SIOUX FALLS, S.D. (KELO) — Access to mental health care in Sioux Falls is not as simple as looking up a therapist online and making an appointment.

New research from Augustana University shows that residents face a variety of barriers ranging from cost to waitlists and access to transportation when trying to receive mental health care. Beacom Research Fellows Brianna Pitz and José Cruz Medina worked in colloboration with local mental health providers and community members to determine the needs of the community.

“They were, you know, reaching out to providers, hanging fliers, they recruited not only providers in the mental health field, but community members, both those who speak primarily English and people who speak primarily Spanish, and they held different focus groups with all of those groups,” Associate Vice President of Enterprise Data Analytics Suzanne Smith said.

In South Dakota, the suicide rate is 21 deaths per 100,000 which is higher than the national rate that sits at 13.93 deaths per 100,000. In Minnehaha County, the rate is 17.6 deaths per 100,000. Sioux Falls has several resources for mental health including The Link Community Triage Center, Falls Community Health and 211 Helpline Center in addition to various non-profits focused on suicide prevention and mental health but research found that community members lack knowledge of the resources or the ability to access them.

A lack of providers as demand for services grows

Erik Muckey, executive director of Lost & Found, and Smith are in agreement: crisis management is important when it comes to mental health but both pointed out that to prevent getting to that crisis point, there needs to be more awareness and access to services.

“Real prevention, primary prevention is really focusing on how do you train folks to have conversation?” Muckey explained. “How do you make sure that they have the tools they need in the case that somebody does come and speak with them about what they’re facing? But also that you’re training people to almost build those resilience skills, those coping skills, those things that will carry with them for the rest of their life, so they know where to go, and also to the point of this report, giving folks education about how to actually seek help.”

The research found that people struggle with where to begin to research mental health resources, relying on search engines to navigate the process. If they’re able to find a service to address their needs, they’ll most likely have to face another obstacle: waiting lists.

One stakeholder interviewed by the researchers said that they heard from someone who had contacted five providers but was turned away due to demand. That wait can last months, which the providers note, is not helpful to the patient that is seeking help now.

“And so, for that someone to finally get to the point of pursuing (therapy) and be like, now I have to wait months, that’s really disheartening,” one community member said.

The wait for a psychiatrist can be even longer, the research notes.

Part of the reason demand is so high is that there is a shortage of counselors. That’s because the licensing process is long and complex, and research found that there is high turnover as counselors work to complete the necessary hours. That can impact mental health providers that cater to low-income patients with sliding scales causing the counselors to be overworked and unable to take on more clients.

One provider compared the process of becoming a counselor to previous experience as an attorney: “It was easier to become an attorney than it was to become a counselor.”

Muckey and Smith both noted that in addition to a shortage of counselors and psychiatrists generally, there is an even greater need for diversity within the profession.

“I think we have a very significant and known shortage of providers, especially psychiatrists, but to know that folks didn’t find themselves represented in the mental health profession and feel comfortable and confident that when they actually get through those steps of finding care that they’re going to find somebody that meets their needs. I think that was probably one of the most powerful messages that we saw,” Muckey said.

Basic needs act as hurdle for care for some

Another area highlighted by researchers was the overlap between mental health needs and basic needs.

“So, if people don’t have a car and they struggle with transportation, getting access to care, you know, that is a whole other hurdle to get to some of the emergency services in town, you can take a bus, but then you’ve got a mile and a half walk to actually get to the front door. And when you’re in crisis, that’s just not a feasible thing for you to overcome, right?” Smith said.

For those without access to reliable transportation, they need to rely on public transit to access care which can be difficult as a driver shortage has forced the Sioux Area Metro (SAM) to reduce departures and the number of routes across the city. Even at full capacity, SAM is not spread to every corner of Sioux Falls making it difficult for people to rely on it depending on where they live and what services they need to access. For one stakeholder interviewed, this is a point of frustration.

“I had a client who either was in severe mental distress or had an appointment at Avera Behavioral. The last bus stop is 1.2 miles from Avera Behavioral. So, you’re asking somebody who’s already in clear mental distress to ride a public transit bus, get off, and walk 1.2 miles over a busy highway to get to Avera Behavioral. That’s unbelievable to me,” the stakeholder said.

Community members quoted in the research stated that there are no direct bus routes to Falls Community Health as well.

Addressing the stigma

Campaigns like Lost & Found’s 30 Days, 30 Stories seek to reduce the stigma surrounding mental health and encourage people to talk more openly about their own struggles. Muckey explained that community campaigns like that can help show people how to seek resources as well.

“I think really, the gap now that we’re seeing then from this data is really pointing us back to where we are, we have people’s attention, people know that there’s a problem and that there’s something that can be done. How do we get folks trained as much as possible, educated as possible on here’s what the resources are, here’s what I’m experiencing, and here’s how I actually go seek care. And that ultimately, then will help us better understand when we think about the providers that are out there,” Muckey explained.

For some community members interviewed there may be a desire to discuss mental health, but cultural and generational differences can make it difficult. For older South Dakotans, there may be an attitude of “rugged individualism” that makes it difficult to seek help when they are struggling.

The research also found that stigma was also prevalent in the Hispanic community where there is an instinct to turn to family for help rather than community resources.

“From personal experience in the Hispanic community, like mental illness is, like taboo, you don’t really talk about it. And if you don’t talk about it, it’s like you either need to grow up or, like, there is not– no really good support system. And a lot of times, they don’t even believe in any of the psychology or Western medicine,” one community member said.

Where to go from here

With the research complete, Muckey said that the organizations that worked together on the project can use the findings on education campaigns.

“I think for us as an organization, given our unique focus on youth and young adults, and taking a very data driven approach, I think what it comes back to for us is when we think about tools that we provide, like our let’s talk about mental health guide, which is really a sort of soup to nuts way for folks to understand, here’s what mental health is, here’s what the impacts look like,” Muckey said.

There is also an opportunity for future collaboration among the already existing providers and resources to prevent the duplication of services that already exist.

“We have tools now to say, we have a language for what this looks like in Sioux Falls. But it also validates and gives language to say, here’s where the shortages are, here’s where we’re seeing gaps,” Muckey continued. “And how do we actually work together with partners of all types to make sure that they’re getting the appropriate attention and resources, especially funding to make these things work?”

The research recommends more community outreach to help navigate resources, recruitment, and training of mental health professionals, better pay and improvements to basic needs such as housing, food security and transportation.

“Those who live with a mental illness already face many barriers, and the challenges to seek out and obtain mental health care should not be one,” the study concludes.