Collaborative Care: A Strategy to Tackle Mental Health Care Gap in America
TL/DR –
Nearly half of Americans will require mental health care in their lifetimes, however, there is a shortage of mental health professionals in the U.S. To meet this rising demand, states like Virginia are considering giving psychologists prescriptive power, an idea that physician experts criticize. Instead, they propose expanding telemental health services, focusing on mental health parity, increasing federal funding for additional residency slots, and promoting collaborative care to increase the number of patients psychiatrists can treat.
Shortage of Mental Health Professionals in the US
Approximately half of Americans will require mental health care in their lifetime to treat mood or substance-use disorders. As stated by the Department of Health and Human Services, 127 million Americans reside in areas with a shortage of mental health professionals.
States like Virginia are considering granting psychologists prescriptive power due to this shortage. However, physician experts caution that this is not a safe or effective solution and could potentially distract psychologists from offering essential behavioral health treatment, their area of unique expertise.
The Potential of Collaborative Care
Improvements in mental health access could come from expanding telemental health services, focusing on mental health parity, and increasing federal funding for additional residency slots. Collaborative care could dramatically increase the number of patients psychiatrists can treat.
“Solutions that work to advance access to care include high-quality, evidence-based, and measurement-based care,” said Rebecca Weintraub Brendel, MD, JD, associate professor of psychiatry at Harvard Medical School and chair of the AMA Council on Ethical and Judicial Affairs.
In a collaborative care model (PDF), the patient’s primary care physician leads a team that includes a consulting psychiatrist and potentially a psychologist, social worker, or other behavioral health professional. This model allows the psychiatrist to assist the primary care physician with diagnosis, treatment planning, and review of challenging cases, thereby increasing their capacity to treat more patients.
The Need for More Psychiatrists in the US
Without action, the gap in mental health care will only widen. The Association of American Medical Colleges predicted a shortage of about 86,000 physicians by 2036, including 44,900 nonprimary care specialty physicians like psychiatrists. Meanwhile, the need for mental health treatment is on the rise, with over 59 million U.S. adults living with a mental illness, according to the National Institutes of Health.
States like Colorado, Idaho, Illinois, Iowa, Louisiana, New Mexico, and Utah have granted some psychologists the authority to prescribe medicine. Virginia lawmakers are also considering this possibility. However, the AMA opposes the prescribing of medication by psychologists, maintaining that scope creep is a threat to patient safety and undermines physician-led, team-based care.
The Power of Collaborative Care
Collaborative care has the potential to transform mental health care. Research suggests that this model of care increases the capability of a psychiatrist to be involved in the care of more patients in collaboration with a primary care physician and a care manager—by a factor of about twentyfold.
The AMA’s Behavioral Health Integration Collaborative, in partnership with 11 major medical associations, is working to integrate behavioral health care into physician practices sustainably. Resources such as the BHI compendium (PDF), an implementation framework for practice, and strategic how-to guides on topics like substance-use disorder, suicide prevention, billing and coding, and more, are available.
Collaborative care offers high-quality treatment to mental health patients where they are, meeting their needs effectively. A majority of those with mental health conditions are treated in primary care settings by medical professionals and clinical practitioners, such as nurse practitioners and physician assistants.
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