There is a shortage of psychiatrists available to treat individuals in the United States, and although this is not a new issue, there is recent data showing it to be at an all-time high and nearing crisis proportion. The 2015 Review of Physician and Advanced Practitioner Recruiting Incentives, prepared by Merritt Hawkins, indicates there were more searches for psychiatrists over a 12 month period (April 1, 2014 to March 31, 2015) than any other time during its 27 year recruitment history. As further example of this crisis, Merritt Hawkins also reported that in Texas alone, 185 of its 254 counties have no general psychiatrist available to provide care. Throughout the United States there are 3,968 whole or partial counties that have been designated as Health Professional Shortage Areas for mental health. (Miller, 2015, para 3)
Two ongoing issues emerge as reasons behind such scarcity.First, there is poor distribution of psychiatric coverage across states.For example, Massachusetts shows 18 psychiatrists per 100,000 individuals while Idaho shows only 5. Provider recruitment of behavioral health is more difficult to achieve in rural areas than in urban ones.
The other issue involves the declining age of psychiatrists — 46% of current psychiatrists are 55 years or older and likely to retire over the next five years (compared to 35% of all U.S physicians) with fewer practitioners available to take their place. (Caccavale, et al., 2008, para 2) Unfortunately this phenomenon is occurring while the demand for service is expanding. Monetary compensation very well may be a third issue. Those psychiatrists recruited by Merritt Hawkins saw their salary increase only slightly (from $217,000 in 2014 to $226,000 in 2015) whereas cardiologists and orthopedic surgeons recruited during that same period saw salaries ranging from $497,000 to $525,000. (Robeznieks, 2015, para. 13)
The lack of available mental health providers is also a worldwide issue. In July of this year the World Health Organization reported that nearly half of the world’s population lives in areas where there is less than one psychiatrist per 100,000 people.Low-income countries suffer the most: while there is one mental health provider per 2,000 individuals in high-income countries, only one per 100,000 provides service in low-income countries. (Robeznieks, 2015, para.2)
The Impact of Psychiatric Shortage.
During a 45 day period (December 2005 through January 2006), research was conducted in Los Angeles County to demonstrate the direct impact this problem has on individuals needing psychiatric care.A mock female patient, 32 years in age, was hired and placed 420 calls to 229 psychiatrists over a six week period, requesting a medication consult for serious depression at which time she would pay cash for services rendered. Only 28 appointments could be scheduled; in addition, 80% of the scheduled appointments had a waiting period in excess of five weeks. Of the 229 psychiatrists, 27.2% were not accepting new patients and 8.8% could not give a definitive appointment.Of the 28 appointments made, 35% had a wait time of a month or more. Only 7.1% of the 28 scheduled appointments could accommodate the patient within the week, with the majority of appointments falling within the range of 2-5 weeks. The median cost of an initial consultation was $450.00. (Caccavale, et al, 2008, para 7-8)
Due to the lack of available psychiatrists, medication evaluations have recently fallen under the auspices of primary care physicians who are forced into the front line of psychiatric care.In fact, one report shows that primary care physicians currently prescribe 70-80% of all antidepressants, although PCPs have minimal psychiatric training and are not equipped to handle more complicated depressions that are resistant to first line medications.In addition, black box warnings on some antidepressants create an added burden for those physicians who only have general knowledge of psychiatric medications.
Solutions to Address the Problem.
The 31st Annual Rosalynn Carter Symposium on Mental Health Policy addressed the issue in November, suggesting ways to build a better pool of providers through this year’s theme Help Wanted: Reshaping the Behavioral Health Workforce.
One idea: whole communities taking on more responsibility in caring for its mentally ill residents. The Certified Peer Specialist Project created in 2001 by the Georgia Mental Health Consumer Network is one such example.Both present and former consumers of mental health must complete training and pass an examination to provide peer support services. These services focus on individual strengths and promote hope psycho-education while building self-determination and personal responsibility. The program assists individuals in skill building, goal setting, problem solving and building tools for recovery.To become a Certified Peer Specialist, individuals must also show an understanding of the Georgia mental health system, client rights, cultural competency, confidentiality and proper documentation. (Francolini, 2015, para. 7)
Another solution to the shortage crisis is to allow clinical psychologists to be trained in psychopharmacology. As Caccavale et al writes: “The arguments that psychiatry have raised against psychologists prescribing should no longer be looked at by organized medicine as valid.The argument that the only way psychologists can safely prescribe is through medical school training simply has no merit.Appropriately trained psychologists have written hundreds of thousands of prescriptions to military personnel and their families without any incidents or reports of patient harm. Psychologists in New Mexico and Louisiana and those prescribing under military contract serving soldiers in Iraq have demonstrated that they can prescribe safely and provide high quality service. These psychologists work side by side with primary care providers and psychiatrists as colleagues. Collaboration is inherent in all psychological practice and will continue with those prescribing psychotropic medications.Surely, independent, doctoral level psychologists with many years of experience evaluating, diagnosing and treating mental disorders and who also have a post graduate degree in clinical psychopharmacology and have passed both a supervised internship in prescribing and who have passed national boards in psychopharmacology can perform safely and effectively.” (Caccavale, et al. 2008, para 17)
ReferencesCaccavale, John, Reeves, John, Wiggins, Jack, 2008, The Impact of Psychiatric Shortage on Patient Care and Mental Health Policy, Retrieved from http://abbhp.org/survey.pdf
Miller, Phillip, 2015, New Report Shows Demand for Psychiatrists at an All-Time High, Retrieved from http://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf
Robeznieks, Andis, 2015, Mental Health Workforce Shortage a Worldwide Issue, Retrieved from http://www.modernhealthcare.com/article/20150715/NEWS/1050719943
Francolini, Janine, 2015, A Simple and Powerful Light, Retrieved from http://www.huffingtonpost.com/janine-francolini/a-simple-and-powerful-light