Demand likely to outstrip available mental health workforce in California, UCSF researchers find

February 03, 2003

03 February 2003

Demand for mental health care professionals in California will rise by as much as 30 percent in this decade, and there may not be enough workers to fill the need, according to a study released today by the California Workforce Initiative of the UCSF Center for the Health Professions.

The labor shortfall is just one of the many trends likely to strain the state’s mental health care system in the coming years, say the study’s authors. Their far-reaching 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 workforce are virtually invisible.”

The new study, funded by the California HealthCare Foundation and The California Endowment and entitled “The Mental Health Workforce: Who’s Meeting California’s Needs?,” offers one of the first comprehensive profiles of the people delivering mental health services to state residents. Among the team’s findings:

* The state will need as many as 80,000 mental health professionals by 2010. Currently California’s licensed mental and behavioral health care workforce numbers 63,000. 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 percent of nurses now work in mental health facilities. In 2001, there were just 419 advanced practice psychiatric nurses working in California.

* Psychiatrists may also be in short supply. More than half are age 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 percent of all professionals work in the Bay Area, though the region is home to only 22 percent of the state’s population. By contrast, two California counties have no licensed mental health care workers. Only 9 percent of mental health professionals are employed in the entire Central Valley and northernmost counties of California.

Because data regarding the size and composition of this important labor pool have been lacking, policy-makers have found it difficult to identify ways to enhance access to mental health services in California, according to the researchers. 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;

* Integrating the state’s medical and mental health systems of care to provide better case management and interdisciplinary team care.

In addition to McRee, authors of the study include Catherine Dower, JD; Bram Briggance, MA; Jenny Vance; Dennis Keane, MPH; and Edward H. O’Neil, PhD, all of UCSF. The full report is available at the UCSF Center for the Health Professions web site at: http://futurehealth.ucsf.edu

The California HealthCare Foundation, based in Oakland, is an independent philanthropy committed to improving California’s health care delivery and financing systems. Formed in 1996, its goal is to ensure that all Californians have access to affordable, quality health care. For more information, visit: http://www.chcf.org

The California Endowment, a private, statewide health foundation, was established to expand access to affordable, quality health care for underserved individuals and communities. The Endowment provides grants to organizations and institutions that directly benefit the health and well-being of the people of California. For more information, visit: Endowment

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