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Mental Health Workforce Shortages in Texas

Mental Health Workforce Shortages in Texas

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Published by cindy_george
Sources: Hogg Foundation for Mental Health and Methodist Healthcare Ministries
Sources: Hogg Foundation for Mental Health and Methodist Healthcare Ministries

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Published by: cindy_george on Apr 18, 2011
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Mental Health Workforce Shortages in Texas
Health Care Crisis in Texas
exas is changing as the population increases, ages and shits in ethnic composition. A growing number o people in exas have multiple conditions that require complex care. With these changes, exas will requiremore doctors, nurses and other health care proessionals — now and in the uture.But the current supply o health care proessionals is not meeting the demand or services, creating a health care workorce crisis. Te state’s health care proessional shortage, particularly in rural and impoverished urban areas, is well known to those seeking services as well as to most policymakers. A similar critical shortage in mental health care proessionals is oten overlooked. Yet the most severe health pro-ession shortages are in mental health services.
exas ranks ar below the national average in the number o mentalhealth proessionals per 100,000 residents. Tis gap will worsen i steps are not taken now to address the mentalhealth workorce shortage in exas.
Why Mental Health Services Matter 
ne in our adults in the U.S. experiences a diagnosablemental illness in a given year. Six percent have a seriousmental illness. Nearly hal o all adults in the U.S. willhave a diagnosable mental health condition in their lietime.People experiencing mental illness can achieve recovery and wellness when appropriate mental health services andsupports are available. Trough recovery, they can livemeaningul, productive lives in their community.Recovery does not happen in isolation. It may requiretreatment and support rom amily, riends and mentalhealth workers such as psychologists, licensed proessionalcounselors, social workers, psychiatrists, psychiatric oradvance practice registered nurses, and certied peer supportspecialists. Tese proessionals have special education, trainingand skills to serve mental, behavioral and emotional needs.
Te individual and societal benets o achieving mental wellness are obvious. Te economic value o providingappropriate mental health services can be measured inavoided costs to hospitals and criminal justice and juvenile justice systems. For example, the estimated lietime cost o maintaining a person in the exas criminal justice system ismore than $2 million.But appropriate services cannot be provided in exas i thesupply o mental health proessionals cannot keep pace withthe state’s needs. According to the exas Department o StateHealth Services, less than one-third (44,787 or 28.9%) o 154,724 exas children with severe emotional disturbancereceived treatment through community mental healthservices. Only 156,880 (33.6%) o 488,520 adults withserious and persistent mental illness received services throughthe community mental healthsystem.
According to the exasHealth and Human ServicesCommission, less than 33%o the state’s 48,700 practicingdoctors accept Medicaidpatients.
 exas can and must addressthis growing crisis by prioritizingaccess to mental health servicesand taking steps to reduceshortages in the state’s mentalhealth workorce.
Source: National Institute of Mental Health. Retrieved on February 21, 2011 at www.nimh.nih.gov/ statistics/1ANYDIS_ADULT.shtml 
Table 1: Prevalence of Mental Illness Among U.S. Adults
% adults who experiencemental illness in their lifetime% adults who experiencemental illness annually% adults who experience aserious mental illness annually
   P   e   r   c   e   n   t   o    f   U .    S .   A   d   u   l   t   P   o   p   u   l   a   t    i   o   n
Snapshot: The Crisis in Texas
s o March 2009,
173 out o 254 exas counties(68%) and two partial counties were designated asHealth Proession Shortage Areas (HPSAs) or mentalhealth.
In 2009, 102 exas counties did not have a psycholo-gist, 48 counties did not have a licensed proessional coun-selor, and 40 counties did not have a social worker. Even morestriking is the act that 171 counties did not have a singlepsychiatrist.
Prepared By:Health Professions Resource CenterCenter for Health StatisticsTexas Department of State Health ServicesMarch 16, 2010
Federally Designated MentalHealth Professional ShortageAreas as of March 2010
Number Served inDSHS-Funded CommunityMental Health Services(including NorthSTAR)156,880 or 33.6%
Texas Adults (FY 2010)
Adult Population(18+ years)18,789,238EstimatedNumber withSerious PersistentMental Illness488,520Number Served inDSHS-Funded CommunityMental Health Services(including NorthSTAR)44,787 or 28.9%
Texas Children (FY 2010)
Child Population(9-17 years)3,094,475Estimated Numberwith SevereEmotional Disturbance154,724
Source: Texas Department of State Health Services (February 2011)
Unmet Need for Community Mental Health Services
Sources:*U.S. Census Data, National and State Population Estimates, 2000 – 2009. Retrieved Nov. 28, 2010 at www.census.gov/popest/states/NST-ann-est.html ** Texas Department of State Health Services, Supply and Distribution Tables (November 2010).
While the population in exas has increased and becomemore diverse and health care needs have grown more complex,the supply o psychologists and social workers has remainedat, causing an overall decline in the ratio o provider to popu-lation. Culturally competent and linguistically diverse mentalhealth proessionals are particularly difcult to nd.Many actors contribute to and exacerbate the mental health workorce shortage in exas: An aging workorce that is beginning to retire. (able 3)
Recruitment and training challenges or mental health
proessionals.Lack o exas mental health proessional internship sites.
Inadequate pay and reimbursement rates in the public
mental health system.Lack o cultural and linguistic diversity in the work-
orce, causing a signicant shortage o mental healthproviders with the knowledge, training and skills toserve people who speak languages other than English orare o racial or ethnic minority populations.Unless steps are taken to address the shortage o mentalhealth care proessionals in exas, the state’s growing demandor mental health services will go unmet.
Table 2: Mental Health Workforce Trends in Texas 2000 20,945,963 1,422 6.79 14,549 69.46 3,417 16.31 2009 24,782,302 1,634 6.59 16,574 66.88 2,789 11.26
 YearTexasPopulation*# ofPsychiatristsper 100,000residentsPsychiatrists**
SocialWorkers**Marriageand Family Counselors**# ofSocialWorkersper 100,000residents# of Marriage& Family Counselorsper 100,000residents
Children at Risk . . .
Studies have estimated that 14.38 child and ado-lescent psychiatrists (CAPs) per 100,000 youth areneeded … With 6.7 CAPs per 100,000, exas hassomewhat less than hal the recommended numberestimated to meet the mental health needs o itspopulation. Most o these CAPs are concentratedin urban areas.
Becker, et al. (March 2010)
Factors Contributing to the Crisis
Recruitment and Retention Challenges
Many mental health proessionals are aging and nearingretirement. Consequently, the state’s mental health workorce will lose many providers in the coming years. At the sametime, exas struggles to recruit and retain mental health careproessionals.Te pool o mental health proessionals is aging. In the
coming decade, many psychiatrists, social workers andother providers will leave the workorce or retirement.(able 3)Between 2000 and 2009, the number o psychiatrists,
social workers, and marriage and amily counselors perevery 100,000 residents declined.
Compared to Cali-ornia, New York, Illinois and Florida – the other ourmost populous states – exas has the most severe short-age o psychiatrists, social workers and psychologists.Te number o licensed chemical dependency coun-
selors, marriage and amily therapists, and psychiatricnurses also steadily declined.
Tese shortages are elt most acutely in rural and un-
derserved areas o exas, such as the border region.
Lack o Training Opportunities
 A scarcity o training programs in exas also contributes tothe growing shortage o mental health care proessionals. A shortage o internship sites or psychology graduate
students orces some students to train in other states. A similar problem exists or medical students specializ-
ing in psychiatry. In 2003, state unding or psychiatricresidency training in state acilities was eliminated. Inthe ollowing years, the number o completed psychi-atric residencies went rom 68 in 2005 to only 49 in2009.
(able 4)Similar shortages exist or other mental health proes-
sionals such as psychiatric nurses, licensed proessionalcounselors and master social workers.Funding or graduate-level mental health training
programs continues to be scarce, and it is oten dicultor students to nd paid internships.  A growing national and state trend enables people inrecovery – reerred to as peer specialists – to provide supportand assistance toothers needingmental healthtreatment. Teexas Depart-ment o StateHealth Serviceshas endorsedthe certicationo peer special-ists and a new organizationcalled Via Hoperecently beganofering trainingand certicationo peer special-ists in exas.However, many mental health programs are not yettaking advantage o this opportunity. Tis is due in part tolimited awareness among employers o the positive outcomesassociated with hiring certied peer specialists. Also, the avail-ability o qualied peer specialists is still limited in exas.Promoting the use o certied peer specialists as mentalhealth providers who are eligible to bill or their services couldsignicantly increase the mental health workorce.
Source: Texas Medical Association (December 2010)
 Year Number ofResidents
2005 682006 592007 532008 492009 49Table 4: Number of PsychiatryResidents Completing ResidencyPrograms in Texas
Source: Statewide Health Coordinating Council (January 2011). Texas State Health Plan, 2011-2016: Aroadmap to a healthy Texas 
Table 3: Aging Mental Health Workforce in Texas
Mental Health Professional Median Age Male Median Age Female
Psychiatrists 57 50Licensed ChemicalDependency Counselors 53 50Social Workers 54 47

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