The COVID-19 pandemic did not invent a lack of capacity in the U.S. mental health care system, but it did highlight and extend the essential need to expand access to care for people of all income levels, races, and ethnicities. One of the major hurdles toward expanded access is the shortage of licensed mental health care providers, including psychiatrists, psychologists, therapists, counselors, and social workers.
According to a 2020 report, the U.S. only has enough mental health care professionals to meet 26% of the need of the population. The U.S. has an average of 30 psychologists and 16.6 psychiatrists per 100,000 people—and those numbers are even lower in rural communities. Rural areas have an average of 9.1 psychologists and 3.4 psychiatrists per 100,000 people.
Psychiatrist Michelle Durham testifies to the Senate about the mental health workforce
In a recent testimony to the United States Senate Committee on Finance, Michelle P. Durham, MD, MPH, a psychiatrist at Boston Medical Center discussed the lack of capacity in the country's mental health care system, focusing on issues related to the workforce.
After an introduction by Senator Elizabeth Warren, Durham laid out how the federal government could play a role in supporting a modern, diverse, and robust workforce of psychiatrists, psychologists, therapists, counselors, social workers, and other mental health care practitioners.
Michelle P. Durham, MD, MPH
"It is widely understood and well-documented that America has a dearth of licensed mental health professionals in general, and that particular areas of the country, largely rural and outside of the Northeast, are disproportionately impacted. Even where I practice in Boston—which has one of the highest number of child and adolescent psychiatrists per capita in the country—the capacity is insufficient to meet the mental health needs of the community.
Increased Medicare Graduate Medical Education funding for psychiatry residency spots can help increase the physician workforce. Increased funding for loan forgiveness programs for those who work in underserved areas to help alleviate the over $250,000 of debt that the average medical student has accumulated by the time their residency education is completed. The need to pay off medical school loan burden is also likely to cost positions to pursue practice in more affluent areas, adversely impacting access to care for the low-income populations.
Beyond the shortage of providers, the mental health workforce is not diverse—for instance, only 2% of psychiatrists identify as Black—and not representative or reflective of the U.S. population. In order to address this, we must understand that the issue at its root is a pipeline issue that requires holistic solutions.
Just as we say in medicine, that a person's zip code is more influential than their genetic code in determining life trajectory and long-term health, where a person lives, the color of their skin, and language they speak is highly determinative of the quality of education and resources available, the level of exposure to the mental health field, and the stigma associated with mental illness…
We are at a pivotal time in our country. Over a year into the COVID-19 pandemic, every person's mental wellbeing has been impacted in some way. The need for a more robust mental health care system has never been more clear or pronounced…. Appropriate investment along the care continuum and for the mental health workforce can improve access to care and retention and recruitment of mental health professionals. The time is now to invest in the 21st century mental health care system in America."
This statement has been excerpted from a longer testimony, which you can read or watch in full on the U.S. Senate Committee on Finance website.