U.S. psychiatrists and mental health treatment facilities are woefully overstretched and the gap between supply and demand will reach crisis proportions in the next decade unless significant changes are made, according to a new report from the National Council for Behavioral Health.

Currently, 55 percent of U.S. counties have no psychiatrists, and the average wait for a psychiatrist appointment is 25 days, according to the report. At the current pace of retiring professionals and recruitment, the demand for psychiatrists will outstrip supply by 25 percent in 2025. 

The report, "The Psychiatric Shortage: Causes and Solutions," from the National Council Medical Director Institute provides a blueprint to increase the availability of psychiatry and fundamentally change the way it is practiced in the United States. Among the recommendations are expanding the workforce that provides psychiatric services, increasing the use of telepsychiatry and other technologies, and implementing innovative models for integrated health care delivery.

With about 200 active practicing psychiatrists, Iowa ranked 46th in the nation for access to psychiatric care in terms of the number of psychiatrists relative to population, according to 2014 data from the Iowa Medical Society. 

In a release, National Council President and CEO Linda Rosenberg warned of the dangers of ignoring the report's conclusions.

"In every town in America, we see the unmet need — young pregnant women with untreated addiction living on the streets; older adults who are isolated, anxious, and at risk for suicide; men and women with mental illnesses released from jails without housing or access to care," she said.

The nation is facing a shortage of trained psychiatrists. From 2003 to 2013 there was a 10 percent decline in the number of practicing psychiatrists. If the current workforce of 45,580 does not grow, the deficit of psychiatrists will double from around 6 percent to 12 percent by 2025, according to a 2016 U.S. Department of Health and Human Services-commissioned study.

The report's specific recommendations include:

  • First, do no harm: Protect the improvements to patients' access to treatment and insurance for psychiatric services gained through the Medicaid expansion, and do not push people out of treatment.
  • Treat the whole person: Often patients receive mental health care apart from their physical health care. Make behavioral health care delivery more patient-centered and involve the patient more in his or her care, no matter where care takes place. 
  • Remove barriers to integrated care: Fund technical assistance programs that help develop alternatives to fee-for-service reimbursement models, as chronic physical conditions are known to improve when mental health conditions are managed, particularly among high-risk populations.

The report also recommends streamlining administrative paperwork so that physicians can spend more time with patients; changing how psychiatrists are paid with a shift to bundled payments to increase the quality of care and reduce the overall cost; and reforming state and federal laws that prohibit physician assistants and advanced practice registered nurses from practicing to the full extent of their licenses.

"This is a call to action to reinvigorate psychiatry for the 21st-century patient, who seeks 21st-century behavioral health care," said Dr. Joe Parks, medical director at the National Council and chair of the institute. "At a time when we are coping with the twin problems of a rising suicide rate and an out-of-control opioid addiction epidemic, we must act now."

Read an article detailing Iowa's psychiatrist shortage at BusinessRecord.com.