Local agencies look to remedy shortage of child psychiatrists

Some suffer from severe psychotic disorders such as schizophrenia.

Others are emotionally disturbed or have neural development disorders such as autism.

Those are the children and teens who have to wait weeks — or sometimes months — to get the help they need.

Nevada has about one child and adolescent psychiatrist for every 21,833 children, putting it at the top of the list when it comes to states that lack professionals with this specialty.

That shortage is particularly pronounced in the Las Vegas Valley, which has about 10 board-certified child and adolescent psychiatrists. San Diego, a city comparable to Las Vegas in size, has more than 60 board-certified professionals in the same specialty, said Dr. Lisa Durette, clinical professor of psychiatry for the University of Nevada School of Medicine.

“We’ve got such a terrible shortage,” said Durette, who also is the medical director for Healthy Minds, a community mental health care provider.

The lack means that some children are treated, sometimes inadequately, by adult psychiatrists or family practitioners. Others go untreated and their conditions worsen, Durette said.

In an attempt to tackle the issue, community agencies have united to start a child and adolescent psychiatric fellowship training program in Las Vegas similar to one in Reno. The goal is to launch the program in July 2014, Durette said.

The challenge is finding the $2.3 million needed to fund the first four years.

The two-year program would take two fellows each year, with the first class graduating in 2016, said Dr. Greg Brown, psychiatry residency training director and interim chairman of the University of Nevada, Reno’s Department of Psychiatry.

“It’s relatively rapid to get someone through, and if you can keep the first eight to 10 (graduates) in the next few years, then it would be a very positive sign,” Brown said. “It would substantially increase the number of services available.”

The four key training sites for fellows would be the Clark County Department of Juvenile Justice Services, the county’s Department of Family Services, the state’s Division of Child and Family Services and University Medical Center. Those agencies, along with the University of Nevada School of Medicine, are behind the effort to establish the new training program.

Participants would also work at sites throughout the community, such as the Spring Mountain Crisis Center and the Clark County School District, Durette said.

About 40 to 50 board-certified child psychiatrists are needed to meet the needs of Clark County’s population, Brown said.

TRAINING, KEEPING CHILD PSYCHIATRISTS

Studies have shown that about 70 percent of training program fellows will stay to establish a practice in the area, said Dr. Yinka Harding, clinical professor of psychiatry for the University of Nevada School of Medicine.

“You can’t force (fellows) to make a commitment when they get into the program, but what we hope to do is encourage them and give them a network to make them want to stay in the area,” Harding said.

Officials attribute the higher number of board-certified child psychiatrists in San Diego to the city’s training program. They say a similar trend could emerge in Las Vegas if it had a program.

There already is a high interest from those wanting to train locally, Brown said. About one third to one half of those who complete the general psychiatry residency program in Las Vegas express interest in child psychiatry.

“When our general residents go to do a child psychiatry program somewhere else, they don’t come back,” Brown said. “We’ve lost a lot of good people.”

For the program to take off, a four-year commitment for two fellows per year is needed, Durette said. It would cost around $2.3 million for the first four years. However, she is still working to nail down a firm price tag.

“That’s our current barrier,” she said of the funding.

The expense would be shared among the training sites, and the University of Nevada School of Medicine would cover some administrative costs, said Thomas Schwenk, dean of the School of Medicine. The agencies involved have yet to finalize a plan to pay for the program.

“I’m completely supportive and very excited about the program, but it comes down to money, and we just have to make sure that we are careful with our expenses. We have lots of good ideas and not enough support for all of them.”

About 20 percent of the School of Medicine’s budget comes from the state, Schwenk said. The remaining 80 percent comes from various funding sources, such as clinical practice, research grants and hospital relationships.

“We just have to look and see what flexibility we have,” he said.

University Medical Center, which would be involved, is also hurting financially.

BENEFITING CHILDREN IN NEED

Family Services Director Lisa Ruiz-Lee said boosting the number of locally trained child and adolescent psychiatrists in Clark County would benefit children in foster care and in the community in general.

The department supports the effort, especially because it has seen the benefits of working with professionals trained in that specialty.

In October, the department began a partnership with the Healthy Minds pilot program, through which it redesigned therapeutic foster care for 30 children and youth in collaboration with Healthy Minds, a community-based mental health care provider.

At its six-month mark, the program showed a 40 percent reduction in medication dependency, a 90 percent reduction in hospitalizations and a 90 percent reduction in placement disruptions for patients, according to Ruiz-Lee. Officials have closed 15 percent of the cases.

Family Services has 402 children and teens with severe emotional disturbances or mental illness in therapeutic foster care placements.

Funding for the pilot program is about $616,000, and Medicaid pays about $175,000 of that. The rest comes from Family Services’ funds, Ruiz-Lee said.

“The pilot program is saving tax­payers tens of millions of dollars in Medicaid funding, which is being monitored by the reduction in medications and hospitalizations,” according to Ruiz-Lee.

This pilot program would be incorporated into the proposed child and adolescent psychiatry fellowship training program.

Brown said the next step is to complete the paperwork and send it to the School of Medicine to approve.

The proposal would then be sent for consideration to the Accrediting Council for Graduate Medical Education’s residency review committee for psychiatry.

Contact Yesenia Amaro at yamaro@reviewjournal.com or 702-383-0440.