Mental health workers face low pay, stressful hours

Apr. 3—The number of professionals in the field of psychiatry has declined over several decades, according to Anthony S. Ragusea, a board-certified clinical psychologist for Evangelical Community Hospital.

Ragusea said there are multiple reasons for the decline, ranging from low pay to stressful hours with stressful cases.

"Part of the problem is that med students don't want to go into psychiatry," said Ragusea. "It's never been a high-status specialty within medicine and it's been looked down on. You don't get a lot of special treatment as a psychiatrist. You work arduous hours working with difficult, complicated patients. It tends to be hard work and not enough money compared to other specialties."

According to, "Both psychologists and psychiatrists can provide psychotherapy. However, most psychiatrists treat patients primarily by prescribing medication, while psychologists mainly rely on providing talk and/or behavioral therapy. Some states now grant psychologists prescription privileges once they complete the required education and training."

This story is part of The Daily Item's yearlong look at mental health issues in the Valley which have been exacerbated by the pandemic, according to studies and local and national experts.

DiscouragingPsychiatrists are typically no longer trained in psychotherapy. Psychiatrists have been reduced to "primarily 15-minute med checkers" who prescribe and manage medications, said Ragusea.

"If they're smart, they know medication is limited in effectiveness and usefulness, but that's the only tool they're allowed to use because they're not really reimbursed for doing psychotherapy with patients," he said. "That's discouraging for many psychiatrists. As a result, the average age of the psychiatrist is getting older and older."

An increasing need for services and a decreasing number of providers created this issue. Efforts to improve the downfall seem to have not been successful, he said.

"The way we've been adapting to that is relying more and more on other professionals to fill that gap," said Ragusea. "That means primary care physicians. It can also mean physician assistants. It can mean psychiatric nurse practitioners who specialize in psychiatric treatment. That's the way we've tried to offset that load."

The problem, he said, is that if there are enough nurse practitioners, they don't have enough training, and levels of comfort in prescribing psychotropics can vastly differ.

Many physicians don't have the "breadth of knowledge" or greater background in psychology to understand that some problems are not best treated with medication, said Ragusea.

"When the only tool you have in your toolbox is a hammer, everything looks like a nail," said Ragusea. "Most people who are seeking mental health services go to their primary care physician first. Because of that, that sets them down a path to treating their issue medically. It biases the whole course of their treatment."

'Very frustrating'

Jacqueline Kieffer, 33, a U.S. Army veteran from New Berlin, was diagnosed with a personality disorder 15 years ago that went untreated for years. She has found medicine to be helpful, but the turnover of mental health professionals has presented extra challenges.

Keiffer found services quickly when she first sought help in 2014, but she said the longest she has seen the same psychiatrist is four months. Right now, she's waiting for another new psychiatrist.

"That is very frustrating. They have to know your whole story, at least a good glimpse of it," said Kieffer. "What works for you, what are your stressors, stuff like that. So, if I start having episodes, I can get it treated."

Not every doctor and patient will work seamlessly together, she said.

Sometimes, she said she feels she must "take what I can get" from professionals because she needs someone to prescribe her medication.

"I love a happy stable life with my medication," said Kieffer. "We're not separate, we're together. I need the doctor to be able to keep up with me."

Kieffer, who with her husband had her first child Kylie in April 2020, said she realized she has to keep her mental health issues in check as a mother. She said she didn't learn growing up how to cope with her emotions or deal with her mental health issues.

"I'm no longer alive for me, I'm alive for her," said Kieffer. "God gave me this little beauty and said 'here you go, this is your purpose.' At times, if I feel like I don't have a purpose at all, she does. I brought her into this world. I'm responsible for her."

Her daughter will have the "best possible future," she said.


When patients can't access care, it causes problems, said Ragusea.

"It puts a greater burden on our penal system," he said. "Severely mentally ill patients who cannot get care often wind up getting arrested. They're arrested for drug addiction and drug-related issues. They're arrested for violent crime or non-violent crime. They're arrested for homelessness. They wind up getting into trouble, they wind up getting arrested and they become the problem of our incarceration system, which does a terrible job at treating people."

While some mental health professionals in the prison system are great, Ragusea said that's not often the case.

"It's not a system designed for care," he said. "It's a system designed for punishment or humiliation, not for empowerment, which is what people who are mentally ill need."

Other consequences are not as obvious. Those without access to care may be more inclined to miss work and lose their job. They may be at greater risk for medical problems and more likely to be on disability and social services. They may be more at risk for more severe consequences such as suicide, he said.

'Short end of the stick'

Evangelical does not have an emergency psychologist on staff and uses a telepsych program for immediate needs. It can take a while to find placement for longer-term psychiatric help, he said.

"There are no psychiatrists locally, depending on how you define locally," said Ragusea. "There's a psychiatric nurse practitioner in Shamokin. To get a psychiatrist, you have to go to Geisinger, which has limited access, or Williamsport, Harrisburg or State College."

Reimbursement rates for psychiatric hospitals are lower than other medical specialties, therefore psychiatric hospitals see very few people without insurance. If you do have insurance, you might be there for a limited amount of time, Ragusea said.

"Mental health care gets the short end of the stick as far as reimbursement dollars. It's a tiny percentage of what insurance companies pay out," said Ragusea. "We don't value mental health care in this country, we don't put a priority on it. If you pay practitioners more, then you would get more people interested in this kind of work and you would also get better care."