Between Oklahoma and New Mexico lies a nearly perfect grid of 26 counties in the Texas Panhandle. In the entire 25,887 square miles, only two counties have a psychiatrist or addiction specialist.
For the first time, policymakers, health associations, educators and researchers have a reliable way to view this kind of behavioral health information. A team of researchers from George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity has created a data mapping tool that has been sorely needed for years, “the first comprehensive national database on the behavioral health workforce.”
People using the Behavioral Health Workforce Tracker “can get a richer understanding of where there are gaps in care,” said Clese Erikson, MPAff, the project’s principal investigator. MedPage today. “It’s a new lens for understanding the workforce in the community and then how you compare to others.”
The database includes about 1.2 million behavioral health providers—about 600,000 psychiatrists, addiction medicine specialists, psychologists, counselors and therapists—as well as 400,000 primary care physicians and advanced practice providers who prescribe mental health medications. health. A map that can be viewed at the state and county level lists an area’s “provider population” by provider type, and the ratio changes when selecting only psychologists or primary care physicians.
Colorado, one of the richest places for mental health providers, has one provider for every 164 people, for example, while the states with the least supply of psychiatrists and addiction specialists include Idaho (106 providers per 14,789 people), Wyoming ( 43 out of 13,108), Mississippi (234 out of 12,681), Montana (91 out of 10,873) and Nevada (252 out of 10,716).
The researchers used retail prescription data from the IQVIA Xponent, representing 92% of retail prescriptions by physicians, nurse practitioners, assistants, and addiction specialists who prescribed 11 or more behavioral health medications (including medication-assisted treatment) during 2020. To account for other nonprescribing behavioral health physicians, they used state licensure data for licensed psychologists, clinical social workers, vocational counselors, and marriage and family therapists.
They then standardized the data across states and linked it to addresses. When state licensure data or addresses were insufficient, they used data from CMS’ national plan and provider listing system to fill in the gaps (even though many therapists are not registered there, they noted).
The gaps it reveals are stark: Half of the counties in the U.S., as well as the Texas Panhandle, had neither a psychiatrist nor an addiction specialist as of 2020. The total volume of mental health drug prescriptions written by primary care providers help — 224 million — far outnumbered the total number of behavioral health professionals that year — 83.5 million — revealing widespread reliance on behavioral health professionals.
Also, the states with the highest rates of drug overdoses are not the ones with the highest percentage of providers who can prescribe drugs for opiate addiction.
The reasons for these behavioral health disparities are many: rural areas tend to have a shortage of health professionals in general. Medical schools and educational institutions are concentrated in urban areas. Structural racism, including redlining and its generational ripple effects, perpetuates persistent mental health inequalities in the workforce.
While this new tool suggests a mental health crisis of enormous proportions, it may also provide the basic information needed to begin fixing it. Erickson said he hopes the tool reaches “state policy leaders who can then start to look and understand where they want to invest the resources … to build a workforce in their community and then give them a more nuanced picture of how to make these investments.”
For example, she said, in areas where primary care physicians shoulder a heavy behavioral health burden, state leaders can focus on how to better support and train them. In other areas lacking providers, they could build telehealth infrastructure “to make sure patients with mental health needs access care in a timely manner.”
Erickson hopes to keep the database running: the team plans to update it with data from 2021. After that, they’ll need to find more funding to continue. So far, there are no real competitors. As Erickson noted, “it just didn’t exist before.”