North Carolina's mental health workforce: unmet need, maldistribution, and no quick fixes.

Abstract

Recent data show a maldistribution of psychiatrists in North Carolina and critical shortages in some areas. However, only 11 entire counties have official mental health professional shortage designation. This paper presents estimates of the adequacy of the county-level mental health professional workforce. These estimates build on previous work in 4 ways: They account for mental health need as well as provider supply, capture adequacy of the prescriber and nonprescriber workforce, consider mental health services provided by primary care providers, and account for travel across county lines by providers and consumers. Workforce adequacy is measured at the county level by the percentage of rieed for mental health visits that is met by the current supply of prescribers and nonprescribers. Ninety-five of North Carolina's 100 counties have unmet need for prescribers. In contrast, only 7 have unmet need for nonprescribers, and these counties have inadequate numbers of prescribers as well. To eliminate the deficit under current national patterns of care, the state would need about 980 more prescribers. Data limitations constrain findings to focus on percentage of met need rather than supplying exact counts of additional professionals needed. Estimates do not distinguish between public and private sectors of care, nor do they embody a standard of care. North Carolina is working to develop its mental health prescriber workforce. The Affordable Care Act provides new opportunities to develop the mental health workforce, innovative practices involving an efficient mix of professionals, and financing mechanisms to support them.