I often write about stigma and the devastating role it can play in terms of keeping people out of treatment. I think a big part of the reason I discuss it so frequently is that it’s the one area that people can actually get involved in and feel like they are making a difference.
That being said, I need to be clear about this one: Stigma reduction, though important, is not the most critical issue facing mental health. That, I would argue, is a lack of capacity, largely in terms of mental health practitioners.
The facts on our ongoing physician shortage crisis are staggering:
- According to a report by the Association of American Medical Colleges, over the next eight years, the United States will experience a doctor shortage of between 61,700 – 94,700.
- That problem is much more acute in the area of mental health. According to one report, in order to meet demand, the United States needs to add 70,000 providers over the next eight years if we are going to meet a growing demand. The problem is even worse for people who live in rural areas; 60% of all people in rural areas live in a mental health professional shortage area. In general, according to NAMI, only 41% of all people with mental illness are treated, while that number increases to 63% of all people with a serious mental illness.
- The shortage doesn’t just affect personnel, but facilities. It can be extremely difficult for the mentally ill who need inpatient care to have access to it, with some surveys estimating that the United States needs a whopping 123,000 psychiatric beds.
How did we get here?
As you can imagine, there are a variety of culprits, including:
- Incredibly high standards to get into medical school and a long length of time for training.
- Crushing medical student loan debt (averaging $207,000).
- A shortage of residency slots for hospitals. These slots are almost entirely funded by Medicaid, and that funding has not increased since 1997.
- High cost of malpractice insurance.
- Varying reimbursement rates for different specialties (more on this later).
Why is this problem so much worse in mental health?
This problem is even more acute in the mental health universe, where amount of psychiatrists declined 10% from 2003-2013. The shortage gets even more severe as you go into mental health specialties, such as pediatric and geriatric care.
Again, there are many reasons that this issue is so problematic for mental health. For one thing, hospitals and insurance companies pay doctors more if they are involved in specialties that turn a profit, like orthopedic surgery and urology…not psychology or psychiatry. Additional public cuts to human services and mental health further exacerbate the problem. As a result, there is less staff in this area, regardless of it’s importance.
Physician burnout is also a problem, with one study noting that “86 percent reporting high exhaustion and 90 percent reporting high cynicism.”
Another problematic area is physician training, where there are concerns that training models have not evolved enough to introduce more medical students to mental health areas.
There’s more – much more than a simple blog entry can handle. For a more in-depth look, I highly recommend that you review this report by the National Council for Behavioral Health.
What can we do about it?
- Increasingly utilize technology and telehealth, which some studies have shown to be promising in the area of mental health. With additional capacity, telehealth can help overcome geographic shortfalls that occur. Other systems, such as bed and doctor registries, can help patients in need of treatment find appropriate resources.
- Expanded number of residency slots.
- Adjustment to reimbursement rates to ensure that mental health services achieve parity with other areas.
- Adjustment to licensure laws in order to allow for other certified professionals – with appropriate training – to treat patients.
It is important to not lose sight of this simple truth: The mental health practitioner shortage can devastate the quality of life of the mentally ill. It can kill people, frankly. In my government job, my office regularly fields calls from constituents who need help but can’t find it. Mental health is an issue that society is only truly starting to understand and deal with. We must ensure that the mentally ill have the access to the resources that they need.