The retirement of two psychiatrists from Essentia Health brings attention to an already heavy demand for mental health care in the Twin Ports.
"If you call around, you cannot find a psychiatrist in Duluth who is taking patients," said Victoria Hansberry, an East Hillside resident who says she was set adrift when her psychiatrist retired earlier this month. "Everybody is overbooked and overworked that's here because there's not enough psychiatrists."
The squeeze is not secret to those who work in the field.
"It's been an issue for many, many years up here, and now it's bigger," said Julie Wilson, director of community-based services for the Human Development Center.
But an Essentia Health official said the health system is well-positioned to respond to the need, even adding to its strength in psychiatric care.
Drs. Michael Messer and Jayme Bork both retired from Essentia on July 3, leaving the health system with 13 psychiatric prescribers - six physicians and seven nurse practitioners - in Duluth, said Diane Holliday-Welsh, operations administrator for behavioral health and emergency medicine.
Hansberry, 61, who was diagnosed with what she describes as major depression in 2001, had been seeing Messer for 11½ years, she said. She came in for a May 14 appointment only to be told by Messer that he'd be retiring on July 2.
"Then he walks me over to the appointment desk and he leaves," Hansberry recounted. "I get to the appointment desk. ... She looks up at me and says, 'We have no psychiatrists. We have no appointments. You'll have to call us at the end of August.' "
Holliday-Welsh said Essentia doesn't do that.
"My understanding is we have appointments available today if a patient needs to be seen," she said. "We have an obligation to serve our patients, and so there should never be a patient calling and saying, 'I really need to be seen,' and we say, 'No.' We have to always say 'Yes.' "
Hansberry charged that Essentia should have known the retirements of long-serving psychiatrists would be coming, and the health system should have been prepared with replacements.
But Holliday-Welsh said Essentia is always in recruiting mode, particularly for psychiatrists, who are the most in-demand among medical professionals.
In fact, Essentia recruited a psychiatrist one year ago who will begin working for the health system in Duluth on Aug. 6, she said. Moreover, for the past year Essentia has been recruiting locums - health professionals who work temporarily in a community - to help fill the gap. The result: Nine locum psychiatrists will be with the health system in Duluth temporarily, working for various periods of time, some full time and some part time. All will be in place within two months.
"We're over-filling those retirements," Holliday-Welsh said. "We are going to be staffed above what we have been historically, because we know that the demand for care is so high."
But at present, other providers say they're experiencing a squeeze.
Wilson said HDC can't take all of the clients it gets who need psychiatric care so it refers some to other providers - with diminishing results.
"At least before (the Essentia psychiatrists left), we had a better chance of getting people in outside of HDC," she said. "But now that's going to be slim to nothing."
Nonetheless, Jim Getchell, the agency's executive director, said HDC is sufficiently staffed for its outpatient psychiatry service with three psychiatrists and four nurse practitioners. But he's aware that could change.
"Our three docs are in their 50s, and I think not their early 50s," he said. "Will HDC be able to replace them? It will be a very interesting thing to see, three, four, five, six, seven years from now."
St. Luke's hospital has five psychiatrists and two nurse practitioners in psychiatry, said Sandra Barkley, vice president of clinics. The hospital hasn't had any recent departures and isn't expecting any. It's stable, if not enough to meet the demand.
"I don't know that anybody has what they consider adequate staffing for mental health," Barkley said. "That's a problem nationwide, not just here in Duluth."
Kathie Norkol, a nurse practitioner with a certificate of psychiatry at the Birch Tree Center, said it's difficult to connect the people with psychiatrists in the community. "Primary care psychiatry is really hard to get into - sometimes a three-, six-month wait, and there's only a few places that are taking new patients," Norkol said.
Birch Tree Center provides short-term residential care for people in mental health crises. Often, 10 of its 12 beds are full, Norkol said, and the vast majority of guests need medication adjustment. She's able to "bridge" the medication gap until they can see a psychiatrist.
Norkol said heavy demand at Birch Tree Center may have been generated, in part, through increased publicity and that it's too soon to really tell what impact the Essentia departures might have.
Hansberry has tried to get psychiatric appointments at both St. Luke's and HDC without success, she said. In the meantime, she's seeing a therapist.
"That does help," Hansberry said. "But psychiatrists go to school a whole lot longer than a therapist."
Essentia recruits aggressively for psychiatrists, Holliday-Welsh said. It offers a "significant" signing bonus and pays relocation expenses. Because it's in an underserved area, there are also national loan-forgiveness programs a recruit could take advantage of.
But Hansberry said she doesn't think Essentia has done enough, and she believes that's leaving many patients in difficult positions.
"I am frazzled, and I am angry," she said. "And I'm angry not for myself, I am angry for all the patients who aren't getting care. ... This should not have happened."
To get help
The mobile crisis response team at Birch Tree Center answers the crisis line 24/7. For help, call (218) 623-1800.