Severe shortage of psychiatrists exacerbated by lack of federal funding

A growing shortage of psychiatrists across the U.S. is making it harder for people who struggle with mental illness to get the care they need — and the lack of federal funding for mental health services may be to blame.

After the school shooting in Parkland, Fla., last month, President Trump promised to "tackle the difficult issue of mental health." But his 2019 budget proposal doesn't devote much funding to mental health care.

While the shortage of primary care physicians has been linked to recruitment, the deficit of psychiatrists is not because medical students lack interest in the field. In recent years, nearly every available training position in psychiatry has been filled, says Dr. Darrell Kirch, president and CEO of the Association of American Medical Colleges, who is a psychiatrist and neuroscientist.

"The thing that's really driving the shortage is the baby boom," he tells Here & Now's Jeremy Hobson. "Every day we have 10,000 baby boomers turning 65. The population is growing, but this segment of the population growing the most are those over 65, and they have the highest health care needs and that includes mental disorders." According to a recent report by Merritt Hawkins, a physician search and consulting firm, nearly 1 in 20 adults in the U.S. — some 13.6 million — live with some form of serious mental illness. Sixty percent of those adults received no mental health services in the past year. The report also notes that in June 2016, mental health took up the largest amount of U.S. health care spending for the first time. Since 2000, Kirch says medical schools have worked to expand psychiatry departments, increasing the number of spots by 30 percent. But the federal government, which funds medical residency programs, put a cap on them under the Balanced Budget Act of 1997.

"That number has been capped for 20 years now by legislation," Kirch says. "No one intended that legislation to become permanent. And now that the population is both growing and aging, it's become the bottleneck."

According to the Merritt Hawkins report, there are about 28,250 psychiatrists in active practice in the U.S., but they are unevenly distributed across the country, with the most doctors practicing in California, New York, Texas, Pennsylvania and Florida.

Seventy-seven percent of U.S. counties have reported a severe deficiency of psychiatrists. To put this in perspective, there are more than 3,800 psychiatrists in California, but only 34 in all of Wyoming, the report says.

"The people who are affected first are those who are typically underserved: people who live in more remote rural areas, people in some less advantaged urban areas, people who lack health insurance," Kirch says.

The report also argues that the problem is about to get a lot worse because of the aging population of active psychiatrists. They place third on the list of oldest types of doctors — 59 percent are 55 years old or older – meaning a wave of retirements is imminent.

"The pool of psychiatrists working with public sector and insured populations declined by 10 percent from 2003-2013," notes a 2017 report by the National Council Medical Director Institute, an organization of mental health and drug addiction providers. "Aging of the current workforce, low rates of reimbursement, burnout, burdensome documentation requirements and restrictive regulations around sharing clinical information necessary to coordinate care are some of the reasons for the shrinkage." When they can't find a specialist, patients often rely on primary care physicians for treatment. Kirch says one of the keys to addressing the crisis is building a collaborative care approach between psychiatrists and primary care clinics. Some states, such as Illinois, New Mexico and Louisiana, have passed legislation allowing psychologists to prescribe antidepressants and other medications to treat mental illness. Advances in telemedicine have also helped improve access to care. Kirch and other mental health advocates are urging Congress to act on legislation to expand medical residency training programs as a method of dealing with this crisis. "There are people who are struggling to get the care they need in this country," Kirch says. "And you can't just pull doctors new doctors off the shelf. It takes time to train them, and that means we need to free up the residency training position, expand it to meet this growing aging population." Copyright 2019 NPR. To see more, visit https://www.npr.org.