What is needed to navigate the US mental health care crisis
The United States is experiencing an increasingly urgent mental health crisis. About one in five Americans suffered from 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 when screened for anxiety and depression, according to Mental Health America.
The mental health care supply chain is broken. More and more people have sought professional care, but getting the care they need has been a struggle. They have been confronted with providers who are not accepting new patients, are out of the network, or are simply not suitable.
Today, 37% of the American population lives in areas with a shortage of mental health professionals. 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 nationwide shortage of psychiatrists, but only just over half of those who practice accept insurance or Medicaid, making high-quality care expensive for many people. This lack of access has resulted in 60% of American adults with diagnosable mental illnesses going untreated each year.
This crisis affects not only those with mental health symptoms and their loved ones, but all Americans. Mental health symptoms have deleterious effects on physical health, increasing the costs for insurers and employers to provide care. For example, people with major depressive disorder have a 227% increase in hospital stays compared to the total population.
Examining the Mental Health Care Shortage
Solving this crisis comes down to two main priorities: increasing the number of practicing mental health professionals and helping existing professionals to better manage their workload.
The first is a daunting task. It takes an average of eight years of graduate school and medical school and four years of residency to become a registered psychiatrist. Even with the arrival of new psychiatrists in the field, over 60% of psychiatrists are currently 55 years of age or older and are rapidly approaching retirement – the fourth oldest group among medical specialties. This will lead to a potential shortage of 6,000 to 15,000 psychiatrists by 2025.
The shortage will further constrain practicing psychiatrists, who are currently scattered with an untenable workload. Fifteen-minute visits once every three months have become the norm 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 is to empower psychiatrists, rather than replacing them, with appropriate technology and support functions.
Innovation, not dressing solutions, is needed
There have been great strides in increasing access over the past decade, from the adoption of telemedicine to excellent consumer-focused therapy and mindfulness applications. However, these do not go far enough.
Historically, opportunities for psychiatrists have not presented themselves in a flexible and clinic-oriented manner. High-quality providers are generally only available for inpatients or out-of-network patients. Many face the challenge of being responsible for opening a private practice, then grappling with low reimbursement rates for services, the burden of coordinating with insurance companies, and the administrative work that goes on. ensues, which on its own can take hours every day and put the brakes on psychiatrists. to focus on providing solutions for their patients.
There is no blood test to diagnose depression, and psychiatrists do not have the tools to monitor their patients’ progress. There is a major lack of transparency and data to quantify results in psychiatry, which is the opposite of most other specialties. A recent CDC study noted that about 60% of psychiatrists do not use a certified electronic health record system and 40% do not use any, which means they are still writing on paper.
Technology can go a long way in alleviating the more tedious aspects of running a mental health practice, including billing, insurance, and appointment scheduling. But these solutions have even more potential, enabling providers to better understand their patient populations, track patient progress, advance the practice of psychiatry, and achieve higher quality outcomes.
With an impending shortage of psychiatrists and mental health care providers amid ever increasing demand for their services, it becomes extremely important to equip providers with the appropriate tools and flexibility in treatment methods. There are many great ideas for increasing access to behavioral health services. However, the most effective solutions and the best results occur when these solutions are supervised by a clinician who considers all treatment options and the patient’s acuity.
Psychiatrists and other mental health care providers have been trained to provide effective treatment, but we must enable them to do so through innovative solutions powered by technology.