A shortage in mental health providers is a domestic and global issue exacerbated by maldistribution and unequal access to service and affects people in all income levels, according to two reports released Wednesday.
According to the World Health Organization's Mental Health Atlas 2014, nearly half of the world's population lives in a country where there is less than one psychiatrist per 100,000 people. In low-income countries, $1,045 per capita income or less, and middle-income, $12.746 per capita nations, the WHO reports that there is usually only one mental health worker for 100,000 people, while there are one per 2,000 in high-income countries.
It also noted in the WHO Atlas that less than $2 per capita is spent annually on mental health in low-income countries with much of that amount going toward inpatient care.
The WHO has launched a 2013-2020 comprehensive mental health action plan that includes decreasing suicide rates by 10% from a 2013 baseline of 11.4 per 100,000 people.
The U.S. is also facing a mental health workforce shortage made worse by maldistribution and the aging of the psychiatry specialty, according to the “2015 Review of Physician and Advanced Practitioner Recruiting” report released by the Irving, Texas-based Merritt Hawkins physician-recruitment firm.
The company cited data from the American Medical Association 2015 Physician Master File, which found that 59% of the nation's 30,088 psychiatrists are at least 55 years old. About 48% are 60 or older and expected to retire within five years, Merritt Hawkins reported.
“Psychiatrists are aging out of practice at a time when demand for their services is spiking,” Travis Singleton, senior vice president of Merritt Hawkins, said in a news release. “Mental health is a topic that the health system and patients themselves often avoid. For that reason, psychiatry can be considered the 'silent shortage,' even though shortages in psychiatry may be even more acute than they are in primary care.”
Some 3,968 whole or partial U.S. counties have been identified by the federal government as Health Professional Shortage Areas for mental health. These are defined as areas where there is fewer than one psychiatrist per 30,000 people. Singleton said this indicates a need for 2,707 more clinicians in those areas.
Merritt Hawkins pointed to the situation in its home state of Texas to illustrate the scope of the problem.
According to the Association of American Medical Colleges 2013 Workforce data book, Texas has about 5.7 psychiatrists per 100,000 people. This puts it just above Iowa (5.6) and in 45th place in terms of its mental health workforce. Massachusetts has the most psychiatrists per capita, with 18,000 per 100,000 people. And Idaho—with about five per 100,000—has the fewest.
A previous Merritt Hawkins report found that most of the Texas mental health workforce practices in its urban areas. That study also revealed that 185 of 254 counties are without general psychiatrists.
The report noted that psychiatrists were third only to family physicians and internists in terms of the number of recruitment assignments it received.
The psychiatrists placed by Merritt Hawkins saw their average salary increase 4.1% to $226,000 in 2015 from $217,000 in 2014. But they lagged way behind invasive cardiologists and orthopedic surgeons who were recruited for positions in 2015 paying averages of $525,000 and $497,000 respectively. It was noted in the report that “current payment models limit the extent to which offers to psychiatrists can increase.”
Merritt Hawkins reported that psychiatrists prefer outpatient settings and it's becoming increasingly difficult to recruit them for hospital positions.