can live and work in Kansas City without a commute," Hannon said. "... That's one of the other barriers is finding people who want to live here."

There is still a significant stigma surrounding mental health in rural areas, which means professionals have to get more creative with their approach. Hannon said the majority of work done at the Family Guidance Center is in the community, and they do outreach programs to meet people where they are. It's a more casual approach, with no name badges and using common language, substituting words like "mental health" for "stress."

Simmons said the issue is twofold: a lack of resources and a stigma surrounding the subject of mental health both hinder people from getting the care they need.

"They either don't know about the resources that do exist and when they do know about them, then there's a wait time to get in and access those services, which then may turn people away from accessing it," Simmons said.

While it is difficult to recruit, Hannon said there are many perks to working in more rural areas, including the sense of teamwork behavioral health organizations share in the area. She comes from a farming family herself and said working with rural patients and being able to provide help is rewarding.

"I think we're much more connected with each other, and that we have a more vested interest in making sure that there's a community solution to the behavioral health workforce," Hannon said. "I don't perceive that it's ever just about what's good for my center as much as it's what's good for the community."

What's being done

In response to the shortage, Hannon said Family Guidance is being more intentional with who they hire and making sure everyone is working to the highest of their licensed ability.

"We know that if we can't figure out some solutions to make sure that we have quick access to care, we know Missourians will continue to have more poor outcomes in terms of their behavioral health," Hannon said.

The agency has partnered with North Central Missouri College and the Department of Mental Health to create an associate degree program that allows the behavioral health organization to hire people with a two-year degree instead of waiting for a four-year degree.

Simmons said other agencies across the state are doing this, as well. There also are different programs across the state that offer tuition or loan reimbursement for those who go into the behavioral health field. She said rates have not always been comparable to other medical positions, so people tend to look at other health care jobs.

"Just trying to make that more accessible and more widely known about the opportunities that are available to someone in the mental health profession," Simmons said. "It doesn't have to be counseling. You can work in a state facility or a community facility, there's a lot more variety that I think people don't really understand."

After struggling to find help growing up, Jackson is now a psychology major at Northwest Missouri State University. She said she thinks her experience will help her relate to future clients and really be able to help them.

"I do want to pick somewhere and be able to stay there and be that person, even if it means sacrificing a bigger salary," Jackson said.


For anyone struggling with mental health, there are still resources available in northwest Missouri. Certified state providers include:

Family Guidance Center

Denovo Recovery LLC

Private Probation Services

St. Joseph Safety and Health Council

Maryville Treatment Center

New Beginnings Counseling Group

Chillicothe Correctional Center

Community Health Centers of Southern Iowa

North Central Missouri Health Center

The Family Guidance Center has four locations in Northwest Missouri: two in St. Joseph, one in Maryville and one in Cameron. The agency also is opening a behavioral health urgent care in St. Joseph in 2023. Hannon said the main premise of this is to make sure people in the area can get help.

"When people need mental health care, they need it right now," she said.

The Family Guidance Center can be contacted at 816-364-1501 and its 24-hour crisis line is 1-888-279-8188.

Aside from visiting an in-person center, there are many telehealth resources available. The new 988 Suicide and Crisis Lifeline is available for anyone needing immediate help.

For those in rural areas, there are many online resources available, as well, including Ag State of Mind. Farmer Jason Medows lives in the Rolla, Missouri, area, and has created a podcast addressing mental health struggles in the farming community. He owns a cow-calf operation and also works full-time as a pharmacist. He has struggled with anxiety and had difficulty finding proper assistance. He said he wanted to combine his knowledge of farming and health care to help others who might be in the same position and let them know they're not alone.

"I think that's a big morale booster for folks, just knowing that they're not alone in these fights and knowing that somebody else feels their pain," Medows said.

To find more resources, visit the Missouri Department of Mental Health website at

Morgan Doyle can be reached at


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