Shortages Predicted in Two Key Mental Health Provider Roles

The nation was already experiencing growing demand for mental health services when the coronavirus pandemic hit.

Then the need for mental health and addiction treatment services increased as the pandemic got underway and as access to care diminished, according to survey results released in September by the National Council for Behavioral Health.

Just over half (52 percent) of the chief executive officers in the survey reported that their behavioral health organizations were seeing an increase in demand for services. At the same time, many of these executives noted that patient capacity was diminishing as a result of the pandemic: 54 percent had to close programs while 65 percent had to cancel, reschedule or turn away patients. Some organizations even had to lay off or furlough some of their workforce.This concerning trend has health experts asking: Do we have enough mental health providers to meet the public’s current mental health needs? And will we have enough to fill the demand for psychiatrist jobs and other roles in the future?

Shortages predicted for psychiatrists and addiction counselors 

The United States could be looking at shortages of two types of mental health providers over the course of this decade.

Psychiatrists are already in short supply, and according to projections from HRSA’s Health Workforce Simulation Model (HWSM), there will be shortages by 2030, too. Retirements are expected to outpace new entrants in the field, and without intervention, there may be a shortage of more than 12,000 psychiatrists by the end of this decade.

Another type of mental health provider that is expected to be in short supply by 2030 is addiction counselors. HRSA’s simulation model is predicting a shortage of more than 11,500 addiction counselors by decade’s end.

Part of the problem may be an unequal distribution of providers. As a 2018 study in the American Journal of Preventive Health noted, rural areas are far more likely to lack an adequate number of psychiatrists.

Other types of mental healthcare providers are not facing such dire predictions.

According to HRSA (the Health Resources and Services Administration), the supply of other types of mental health providers should be “adequate” or “may potentially experience an oversupply at the national level.” These roles include psychiatric nurse practitioners (NPs), physician assistants (PAs), psychologists, social workers, mental health counselors, school counselors, and marriage and family therapists.

And while the various occupations in the behavioral health realm are not interchangeable, utilizing some of those providers to provide access to care and to fill in gaps may be a possible solution.

“We need to be flexible in our strategies,” said Jean Moore, DrPH, FAAN, director of the Health Workforce Technical Assistance Center at the University at Albany, SUNY, in New York.

For example, PAs working in psychiatry could be positioned to meet some of the need, according to a presentation made at the Psych Congress 2020 by a group from the National Commission on Certification of Physician Assistants.

And psychiatric/mental health nurse practitioners can also care for the needs of many patients, said Moore, although she added that scope of practice laws do vary by state.  Locum tenens providers may also be called into service to expand access to care, as some were during the earlier months of the pandemic. Locum tenens psychiatrists who are willing to work in rural or other underserved areas may find that there is a high demand for their services.

Mental health needs of the mental health workforce

But the challenges facing the mental health workforce are not just about shortages, experts note.

The mental health needs of the mental health workforce matter, too. And that’s especially true in the wake of the pandemic.

“We will also need to ensure that our health care workers are getting the behavioral health care that they need as there are a number of emerging surveys suggesting that health care workers are struggling with depression, anxiety and substance abuse,” said Bianca K. Frogner, PhD, director of the University of Washington Center for Health Workforce Studies.

“The challenge that needs to be addressed is the stigma attached with getting behavioral health care and the real consequences of losing one’s license that may make a health care worker avoid getting the care they need,” Frogner noted.

Something else to keep in mind: mental health professionals working at safety net behavioral health (BH) centers are especially vulnerable, according to Susan Skillman, MS, a research scientist and the senior deputy director of the University of Washington Center for Health Workforce Studies.

“Safety net BH clinics are frequently understaffed and experience high staff turnover,” said Skillman.

“While important training sites for new graduates, BH professionals in safety net sites often leave once they’ve obtained their required post-graduate training and seek higher wages and more manageable caseloads at other clinics.”

Related:
Depression in Patients: Helping Those Who Have Lost So Much 
Mental Health and Physician Burnout During COVID-19

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