Deanna L. Kelly, PharmD, BCPP
In late March 2017, the National Council for Behavioral Health’s Medical Director Institute released a White Paper with recommendations to ensure there is an adequate psychiatric workforce of providers to care for patients with mental illness in the US. This comes at a time when we face a growing shortage of psychiatrists to treat all people who need behavioral health care. The Medical Director Institute and this project was led by Joe Parks, M.D., Medical Director at the National Council for Behavioral Health, Chair of the Institute, and Patrick Runnels, MD, Medical Director at the Centers for Families and Children and Co-Chair of the Institute. Howard Liu, MD, University of Nebraska Medical Center and Adam Biuckians, MD, Community Services Group served as co-leaders of the expert panel.
The Medical Director Institute completed an environmental scan suggesting that 77% of counties in the US are underserved and 55% of states have a serious shortage of child and adolescent psychiatrists. Additionally, they noted that 40% of the psychiatrist workforce are exclusively cash-only practices leading to a serious shortage of providers for the majority of patients with mental health needs in the public sector. The paper pointed out that if nothing is done to change these gaps, the demand for psychiatrists will be 25% higher than the supply by 2025.
The report this group put forward was entitled, The Psychiatric Shortage: Causes and Solutions, and it comes at a critical time when clinical appointments are difficult to schedule, wait times are long, reimbursement models are antiquated, and government regulations challenge all. Furthermore existing mental health care services face potential cuts and slowed progress in the years to come. The workgroup assisting with the report was an expert panel comprising a diverse group of practitioners, administrators, researchers, policymakers, advocates, payers, and educators. The discussion involved a two day meeting with presentations, discussion, brainstorming and vetting. Each attendee provided literature and research from their area of expertise for review, as well as their unique perspectives to the challenging psychiatry shortage. CPNP was represented by Jennifer Zacher, PharmD, BCPP, Assistant Chief Consultant, Veteran’s Affairs Pharmacy Benefits Management Service in Chicago, IL. Dr. Zacher assisted with review of content, presentations and the final document along with CPNP Board of Directors
The Institute recommended a comprehensive approach with actionable items. The recommendations were directed at a variety of stakeholders including the Centers for Medicaid and Medicare Services (CMS); the National Association of Medicaid Directors (NAMD); the Substance Abuse and Mental Health Services Administration (SAMHSA); professional membership organizations for psychiatrists, nurse practitioners, physician assistants and pharmacists; health care provider organizations; payers; advocacy organizations and consumer organizations. Generally some of the recommendations included expanding the workforce that provides psychiatric services, increasing telepsychiatry for those in rural areas, implementing innovative models of integrated health care delivery, training residents, and adopting novel and effective payment structures.
Expansion of the workforce specifically focused on increasing the number, distribution, and population served by current psychiatrists but also called out expanding the use of advanced practice registered nurses (APRNs), psychiatric physician assistants (PA), and board certified psychiatric pharmacists (BCPPs). The recommendations called for delivering innovative models of integrated care in more settings. The report proposes that the efficient use of other providers such as BCPPs would draw on unique skills that can complement the team-based approach particularly for patients with complex comorbid and behavioral health issues.
In addition, calls to action were issued to a variety of other stakeholders and organizations encouraging them to play a role in the addressing the shortage. These calls to action target the removal of barriers such as state and federal law that restricts other providers such as BCPPs from providing psychiatric care consistent with their education and experience. Services such as initial assessments and routine follow-up visits were suggested as tasks that should be performed by providers other than psychiatrists. CPNP and other organizations were challenged to encourage all members to organize practices and work routines to increase interactions with other medical professionals in the interest of collaborative care. In addition, organizations were encouraged to create more tracks and rotations that allow PGY2 residents to provide services to Health Professional Shortage Areas (HPSA) and public psychiatry settings.
Since the report, CPNP has been involved with follow-up conversations with National Council through an invitation to participate in a Twitter Chat cosponsored with the APA and through other exploratory meetings. We applaud the efforts of the National Council and CPNP is prepared to help improve care for our patients and play a critical role in the impending psychiatric shortage.
If you would like more information on the National Council for Behavioral Health visit www.TheNationalCouncil.org. This organization is a unifying voice of America’s mental health and addictions treatment organizations.