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Solving the Mental Health Provider Shortage

Almost half of the U.S. lives in a mental health workforce shortage area.

Nearly half of all Americans will experience a mental health issue in their lifetime, from a mood disorder to a substance use problem. However, the scarcity of mental health professionals in the United States threatens people's ability to get timely and effective care. This is due to historical underinvestment in mental health care by public insurance programs, private insurers, and employers, including a lack of coverage, low reimbursement rates, structural barriers, and disincentives to entering the mental health workforce. The pandemic has exacerbated mental health and substance use issues further, creating a greater strain on limited mental healthcare providers.

Approximately 47 percent of the U.S. population (158 million people) live in a mental health workforce shortage area. The shortage of mental health professionals is particularly prominent in rural areas and economically stressed cities. Counties outside of metropolitan areas have one-third the supply of psychiatrists and half the supply of psychologists in urban areas.

To a lesser extent, people covered by Medicaid and Medicare struggle to find providers that accept their insurance, largely because of low reimbursement rates, particularly for Medicaid. Only 36% of psychiatrists accept new Medicaid patients, which is lower compared to other payers and compared to rates for physicians overall (71%). Even when providers accept Medicaid, they may only take a few patients or may not be presently taking new Medicaid patients.

This has profound implications for equitable access, as Medicaid is the nation's largest payer of mental health services. Underserved groups like people of color, non-English speakers, and LGBTQ communities often struggle to find appropriate services. The demographics of the mental health workforce often do not reflect those of the people they serve, limiting the ability of people to get culturally and linguistically appropriate care.

The recent Biden administration proposal to strengthen the existing law by requiring plans to evaluate the outcomes of their coverage policies and address material differences with medical benefits is a positive start to increasing access for the public. However, this progress may be hamstrung by the provider shortage if further action is not taken.

To address these shortages, policymakers must take a comprehensive approach to bolstering the mental health workforce. This includes promoting the development of a more extensive and diverse pipeline of licensed providers and supporting the community care workforce. Steps they could take include:

1. Ensuring payment parity and less administrative burden: Existing laws should be strengthened with better guidance, oversight, and enforcement to ensure those in the mental health workforce are reimbursed equitably, compared to their peers in the medical and surgical workforce. Public-private partnerships can help align payers and promote financial incentives while removing administrative burdens such as excessive paperwork and complex requirements for joining health insurance networks. Developing standards for prior authorization can also ensure timely access to services while reducing costs and burden on the healthcare system.

2. Creating pathways for career advancement: Organizations need support to develop clear pathways for career advancement and sustainable workloads for all roles, including community care workers. This will encourage people to enter the mental health workforce, help with long-term retention, and prevent burnout.

3. Making training and education more accessible: We need to invest more in scholarships and loan forgiveness to promote a more diverse and representative workforce, particularly in underserved areas. Federal policymakers should expand and restructure federal Graduate Medical Education funding to increase the number of psychiatry, addiction medicine, and child psychiatry residency positions and fellowships and establish new residency programs. Restrictions like the cap on the number of federally funded residency positions available for psychiatrists limit the number of new psychiatrists entering the field. In addition, states and hospitals should be incentivized to contribute matching funds for new residency programs.

4. Promoting the use of telehealth: While many have resumed in-person care for other medical appointments, the proportion of mental health services provided via telemedicine has remained high at 40%. Reducing barriers to telehealth can address behavioral health workforce shortages and increase access to care, particularly in rural areas. In a recent survey, the state of Nebraska noted that telehealth was the most effective strategy for addressing its behavioral health workforce challenges.

We need a comprehensive approach to reducing the provider shortage. By doing so, we can ensure that all Americans can access timely, culturally and linguistically appropriate mental healthcare.

More from William A. Haseltine Ph.D.
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