Millions of people suffer because they lack access to psychiatric care that they desperately need. The shortage of psychiatrists grows worse every day.
As a result of this anemic supply of psychiatrists, the mental health of the country’s populace is in jeopardy.
The facts paint the picture
The landmark National Institutes of Health-funded Epidemiologic Catchment Area (ECA) study, published a quarter of a century ago, found that 25% of the population suffered from a psychiatric disorder at some point in their life.1 In 1990, that translated to 62 million people; today, the number would be 82 million.
Regrettably, the findings of the ECA were not followed by necessary action—simply, ensuring sufficient psychiatrists to meet the significant mental health needs of the nation.
Signs and symptoms
Manifestations of psychiatrynemia continue unabated:
• frustration by primary care providers when they try to refer a patient to a psychiatrist—with appointments often unavailable for 4 to 6 months
• lack of access to a psychiatrist within 100 miles in many rural areas
• a large number of unfilled positions for psychiatrists in many health care settings nationwide, which has created a thriving locum tenens industry
• emergency rooms packed with psychiatric patients
• a huge patient load in community mental health centers
• a large increase in the percentage of seriously mentally ill people in jails and prisons because of a lack of psychiatrists and psychiatric beds; according to Torrey et al,2 the percentage of mentally ill patients incarcerated in the United States today is the same as it was in 1840, the pre-asylum era—shameful for a civilized country
• an escalation of cash-only practices and concierge psychiatry
• a suicide rate that continues to rise (one wonders how many of the 40,600 deaths by suicide and 650,000 suicide attempts in 20123 could have been prevented by prompt access to psychiatric care)
• a severe shortage of psychiatric subspecialists (child, geriatric, addiction, psychosomatic); their numbers need to rise by 200% to 300% to meet the needs of those populations
• an alarming overreliance on absurdly brief 15-minute med-checks as a way to cope with a large patient load.
What can be done?
To boost the number of psychiatric clinicians and provide better access to care, I offer several prescriptions in the Box.4 (Yes, polytherapy is needed.)
Curing psychiatrynemia requires bold action on multiple fronts by different stakeholders. Considering the failure to act over the past 25 years, however, prospects for a quick remission are low.
We’re past needing an ounce of prevention; we need many pounds.