Nov. 22--If you want to get in to see Rick Gertesma, you'd better plan ahead.

It takes at least three months to get an appointment with the SMDC psychologist who works with adolescent and teen boys struggling with mental illness.

There just isn't enough of him to go around, Gertesma says.

"We've got more kids seeking services and not enough providers," he said. "My caseload alone is between 200 and 300 kids."

For children suffering from anxiety, depression, bipolar disorder or schizophrenia, having to wait for treatment can be disastrous. Sometimes treatment is put off indefinitely; the worst-case consequence is suicide.

"By the time parents get up the courage to call, their child has already been suffering and maybe for months," Gertesma said. "To finally make that call and find out it could be three months before they can get in to see somebody can be really disheartening and scary. ... It means problems are going untreated."

The problem is a national one, said Dr. Read Sulik, assistant commissioner of Chemical and Mental Health Services Administration for the Minnesota Department of Human Services. He said a 1990 study by the Council of Graduate Medical Education determined the U.S. would need 35,000 child and adolescent psychologists by 2000 to meet the number of kids in need. At the time there were 7,200. By 2000, the number hadn't changed.

Read said the picture is even more dire in Minnesota, which is ranked in the bottom third of the county for the number of child mental-health providers.

It's even worse in non-metro Minnesota.

"Once you get outside the metro region, there is a very significant shortage," he said.

That testament was backed up by several other mental-health providers and referral centers in the area -- the Human Development Center, St. Louis County, Duluth Psychological Clinic -- who all said one of the biggest problems facing a growing child mental-health field locally is the amount of time it takes to get help.

The problem is compounded when you consider the number of children seeking mental-health help today, a figure that local providers say is growing.

St. Louis County's referrals nearly doubled between 2004 and 2008 in the Duluth area, jumping from 62 to 115, said Holly Church, county social supervisor for children's mental health.

The Human Development Center saw a 29 percent increase from last year to this year in the number of new children served, said executive director and licensed psychologist Jim Gruba.

The number of St. Louis County children needing help for mental illness -- 2,629 -- was third-highest in the state behind Hennepin and Ramsey counties in 2008, according to the Minnesota Department of Human Services. The true number treated is even higher, because the department's report only included families that received county or state assistance for at least 25 percent of their mental-health costs.

"There are so many more stressors and demands on kids today," Gertesma said. "Technology has made the world seem a lot smaller and a lot faster, and it's sometimes more than kids can handle."

An even bigger contributor is that more families today are willing to seek out the help they need.

"There is just more willingness and acceptance that accessing mental health resources for children is OK -- and not just OK, but a good thing," Church said. "So, though it's getting worse in some ways, I also see it as getting better because there is more willingness to reach out for help."

Turning children away

But the plea for help often is met with months-long wait times. The crunch is worst with professionals who perform psychological evaluations on children or prescribe medication for treatment, both which require advanced degrees.

"Those are a lot harder to come by," said Dan D'Allaird, a clinical psychologist who works with children at the Duluth Psychological Clinic.

Psychological evaluations are performed when primary-care doctors aren't able to uncover a child's core mental illness. When needed psychological evaluations aren't done, D'Allaird said children can suffer from misdiagnosis or misdirected treatment. About a third to a half of his patients could benefit from the test.

"It's extremely frustrating for families when they don't know what's really going on with their child," he said

As they worsen, untreated problems sometimes generate suicidal or homicidal thoughts or behaviors. The only inpatient treatment center in the area that offers the intense therapy called for in those situations is SMDC Medical Center's Behavioral Health unit. But limited providers and space at the facility make it tough to meet the demand, said Colleen Baggs, a nurse manager of inpatient behavioral health at SMDC.

The SMDC center served 748 children in its inpatient unit last year but had to turn away 54 others. Its bedroom-sized partial hospitalization unit can serve only five children at a time and about eight in its living-room sized adolescent and teen unit. Both have waiting lists.

When kids fall through the gaps in the system, the ultimate consequence can be suicide or accidental drug overdose.

Since 2006, 15 children and adolescents have committed suicide in St. Louis County and six accidental drug overdoses, according to the St. Louis County Medical Examiner's Office. But less-severe consequences are still significant, Baggs said.

"They might start failing in school because they can't concentrate," she said. "They can start to isolate themselves and lose friends. There is a devastating ripple effect."

The most frustrating part, Baggs added, is that all of it can be prevented with the right treatment.

"Mental illness is treatable and suicide is preventable, but not enough kids are getting help," she said. "That should be unacceptable. As a parent and member of this community, I want better."

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Copyright (c) 2009, Duluth News Tribune, Minn.

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