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National Council addresses shortages in psychiatric care
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The National Council for Behavioral Health recently released a report that discussed causes of the current shortage of trained psychiatrists and provided recommendations to reverse it.
“The coverage of, and increasing demand for, psychiatric services is occurring at the same time as a growing shortage of outpatient and inpatient programs. The lack of access has created a crisis throughout the U.S. health care system that is harmful and frustrating for patients, their families and other health care providers, and is becoming increasingly expensive for payers and society at large,” Joe Parks, MD, medical director of the National Council for Behavioral Health, and colleagues wrote.
From 2003 to 2013, psychiatrists working with public sector and insured patient populations decreased by 10%, according to researchers, partially due to aging of the current workforce, low reimbursement rates, burnout, burdensome documentation requirements and restrictive regulations for information sharing essential to coordinated care.
To address shortages, the National Council for Behavioral Health’s Medical Director Institute established an expert panel of clinicians, administrators, policymakers, researchers, educators, advocates and payers. The panel reviewed literature, held discussions and brainstorming sessions on solutions and recommendations.
Psychiatric service providers experience overcrowded daily routines that do not allow for proper in-depth clinical assessment or necessary collaboration with treatment teams and primary care providers.
Additionally, psychiatric care in hospitals and inpatient services are also lacking.
Challenges and solutions
Some challenges to psychiatric care occur within training, according to the panel.
The Accreditation Council for Graduate Medical Education psychiatry milestones suggest consultation and coordination with primary care, but do not address specific skills needed for improved psychiatry access, according to researchers.
To combat this, training should include a greater emphasis on telepsychiatry, collaborative care and other team collaboration strategies.
National organizations responsible for developing and approving residency training programs can expand and improve skills by:
- adding specific milestones that address new models of care, such as collaborative care, telepsychiatry and data-driven population health;
- securing increased funding for graduate medical education programs in underserved areas from the Health Resources and Services Administration; and
- investing in psychiatry clerkship rotations for third-year medical students that can be utilized in other training programs.
Another strategy to expand the psychiatric workforce is reducing the number of psychiatric providers who practice in cash-only practices, which requires the APA, National Council and their members to incentivize engagement with programs that accept commercial, Medicare and Medicaid coverage.
To improve delivery of psychiatric care, the panel recommended:
- reducing no-shows in outpatient programs by using Open Access scheduling models;
- expanding telepsychiatry by minimizing regulatory barriers and adequately reimbursing;
- providing adequate support for prescribers; and
- reducing administrative burdens to information sharing and documentation requirements.
The panel acknowledged that these changes will require technical assistance from multiple sectors, including states that utilize accountable care models with high-risk, high-cost Medicaid members, the federal government, and training and research organizations.
“In every town in America, we see the unmet need-young pregnant women with untreated addiction living on the streets; older adults who are isolated, anxious, and at risk for suicide; men and women with mental illnesses released from jails without housing or access to care,” Linda Rosenberg, PhD, president and CEO of the National Council, said in a press release. “Our nation’s treatment capacity desperately needs to be expanded. We urge all stakeholders to take the recommendations in this report seriously and help modernize psychiatry to avert a crisis that would affect the most vulnerable people in society.”
In a closing note, the panel urged President Trump and Congress to consider the effects of proposed policy changes on already limited access to psychiatric services. – by Amanda Oldt
Reference :
Parks J, et al. The psychiatric shortage: Causes and solutions. National Council for Behavioral Health. Accessed March 28, 2017.
Perspective
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Steven S. Sharfstein, MD
A large part of the crisis in behavioral health care today is the shortage of physician psychiatrists throughout the country. Access to care is about access to treatment along a continuum of biological, psychological and social dimensions for the many individuals who suffer from mental illnesses often co morbid with substance use and general medical conditions. It’s about provided integrated mental and medical treatment to the whole person.
Psychiatrists are essential members of the behavioral health team and the medical team. There are not enough of us to meet the need. "The Psychiatric Shortage: Causes and Solutions," a report from the Medical Director Institute of the National Council for Behavioral Health, describes the consequences of the shortage of psychiatrists and suggests solutions not only to expand the workforce but also to utilize new technologies such as telepsychiatry to create new spaces to expand care. As a practicing community psychiatrist dealing with the everyday reality of lack of resources and system dysfunction I found it wonderful to read a report such as this with recommendations for real change and progress. As a mental health policy wonk, I loved this report for its comprehensive and multidimensional approach to solving the extreme shortage we are experiencing. It must be read and put into action.
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