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Demand for mental health care is booming. With a shortage of psychiatrists, author of this opinion piece, Robert Krayn, asks how can we ensure providers are empowered to deliver the best care possible for their patients?
The U.S. is experiencing an increasingly urgent mental health crisis. About one in five Americans experienced a mental illness from 2017 to 2018, and the pandemic has sparked even more feelings of anxiety, depression, and isolation. The rate of moderate to severe anxiety peaked in September 2020, with more than eight in 10 people showing moderate to severe symptoms in screenings for anxiety and depression, according to Mental Health America.
The supply chain for mental health care is broken. More and more people have been seeking professional care, but getting the care they need has been a struggle. They’ve been faced with providers that are not accepting new patients, are out-of-network, or simply not the right fit.
Today, 37% of the U.S. population are living in areas experiencing mental health professional shortages. For every 100,000 people, there are only 30 psychologists and 15.6 psychiatrists — compared to about 156 primary care physicians per 100,000 Americans. Not only is there a national shortage of psychiatrists, but only slightly more than half of those practicing accept insurance or Medicaid, making high-quality care expensive for many people. This lack of access has resulted in 60% of U.S. adults with diagnosable mental illnesses going untreated every year.
This crisis not only affects those experiencing mental health symptoms and their loved ones, but all Americans. Mental health symptoms have deleterious effects on physical health, driving up the costs incurred by insurers and employers to provide care. For example, those with Major Depressive Disorder show a 227% increase in inpatient stays compared to the total population.
Examining the Mental Health Care Shortage
Fixing this crisis comes down to two large priorities: increasing the number of practicing mental health professionals and helping existing ones better deal with their caseloads.
The former is an arduous task. It takes an average of eight years of higher education and medical school and four years of residency to become a licensed psychiatrist. Even with new psychiatrists entering the field, more than 60% of psychiatrists are currently aged 55 or older and are rapidly approaching retirement — the fourth oldest group among medical specialties. This will lead to a potential shortfall of 6,000 to 15,000 psychiatrists by 2025.
The shortage will further squeeze practicing psychiatrists, who are currently spread thin with untenable caseloads. Fifteen-minute visits once every three months have become standard in many settings, which is barely enough time to properly complete a progress note, let alone provide high-quality medical care. The appropriate long-term solution to this involves empowering psychiatrists, rather than replacing them, through technology and proper support functions.
Innovation, Not Band-Aid Solutions, is Needed
There have been great strides in increasing access within the past decade, from the adoption of telemedicine to excellent consumer-oriented therapy and mindfulness apps. However, these don’t go far enough.
Opportunities for psychiatrists have not historically presented themselves in a flexible and clinically-driven manner. High-quality providers are typically only available to hospitalized patients or on an out-of-network basis. Many face the challenge of being responsible for opening up a private practice, then struggle with low reimbursement rates for services, the burden of coordinating with insurance companies, and the administrative work that follows, which alone can take up hours each day and hold back psychiatrists from focusing on providing solutions for their patients.
There is no blood test to diagnose depression and psychiatrists don’t have the proper tools needed to keep track of their patients’ progress. There is a major lack of transparency and data to quantify outcomes in psychiatry, which is the opposite of most other specialties. A recent CDC study noted that roughly 60% of psychiatrists don’t use a certified electronic health record system and 40% don’t use any at all — which means they are still writing on paper.
Technology can go a long way in lifting the more burdensome aspects of running a mental health practice, including billing, insurance, and appointment scheduling. But these solutions hold even more potential, allowing providers to gain deeper insights into their patient populations, track patient progress, further the practice of psychiatry, and result in higher quality outcomes.
With a looming shortage of psychiatrists and mental health providers against a backdrop of ever-increasing demand for their services, equipping providers with the proper tools and flexibility in treatment methods becomes extremely important. There are many great ideas to increase access to behavioral health services. However, the most effective solutions and best outcomes occur when these solutions are supervised by a clinician who considers all treatment options and the patient's acuity.
Psychiatrists and other mental health providers have been trained to deliver effective treatment, but we need to enable them to do so through innovative solutions powered by technology.