Supply Dynamics of the Mental Health Workforce: Implications for Health Policy

Abstract

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.

Primary Care, Behavioral Health, Provider Colocation, and Rurality

“…21 Broadening the use of small-business loans, debt relief, enhanced infrastructure for telehealth opportunities, and additional payment incentives like those found to be beneficial in regional and international settings should all be considered among efforts to recruit and retain both PCPs and behavioral health providers in rural areas. 20,22,23 Incentive plans and innovative curricula also are needed to encourage behavioral health providers to train for the provision of services within a primary care environment.…”

Managed behavioral health care and supply-side economics. 1998 Carl Taube Lecture

“…Indeed, with co-investigators Susan Ivey and James Zazzali, I documented those provider increases in earlier research on managed care and the supply dynamics of the mental health work force. 4 The final set of data from McKusick and colleagues that is of special interest here concerns MH/SA expenditures in relation to national health spending in total over the 1986-1996 period. The point to make here is that the average annual growth rate of mental health spending was lower than that for health care spending in general, 7.2% versus 8.3%.…”

“…2, 21-28 (1999) types of mental health workers, a trend that more reflects a higher demand for mental health services than economic substitution among provider types. As I have detailed elsewhere, 4 there are a number of possible explanations of why the mental health work force is distributed the way it is nationally: regional variations in insurance coverage and state expenditures on health, levels of income for both clients and providers, state regulations on licensing and scope of practice, regional preferences for certain types of providers and even the location of mental health care training programs. In short, supply and demand and the impact of managed care on cost is a tricky and complex business.…”

“…I have found that there are about twice as many psychologists as psychiatrists, and over twice as many clinical social workers as psychologists. 4,21,24 During the period 1989-1995, growth in the number of psychologists was about twice that of psychiatrists, while the rate of growth in the number of clinical social workers was almost double that of psychologists. Overall, it is at present difficult to tell from these supply figures whether the faster rate of growth in the numbers of psychologists relative to psychiatrists signals higher demand for, or oversupply of, psychologists relative to psychiatrists, and likewise for social workers relative to psychologists.…”

Organizational determinants of psychosocial treatment activity of providers in Va mental health facilities

“…This pattern of findings suggests that different roles operate in the delivery of care under the psychosocial rehabilitation model. 30 Each discipline contributes to psychosocial care in different ways and, therefore, should be subject to different standards of productivity. In the context of increasing pressures imposed by managed care and the psychosocial rehabilitation model, the question may not be whether different members of the treatment staff provide different levels and intensity of care to their patients but the extent to which variation in these psychosocial treatment behaviors exist within a particular occupational category (e.g.…”