How Can the US Build Capacity for the Mental Health Workforce It Needs?

The Affordable Care Act (ACA) and additional legislation that has mandated extending mental health parity coverage are contributing to an increased demand for mental health services that the United States is not meeting.

Approximately one-third of the roughly 10 million Americans with serious mental illnesses, such as major depressive disorder, bipolar disorder, and schizophrenia, received no mental health treatment, and many who received services got inadequate care. According to a recent analysis, the number of Americans who reported needing but not getting mental health care increased by approximately two-thirds between 1997 and 2010.

Writing in the June 2016 issue of Health Affairs, Mark Olfson, MD, professor in the Department of Psychiatry at the New York State Psychiatric Institute of Columbia University Medical Center in New York City, noted that unmet need for mental health care in the United States is concentrated among people who are working age, lower income, reside in rural areas, and lack health insurance. Because unmet need for mental health is about 5 times greater for the uninsured than the privately insured, increases in the number of people with insurance brought about by the ACA have placed new strains on mental health professionals. Mental health problems first commonly present in general medical settings, he pointed out, but two-thirds of primary care physicians report that they cannot secure a mental health referral for patients with mental health problems.

Olfson delved into the many and complex factors driving the issue, and suggested a range of potential solutions, including providing intensive training and support for social workers so they can treat patients with serious mental illness. He recommended mainstreaming mental health care to the general medical sector through a team-based approach that includes nurses, clinical social workers, and licensed psychologists with appropriate training to monitor symptoms and advise patients on self-management, while primary care providers maintain primary responsibility for patient care.

In addition to exploring the potential benefits and limitations of relocating treatment of patients with serious mental illness to primary care settings, Olfson discussed the poor geographic distribution of mental health professionals treating patients with serious mental illnesses, the low proportion of mental health professionals treating people with serious mental illnesses, and his policy recommendation to address these gaps in care. These include:

• Expanding loan repayment programs for mental health professionals to encourage and reward practice in underserved areas,
• Increasing training opportunities for social workers in relevant evidence-based psychosocial services, and
• Raising Medicaid reimbursement for treating serious mental illnesses.

Finally, Olfson noted that it is unreasonable to expect that these recommendations, even if fully implemented, would repair the long-standing maldistribution of mental health specialists. Still, focused and robust policy efforts such as the ones he recommends can potentially ease shortages in the number and distribution of mental health professionals dedicated to working with people with severe mental health disorders.