A Bad State of Mind: Minnesota's fractured mental health system An 'ugly' process The long wait On the front lines Managing the illness The elderly's struggles Five people who make a difference Resources Audio On the front lines (story audio) Photos Dr. Reed Sulik Pediatrician Bill Rabe Respond to this story Talk about this story in the MPR News Forum Submit a commentary Help us cover this story

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On the front lines
by Lorna Benson, Minnesota Public Radio
February 9, 2004

Dr. Reed Sulik, left, knew his odds of recruiting more child psychiatrists to St. Cloud were slim. So he changed tactics (MPR Photo/Lorna Benson)

Minnesota's shortage of child psychiatrists is so severe that most mentally ill kids must wait months for a psychiatric appointment. While they're waiting some children get dangerously sick and are forced to go to the emergency room. Even then, they might not get the skilled help they need. State officials and health plans say they're aware of the problem and they agree the solution might require a radical change in the way Minnesota doctors care for their patients. In St. Cloud one child psychiatrist is trying to address the psychiatrist shortage by redefining his and his colleagues' jobs.

St. Paul, Minn. — Dr. Read Sulik is a rare specialist in Minnesota these days, but not in St. Cloud. In the four years he's worked there, Sulik has convinced three other child psychiatrists to join his practice. Still, even with a staff of specialists that rivals the biggest Twin Cities hospitals, they were flooded with patients. "Probably within three months, there was at least a three-month waiting list to see us. Within six months there was probably a six month waiting list to see us. And so immediately we recognized there's no way that we can meet the demand by this traditional way that we had of seeing patients," he says.

Sulik knew his odds of recruiting more child psychiatrists to St. Cloud were slim. So he changed tactics. Instead of looking for more mental health specialists, he looked for doctors who wanted to learn more about mental health. His first priority: pediatricians and family doctors.

	Pediatrician Bill Rabe

Sulik has spent a lot of time here working side-by-side with pediatricians at CentraCare Health Plaza. When clinic officials were building the new complex, Sulik lobbied hard to locate his office next to pediatrics. He prevailed and now works less than 30 feet away from the other doctors.

"The difference here is just huge," says pediatrician Cindy Melloy. "The fact that we can walk down the hall while the families are still in the room, get our questions answered, have a consult with a pediatric psychiatrist, walk back to the family and have an answer; there's no comparison."

Initially the pediatricians had a lot of mental health questions for Sulik, but he says they don't come to him as often anymore, and that's good. It means they're handling more patients on their own and referring only the sickest kids to Sulik and his colleagues. That's given him more time to see children in crisis.

Recently Sulik began working with the St. Cloud schools. When teachers suspect a student has a serious mental health problem they can bypass the long wait for a psychiatric appointment and go directly to Sulik. He has set aside two slots in his schedule each week for troubled students.

BROOKE'S STRUGGLE

That open slot made a huge difference to five-year-old Brooke when she started kindergarten. Immediately she began disrupting class. Her mother, April, was called into the school several times a day to try to get her daughter under control. Brooke had a history of developmental problems, but April couldn't believe her sudden strange behavior.

"She would squirm away from me and make all of these awful sounds. It's almost like she was possessed by somebody else," she says.

April doesn't want her last name used for this report. She says her daughter would scream for hours and couldn't explain what was wrong. Brooke's teachers tried to calm her down. But she was inconsolable. Brooke would hide under tables and rock back and forth, covering her ears and shouting gibberish. Her teachers were so concerned, they videotaped Brooke arguing with her counselor.

April says the situation was terrifying and she knew Brooke needed immediate help.

"People were telling me that you could end up waiting six, eight months out because they're so busy. It would have been too late. She would have missed everything in kindergarten," April says.

I just had somebody last week who came in and said, 'You know what? None of them on your list are taking patients.' And we just put it together in July. - Pediatrician Bill Rabe

But Brooke was in the right place at the right time. The school sent her videotape to Dr. Sulik and asked if Brooke could get one of his emergency appointments.

Sulik says it was clear right away that Brooke needed to go to the head of the line.

"When you look at this videotape, one of the most striking things that I saw is, this is a child who's clearly suffering," Sulik says.

Sulik saw Brooke right away. He says she had an extreme sensory disorder that made her shut down in her noisy classroom. She also had Attention Deficit and Hyperactivity Disorder. Sulik gave Brooke medication for both conditions and within a few weeks she was significantly better.

Today Brooke enjoys school.

WILL SULIK'S SYSTEM WORK ELSEWHERE?

Dr. Sulik thinks all child psychiatrists have to figure out better ways to see extremely sick kids fast. He believes what he's doing in St. Cloud can be replicated elsewhere, but his plan requires help from everyone who deals with children. Sulik says schools and state agencies need to do a better job identifying kids with the most significant problems. And he says other doctors have to learn to treat simple mental disorders that clog the system.

Sulik has held several seminars for doctors who want to learn about common conditions and treatments.

After one recent talk, Pediatrician Bill Rabe sought out Sulik.

Rabe says he's been overwhelmed by patients with mental health problems who can't find care elsewhere. He says parents are frustrated when they hear that he can't help them either.

"I suppose I'm kind of just a typical pediatrician. I'd like to be much better at these particular things, but it isn't really where I'm good. I'm very good at some other parts of medicine. This just isn't one of them," Rabe says.

DOCTORS 'FEEL HANDICAPPED'

Rabe is willing to learn more about mental disorders but without a child psychiatrist to back him up, he feels handicapped. This past year his clinic contacted dozens of psychiatrists to see if they would help with patients. Those who said yes were put on a list.

"And we tell the parents, 'look, you will need to call all of them and find somebody who's willing to take a patient.' And I just had somebody last week who came in and said, 'You know what? None of them on your list are taking patients.' And we just put it together in July," he says.

Rabe says he went to the St. Cloud conference hoping to persuade Dr. Sulik to see his patients. But then he realized that won't solve the problem.

"Our particular area is equally as large as St. Cloud and we should be able to service these patients. We should not have to hope that St. Cloud puts in a system so that we can send patients from Anoka County up to St. Cloud. That's not right."

Rabe has asked Mercy Hospital in nearby Coon Rapids to consider the St. Cloud model. But he says money is a concern because insurers don't pay hospitals enough to cover their mental health costs.

Psychiatrist Read Sulik admits he's in a unique situation in St. Cloud. His hospital convinced local donors to kick in $3 million for mental health care.

"I think they're probably one of the few hospital systems in the country trying to raise money for children's mental health services," Sulik says. All the big players are talking about ways to fix Minnesota's mental health crisis, from state officials to insurers to lawmakers. There are lots of ideas, but unfortunately, no quick fix. Still, Sulik says Minnesotans should not feel like it's an impossible task.

"The time is right. We've reached a point really of an epidemic and sometimes when you reach an epidemic of need that's when people are willing to be creative and willing to come together to look at more creative options," Sulik says.

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