MARY LOUISE KELLY, HOST:
In rural areas all across the country, there's a drastic shortage of mental health care. A trip to the psychiatrist may mean driving for hours. Alisa Roth of Minnesota Public Radio brings us the story of one northern Minnesota town and what happened when it lost its only psychiatrist.
ALISA ROTH, BYLINE: International Falls is on the Canadian border. Only about 6,000 people live here. There's a tiny airport, a paper mill, a couple of supermarkets and hardware stores. There's a small hospital and a family clinic. When Dr. Jeff Hardwig retired this fall, he wasn't just the only psychiatrist in town; he was the only psychiatrist for more than a hundred miles around.
JEFF HARDWIG: I had to take care of people of all ages, all the way through to the nursing home. You can't really specialize if you're in a small town. You take all comers.
ROTH: He treated patients with anxiety and depression, bipolar disorder and schizophrenia and anything else that came up - and there were a lot of them. His nurse, Wendy Dougherty, says he was certainly in demand.
WENDY DOUGHERTY: Oh, my God. He never, ever - I don't know in the five years that I ever worked with him - ever had an empty slot. And one thing about his patients - if they called and canceled, that empty slot was filled by somebody that had been waiting for two months to get in.
ROTH: More than 90% of psychiatrists limit their work to urban areas, even though more than 20% of the population lives outside of cities. We're sitting in the clinic where Hardwig used to work. It's the kind of place you go for all the basics - your kid's checkup, high blood pressure checks and regular psychiatric care. Daniel Carr says Hardwig was his psychiatrist for 25 years, and he counted on Hardwig's expertise to treat his schizophrenia.
DANIEL CARR: I had some trouble with my medicine changing a little one way or the other, but he usually knew what was best. I'd tell him what I was experiencing, and he knew what to do.
ROTH: These days, Carr gets his medications from his regular doctor, though he worries about what will happen if he ever needs more specialized care. Wendy Dougherty, the nurse, says Dr. Hardwig always took the toughest cases.
DOUGHERTY: Jeff took care of the hard ones, the schizophrenics and the bipolars and the - you know, he took care of so many of those. And these docs kind of put up their hands and say - oh, my God - I don't know what meds to give them.
ROTH: Right now, there's a psychiatric nurse practitioner who still handles some of the clinic's more difficult cases. But she's hoping to retire soon, too. Even so, International Falls is better off than a lot of places. There's a community mental health center in town and a mobile crisis team that responds to some emergencies. In more serious situations, though, the patient will end up here - in the hospital emergency department.
Cherrie Belanger is the hospital's nursing director. She shows me a small room next to the nurse's station that gets retrofitted for a patient experiencing a psychotic episode.
CHERRIE BELANGER: We can remove all of the chords and everything from the room. There's no curtains or anything hanging that they can harm themselves with.
ROTH: But there are no inpatient psychiatric beds here or for miles around. So if a patient needs to be admitted, Belanger and her colleagues call every inpatient facility in the state - and beyond.
BELANGER: And we try to find a bed. It takes hours upon hours of nursing care to locate a facility that has an opening.
ROTH: Sometimes it takes days or even weeks to find one.
People who study the shortage of mental health care in rural areas say we need to start training people specifically to work in places like International Falls. It was two years ago that Hardwig told the clinic he was planning to retire. It's been looking for a replacement since then. Nobody has applied for the job.
For NPR News, I'm Alisa Roth in International Falls, Minn. Transcript provided by NPR, Copyright NPR.