Veterinary medicine seemed like a natural career path for Shea Jorgensen. Growing up in Grafton, Iowa, a town of 200 north of Mason City, with a father who was a farmer, she loved showing animals in 4-H.

But an opportunity to shadow internist and University of Iowa alumnus Mark Johnson at the clinic where her mother worked as a medical transcriptionist changed her career trajectory.

“He said, ‘You should at least consider human medicine. Shadow me for one day, and then I won’t bring it up ever again,’” Jorgensen remembers.

The day she shadowed Johnson, they visited a hospice patient whose extensive cancer treatment had previously left him unable to walk or talk. Because of Johnson’s guidance and care, the patient was able to regain the strength to write letters to family members in their remaining time.

“The patient was able to spend their last weeks in a meaningful way,” Jorgensen says. “He told me that Dr. Johnson changed his life. He was that beloved, small-town kind of doctor, and it was just really striking that one person can have that kind of impact on somebody.”

A calling to mental health

Jorgensen began medical training at the UI Carver College of Medicine in 2013. She was part of the second cohort of students in the Carver Rural Iowa Scholars Program (CRISP).

The program was created to help address the shortage of doctors practicing in rural Iowa by exposing four students from each incoming class to different elements of rural medicine through targeted mentorships, seminars, research experiences, and electives. Another benefit of the experience: CRISP students became a network of mutual support.

“To me, Iowa City was a really big city,” she says. “It still is the biggest place I’ve ever lived. Having that transition with other people from small towns really helped.”

Jorgensen volunteered with the Free Mental Health Clinic throughout medical school and residency training. Initially, she saw it as a way to practice patient interactions before her clinical rotations began. But as her interest in psychiatry grew, she witnessed how the shortage of rural physicians impacted access to mental health care in Iowa, and it began to feel like a calling.

“Most of our state is underserved in terms of psychiatrists,” she says. “Where I am now, there are three psychiatrists at the main hospital in Mason City, but the community mental health center where I practice had no psychiatrist before me. We just hired a child psychiatrist, but before she started, our nearest was in Decorah, 90 miles away.”

Physicians are more likely to practice near where they train, so it’s important to expose primary care physicians in training to the small communities where they are most needed.

“That was the impetus for the Public and Rural Psychiatry Track,” Jorgensen says. “Gov. Reynolds and our legislature wanted to do something to increase psychiatrists in the state. They funded two additional residency slots—so our psychiatry program went from seven categorical slots to nine—and those two extra slots are dedicated toward Rural Track residents.”

Jorgensen helped create the program during her year as chief resident, and she now serves as director. That work, coupled with her experience as medical director of Mason City’s Prairie Ridge Integrated Behavioral Healthcare, has demonstrated to her the importance of community-focused mental health care.

“A lot of the patients I see have gone years without treatment, in part because of stigma and in part because of access issues,” she says.

Community care

One way Jorgensen works to meet this need is through Prairie Ridge’s Assertive Community Treatment (ACT) team. She works alongside five providers on the ACT team to make home visits to patients with serious mental illness who need more individual support than outpatient care can provide. By integrating mental health services into the community setting, the team not only breaks down barriers to access, but also builds patients’ trust of mental health care in general.

“We know people are much more likely to talk to their family and friends about their mental health issues than they are to seek a professional,” she says. “I helped in a training for community members about some red flags and warning signs that tell you it’s time to seek professional help.”

The ACT team also prioritizes preserving patients’ dignity and privacy—a goal that can be difficult to achieve in a small town where everyone knows one another.

“We very intentionally avoid wearing any clothing that ‘outs’ us as being mental health care workers,” Jorgensen says. “We don’t dress up. We don’t have Prairie Ridge cars. We try to look like community members so that your neighbor is not like, ‘Oh, who is that coming to your house every other day?’”

The focus on patient dignity even influenced the physical space of the clinic during a building renovation five years ago.

“One of the major complaints from patients on the planning committee was that people sitting in the waiting room would see other community members, and they were really uncomfortable because the majority of our treatment is for mental health and substance use,” Jorgensen says. “When redesigning the building, they made little coves where you can go sit, and it’s more secluded. You get a device that looks like a restaurant beeper and alerts you when it’s your time to walk up. That gives you a little bit more opportunity for anonymity.”

Aside from in-home counseling services, the ACT team also helps community members address logistical barriers that can be difficult for those struggling with their mental health, such as grocery shopping, picking up Social Security checks, and managing medications.

“If someone keeps ending up in the hospital in a mental health crisis when their rent is due, it might be because they ran out of money for the month. Maybe they need help budgeting,” Jorgensen says. “Treating them is not always just about medication. It’s treating them with the services that they need.”

The clinic’s compassionate, community-based approach has proven effective. Before Jorgensen started working at Prairie Ridge, the clinic was reliant on virtual providers contracted through a telehealth company to provide care. As of April 2023, the clinic is staffed entirely by its own employees. Though telehealth remains an important tool in meeting rural patients’ mental health care needs, she says that, in some cases, a local provider can make a big difference.

“I think that people who are from the Midwest have an idea of how to talk to these patients,” she says. “One of our Florida telehealth providers said she learned over the years not to expect people to come in the fall, because they will be out in the field working.

“I think psychiatry has this stigma for patients about who you are going to see and how they are going to treat you. Multiple people have met me and said, ‘You’re a lot more normal than I thought.’”

Now working within a 30-minute drive from her hometown, Jorgensen feels grateful for the opportunity to serve patients in the community that raised her.

“In my job, I get to sit with college professors and physicians, and with people who are homeless,” she says. “It sounds corny, but I wish everybody could have the experience of sitting in my chair and hearing a day’s worth of patients. The most meaningful part is just getting to see what life is, and just being there with people through that.”