Guest Blog: The Upsurge in Mental Health Needs and The Escalating Demand for Psychiatrists: An Insight

As part of PRMS’ ongoing efforts to support the behavioral healthcare community and to promote the organizations that work towards this mission, we are pleased to highlight our partner, the Queens County Psychiatric Society (QCPS), and President of QCPS Dr. Maria Chona P. San Gabriel, DFAPA, as our featured guest blogger. Dr. San Gabriel, Program Director for the Psychiatry Residency Training Program at Elmhurst Hospital Center and Assistant Professor in Psychiatry at Mount Sinai Health System, in New York, NY discusses the shortage of psychiatrists and offers a few solutions to help alleviate the crisis.                                  

Even prior to the COVID-19 pandemic, the U.S. has been inundated by the increasing demand for psychiatrists. In 2019, one out of five people in the U.S. suffered from a mental illness.¹ On January 30, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a Public Health Emergency of International Concern.² On top of the ongoing mental health crisis, the unprecedented stress inflicted by the pandemic further weakened our physical, social, mental, and emotional well-being. It is therefore not surprising that in 2021, the Centers for Disease Control and Prevention (CDC) issued an unparalleled increase of adult psychiatric conditions and suicide rates in the U.S.³ Similarly, the WHO reported an astounding 25% uptick in the global prevalence of anxiety and depression.⁴

The worsening mental health crisis alarmed world leaders (including the U.S.) to investigate care gaps and identify measures to address the concern. In the U.S. alone, 150 million residents are located in areas with shortage of mental health professionals and care.⁵ The study of Satiani et al. in 2018 highlights the projected shortage of about 14,280 mental health providers and 31,109 in the next few years. The same study mentioned workforce expansion by 2025, but was unclear of shortage resolution by 2050.⁶  Factors that fueled the shortage of psychiatrists include growing U.S. population; expanding mental health needs, especially with the pandemic; retirement drain of the current workforce; and scant residency slots for training. Globally, mental health care under-funding has been identified with an average national health spending of approximately 0.5%.⁷

Despite the odds, as a civilian and a psychiatrist, I am reassured knowing that world leaders and U.S. officials are looking into the matter and formulating effective solutions. Crucial measures in filling the gap include additional support provided by the primary care providers and application of a collaborative, interdisciplinary approach; utilization of telemedicine to provide broader range of care; enhancing the educational system on mental health and psychiatry; and expansion programs directed toward recruitment and training of psychiatry residents.

In 2020, the expansion of the Medicare-supported residency slots translated to an additional 200 slots annually over the next five years disseminated across the U.S. and all specialties.⁸ This includes behavioral health, which is an additional boost to our proposed solutions. Of note, it is heartwarming to witness the sustained interest in psychiatry amongst U.S. medical school graduates. Albeit, this failed to translate amongst the International Medical Graduates (IMG), with a downtrend from 30% in 2013 to 16% in 2023. Yet still, recent residency match showed a total of 2,143 medical school graduates matched into psychiatry residency slots this year (1,746 U.S. medical graduates, 351 U.S. and non-U.S. international medical graduates, and 46 other applicants from the previous year). Only 21 psychiatry slots were left unfilled. This converts to greater than a 10% increase in interest over the last five years, with psychiatry being one of the only 10 specialties on this track.⁹

Undeniably so, the battle against the mental health crisis and lack of access to care rages on. Every individual is being summoned to fight this battle. Mental health professionals play a big role in this fight. Unfortunately, so much more needs to be done. But, with proposed solutions and the unwavering commitment of world leaders, local officials, mental health professionals, and our community at large, we hope for continued resiliency, crisis deceleration, and eventual crisis resolution.  

References:

1. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (samhsa.gov).
2. World Health Organization. Coronavirus disease (COVID-19) pandemic (who.int).
3. Suicide Increases in 2021 After Two Years of Decline (cdc.gov). pdf (cdc.gov).
4. World Health Organization. (2022, June). WHO highlights urgent need to transform mental health and mental health care. https://www.who.int/news/item/17-06-2022-who-highlights-urgent-need-to-transform-mental-health-and-mental-health-care.
5. HPSA Find (hrsa.gov).
6. Satiani, Niedermier, Satiani and Svendsen. Projected Workforce of Psychiatrist in the United States: A Population Analysis. Psychiatr Serv. 69(6). 710-713.
7. World Health Organization. Investing in mental health: Evidence for action.Geneva: World Health Organization; 2013. 
8. Association of American Medical Colleges. A growing psychiatrist shortage and an enormous demand for mental health services. https://www.aamc.org/news/.
9. Moran, M. Psychiatry’s Match Number Continue to Climb. Psychiatry Online. Published online. 11Apr 2019. https://doi.org/10.1176/appi.pn.2019.4b24

Maria Chona P. San Gabriel, MD, DFAPA

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