Elsevier

Clinical Psychology Review

Volume 26, Issue 5, September 2006, Pages 600-625
Clinical Psychology Review

The mental health professions: Workforce supply and demand, issues, and challenges

https://doi.org/10.1016/j.cpr.2006.05.002Get rights and content

Abstract

The U.S. mental health (MH) workforce is comprised of core disciplines: psychology, psychiatry, social work, psychiatric nursing, and marriage and family therapy. A broader group of practitioners also deserves recognition. Diverse professions provide significant services in a variety of settings, extending the de facto mental health workforce. A tally of key disciplines estimates there are 537,857 MH professionals, or 182 per 100,000 U.S. population. This article provides an overview of the need and demand for mental health services and summarizes the MH professions (e.g., training, educational credentials, workforce estimates). It also discusses a range of challenges confronting MH professionals and the need for greater understanding of the workforce and integration of services. Methodological factors that confound estimates of the magnitude of the MH workforce are reviewed.

Section snippets

Need and demand for mental health services

The necessity for an MHW stems from the need and demand for MH services. Need can be inferred, in part, from epidemiological data, such as the landmark Epidemiologic Catchment Areas (ECA) study of the prevalence of mental disorders in the United States. It estimated adult rates of psychiatric disorders (19%), addictive disorders (6%), and comorbid psychiatric and addictive disorders (3%; Regier et al., 1993). Regier et al. further estimated that 14.7% of U.S. adults annually seek services for

The mental health professions

Webster's Dictionary defines profession as:

“A calling requiring specialized knowledge and often long and intensive preparation including instruction in skills and methods as well as in the scientific, historical, or scholarly principles underlying such skills and methods, maintaining by force of organization or concerted opinion high standards of achievement and conduct, and committing its members to continued study and to a kind of work which has for its prime purpose the rendering of a public

Estimates of the mental health workforce

The term workforce, which aptly reflects the expanded roles and increased proportions of women in the health professions, has replaced “manpower” in denoting the number of professionals available to provide services. As evident in Table 1, several MH professions are comprised of majorities of women while the proportion of women is increasing in other fields. As with other professions, racial and ethnic minorities are under-represented in the MHW relative to the U.S. population.

Estimating the

Challenges to the mental health professions

The MH professions face numerous challenges. These include responding to healthcare trends, demographic trends, changing research agendas and funding instability, clarifying areas of competence needed, and defining their respective roles. The following section summarizes trends and issues that affect practice.

Demand for mental health services and professionals

Sanford's (1951) forecast that, “our society may be neither inclined nor able to support an infinite number of psychologists” can be extended to other MHPs. The end of the era when access to MH care can be determined principally by the number of practitioners who wish to provide services and generate revenue is approaching (Robiner, 1991b). Instead, the demand for services needs to be conceptualized within a larger, societal framework.

Assessing the demand for professionals is a complex task,

Future directions for the mental health professions

The combined MHW has grown dramatically in recent decades. As seen in Table 1, broadening the definition of MHP yields an estimate of 537,857 individuals, or 182 per 100,000 civilians. More traditional, narrower definitions yield estimates of approximately a quarter million MHPs in the US. Together, they provide a vast array of services, ranging from generic MH services, to highly specialized services (e.g., neuropsychology). The professions' common goals (i.e., of preventing problems,

Closing comments

The MHW is complex, composed of complementary, competing, and interdependent disciplines that are characterized by both differentiation and overlap. Whereas some fields show signs of saturation, current growth rates are likely to produce even greater supplies of MHPs. This is despite the likelihood that greater numbers of MHPs will not necessarily ensure adequate service to underserved populations. It should not be presumed that a large MHW with an excess of some types of MHPs will compensate

William N. Robiner is Associate Professor and Director of Health Psychology and of the Psychology Internship at the University of Minnesota Medical School. He earned his Ph.D. (1981) in clinical psychology at Washington University in St. Louis. He is board certified in Health Psychology by the American Board of Professional Psychology. Dr. Robiner has served as the Vice President of the Minnesota Psychological Association, and in several capacities for the Minnesota Board of Psychology. He has

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    William N. Robiner is Associate Professor and Director of Health Psychology and of the Psychology Internship at the University of Minnesota Medical School. He earned his Ph.D. (1981) in clinical psychology at Washington University in St. Louis. He is board certified in Health Psychology by the American Board of Professional Psychology. Dr. Robiner has served as the Vice President of the Minnesota Psychological Association, and in several capacities for the Minnesota Board of Psychology. He has served on the Education and Training for Credentialing Committee and on the Task Force for Master's Level Issues of the Association of State and Provincial Psychology Boards (ASPPB) and is an ASPPB Fellow. He chairs the Psychology Standards Committee of the University of Minnesota Medical Center, Fairview. He represented the American Psychological Association to the U.S. Council on Graduate Medical Education in 1990. He represented the APA Board of Scientific Affairs (BSA) with the APA Board of Educational Affairs Task Force on Workforce Analysis of Psychology Education and Training in 2003.

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