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Study shows spike in demand
A new study is painting a bleak picture for mental health care in California in the next decade. Published by the University of California, San Francisco Center for the Health Professions, the study shows demand for mental health care will rise by as much as 30% in the next 10 years and there may not be enough workers to fill the need.
The report describes a fragmented professional population in which occupational roles often overlap, coordination of patient care is spotty or nonexistent, certain kinds of expertise are slipping away, and structural change has been difficult. "We really don’t know who will be providing mental health care in the future — we don’t know enough about those providing care now," says Center Research Associate Tina McRee, MA, who led the study. "In terms of information for effective planning, whole segments of this work force are virtually invisible."
Among the team’s findings:
• The state will need as many as 80,000 mental health professionals by 2010. Currently there are 63,000 licensed mental and behavioral health care workers in California. More than half are marriage and family therapists or licensed clinical social workers.
• Between 1990 and 1997, the percentage of nurses working in mental health settings fell by one-third. Just 4% of nurses now work in mental health facilities. In 2001, there were just 419 advanced practice psychiatric nurses working in California.
• Psychiatrists also may be in short supply. More than half are 55 or older, and declining numbers of residents are choosing the specialty. Already there are not enough psychiatrists focusing on children, adolescents, and the elderly.
• California may be seeing an oversupply of psychologists. There are almost 40 per 100,000 California residents, a far higher ratio than for any other mental health specialty. More than other specialists, psychologists are heavily concentrated in wealthy areas of the state. Comparatively few psychologists provide care in rural areas.
• Urban areas host a disproportionate number of mental health professionals. Nearly 30% of all professionals work in the Bay Area, though the region is home to only 22% of the state’s population. By contrast, two California counties have no licensed mental health care workers. Only 9% of mental health professionals are employed in the entire Central Valley and northernmost counties of California.
Among more specific measures, they suggest that mental health care in California could be improved by better defining the professional roles and responsibilities of each mental health specialty; moving to a "demand" model of patient care that identifies mental health needs and then determines the number and qualifications of professionals necessary to meet those needs; and integrating the state’s medical and mental health systems of care to provide better case management and interdisciplinary team care.
The full report is available at the UCSF Center for the Health Professions web site at: http://futurehealth.ucsf.edu.