David Woodside, who has lived with bipolar and schizoaffective disorder his whole life, is getting help this way. Not long ago, he wound up in a Dallas County jail for the first time, at age 57. Woodside had gotten upset and kicked his brother.

“Nothing good happens in jail,” he said. “They don’t give you your medication.”

At Metrocare, Woodside started visiting David Yarborough’s office several times a week. Inside, there’s an American flag on the wall, a popcorn machine in the corner and tissues on the wooden desk.

The two Davids have much in common.

Both are fathers and have worked as electricians, and both are taking the same antipsychotic medicine. That’s because Yarborough also copes with mental illness. He’s not a volunteer — he’s a full-time, paid, peer specialist. Woodside said, for him, seeing Yarborough has been better than seeing a psychiatrist.

“[Psychiatrists] see you for about six or seven minutes,” Yarborough said. “They don’t know what’s going on with you. And Dave’s been through a lot of the things I’ve been through — and vice versa.”

Metrocare employs five trained peer specialists, including two who are part of the statewide Military Veteran Peer Network. In Texas, more than 900 people have gone through the statewide certification process provided by the nonprofit organizationÌý. The training requires 43 hours over five days and covers topics such as ethics, effective listening, the role of peer support in recovery and using your personal story as a recovery tool. The certification is valid for two years, and a person needs to earn continuing education credits to renew their certification.

Dennis Bach, executive director of Via Hope, said most of the certified peer specialists are employed by community mental health clinics and state hospitals.

, with, said the idea of peer services has been around for decades but only recently have research studies shown how powerfully effective the approach can be.

“One of the problems with mental health is we’ve learned how to keep people ‘stable’ on their medications and get them out of the hospital. But recovery is about having a life in the community,” Zahniser said. “And peer services are often focused on those things: How do you get your life back?”

Ìýshow peer support specialists can do as well as traditional case managers — if not better — in keeping patients with severe mental illnesses out of psychiatric hospitals.

And, Zahniser said, when it comes to persuading people who are suspicious of doctors to seek help, peers are often the ones who can connect fastest, and get them to accept treatment.

Peer counselors historically were volunteers. But as the Centers for Medicare & Medicaid Services recognized their value, and more training programs were established and standardized, it became easier for hospitals and clinics to employ these specialists full time.

Texas is one of more than 35 states that finance peer services through Medicaid. There’s a severeÌýin the state, so certified peer specialists bridge the treatment gap.

, a researcher of workforce issues with the Institute for Health Policy Studies at the University of California-San Francisco, saysÌýÌý— alongside doctors and social workers.

“When [programs] first brought in peers,” Spetz said, “[they] had to spend a lot of time with the social workers, explaining to them that we were not going to take their work and hand it off to a cheaper person — that what the peer did was complimentary, but it was different.”

Peer specialist Yarborough was offered a job precisely because of his success in coping with his own mental illness and overcoming his past use of methamphetamines. When he works with clients, he can talk openly about how, decades ago, he fell into a very dark place.

“I went from the outdoorsman — fishing, yardwork, just really enjoying all that stuff — to … the guy who wants to lie in bed all day and stare out the window,” Yarborough remembers.

He started having suicidal thoughts.

“I gave my wife the key to my gun safe,” Yarborough said, “because I did not feel comfortable having access to my pistols.”

Eventually, Yarborough was diagnosed with bipolar II disorder. His condition has been stable for seven years and he has been drug- and alcohol-free for 10.

When he trained to become a peer specialist, Yarborough said, he learned to work with others while keeping a close watch on his own mental health. Every week, he helps dozens of people manage their symptoms.

His mantra? “It’s not how you fall, it’s how you get back up,” he said. “And I’ve really stuck to that concept.”

There can be a lot of stumbling with a mental illness, Yarborough noted, and having a shoulder to lean on makes the journey much smoother.

The idea of relying on peer providers in this way isn’t unique to the U.S.

“There are many parts of the world where peer specialists are being deployed in the health care system to provide mental health care interventions,” says, a psychiatrist and professor of global health and social medicine at Harvard Medical School.

Patel says nearly 450 million people are affected by mental illness worldwide. In developing countries, theÌý, he says, because psychiatrists are in such short supply. Patel has looked at the potential of peer support to help meet mental health needsÌýÌýand Pakistan.

“We’ve completedÌýshowing people affected by schizophrenia can be very effective in supporting other people in their own community by befriending them and giving them social support,” he said.

Patel is completing a trial that trains women in a community to help their neighbors recover — mothers suffering from depression.

He hopes Texas and other states in the U.S. continue to experiment with using peer providers, especially to serve people who are finding it difficult to get access to mental health professionals.

“Many groups experience such difficulties — for example, minorities and those who are homeless,” Patel said. “This model is one that should be adopted and integrated into the mental health care system.”

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“I was top of the class,” she said. “I had a GPA of 4.5, a full-tuition scholarship to UTD. I was not the stereotypical girl someone would look at and say, ‘Oh she’s going to get pregnant and drop out of school.'”

But right before her senior year of high school, Chester, then 17, missed her period. She bought a pregnancy test and told her mom to wait outside the bathroom door.

“I saw both lines came up,” Chester said. “I had tears and I remember just opening the door and she was standing there with her arms out and she just wrapped me up and hugged me. I just cried and she told me it’s going to be OK.”

“We controlled for poverty as a variable, and we found these 10 centers where their teen birth rates were much higher than would be predicted,” she said.

DeCesare, whoseÌýÌýappears in the June issue of the journalÌýObstetrics & Gynecology, said several of those clusters were in Texas. The Dallas and San Antonio areas, for example, had teen pregnancy rates 50 percent and 40 percent above the national average.

Research showsÌýÌýare having sex. Gwen Daverth, CEO of the Texas Campaign To Prevent Teen Pregnancy, said the high numbers in Texas reflect policy, not promiscuity.

“What we see is there are not supports in place,” Daverth said. “We’re not connecting high-risk youth with contraception services. And we’re not supporting youth in making decisions to be abstinent. We’re just saying that is an approach we want to take as a state — whereas other states have put in more progressive policies.”

Daverth said California invested in comprehensive sex education and access to contraception. There, the teenage birth rate droppedÌýfrom 1991 to 2015. The teen birth rate in Texas also fell, but onlyÌý.

In South Carolina, young women on Medicaid who have babies are offered the opportunity to get a long-acting form of birth control right after they give birth. They’re also in parts of North Carolina. And subsidizes the cost of long-acting birth control. There, both abortions and teen birth rates are dropping faster than the national average.

Texas makes it hard for teenagers to get reproductive health care, Daverth says.

In Texas, if a 17-year-old mom wants prescription birth control, in most cases she needs her parents’ permission. “Only [Texas] and Utah have a law that if you’re already a parent, you are the legal medical guardian of your baby, but you cannot make your own medical decisions without the now-grandma involved,” Daverth said.

That’s part of the reason, she notes, Texas has the highest rate of repeat teen pregnancies in the country.

After Skylar was born, Chester wasn’t given contraception counseling and still wasn’t sure where to go for help. Three months later, she was pregnant again. She and her then-boyfriend, now-husband, Marcus Chester, hadn’t realized she could get pregnant so soon after having a baby. She was a full-time student at UT-Dallas at that point, double-majoring in molecular biology and business administration. But the education Chester never got, she said, was sex ed.

“In hindsight,” she said, “it’s like, ‘Dude, what were you all thinking? I came in 17, pregnant, why weren’t you all lining up the chart and showing me [my] options?'”

Chester’s high school, likeÌý, teaches abstinence-only or doesn’t offer any sex education at all, though more districts do seem to be adopting “abstinence plus” — which still encourages abstinence but also includes information on other pregnancy prevention methods and sexually transmitted diseases.

Still, abstinence-only education is king and, of course, some parents aren’t comfortable discussing sex with teens, much like Chester’s mother wasn’t.

Nicole Hudgens, with the socially conservative Texas Values public policy group, supports abstinence-only education and said there are plenty of options for young moms who become pregnant.

“There are so many places like crisis pregnancy centers that are able to help these girls that are in need,” Hudgens said.

Crisis pregnancy centers provide counseling and support for pregnant teens but don’t offer abortions or contraception.

Ìýshow access to contraceptionÌýÌýto reducing the teen pregnancy rate. And according to the National Campaign to Prevent Teen and Unplanned Pregnancy, teen pregnancies in Texas cost the state $1.1 billion each year. Gwen Daverth said the costs are due to lost wages and an increased reliance on social services.

“One of the things we know is that 60 percent of teen parents will not graduate from high school, and only 2 percent will go on to graduate from college,” Daverth said.

Jessica Chester did graduate from college. Her mom helped her through it and she did end up taking out loans for day care, but she got a degree and now has a job doing community outreach and family planning for a Dallas hospital.

“I have a lot of support with my mother alone,” Chester said. “I had the example in front of me of [getting pregnant young] doesn’t have to derail your plans, it doesn’t have to stop you from getting an education and a career.”

Jessica and Marcus Chester married in 2010 and have a third son — Kameron, now 21 months old. That pregnancy was planned, she said.

Sitting on the couch at her home in Garland, Chester admitted it can be tough watching friends graduate with medical degrees who are further along in their careers. She has a good job, but it’s not what she was imagining when she graduated at the top of her high school class. Sometimes, she admits, it feels as if she failed.

“Like I gave up on my goals and dreams or messed them up. But when I look at my children, I don’t regret a thing. I’m not sad,” she said, even though her tears were flowing. “It’s just the reality of knowing my life is completely altered because of decisions I made as a teenager.”

Then Chester heard her older boys laughing upstairs, wiped her tears and went to cheer them on.

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“It’s a small town, so they will sometimes bring you chickens, bring you eggs, bring you homemade cakes,” he said. One woman even gave him a puppy. “That was really nice.”

Tauseef was born and raised in Pakistan. After going to medical school there, he applied to come to the U.S. to train as a pediatrician.

It’s a path thousands of foreign-born medical students follow every year — aÌýÌýthat’s been around for more than half a century. And, like most foreign-born physicians, Tauseef came on aÌý. That meant after training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having aÌý. He chose to work with mostly uninsured kids at a pediatric practice in Alexandria, La.

“That was a challenge,” he said, “but it was rewarding as well, because you are taking care of people who there aren’t many to take care for.”

The U.S. medical system depends on doctors like Tauseef, said Andrew Gurman, president of the American Medical Association. He worries that President Donald Trump’sÌýÌýon immigration, which is after a federal appeals court ruling.

The uncertainty is hitting medical schools at a tough time of the year.ÌýÌýis in charge of recruiting top students from across the world for the University of Texas Southwestern residency program.

“Typically we have 3,000 people applying for our 61 positions — of those 3,000, at least half of them are international medical graduates,” he said.

Applicants find out theirÌýÌýin March and usually start working in June. That gives them about 90 days to getÌý. Kazi worries this year that won’t be long enough, and that students from countries included in the travel ban won’t be let in.

“That would create hardship for the hospital, for us, and for our remaining residents,” he said. “They’ll have to pick up more shifts or give up vacation.”

Two-hundred and sixty people have in the U.S. from the seven countries included in the travel ban, according to the Association of American Medical Colleges.

Tauseef left Louisiana two years ago but continues to care for low-income patients at Los Barrios Unidos Community Clinic in Dallas. Six of the 30 physicians who work at this clinic are from other countries. Tauseef said they’re all educated to do the same thing.

“As a physician, being a foreign medical graduate, U.S. medical graduate, a Muslim doctor, a non-Muslim, we are trained to look for signs and symptoms,” he said, “We do not look at anybody’s color, we are not trained to look at anybody’s religion or ethnicity.”

Tauseef, who has been in this country for 13 years, will apply for U.S. citizenship next month.

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Since Aug. 31, when the Drug Enforcement Administration its intention to classify the plant as a Schedule I substance, a group of kratom vendors Ìýagainst the government to block the move, took to social media in protest and scientists whether they would be able to continue kratom research.

Now, the DEA is to put kratom in the most restrictive category of , with drugs like LSD and heroin. The DEA says it will instead open an official public comment period — to last until Dec. 1, 2016 — for people to share their experiences using kratom as a medical treatment. It has also requested that the Food and Drug Administration expedite scientific research.

DEA spokesman Russ Baer says the DEA received more than 2,000 phone calls since August, mostly in opposition to the plan to classify kratom as Schedule I.

“So in a spirit of transparency, and to open this up to public dialogue, we withdrew our notice to temporarily schedule kratom,” Baer said. “We will then give full consideration to those comments before we move forward with any action.”

Still, the DEA attributed 15 deaths to kratom between 2014 and 2016. Fourteen of the 15 people who died also had other drugs or illegal substances in their systems.

Kratom advocates, like Karisa Rowland of Cleburne, Texas, point out that tens of thousands of people every year. She’s thrilled that the DEA will now take time to gather public comments and more scientific research.

“Now that the DEA is officially withdrawing the proposal, I can continue the crusade for the rights of chronic pain sufferers like myself,” Rowland said.

She attributes the change in position to work by activists and to lawmakers who urged the DEA to its “hasty” ban.

Kendra Jowers, an attorney who works in the substance abuse treatment industry in Florida, said in an email she is heartened that the DEA has reconsidered what she calls a “misguided and improper attempt to schedule kratom without the input of relevant stakeholders.”

“This represents a huge sigh of relief for individuals who have come to rely on kratom to overcome addiction or maintain their sobriety,” Jowers said. “At least for the time being, it relieves some [of] the terror people felt at once again facing a life of intractable pain or depression. It has been a lot of work to get to this point, and now I encourage people to fully engage in this hard-fought comment period.”

Kratom user Seth Long of Kearney, Neb., is also pleased the DEA is listening to the public. “The DEA spokespeople have emphasized their reliance on science rather than anecdote in making scheduling decisions, so given the response not just from the public but from research scientists at Columbia University, among other institutions, they seem willing to admit their mistake in lumping together a coffee plant with synthetic ‘designer’ drugs,” he wrote in an email. “I hope the decision signals the DEA’s willingness to become a more responsive institution and isn’t just squid ink covering the same old drug war policies.”

Instructions for submitting a comment by mail or electronically can be found in the DEA’s Oct. 12 . After the public comment period ends Dec. 1, the DEA could still decide to temporarily ban kratom, or permanently place the plant in a scheduled category defined by the Controlled Substances Act. The agency could also decide to leave kratom unregulated.

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In the past, Rowland, who lives a half hour south of Fort Worth, Texas, struggled with a serious prescription opioid dependence. After several back surgeries, she was using pills — hydrocodone, fentanyl and oxycodone — to deal with her chronic pain. Her morning ritual with kratom has helped her handle her pain without taking opioid drugs, she said.

Kratom, a relative of the coffee plant, is made from the leaves of a tree native to Southeast Asia. According to David Kroll, a pharmacologist and medical writer, farmers and indigenous people have used it for hundreds of years as both a stimulant to increase work output and also at the end of the day as a way to relax.

The leaves are brewed like a tea, crushed and mixed with water or pulverized and put into capsules. In the U.S., kratom has become popular among people like Rowland.

She recalls the night, in jail after being picked up for a DUI, when she hit a low. “I’m looking around and I’m watching raw [sewage] flow through a vent in the floor and I’m thinking, ‘Wow. This has to stop. I’m going to end up dead,’ ” she said. She stopped using opioids, went to a 12-step programÌýand started taking kratom. ÌýÌý

In a YouTube video, a he says contains prescription opioids he has been given for pain. “This,” he says, “is not Schedule I.”

“Do I seem angry?” he continues, “Yes. Because you’re taking away a right that I fought for. When I did my tour in Iraq, I fought for my right to be in America and be able to help myself, to cure myself. I’m not talking about snorting cocaine, shooting up heroin, I’m not even talking about puffing a joint. I’m talking about brewing some tea leaves, having a sip and feeling better.”

In another video, says, “This would be like us banning pole vaulting because of concussions.” (Please note, the video contains prolific and inspired cursing.)

People have uploaded hundreds of videos talking about why they drink or swallow kratom pills — veterans coping with PTSD, recovering alcoholics, people with fibromyalgia. A to keep it legal has more than 118,000 signatures.

Even the DEA has been hammered with calls, says spokesman Melvin Patterson. “The response has been unexpected,” he said. “People calling us in opposition of our plan to temporarily schedule kratom as a Schedule I, due to it not having a medicinal use.”

Patterson says the move to schedule kratom come out of a concern for public safety. Between January 2010 and December 2015, U.S. related to kratom, he says.

In Texas, there have only been 17 kratom calls so far this year, but Kristina Domanski, with the North Texas Poison Center, says the numbers are creeping up.

“Most people obtain this online,” Domanski said. “Because this is not necessarily legal or regulated, you don’t know what you’re buying, there’s no quality control, it’s not a supplement [that’s] regulated. You don’t know what you’re buying, so there’s a risk that it’s not kratom; it could be mixed with something else.”

The DEA attributed 15 deaths to kratom between 2014 and 2016. Critics call it a legal heroin, ripe for abuse and addiction.

The science behind kratom is still evolving.

Pharmacologist Kroll said it is going overboard to classify this plant as a dangerous drug. “Kratom being lumped in with other opioids is both unfair and unscientific,” he said. “It glosses over the subtleties of how the main chemical in kratom actually works.”

That chemical is . It binds to some of the same receptors in the brain as opioids, providing some pain relief and feelings of euphoria, but, Kroll said, not the same high. And the chemical doesn’t cause the same, sometimes deadly, side effects as opioids, such as respiratory depression.

“It turns out mitragynine has a very low risk of respiratory depression,” Kroll said. “It also appears that it’s very difficult to get mice addicted to ‘mitra’ — either with the herb or with the pure chemical.”

So what about the people who died? Fourteen of the 15 people also had other drugs or illegal substances in their systems. Advocates for keeping kratom legal also point out that tens of thousands of people every year.

Kroll worries an outright kratom ban could push people back to opioids or alcohol. And, he says, it would delay scientists’ researching the possible risks and benefits of the herb.

Kratom user Rowland is trying to get her friends and kratom users to speak out along with her. She has already sent letters to Texas Sens. John Cornyn and Ted Cruz seeking support.

“I’m the one in pain. The people making these laws, they’re not the ones going through this pain; they’re not the ones whose families have broken up,” she said. “I found life and I have no intention of letting it go.”

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, who wrote A Sniper in the Tower, saidÌýthe school psychiatrist, Dr. Maurice D. Heatly, claimed he’d had many students who recounted violent fantasies during therapy sessions.

“Today we take it a whole lot more seriously because of our history,” Lavergne said. “But back then, that kind of thing didn’t happen.”

Soon after the 1966 shooting, Heatly spoke in a news conference.

“It’s a common experience for students who come to the mental hygiene clinic to refer to the tower as the site of some desperate action,” Heatly told reporters. “They say ‘I feel like jumping off of the old tower.’ [Charles Whitman had] no psychosis symptoms at all!”

Whitman never went back to the clinic, but he did return to his violent fantasy. Lavergne said the 25-year-old former Marine and Eagle Scout was incredibly methodical as he went about killing his mother the night before the tower shootings, placing her body in bed as if she were sleeping. Then he went back home and stabbed his wife.

“By 3 o’clock in the morning, his wife and his mother are both murdered,” saidÌýLavergne. “After that, until he goes to the campus, he spent the rest of his time polishing, getting weapons ready, buying more ammunition. All for the specific goal of going to the top of the UT tower and shooting people.”

Nearly two hours later, 16 people were dead and 32 more were wounded. Police finally killed Whitman.

Speaking to the media, John Connally, who was then governor of Texas, could barely find words.

“Of course I am concerned, disturbed, and yet somewhat at a loss to know how you prevent a maniacal act of a man who obviously goes berserk,” Connally said.

Fifty years later, when news about , in Orlando or San Bernardino hits, our reactions are much the same. We avoid those charged words, but we often assume the shooter is mentally ill, and that crimes like this could be avoided if those with serious mental illness didn’t have guns.

Which raises two questions: First, was Charles Whitman mentally ill? And second, could policies focusing on mental health prevent mass shootings?

As to the first question, Lavergne said he doesn’t think Whitman had serious mental illness. Whitman, he said, did have mental health challenges that are common —Ìýdepression and anxiety. But more than anything, he was manipulative.

“He was always who he was expected to be,” Lavergne said. “In front of his father-in-law, he at times appeared to be a dutiful husband, when — in fact — he assaulted his wife, just like his daddy assaulted his mother. And he gave people the impression he was an honor student, when — in fact — when he died he had a 1.9 grade point average.”

Charles Whitman did seem to think something was wrong with him. This is an excerpt from a note he left on his wife’s body:

“I don’t really understand myself these days,” he wrote. “I’m supposed to be an average, reasonable and intelligent young man. However, lately, I can’t recall when it started, I have been a victim of many unusual and irrational thoughts. These thoughts constantly recur.”

Whitman didn’t mention he’d also been abusing amphetamines. The potential impact of those chemicals fizzled out of the public conversation as soon as a pathologist made a striking discovery in his autopsy: a brain tumor.

One doctor said the “grayish yellow mass” wasn’t a factor in explaining what Whitman had done. But a medical panel later diagnosed the mass as a glioblastoma and said it could have contributed to Whitman’s inability to control his emotions and his actions.Ìý, a Dallas pathologist, agrees it’s possible.

“You can have headaches, you can have seizures, and you can have changes in cognition, and you can actually have personality changes,” she said.

But plenty of people have tumors and are not violent. And plenty of people have depression, anxiety and paranoia and aren’t violent.

, a psychiatrist and director of the division of law, ethics, and psychiatry at Columbia University, pointed out that only a tiny percent of violence —Ìý. — is attributable to mental illness.

“We know that people with serious mental disorders are at somewhat elevated risk of committing violence,” Appelbaum said. “Even so, the vast majority of them . And we know that people with serious mental illnesses are much more likely to end up as victims of violence rather than as perpetrators.”

But and Ìýhave both touted mental health care legislation as a way of preventing mass shootings.

After a shooter killed 20 children in Newtown, President Obama called for a gun crackdown. That didn’t happen. But, Obama’s 2017 budget Ìýa request for $500 million for mental health services.

Appelbaum saidÌýthis is a misguided approach.

“We need more funding for treatment of people with mental illness in this country,” Appelbaum said. “But to argue for that funding on false grounds — namely to try and persuade the public that it will protect them [to] have more mental health clinics — in the long run can only backfire.”

Applebaum said he believesÌýthere are alternatives. At least temporarily limiting access to guns for some people make sense, he said. In general, people who have been convicted of violent misdemeanors, or who are a under temporary restraining order, or who have multiple over a 5-year period are more likely to commit acts of violence than people with mental illness are.

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Name placement matters in academia, too. A revealed there’s a gender gap in who gets top billing on medical studies published in several of the most prestigious research journals.

, a cardiologist and faculty member of the Duke-NUS medical school in Singapore, said getting top billing isn’t just about ego. The number of times you nab that “first author” spot on a research paper shapes how you’re evaluated at work — everything from tenure possibilities to pay.

“This is our livelihood,” Lam said. “It’s important.”

Traditionally, the last name in a series of authors on a science paper is also prestigious — it’s reserved for the most established colleague. First and last in the series is best. That’s why she was upset when she heard about the study in the British Medical Journal showing women are underrepresented in that first position.

While women were better represented as first authors in 2014 than 20 years earlier, their numbers have plateaued in recent years, the scientists found, and have declined in some journals.

And that can also be a problem for women’s health, it turns out. In the same way that having in the movie business makes it more likely a film will have a female protagonist, research shows that studies of new drugs or therapies that have women as first authors are more likely to include a significant number of women as research subjects.

, who chairs the department of emergency medicine at UT Southwestern, says when she designs studies of why women are more likely to die from heart attacks, she approaches it differently than some male doctors do.

“I think a little bit more than some of my colleagues do about outside pressures,” Diercks said. “Such as, the reasons women delay going to the hospital —Ìýis because they’re a caretaker or because they have pressures to finish the wash or pick up the kids?”

She wonders if those pressures might also help explain why women get top billing less often on research papers. Another possibility, she says, is bias in the review process. The editors making decisions about who gets published are often men.

“I struggle that a lot,” she said. “I do believe it’s truly unconscious and unintentional but it amazes me that it is still there.”

Gender bias, intentional or not, is something Carolyn Lam thinks about often.

Just one in five students in her medical school class in Singapore in the early 1990s were women. After graduation, Lam entered a — cardiology. Still, she doesn’t fault the system entirely for the gender gap among first authors. In part, she blames herself.

For example, Lam was recently working with two male colleagues on a journal submission when they started talking about whose name should appear first. She stayed silent. And her name went second.

“I started examining myself a bit,” Lam said. “Why didn’t I ask to be first author?” She realized she should have advocated for herself.

“I think that sort of behavior is pervasive in many, many fields,” she said. “Some may be surprised that it’s even in medicine, where it may seem cut and dried — but it’s not.”

So, last month, when Lam was finishing up another study she’d worked on with two different men and the question of authorship came up, she spoke out.

“My colleague — whom I totally respect — he wrote himself as first author, our senior colleague as last, and me as second,” she said. “I was about to shoot off an email saying, ‘OK, as long as our data get published.’ ”

But she caught herself and, instead, asked to be first author. Her colleague agreed.

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In a class of 237 people, they are two of only five black men.

“I knew the ones above us, below us,” Okonye says. “We all kind of know each other. It’s comforting to see another person that looks like you.”

While more black men than before have graduated from college over the past few decades, the number applying to med school has dropped:Ìý. Enrollment statistics are similar: Ìý542 black male students enrolled in 1978, compared to 515 in med school in 2014.

That’s according to aÌýfrom theÌý. Every other minority group — including Asians and Hispanics — saw growth in the number of applicants. And black women also saw an uptick in applications.

Enrollment statistics for 2015 are just out and they show a modest gain of 8 percent more black men in medical school over the year before.

“This is a positive sign,” says Marc Nivet, AAMC’s chief diversity officer, “but it does not change the fact that for 35 years the number has been trending poorly.”

“I was really surprised,” says Akpotaire, who is studying internal medicine. “I sent [the study]Ìýto my mom and dad immediately.”

The total number of applicants to U.S. medical schools , with about 20,000 enrolling, according to the AAMC.

Not Just A Numbers Problem

Increasing ethnic and gender diversity among doctors is important for patient health. Ìýshow people are more likely to follow doctors’ directions on things like medication or exercise if they can relate to them.

“It’s good to see you brother!” I had never met this man, but I knew exactly what he was talking about. With a large smile on his face and a look of pride, he extended his arm to give me a handshake. “There aren’t too many of us doing what you do. I’m glad we got some representation in here.”

What’s Missing?

For years, Okorodudu has been trying to figure out why so few black men go into medicine. His conclusion:ÌýThe lack of role models.

“If you’re a black male, let’s say you’re growing up in an inner-city neighborhood,” he says. “There’s so many things directly in front of you that you have the option to go into.”

From music and sports to small business and church, Okorodudu says those professions are visible and present in the lives of young African American boys. “But when you talk about the medical workforce, none of us are directly there in front of them,” he said.

Okorodudu decided to become a doctor when he was 18. A year from now, when he’s done with his fellowship, he’ll be 32.

Med student Jeffrey Okonye points out that for students like him who embraced math and science, there are much faster ways to “make it.”

“A lot of friends of mine, black males, are engineers,” OkonyeÌýsays. “They go to school for four years. They have a job, great pay, even had internships in undergrad, I was highly jealous of.ÌýWhereas my route, four years undergrad, then another four years of school, and then another XÌýamount ofÌý training after that.”

So why did he take the longer route?

“It’s hard to describe the feeling you get when you make someone actually feel better,” Okonye says. “When you can see them go from one state to another and recognize that you were a part of literally changing this person’s life.”

Tools To Fix The Pipeline

A desire to care for others isn’t the only thing that Okonye, Akpotaire and Okorodudu have in common. All three have hadÌýrole models of doctors or nurses in theirÌýfamilies. And all three are the children of immigrants — from Nigeria. Okorodudu says that means the group of 1,337 black men who applied to med school last year is veryÌýdifferent from the group in 1978.

“In 1978, those people we’re looking at, a lot of them were probably black American males” whose families had been in this country for generations, he says. Today’s black medical school students may be more recent immigrants from Africa or the Caribbean. “So if we broke it down that way, that factoid is actually even more alarming.”

That study by the AAMC has some suggestions on how to rebuild the doctor pipeline. Among them: createÌýmore mentoringÌýprograms, invest in education at K-12 public schools, increase financial aid options, and convince medical schools to put less emphasis on standardized tests scores like the MCATs.

Okorodudu is trying to help with an online service calledÌý. Users connect with mentors on chat or video.

Sometimes, he says, the key to getting kids interested is simply seeing a black man in a white coat.

This story is part of a reporting partnership that includes , , and Kaiser Health News.

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“Hereford is known for being the beef capital of the world,” she says, laughing. “There’s definitely more cows than people out there.”

It’s even named after a breed of cattle. Out here, there aren’t many people who provide mental health care. In fact, there aren’t any psychiatrists. That’s the reason Duong went there – she’s studying psychiatry as a medical student at the . This assignment showed her just how severe the state’s mental health care shortage is.

The shortage goes beyond Texas. In the past year, Singleton’s firm has been asked to recruit more psychiatrists nationwide than ever before.

“While we knew the demand was high, I don’t think anyone expected it to that extent,” he says.

Supply issues have crept up on psychiatry, Travis says. “You have less and less residents wanting to go in this specialty in genera,l and then you have those that actually do practice medicine not necessarily in the most optimal settings for us.”

So how do you persuade students to become psychiatrists, social workers and psychologists, and then be willing to work in rural areas?

Republican state Sen. is trying cash. He a law that, starting in 2016, will help around 100 medical health professionals repay loans if they go to work in underserved areas. Schwertner says the investment will pay off.

“Where we don’t have those services for mental health patients, they wind up cycling back through our jails and our emergency rooms,” he says.

There are a number of loan repayment programs for students focused on mental health across the country. They’re “at least somewhat successful,” says , director of state policy and advocacy with the National Alliance on Mental Illness.

But she doesn’t think they go far enough.

“The most successful strategies are to find young people within the rural community. They know the community, they have an investment in the community,” Diehl says. “Otherwise the turnover rates in these loan repayment programs are pretty high.”

For medical student Duong, it’s also important to address the stigma of seeking and treating mental health care.

“Even I have some family members who aren’t supportive of me going into psychiatry,” she says. “There are people out there who don’t think mental illness should be considered a diagnosis.”

But Duong says she’s now committed to working in a rural Texas town, despite some sacrifices.

“It doesn’t compare,” she says, “having all these luxuries in a city versus being able to go out there and really make a difference in your patients’ lives.”

This motivation is exactly what Schwertner is looking to spark with the state’s loan repayment program.

This story is part of a reporting partnership with , and Kaiser Health News.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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“This weather was really cold and rainy, and I had a lot of pressure in my sinus area,” Broyles said.

Since she was nowhere near her primary care doctor in Dallas, she calledÌý, the largest telemedicine provider in the U.S., for advice. Patients whose employers or insurers have deals with the Dallas-based company can call any time and be connected with a physician on duty within minutes.

Broyles said the doctor on the call gave her a prescription for antibiotics that soon cleared up her sinus infection.

, Teladoc’s chief executive officer, says such encounters use familiar technology, “whether it’s your cellphone, your laptop that has a webcam built in to it, or simply the phone.”

In Texas, hundreds of employers offer Teledoc’s services to more than 2 million employees, Gorevic said. Nationwide, Teladoc reaches 11 million people.

But new rules from theÌýÌýcould make it a lot harder for people like Broyles to get antibiotics through the service. In response to the board’s restrictions, Teladoc has filed aÌýÌýthat accuses the medical board of artificially limiting supply and increasing prices.

“The rules, as they’re written today, only allow a physician who has seen a patient in person to interact with them remotely,” Gorevic said. “That’s basically saying you can’t go shop anywhere else.”

The rules do allow forÌýÌýthat would permit a physician to diagnose or prescribe medications via phone or video. It would be OK, for example, if the patient were at a medical clinic, or another health care worker were with the patient and could do a sort of surrogate exam. There’s also an exemption for remote mental health visits.

, executive director of the Texas Medical Board, says the rules aren’t meant to stifle competition. They’re meant to ensure patient safety.

“How can a physician make an accurate diagnosis when they have no objective diagnostic data?” Robinson asked. “All they have is what the patient has told them.”

And that’s not enough information, she says.

“No one would think if they showed up at their doctor’s office they would go back to a room, have the doctor stand on one side of the door, they would stand on the other, tell the doctor their symptoms and the doctor would slip a prescription under the door. No one would think that was good care,” said Robinson. “That is exactly the same as doing it over a telephone.”

But Dallas health care attorneyÌýÌýsaid that if you peek behind the curtain, the strict rules aren’t just about patient safety.

“Doctors are trying to protect their practice from telemedicine, basically,” she says.

Still, Tso said she thinks Teladoc’s motivations are also financial.

The medical board is not suggesting that telemedicine should be completely stopped, Tso said. “That would be stupid. And nobody is saying that. Now, what the Texas Medical Board and the doctorsÌýareÌýsaying [is], ‘Well, we should use it in a limited sense, as long as it doesn’t affect the standard of care.’ ”

While the Texas Medical Board doesn’t think it’s good practice for patients to send photos, videos and text messages to unfamiliar doctors, attorneyÌýÌýpoints out that other states permit all those activities.

“Now there’s quite a bit of interest from our members in having the convenience of a telehealth visit. Folks want that,” she said.

By next year 800,000 of the 3.5 million Blue Shield members will be able to use Teladoc in California.

In Texas, the medical board has already received more than 200 comments on the change of rules. It says key players, such as the Texas Medical Association, support the stringent rules. Teladoc points out, on the other hand, that the vast majority of the comments opposed the new rules. The new rules governing virtual visits were supposed to go into effect June 3, but have been delayed until the case goes to trial.

This story is part of NPR’s reporting partnership with and .

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).