Desire Christensen’s small office at the University of Iowa is filled with toys.
"Some of my favorite ones are my dinosaurs," said Christensen. "I was always a huge dinosaur nerd as a kid so I love these."
Christensen is a rarity in the state. She has one of just six residents slots at the University of Iowa’s child and adolescent psychiatry program -- the only one in the state.
She said she regularly uses toys, like a set of dinosaurs, to help kids understand the complexities of the brain.
"I use this prickly Stegosaurus as the protector, anxious part of the brain. And so I help kids visualize and I’m like, 'you know, you get really kind of prickly and sensitive and you're afraid of the world, and you kind of want to go into your shell,'" Christensen said.
Iowa could use more such residents. The National Alliance for Mental Illness says one in five kids has a serious mental health condition. But Iowa has just 55 child psychiatrists -- and they work in just 14 of the state’s 99 counties.
Christensen is also unique because when she finishes her residency in about two years, she’s staying in Iowa.
"What we're hearing about is how much we need child psychiatrists in rural Iowa," she said. "My plan is to go do that."
"We call them unicorns because everyone knows what they look like, but it’s really hard to find one." -Anne Starr, CEO, Orchard Place
Program director Peter Daniolos says he’d love for more residents to stay in Iowa like Christensen. But he says it can be hard to get people to come to the state and do the extra training.
"Often it's just convincing that person one more year of not making a salary of a physician, and being in a training level, even when you have a lot of, you know, debt is worth it," said Daniolos. "So for those who carry a big debt burden, that can be painful."
It also doesn’t help that psychiatry is one of the lowest paid specialties in medicine -- and that’s even worse in Iowa.
"We have one of the lowest reimbursement rates in the nation for medical services. Those are set by Medicare, and the Medicare rates tend to influence all other reimbursement forms," said Peggy Huppert, the director of the National Alliance on Mental Illness Iowa.
Huppert says another factor is the Affordable Care Act. It actually hurt the field when it incentivized med students to study family medicine.
That means fewer psychiatry residents in a state that desperately needs them.
Anne Starr, the CEO of Orchard Place, a non-profit in Des Moines that provides child mental health services, said she has a name for child psychiatrists.
"We call them unicorns because everyone knows what they look like, but it’s really hard to find one," said Starr.
Starr says their expertise is vital to get the hundreds of kids it treats annually on the correct medication.
"Medications are very powerful and can change a child's metabolism," she said. "So it isn't just impacting their brain and the chemicals in their brain, but it changes the chemicals throughout their body."
That’s why Starr calls it “nothing short of a miracle” when they found their current chief of medicine just six months after the previous one left.
"We were really pretty concerned that it would take months to possibly even a year or more to fill the position just because of the lack of psychiatrists," she said.
Stephen Mandler, Orchard Place's current chief of medicine, said he moved to Iowa specifically because it ranks low for children’s mental health care, but he said he constantly gets offers from around the country.
"I receive hundreds of emails a week, offering more to go work in different places," Mandler said.
Recently, the state has started to take some action to address the shortage.
Earlier this year, Gov. Kim Reynolds called for funding for more psychiatric residency positions at the University of Iowa.
This shortage means parents like Carrie Clogg in Des Moines are still traveling as far as Chicago to get care. Clogg’s 11-year-old son, Sam, has bipolar disorder.
"We just did not have a resource in Des Moines or even in Iowa that can provide the care that he needed," she said.
Clogg said child psychiatrists stabilized her son, but she worries about other severely mentally ill children in Iowa.
"When you're at that level, a general practitioner just isn't going to cut it," she said.
But Clogg said she’s at least hopeful that she’s hearing more conversation around the issue.
Natalie Krebs is IPR's health reporter. Funding for her work is provided by the Mid-Iowa Health Foundation.