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May 01, 2018 — By IHPL

In 2004, California passed a 1% tax on millionaires to support mental health prevention and intervention with a bill known as the Mental Health Services Act (MHSA).1 Recently, the effects of the MHSA have been in the news with a RAND study showing that the funds have had beneficial impacts in Los Angeles County while local newspapers are criticizing the delay in rolling out funds to other areas that need them.2,3 There is also criticism that there may be a surplus of funds that is not being adequately utilized.4

While developing programs and creating infrastructure is important, quality, cost, and access to mental health services primarily depend on training, reimbursement, and the number of mental health providers.5 Given that mental health is a vast field in itself, people may not know who provides mental health care or where to get it. While primary care physicians and specialists (neurologists) can provide medical treatment, there is an entire skilled workforce that is trained to provide psychological treatment for mental illness and promote prevention through mental and emotional wellbeing.

What it takes to join the mental health workforce

Licensing requirements and scopes of practice vary across the country. The state of California recognizes seven types of mental health providers: psychiatrists, psychologists, marriage and family therapists (MFTs), professional clinical counselors (PCC), clinical social workers (CSW), psychiatric nurse practitioners (PNPs), and psychiatric technician. Of the seven, only the first two are allowed to prescribe medications while all of them can provide psychotherapy. In California, psychiatrists and psychologists are required to complete a terminal-level degree (M.D., Ph.D., or Psy.D.) while the others require completion of either a masters-level or a doctoral degree. Psychiatric technicians only require a high school diploma or GED. Following the coursework, each of the professions is required to undergo numerous hours of supervised professional experience and pass an examination to receive their license to practice in the state. A majority of behavioral health professionals in CA are MFTs (38 percent) and social workers (23 percent) with very few PCCs (1 percent).6 The workforce pyramid is slightly different at the national level where clinical social workers and clinical psychologists make up a large portion of the workforce, followed by marriage family therapists and psychiatrists.7

General mental health workforce statistics for California

California has an uneven distribution of mental health providers, which leads to multiple shortage areas.8 With close to half of state’s psychiatrists and more than a quarter of the psychologists over the age of 60 years, California’s mental health workforce is expected to decline substantially by 2028. With respect to the demand, the Healthforce Center predicts that there will be a 50 percent shortage of psychiatrists and a 28 percent shortage of all other mental health workers.6 Given the large discrepancies in demographic characteristics of the current workforce, with underrepresented minorities (Latinos and African-Americans), this gap is expected to worsen over time. Since African American adults are more likely to suffer from a variety of mental illnesses compared to non-Hispanic white adults and are less likely to seek care from Caucasian mental health providers due to fear of stigma, the workforce projections must be addressed immediately.9  

Recommendations

Increase Funding: Some of the apparent policy solutions include allocating funds for mental health providers based on areas of need and providing a greater number of grants with higher amounts of funding. Loan repayment may also be a useful incentive for people to work in underserved areas.

Improve Racial Disparity in Mental Health Profession: As previously mentioned, the underrepresentation of certain races in the mental health workforce can be a barrier to seeking care for many minorities. California communities should consider educating students at the primary and secondary levels about the psychiatric technician programs available and developing licensure partnership between employers and educators to guarantee students a job upon finishing their requirements. Moreover, there should be opportunities for students with experience to attain an associate’s degree or a funded dual degree program to attain their bachelors and masters to continue their training. By creating this academic ladder of guided opportunities, more students would be encouraged to join and work in their communities.

Integrate Behavioral Health into Primary Care: Given that only clinical psychologists and psychiatrists are allowed to prescribe medication, behavioral health integration into the primary care setting will be essential. This will allow mental health workers to provide care in clinical settings while ensuring that patients receive proper prescriptions from their primary care physicians who can also perform physical check-ups and coordinate whole-person care. Moreover, this could potentially capture a significant number of people who fall through the cracks since many people who are told to seek mental health care do not do so, and there is no system in place to monitor the continuity of care.

Author bio and photograph:

Priya Vedula is a health policy analyst at the Institute for Health Policy and Leadership. Her work involves examining health policies and regulations with a focus on oral health, mental/behavioral health, and hunger. She received her Master of Public Health degree from Columbia University.

References:

  1. http://www.dhcs.ca.gov/services/mh/Pages/MH_Prop63.aspx
  2. https://www.rand.org/pubs/research_reports/RR2327.html
  3. http://www.sacbee.com/news/politics-government/capitol-alert/article2023...
  4. https://www.mercurynews.com/2018/03/17/editorial-californias-unspent-mental-health-funds-are-an-outrage/
  5. https://www.ncbi.nlm.nih.gov/books/NBK19817/
  6. https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/California%E2%80%99s%20Current%20and%20Future%20Behavioral%20Health%20Workforce.pdf
  7. https://psychcentral.com/lib/mental-health-professionals-us-statistics/
  8. http://gis.oshpd.ca.gov/atlas/content/report/shortage/hpsa_mh.pdf
  9. http://www.mentalhealthamerica.net/african-american-mental-health

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