Workforce Issues and Problems
The President's New Freedom Commission on Mental Health, Subcommittee on Rural Issues (2004) report identified several workforce issues specific to rural communities:
- More than 85% of 1,669 Federally designated mental health professional shortage areas are rural (Bird, Dempsey, & Hartley, 2001).
- Holzer and colleagues (2000) found that few psychiatrists, psychologists, or clinical social workers practice in rural counties, and that the ratio of these providers to the population worsens as rurality increases.
- For the past 40 years, approximately 60% of rural America has been underserved by mental health professions.
- The National Advisory Committee on Rural Health (1993) noted that across the 3,075 counties in the United States, 55% had no practicing psychiatrists, psychologists, or social workers, and all of these counties were rural.
- These workforce shortages are even worse for specialty areas, such as children's mental health, older adult mental health, and minority mental health.
Many rural states face problems in attracting and keeping behavioral health professionals in rural communities, especially those who have training relevant to rural communities and their culture. Rural workforce strategies involve two primary aspects: 1) development of the existing workforce and 2) expansion of the workforce through recruitment and retention activities. The Institute of Medicine Report Crossing the Quality Chasm (2005) identifies a third strategy which is to enhance the “health readiness” of rural residents. This involves educating rural residents about the symptoms of mental illness so they can be more proactive in seeking care for possible mental health issues.
In March, 2005, the Western Interstate Commission on Higher Education (WICHE) Mental Health Program facilitated a conference on rural workforce development (Bridging the Gap: Bringing Higher Education and Mental Health Practice Together ) in Mesa, Arizona. This conference built on gains made during a previous workforce development conference in 2003. The stakeholders at the conference developed recommendations on how to link higher education programs with mental health disciplines to meet the growing need for mental health services in rural areas. Recommendations from this conference will be used to inform a national strategic plan for rural behavioral health workforce development for the Annapolis Coalition project. That plan, with support from SAMHSA, will hopefully give rise to new initiatives at the federal, state and local levels that will begin to solve what is quickly becoming a behavioral health care workforce crisis in rural areas.
States such as Alaska, Arizona, and Montana have been undertaking processes through which higher education, public mental health, and provider agencies work together to identify shared goals and activities to better integrate their systems, train existing providers, and attract students into the mental or behavioral health field. Specific activities have included creating “career ladders” in mental health, articulation of coursework across disciplines or from one degree level to the next, and distance learning for providers in remote areas.
(Note other promising initiatives listed in the “Links” section on this webpage.)
References for this overview are available at the Annapolis Coalition website.