How Kalamazoo can address the shortage of psychiatrists — and make a name for itself in the process – MLive.com

KALAMAZOO, MI -- In 2006, Susan Brown lost a close friend to suicide. Another friend died the same way in 2011.

The two incidents left her reeling. Both men were highly accomplished, with plenty of resources at their disposal. If even people in that position could succumb to mental illness, what did that say about the status of mental-health care?

It was such a shock to all of us to have a contemporary die that way, said Brown, a longtime Kalamazoo resident and wife of Bob Brown, founder of the Treystar commercial real estate firm. How did this happen?

For the past decade, Brown -- who is now 80 -- has channeled her grief into action, rallying friends to raise money and researching how to improve access to mental-health services.

Her efforts led to the formation of the Kalamazoo Collaborative Care Program, which provides social workers and other mental-health expertise to help primary-care physicians treat patients with behavioral health issues.

Now Brown wants to take her efforts to the next level. The vision: Creating a Kalamazoo psychiatric clinic modeled after the University of Michigan Depression Center, a place that would combine high-quality care with cutting-edge research and education on mental health.

The tentative proposal calls for a clinic that would hire a dozen or more psychiatrists and include outpatient services for children, adolescents, adults and geriatric patients. Doctors would treat a wide variety of behavioral health disorders, including depression and anxiety, autism and autism spectrum issues, attention deficit disorder, bipolar and schizophrenia, psychosis, PTSD and Alzheimers and other memory issues.

Under this proposal, the clinic would be affiliated with the Western Michigan University School of Medicines psychiatric department. Brown is looking to raise about $25 million to finance a facility.

Such a project would achieve multiple objectives, say Brown and others. One would be the ability to recruit and retain psychiatrists based in Kalamazoo, addressing a critical shortage.

Treatment for mental-health disorders typically involve both medication and talk therapy. While a psychologist or other therapist can provide the latter, patients need a psychiatrist or other medical doctor to prescribe medications and oversee treatment regimes, especially for people with other medical issues.

A psychiatric clinic also would be a way to pull together the communitys fragmented mental-health system, improve coordination and create more consistency in regards to quality, said Dr. Rajiv Tandon, who recently retired as chairman of the WMU medical schools psychiatry department.

Absolutely, such a clinic would benefit the Kalamazoo community, especially people with private insurance, said Jeff Patton, CEO of Integrated Services of Kalamazoo, the countys community mental health agency.

His agency provides very comprehensive mental-health services for clients, but the vast majority are Medicaid patients, he said. By comparison, people with private insurance lack the same kind of comprehensive system.

Kalamazoo psychologist Larry Beer said having a comprehensive psychiatric clinic would be great.

My practice has really tried to recruit psychiatrists, even psychiatric nurse practitioners, but its been really, really hard to do that, Beer said. Services provided by such a clinic would go a long way toward filling a void.

The idea of creating a psychiatric clinic to get more psychiatrists to base here is a model used in other domains, and its been very successful, said Troy Zukowski, a clinical social worker in Kalamazoo. We dont want a situation where people are graduating from the WMU medical school and taking jobs in New York or Chicago. We want them to stay in Michigan and hopefully the Kalamazoo area, because theres definitely a shortage of psychiatrists here.

Patton added such a project would be an excellent way to leverage the assets of the WMU medical school, which was established in 2012 and is based in downtown Kalamazoo.

I think we need to promote our med school much more, and support their abilities to recruit and retain both students and (medical) residents, Patton said. Its quite a gem for a community the size of Kalamazoo to have a med school;. Its quite extraordinary to have that infusion of knowledge and science coming into our community. We need to talk that up.

Is WMU medical school on board?

While people in Kalamazoos mental-health community are enthused about the idea, institutions that would be key players -- the WMU medical school, Ascension Borgess Medical Center and Bronson Healthcare -- are much more cautious.

Borgess and Bronson did not respond to requests for comment for this story. As for the WMU medical school, Tandon -- who drafted the vision that Brown would like to bring to fruition -- recently retired and no long speaks for the college.

The WMU medical school has not yet hired Tandons permanent successor, and the new psychiatry chair undoubtedly will have their own vision of the departments direction, said Dr. Michael Redinger, the interim psychiatry chair of the WMU School of Medicine.

Were looking for somebody who can take a lot of the work that started with Rajiv and Susans conversations, look at the resources from U-M, the lessons we can take from them and build that out, Redinger said.

What form that takes, I cant really tell you right now, because the new chair is going to be the one who has the prerogative in terms of modifying and building that vision. he said.

All that said, the shortage of psychiatrists is a very real issue, Redinger said, and is a nationwide problem attributed to a number of factors.

One is a so-called retirement drain: A common scenario these days is that when a psychiatrist retires, theres no one to take over their caseload. And its a problem thats getting worse.

In Michigan, more than half of practicing psychiatrists are over the age of 55, one of the highest proportions among all physicians. Meanwhile, it can be hard to convince young doctors to specialize in psychiatry, especially when many have enormous medical school debt and psychiatry pays less than many other medical specialties.

The shortage of psychiatrists is definitely a bottleneck, no doubt about that, Redinger said. And the more the sub-specialty, the more acute the bottleneck, especially for people needing to see specialist in children and adolescents, or geriatric, or substance-use disorder. That doesnt mean we have an abundance of adult psychiatrists, but the waiting lists are just that much longer for the sub-specialties.

Addressing that shortage requires a multi-prong strategy, Redinger said. Already, the Kalamazoo Collaborative Care Program is arranging for consultants between psychiatrists and primary-care physicians, which is a way to extend the expertise of local psychiatrists.

One thing thats clear is that the mental health needs in the community are significant, they are not going away, and its going to take a multifaceted multifaceted approach to tackling all of that, Redinger said.

Institutional barriers

Tandon, the former psychiatry chair of the WMU medical school, agrees more than one approach is necessary. But hes also convinced that a standalone psychiatric clinic would be an immense boost for the public, the local mental-health system and the medical school.

For the public, such a clinic would provide much-needed high-quality specialized mental-health care. For the local mental-health system, the clinic would be a huge resource, particularly in providing access to research and professional training and support.

For WMU, it would be a way to hone the reputation of the medical school and help put Kalamazoos name on the map.

In terms of creating a nationally recognized program, psychiatry is an easy win because theres not many high-quality, go-to psychiatry places in the country, Tandon said.

Secondly, from a cost perspective, investing in psychiatry makes sense, he said. You dont make money in psychiatry, but you make money off it by significantly improving the quality of outcomes for people across the board -- surgical patients, cardiac patients, orthopedic patients.

Such a clinic also would provide WMU medical students with a better education, help with faculty recruitment, and expand the opportunities for research, as well as help recruit and retain psychiatrists to base in Kalamazoo, Tandon said.

Bu there are institutional challenges sin creating such a clinic, related to the particular setup of the WMU medical school.

Unlike most medical schools, WMU does not have its own hospital. Rather, its affiliated with Bronson and Borgess. Each hospital has three seats on the medical schools 11-member board, which means the hospitals together control the med school.

Thats a challenge in creating any new clinical programs because Bronson and Borgess are in competition, with legendary turf wars that extend back decades.

To complicate matters, of the two hospitals, Borgess is the one that operates an inpatient psychiatric unit. But Borgess is no longer locally operated; its now part of the Ascension healthcare system based in St. Louis. That means Borgess is now a very small fish is a very large pond.

And its unclear whether Ascension would back plans for a standalone Kalamazoo psychiatric clinic that would might require their investment -- or at least their approval -- especially if that clinic is perceived as creating competition to Borgess operations.

Its very frustrating, Brown said. We know the local people (at Borgess), who are fabulous and they get it, but they dont have control in making major decisions.

Its also unclear whether Bronson would want to expand its investment in psychiatry, and if or how that aligns with the hospitals future plans.

But Brown doesnt want to let the vision die.

I think Kalamazoo could do this, she said. WMU has a really good medical school. We need this. If people would just step up and get the word out, we could get this going.

This story is part of the Mental Wellness Project, a solutions-oriented journalism initiative covering mental health issues in southwest Michigan, created by the Southwest Michigan Journalism Collaborative. SWMJC is a group of 12 regional organizations dedicated to strengthening local journalism. For more info visit swmichjournalism.com.