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CRISIS POINT:
Mental Health Workforce Shortages in Texas
Health Care Crisis in Texas
T
exas is changing as the population increases, ages and shits 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 proessionals — now and in the uture.But the current supply o health care proessionals is not meeting the demand or services, creating a health care workorce crisis. Te state’s health care proessional 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 proessionals is oten overlooked. Yet the most severe health pro-ession shortages are in mental health services.
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exas ranks ar below the national average in the number o mentalhealth proessionals per 100,000 residents. Tis gap will worsen i steps are not taken now to address the mentalhealth workorce shortage in exas.
Why Mental Health Services Matter
O
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 lietime.People experiencing mental illness can achieve recovery and wellness when appropriate mental health services andsupports are available. Trough recovery, they can livemeaningul, 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 proessionalcounselors, social workers, psychiatrists, psychiatric oradvance practice registered nurses, and certied peer supportspecialists. Tese proessionals have special education, trainingand skills to serve mental, behavioral and emotional needs.
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Te individual and societal benets 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 lietime 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 proessionals 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.
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According to the exasHealth and Human ServicesCommission, less than 33%o the state’s 48,700 practicingdoctors accept Medicaidpatients.
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exas can and must addressthis growing crisis by prioritizingaccess to mental health servicesand taking steps to reduceshortages in the state’s mentalhealth workorce.
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
204008010060
46.426.25.8
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
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s o March 2009,
173 out o 254 exas counties(68%) and two partial counties were designated asHealth Proession Shortage Areas (HPSAs) or mentalhealth.
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In 2009, 102 exas counties did not have a psycholo-gist, 48 counties did not have a licensed proessional coun-selor, and 40 counties did not have a social worker. Even morestriking is the act that 171 counties did not have a singlepsychiatrist.
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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 remainedat, causing an overall decline in the ratio o provider to popu-lation. Culturally competent and linguistically diverse mentalhealth proessionals are particularly difcult to nd.Many actors contribute to and exacerbate the mental health workorce shortage in exas: An aging workorce that is beginning to retire. (able 3)
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Recruitment and training challenges or mental health
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proessionals.Lack o exas mental health proessional internship sites.
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Inadequate pay and reimbursement rates in the public
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mental health system.Lack o cultural and linguistic diversity in the work-
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orce, causing a signicant 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 proessionals in exas, the state’s growing demandor mental health services will go unmet.
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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.
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Becker, et al. (March 2010)
Factors Contributing to the Crisis
Recruitment and Retention Challenges
Many mental health proessionals are aging and nearingretirement. Consequently, the state’s mental health workorce will lose many providers in the coming years. At the sametime, exas struggles to recruit and retain mental health careproessionals.Te pool o mental health proessionals is aging. In the
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coming decade, many psychiatrists, social workers andother providers will leave the workorce or retirement.(able 3)Between 2000 and 2009, the number o psychiatrists,
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social workers, and marriage and amily counselors perevery 100,000 residents declined.
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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-
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selors, marriage and amily therapists, and psychiatricnurses also steadily declined.
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Tese shortages are elt most acutely in rural and un-
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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 proessionals. A shortage o internship sites or psychology graduate
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students orces some students to train in other states. A similar problem exists or medical students specializ-
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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.
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(able 4)Similar shortages exist or other mental health proes-
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sionals such as psychiatric nurses, licensed proessionalcounselors and master social workers.Funding or graduate-level mental health training
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programs continues to be scarce, and it is oten dicultor students to nd paid internships. A growing national and state trend enables people inrecovery – reerred to as peer specialists – to provide supportand assistance toothers needingmental healthtreatment. Teexas Depart-ment o StateHealth Serviceshas endorsedthe certicationo peer special-ists and a new organizationcalled Via Hoperecently beganofering trainingand certicationo 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 certied peer specialists. Also, the avail-ability o qualied peer specialists is still limited in exas.Promoting the use o certied peer specialists as mentalhealth providers who are eligible to bill or their services couldsignicantly increase the mental health workorce.
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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