The mental health system in the U.S. faces considerable challenges in delivering behavioral healthcare to populations in need. In a special supplement to the American Journal of Preventive Medicine, experts focus on the issue of behavioral health human resources for which substantial investment is needed to effect change.
More than 44 million American adults have a diagnosable mental health condition, and rates of severe depression are worsening among young people. Mental health and disability are well-established drivers of substance use, and drug overdose deaths fueled by opioid misuse have more than tripled from 1999 to 2016.
A 2016 report by the Health Resources and Services Administration on the projected supply and demand for behavioral health practitioners through 2025 indicated significant shortages of psychiatrists, psychologists, social workers, mental health counselors, and marriage and family therapists.
But the magnitude of provider shortages isn't the only issue when considering access to behavioral health services. Another major concern is maldistribution, since parts of the U.S. have few or no behavioral health providers available, and access to mental health services is especially critical in areas of poverty.
The supplement summarizes the supply challenges of the behavioral health workforce, including severe shortages in rural areas. The results showed substantial variations across Census Divisions in the supply of psychiatrists, psychologists and psychiatric nurse practitioners and showed that rural populations have far less access to behavioral health providers than populations in cities.
The New England Census Division had the highest supply, and the West South Central Census Division had among the lowest supply of all provider types. There was a more than tenfold difference in the percentage of counties lacking a psychiatrist between the New England Census Division (6 percent) and the West North Central Census Division (69 percent).
In 2015, almost 4,500 behavioral health providers completed a survey as a mandatory component of license renewal, the experts said. Findings indicated a dearth of licensed behavioral health providers representative of the populations served, limited access to services via Medicaid and Medicare payer sources, limited access to providers working in public health settings, and limited access to health information technology.
Medicaid is the single largest payer for mental health services in the U.S. and increasingly plays a significant role in the reimbursement of substance use disorder services. Sp the finding that more than a quarter of providers surveyed did not have a single Medicaid patient enrolled in services was alarming to the authors.
The researchers recommend effective recruitment and retention of professionals representative of the populations served, policy reforms to enhance the training environment and reduce unnecessary barriers to practice, post-licensure programs to encourage students from diverse backgrounds to participate in training opportunities in areas of high need, and increasing access to supervision for clinicians working in rural and underserved communities.
They highlight telehealth as an innovative strategy for quickly expanding access to supervision and propose permitting interdisciplinary supervision from a variety of behavioral health professionals to increase access. Medicaid is examining reimbursement for services provided by trainees under the oversight of an independently licensed Medicaid provider.