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Workforce shortage escalates to crisis point

The workforce shortage in mental health, already a concern before 2020, has gotten worse during the pandemic and, in many areas of the country, is at a crisis point right now.

A study done by the APA in November of last year found that nearly a third of psychologists were seeing more patients and 30 percent said that they were not able to meet the demand for treatment from patients.

In 2015, an APA-commissioned study reported that workforce projections show that there is an insufficient supply of psychologists for certain groups and that even with a proposed increase in new graduates or encouraging later retirement, the gap may narrow but would not be eliminated.

Although the 2015 study was expected to reliably predict the trajectory through the year 2030, everything changed last year.

“A lot of the work force patterns and assumptions that were built into those projections were upended during the pandemic,” said Karen Stamm, Ph.D., director of APA’s Center for Workforce Studies. “Then provider burnout and psychologists simply having a finite capacity to provides services have pushed us in this direction.”

And, while everyone may be dealing with the pandemic, as with other issues that we have seen during the pandemic, the effects are not the same across the board. The problem has hit some groups harder than others, owing to fewer mental health providers in minority communities or for certain specialties or in more rural areas.

“Population-level increases in anxiety and depression and the rapid switch to telehealth, as well as health, economic and education disparities affecting different groups of marginalized communities all affected our ability to meet need,” said Stamm. “There are some groups that were highlighted in the 2015 study, such as Hispanic and African American, along with older adults and certain geographic areas, where we feel shortages will be worse.”

The problem, Stamm explained, is one that has been increasing over time. As stigma around mental health has lessened and athletes or celebrities have spoken up about their own mental health struggles, more people have turned to mental health care for more than acute needs.

Changes to insurance coverage has also made mental health care more accessible for many. But, as Stamm pointed out, not for everyone.

“The biggest barrier to receiving services was always financial,” she explained. “Then for certain groups there is a lack of free time or of awareness around where to find a professional. It has gotten a little better with some increases in insurance coverage but financial issues are still one of the top reasons for unmet need.”

Other issues include a shortage of practitioners coming into the field, said Stamm.

“There are a number of older psychologists who are nearing retirement age,” she said, “and they might be leaving the workforce soon and not necessarily being replaced by new graduates.”

According to Jamie Lehane, MPH, president and CEO of Newport Mental Health in Rhode Island, where the percent of unmet need for mental health professionals was already much higher than in other New England states (at 61 percent in 2017 as compared to 34 percent in Connecticut according to a Kaiser Family Foundation report), pay scales affect the mental health workforce.

Younger therapists may also choose not to work where the pay is lower, especially while paying off school loans. Over time, as the mental health field has changed around managed care coverage, mental health pay has not remained competitive.

“In our mental health center, the largest body of clinical positions are trained case managers and we require a bachelor’s degree,” he explained. “They are making $15 an hour coming out of a four-year-program when they can go into nearly anything else and make more money by far. Most provider agencies start licensed clinicians in the $50-60,000 range with a master’s degree. Again, they can do just about anything else and start at much higher rates. We try to give every penny we can to our work force but salaries are 25 t0 30 percent less than if they went elsewhere.”

Lehane added that those psychologists who are coming in are not always trained in team-based therapy so are not prepared for work in community mental health centers where much of the unmet need is centered.

“We just don’t have the people entering the field and we also don’t have universities and colleges that are, in my opinion, training to the latest evidence-based practices,” he said.

The APA and other professional organizations continue to lobby for programs that will address the shortages. Piecemeal approaches may be the only way to keep moving forward, though.

“We are dealing with a lot of big structures and systems so it is not an easy fix,” said Stamm. “It is such a large gap that no one policy change could fix it.”

A grant program for community behavioral health clinics that SAMHSA piloted in 2015 may help ease problems, Lehane added.

“We have been petitioning Congress to roll it out nationally,” said Lehane. “This would provide significant federal dollars to support the community behavioral health system.

“This is happening, it is on our doorstep and I have to be hopeful. It has to get better because it is horrible.”

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