County-Level Estimates of Mental Health Professional Shortage in the United States

Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 10/2009; 60(10):1323-8. DOI: 10.1176/
Source: PubMed


This study examined shortages of mental health professionals at the county level across the United States. A goal was to motivate discussion of the data improvements and practice standards required to develop an adequate mental health professional workforce.
Shortage of mental health professionals was conceptualized as the percentage of need for mental health visits that is unmet within a county. County-level need was measured by estimating the prevalence of serious mental illness, then combining separate estimates of provider time needed by individuals with and without serious mental illness derived from National Comorbidity Survey Replication, U.S. Census, and Medical Panel Expenditure Survey data. County-level supply data were compiled from professional associations, state licensure boards, and national certification boards. Shortage was measured for prescribers, nonprescribers, and a combination of both groups in the nation's 3,140 counties. Ordinary least-squares regression identified county characteristics associated with shortage.
Nearly one in five counties (18%) in the nation had unmet need for nonprescribers. Nearly every county (96%) had unmet need for prescribers and therefore some level of unmet need overall. Rural counties and those with low per capita income had higher levels of unmet need.
These findings identified widespread prescriber shortage and poor distribution of nonprescribers. A caveat is that these estimates of need were extrapolated from current provider treatment patterns rather than from a normative standard of how much care should be provided and by whom. Better data would improve these estimates, but future work needs to move beyond simply describing shortages to resolving them.

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    • "This may be reflective of constraints in the behavioral health workforce in the U.S. in general. Shortages of providers, particularly psychiatrists, have been described, and the workforce is aging as fewer graduates are entering some behavioral health professions [31,32]. The need for additional providers in rural and less affluent areas has also been well documented [33]. "
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    • "The church and leaders within the faith community shape the way many parishioners understand society in general (Lee 2003) and influence their perceptions of mental health in particular (Stanford 2007). Pastoral care is also integral to the lives of those in rural, southern communities where formal mental health services are sparse (Hendryx 2008; Thomas et al. 2009, 2012). It is important to note though that differing viewpoints of illness and approaches to healing can impact the individual seeking help and possibly increase tension and mistrust between the clergy and healthcare providers (Neighbors et al. 1998, 1999). "
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    ABSTRACT: The history of the relationship between religion and mental health is one of commonality, conflict, controversy, and distrust. An awareness of this complex relationship is essential to clinicians and clergy seeking to holistically meet the needs of people in our clinics, our churches, and our communities. Understanding this relationship may be particularly important in rural communities. This paper briefly discusses the history of this relationship and important areas of disagreement and contention. The paper moves beyond theory to present some current practical tensions identified in a brief case study of VA/Clergy partnerships in rural Arkansas. The paper concludes with a framework of three models for understanding how most faith communities perceive mental health and suggests opportunities to overcome the tensions between "the pew" and "the couch."
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    • "Many countries have difficulty in recruiting adequate numbers of doctors to psychiatry. In the USA, it has been estimated that three-quarters of its counties (the administrative level within US states) have a shortage of psychiatric prescribers.1 The percentage of medical students pursuing a psychiatry residency in the USA was 7–10% in the 1940s but it dropped to 3–4% in 2002–2007.2,3 "
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