Mental Health Provider Shortages and Accessing Care

Families shouldn’t have to sell a vehicle or refinance a mortgage to pay for mental health or addiction treatment programs. For example, if an addict relapses, they may go through detox and treatment two, three or four times. In some cases, the financial and emotional pressure can lead to divorce and cause your loved one’s mental and physical health to deteriorate.

So why is it so hard to find a mental health provider and available/affordable mental health treatment centers in America? Because there is an immense shortage to meet the demand, according to the Health Resources and Services Administration (HRSA).

Mental health provider shortages result in little access to care, high burnout rates among providers and long waits for necessary treatment. In Texas (where I reside) there is a months-long waiting list to schedule an appointment. While integrating primary care and behavioral health care is a necessary first step in reducing the impact of the shortage, primary care providers cannot solely fill the void created by a lack of psychiatrists.

Mental health providers can include psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists and advanced practice nurses specializing in mental health care.

What does that mean for someone who needs care? Our failed mental health treatment system now substitutes appropriate inpatient psychiatric care with a revolving door of jails, prisons, emergency rooms, homeless shelters and a long list of other consequences.

Fifty years of public policy designed to eliminate state hospital beds have produced a psychiatric bed shortage unseen in the United States since the early 1800s—a gap between bed supply and demand that hurts individuals with serious mental illness and their communities and grows wider every year.

Known as “deinstitutionalization,” the drive to eliminate beds was motivated by the idea that every mental hospital patient would be better off in a small community setting than in a larger facility. The goal was achieved with federal economic incentives, consumer advocacy and state legislation that restricted bed access to people whose symptoms had made them dangerous.

Public Psychiatric Beds in Texas:
A minimum of 50 beds per 100,000 people is considered necessary to provide minimally adequate treatment for individuals with severe mental illness. Like every state, Texas fails to meet this minimum standard.

The numbers are alarming for those that require services and can’t find a professional in the mental health field.

Fifteen percent of adults over age 60 have a mental health disorder. The demand for geriatric psychiatrists will continue to increase, as the proportion of the population over 65 is expected to be 20 percent by 2030.

According to the Behavioral Health Workforce Research Center, reports indicate that 21.5 million Americans ages 12 and over have a substance use disorder. Meanwhile, many open psychiatry positions remain unfilled due to high demand and the lack of proper addiction training for providers. Only 0.9 percent of psychiatrists specialize in addiction, making it one of the rarest subspecialties, and most APs find employment in urban settings.

To better understand their geographic distribution, psychiatrists and psychiatric sub-specialists need to be mapped across the country. Particular attention could be paid to tendency of these sub-specialists to practice in urban or rural counties. Three methods for correcting the maldistribution of psychiatric providers are:

1. Developing/bolstering programs that recruit/incentivize providers to practice in underserved areas;
2. Strengthening ties between psychiatric residency programs and rural practice sites to encourage new psychiatrists to later practice in those sites; and
3. Removing barriers that prevent tele-psychiatric services in rural areas.

According to the Treatment Advocacy Center, the estimated prevalence of severe mental illness in Texas (2017):

• Total adult population: 20.9 million
• Individuals with schizophrenia: ~ 230,000
• Individuals with severe bipolar disorder: ~ 461,000

A well-functioning mental health system provides a continuum of care for the entire spectrum of individuals with psychiatric conditions, including hospitalization. Such a continuum no longer exists in the United States.

Restoring psychiatric hospital beds by reforming the policies and practices that eliminate them from the spectrum is essential to providing a full range of treatment options for those who are most acutely or chronically ill. And while private insurance companies continue to place subtle restrictions on coverage for mental health treatments, the government and private sector must make mental health a priority and end the stigma of mental illness and addiction.

To find a provider go to: mentalhealthtx.org