No one is in charge of training providers for mental health care.
1. The US has a massive mental health crisis.
2. There is a chronic, severe shortage of mental health professionals.
3. The medical clinicians who provide 85 percent of care lack training.
4. No federal agency has responsibility for health care education.
This post was published earlier today in Psychology Today.
In a recent blog, I report what I’m sure will surprise many in mental health. Dr. Thomas Insel, the former Director of the National Institute of Mental Health (NIMH), resoundingly condemns modern mental health care. In his new book, Healing–Our Path from Mental Illness to Mental Health,1 he asserts that present deficiencies are so severe that they flout basic human rights for health care. He puzzles why we haven’t improved mental health care in the last quarter century and cites this cruel irony: in spite of considerable research evidence for effective treatments, clinicians do not use them.1
Here’s why. As you’ve heard in a previous blog, primary care clinicians conduct upwards of 85 percent of all mental health care in the US—but they lack the education necessary to deploy effective therapies, often unaware of them altogether. Predictably, their care founders and seldom meets standards.2
Although mental health professionals receive training in research-based treatments and conduct competent care, another problem surfaces: their small numbers restrict them to care for no more than 15 percent of mental health patients.
The Health Resources and Services Administration (HRSA) provides the details of the shortage. HRSA indicates that the frontline mental health workforce comprised the following in 2017: 91,440 psychologists, 33,650 adult psychiatrists, 8,090 child and adolescent psychiatrists, 10,450 psychiatric nurse practitioners, and 1,550 psychiatric physician assistants.3 These professionals receive the extensive, supervised education required to serve as the primary caretakers for all levels of mental illness severity, from psychosis on one extreme to daily stress on the other.
Suresh Parambath: Need Someone To Listen
But their combined numbers—less than 150,000—are more than an order of magnitude short of the number needed to provide care to 330,000,000 Americans, where 25 percent have a major mental disorder in any given year, 50 percent over a lifetime.4,5 To be certain, other mental health specialists exist, but they do not conduct comprehensive care, playing a more restricted, often consultative role: social workers, family and marriage therapists, licensed mental health counselors, addiction counselors, and school counselors.3
All told, the American health care system has a massive shortage of those who can provide frontline mental health care.
Two things will go a long way to resolving the mental health care crisis and deliver already proven treatments to all US citizens.
- Train the primary care clinicians who provide nearly all care.
- Train more psychiatrists, psychologists, psychiatric nurse practitioners, and psychiatric physician assistants.
US Post Office Department: Higher Education US postage stamp
Importantly, although Congress charges the NIMH to ensure mental health care, the latter focuses only on research and does not address training for mental healthcare providers—as I learned talking with Dr. Insel many years ago.
Right now, a few federal agencies provide a modicum of support for mental health education. Specifically, this responsibility is diffused among Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), the National Institutes of Health (NIH), the Health Resources and Services Administration (HRSA), and the Substance Abuse and Mental Health Services Administration (SAMHSA).6
As proposed by the Institute of Medicine, we must considerably strengthen federal support for mental health education.6
Given the present paltry, uncoordinated support for mental health instruction,6 I propose that the US Congress establish a National Institute of Healthcare Education (NIHE). It would guarantee sufficient numbers of competent clinicians to serve the tens of millions of Americans now lacking basic mental health care—addressing Dr. Insel’s point about basic human rights for competent care. While cost should not be a determinant for improving America’s most common health problem, I aver that a NIHE will easily pay its own expenses from the savings generated by improved mental health care.
Copyright Robert C. Smith, June 2022
1. Insel TR. Healing–Our Path from Mental Illness to Mental Health: Penguin Press; 2022.
2. Dwamena F, Laird-Fick H, Freilich L, et al. Behavioral health problems in medical patients. J Clin Outcomes Management 2014;21:497-505.
3. Behavioral Health Workforce Projections, 2017-2030. 2020. (Accessed February 17, 2021, at https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/bh-workforce-projections-fact-sheet.pdf.)
4. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593-602.
5. Norquist GS, Regier DA. The epidemiology of psychiatric disorders and the de facto mental health care system. Annu Rev Med 1996;47:473-9.
6. IOM. The Mental Health and Substance Use Workforce for Older Adults — in Whose Hands? Washington, DC: Institute of Medicine; 2012.