Nearly half of all Americans will have a behavioral health issue in their lifetime, from a mood disorder to a substance use problem. Behavioral health care encompasses a wide variety of interventions delivered by many different types of providers. In the U.S., nearly all these providers are in short supply.
The scarcity of behavioral health professionals is undermining people’s ability to get timely care. This is reinforced by historical underinvestment in behavioral health care by public insurance programs (like Medicaid and Medicare), private insurers, and employers — including lack of coverage and low reimbursement rates. In 2021, fewer than half of people with a mental illness were able to access timely care; those with substance use disorders were even less likely. Some groups are disproportionately impacted by workforce shortages:
- Many rural areas and economically stressed cities have few, if any, behavioral health care providers. For example, in 2018, more than half of the counties in the U.S. did not have a practicing psychiatrist. One study found that counties outside of metropolitan areas had one-third the supply of psychiatrists and half the supply of psychologists as their more urban counterparts. As of March 2023, 160 million Americans live in areas with mental health professional shortages, with over 8,000 more professionals needed to ensure an adequate supply.
- People covered by Medicaid and, to a lesser extent, Medicare struggle to find providers that accept their insurance, in large part because of low reimbursement rates, particularly in Medicaid. One study found that in Oregon, more than half of the mental health providers listed in network directories of Medicaid managed care plans did not actually see Medicaid enrollees. This has profound implications for equitable access, as Medicaid is the nation’s largest payer of behavioral health services.
- Underserved groups like people of color, non-English speakers, and LGBTQ communities often struggle to find appropriate services. As is the case with many other health care specialties, the demographics of the behavioral health workforce often do not reflect those of the people they serve. For example, while nearly one-third of the U.S. population is Black or Hispanic, only about a tenth of practicing psychiatrists come from these communities. This mismatch limits the ability of people to get culturally and linguistically appropriate care.
To better understand these shortages, we need to know who makes up the behavioral health workforce and the challenges they face in providing care to underserved communities.