Missouri's mental health ranking is among the worst in the country. Why and how can it be fixed?

She called 10 local therapists trying to get an appointment. Half of them told her they were not taking any new patients and that their waiting lists were full. The other half said they would put her name on a list but could not say when her turn might arrive. It could take several months — or longer.

Davis and her husband live in Clayton and own a real-estate business. They pay for private health insurance coverage, but Davis said she was shocked to discover how many social workers and licensed clinical therapists no longer accept insurance. She said was willing to pay out of pocket.

“No matter what I tried, by money or insurance, I couldn’t get her to be seen by someone,” Davis said.

Her family’s experience is common in Missouri.

The state ranks in the bottom 10 in an annual ranking by the nonprofit Mental Health America. The organization looks at residents’ access to mental health services and overall adult mental health in a state. The lower-ranked states are ones in which adults have a higher prevalence of mental illness and lower rates of access to care. Another recent study ranked Missouri 49th in among states with the best mental health care.

In many ways, the state’s behavioral health industry is struggling with the same basic problem that has affected others: There’s simply not enough providers to meet the demand. But, years of underfunding mental health, denying Medicaid expansion and failing to grow or recruit the behavioral health workforce has left the state near the bottom.

Local and state officials, along with agencies and advocacy groups, recognize the crisis and are trying to address the underlying issues.

If it’s been this difficult for Davis’ family, who have resources to pay out of pocket plus insurance coverage, to find help, she wondered how hard it is for those lacking the same resources?

It is significantly harder. Back in 2014, the federal government began providing extra funding to expand Medicaid to cover more people. Missouri was one of 13 states that continued to reject the program until voters approved it through a ballot measure in 2021. Even after voters approved it, however, Republican lawmakers sought ways to undo the expansion. In July 2021, the Missouri Supreme Court ruled unanimously that the ballot measure was constitutional and that the state must expand Medicaid coverage to about 275,000 people.

But even when more Missourians have coverage, there’s not enough staff or space currently to serve everyone who needs help.

Debra Walker, spokeswoman for Missouri’s Department of Mental Health, said the agency is focused on efforts to expand the behavioral health workforce in the state. Walker cited a community college program to develop the associate of applied science in behavioral health support, which has expanded to five campuses — Ozarks Technical College, Three Rivers Community College, St. Louis Community College, St. Charles Community College and North Central Missouri Community College. She added that several state-operated facilities and community providers are teaching centers and offer tuition reimbursement or loan repayment in exchange for periods of employment.

St. Louis County has been investing in programs to address the lack of access to mental health care. Family Solutions for Kids, funded by the St. Louis County Children’s Service Fund, offers in-home therapy for any families in St. Louis or Franklin counties facing challenges with children from ages 4 to 19. The therapists travel to families’ homes, so transportation and babysitting are not barriers to getting help. They serve about 180 families per year.

The program has always had a waiting list of families, according to Robert Giegling, vice president for programs at Presbyterian Children’s Homes and Services, one of the partners that operates the program. While they have the budget to operate with up to 10 therapists, they currently have four. They are actively trying to hire more, in addition to partnering with Lindenwood University to grow an internship program.

He said he hopes the state department of mental health sees private providers as effective partners to help deal with the problems facing the state.

“In Missouri, there has never been a high priority on social services and mental health,” Giegling said. These tended to be the first areas that got cut in the state budget.

That has started to change.

“It really is an all-hands-on-deck approach to meet the demand in the field,” Brent McGinty, CEO and president of Missouri Behavioral Health Council, said. Hospital systems are working with universities, providers are investing in their current staff and the state is investing in community-based mental health clinics, he said.

“(Mental health) has been underinvested in for a very long time, and we are paying the price for it,” he said. “But we’re starting to move in the right direction.”