Psychiatrist Shortage Demands Collaboration and Innovation

Education programs have softened some of the stereotypes about mental health. Modest hopes have risen around effective pharmaceutical and therapeutic treatments. Stigma is a barrier between those suffering from disorders and the treatments available to them, but in populations more educated about mental illness, that barrier is lowered.   

The limited destigmatization is in part generational: the acceptance among millennials for psychological treatment is significantly higher than for their elders. In a recent study of a college-age population, for example, more than 85 percent of those surveyed said they would be comfortable making friends with or working on a project with someone diagnosed with a mental illness.    

The Affordable Care Act also lowered barriers to care: included among the essential points of the law are requirements for health plans to cover treatment of mental health and substance abuse disorders.   

 Yet as potential for demand rises, the supply is falling.  In the United States, 4,000 psychiatrist shortage areas exist, where the psychiatrist-to-resident ratio is equal to or greater than 1:30,000. The population of psychiatrists is aging faster than other physicians are, and the specialty remains less than popular with residents.   

An application of telemedicine known as telepsychiatry is often touted as the solution these shortages. Telepsychiatry uses secure videoconferencing solutions to alleviate the problematic distribution of psychiatrists throughout the United States. Remote clinics, hospitals or prisons can receive care that can include remote family members as well.     

While this addresses some issues of distribution, a solution that takes into consideration the shrinking numbers of specialists is needed. One such solution is distributing the load for psychiatric care to general practitioners as well. While this solution may not sound ideal, a new school of thought called collaborative care is working to use this reorganization of provider duties to improve the overall care of patients.    

In collaborative care, the whole patient is taken into consideration by a team that includes psychiatrists in an advisory role, while emphasizing the connection between physical and mental health in treatment plans. Regarding common mental disorders, over 70 randomized studies across diverse practice settings and patient populations have shown collaborative care to be more effective and cost-effective than psychiatric care alone.   

Just as there is reason for cautious hope in new and newly effective treatments for mental disorders, perhaps collaborative care will transform the shortage of psychiatrists into a modest win for mental health.  While there is nothing positive about having fewer and fewer psychiatrists, it may result in localized and limited progress, with treatment plans better integrating physical and mental health care.   

Crises accelerate change. With fewer barriers to mental health services and less care to be found, new kinds of collaboration are being forced upon physicians.  Mental health needs more than awareness; it needs a new mindset altogether. Telepsychiatry and collaborative care are departures from conventional approaches, but it remains to be seen if either will be what under-treated patients or overburdened physicians need. In the meantime, the patients are left waiting.

Dylan Brock