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County-Level Estimates of Mental Health Professional Shortage in the United States

Dr. Thomas, Mr. Ellis, Dr. Konrad, and Dr. Morrissey are affiliated with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Campus Box 7590, Chapel Hill, NC 27599 (e-mail: joe_morrissey{at}unc.edu). Dr. Holzer is with the Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston. Preliminary findings from this study were presented at a session on mental health workforce and needs assessment at the annual meeting of American Public Health Association, November 3–7, 2007, Washington, D.C.

OBJECTIVE: This study examined shortages of mental health professionals at the county level across the United States. A goal was to motivate discussion of the data improvements and practice standards required to develop an adequate mental health professional workforce. METHODS: Shortage of mental health professionals was conceptualized as the percentage of need for mental health visits that is unmet within a county. County-level need was measured by estimating the prevalence of serious mental illness, then combining separate estimates of provider time needed by individuals with and without serious mental illness derived from National Comorbidity Survey Replication, U.S. Census, and Medical Panel Expenditure Survey data. County-level supply data were compiled from professional associations, state licensure boards, and national certification boards. Shortage was measured for prescribers, nonprescribers, and a combination of both groups in the nation's 3,140 counties. Ordinary least-squares regression identified county characteristics associated with shortage. RESULTS: Nearly one in five counties (18%) in the nation had unmet need for nonprescribers. Nearly every county (96%) had unmet need for prescribers and therefore some level of unmet need overall. Rural counties and those with low per capita income had higher levels of unmet need. CONCLUSIONS: These findings identified widespread prescriber shortage and poor distribution of nonprescribers. A caveat is that these estimates of need were extrapolated from current provider treatment patterns rather than from a normative standard of how much care should be provided and by whom. Better data would improve these estimates, but future work needs to move beyond simply describing shortages to resolving them.

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				T. R. Konrad, A. R. Ellis, K. C. Thomas, C. E. Holzer, and J. P. Morrissey County-Level Estimates of Need for Mental Health Professionals in the United States Psychiatr Serv, October 1, 2009; 60(10): 1307 - 1314. [Abstract] [Full Text] [PDF]

				A. R. Ellis, T. R. Konrad, K. C. Thomas, and J. P. Morrissey County-Level Estimates of Mental Health Professional Supply in the United States Psychiatr Serv, October 1, 2009; 60(10): 1315 - 1322. [Abstract] [Full Text] [PDF]

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