Governors Health Reform Task Force

Transcription

1 Governors Health Reform Task Force Workforce Work Group Mental Health and Substance Abuse Workforce Needs Nancy Dillon Ph.D, RN, CNS-BC Minnesota Department of Human Services

2 Thanks to: Martha Aby, Children s Mental Health Division Karen Christensen, Alcohol and Drug Addiction Division (ADAD) Cindy Swan-Henderlite, ADAD Michael Landgren, AMH Dr. Alan Radke, Chief Medical Director, DHS

3 Increased Demand: Possible Factors* Increase in number of patients utilizing services Growing and aging population Mental health parity, Affordable health care act Some progress in anti-stigma efforts Psychiatric problems related to: Economic downturn Psychological toll of two wars Direct marketing to the public for psychoactive meds Ask your doctor if the addition of Abilify to your antidepressant is right for you?

4 Categories of Mental Health and Substance Abuse Workforce Advanced Practice Registered Nurses (APRN)* Behavior Analysts Certified Peer Specialists Licensed Alcohol and Drug Counselors (LADC)* Licensed Professional Counselors (LPC) Marriage and Family Therapist (LMFT)*

5 Categories (con t) Occupational Therapists (OTs) Psychiatrists* Psychologists* Registered Nurses Social Workers (esp. LICSWs)* * Connotes HRSA definition as Mental Health Professional

6 Current supply and need of psychiatrists Estimated need of 25.9 psychiatrists/100,000 population With current population of 300,000,000, this is 78,000. Current supply is ~ 48,000 total or (~ 16/100,000) Current gap = at least 30,000 Much greater supply vs. need gap for child and adolescent psychiatry (~ 7,500 total) Sources: Konrad et al, Psych Services, 60: , 2009

7 Psych Times Series The Bureau of Health Professions predicts demand for general psychiatry services will increase nearly 20% between 1995 and % increase in the need for child and adolescent services

8 Board Certified Psychiatrists Minnesota 2010 Region by mailing address 2010 Certified in Psychiatry EXCEPT Child Certified in Psychiatry and Child Psychiatry Certified in Child Psychiatry only Total Central Northeast Northwest county Metro Southeast Southwest Total

9 Advanced Practice Registered Nurses Minnesota Certified Nurse Practitioners 2792 Acute Care 55 Adult 489 Adult Acute Care 2 Adult Psychiatric/Mental Health 56 Family 1224 Family Psychiatric/Mental Health 28 Gerontological 286 Neonatal 156 Pediatric 401 Pediatric Acute Care 28 Women's Health Care 256

10 Advanced Practice Registered Nurses Minnesota Certified Clinical Nurse Specialists 514 Adult Health 220 Adult Psychiatric/Mental Health 201 Advanced Diabetes Management 8 Child Psychiatric/Mental Health 35 Community Health 7 Critical Care - Adult 19 Critical Care - Child 1 Gerontological 22 Home Health 0 Neonatal 5 Pediatric 17

11 Advanced Practice Registered Nurses National Issues Entry into Advanced Practice will by DNP as of 2015 As of 2014 Certifying body will only offer Family Psych NP for new applicants Others will keep their certification and continue to function. Due to lack of applicants for the other certifications

12 Data from Other Disciplines The plan is to gather similar data in the next 2 years.

13 Addiction Treatment Workforce Facts Workforce estimated at 200,000 Average counselor is 45 y.o. female seeing about 29 clients in a 50 hr workweek 50% are female, but 68% of clients are male Workforce contines to gray ((between y.o.) 85% or RX professionals are white but 44% of clients are non-while

14 FACTS (con t) Average LADC counselor salary $34,000 58% of all professional perceive substance abuse counselors as having a lower status than other helping professions Nearly ½ report spending of time on paperwork Majority spend less than 50% of time on counseling

15 Substance Abuse Workforce difficulties Priority of family and community, Individual concerns are considered a lesser priority (career development STIGMA Some who pursue work/credentials in substance abuse are actually shunned by their communities

16 ADAD recommendations Examine workforce development projects Target unemployed when traing dollars are available Present ATTC DVD Imagine Who You Could Save at multiple venues with panels Collaborate with training programs on standardized curriculum Bring together training programs with field to discuss training gaps

17 Recommendations (con t) Create Learning Days 90 minute webinar recorded and downloaded on ADAD website Free to all providers with 1.5 credit ours of CEU Provided by experts

18 Resources eas/wfd/overview/whatiswfd.asp 4. eas/wfd/overview/surveys.asp &subarticlenbr=141

19 Child and Adolescent Issues Those professionals with licenses are needed statewide but especially in Greater MN SW, Psychology, Marriage and Family Therapy, Nursing, Behavioral Health and Therapy, Psychiatry Require experience specific to treating and working with children with MH diagnoses Diversity of providers is also a need Have to increase #s and to retain those workers we have

20 Adult Mental Health Issues Limited pool Fewer professionals seeking these specialties Faculty limited STIGMA Salaries

21 Anticipated Supply and Demand of Psychiatrists?? Anticipated Demand Anticipated Supply? Time

22 CURRENT SHORTAGE Best data: Study by University of North Carolina commissioned by Health Resources and Services Administration (HRSA) Demonstrated shortages for all MH professionals, especially prescribers 77% of U.S. Counties have a severe shortage of prescribers, with over half their need unmet 96% of US counties have some unmet need Konrad et al, Psych Services, 60: , 2009

23 Potential Options and Concerns 1. Primary Care Physicians take on more psychiatric patients already overloaded and not doing the best job in treating people with psychiatric problems need consultation/training and support 2. Train more Psychiatrist $100,000 per residency slot (times 45,000 = $4.5B) 3. Train more APRNs and Physician Assistants in Psychiatry very little training in psychology or psychotherapy

24 Potential Options and Concerns 4. Psychologists Prescribing Authority guild war. What is adequate training in basic science medicine and clinical science medicine to prescribe?

25 Conclusions Current national shortage of MH professionals at all levels, especially prescribers All projections estimate the gap between unmet need and supply will widen substantially over the next 20 years Traditional workforce strategies alone will do little to mitigate this projected gap Training, recruitment and retention strategies must be directed at maintaining current supply and learning how to use that supply most effectively

26 Conclusions (continued) Need to do business differently Integration and collaboration models will likely be a significant strategies of the solution Telehealth will play a role Training strategies should be directed at selecting and preparing trainees who are most likely to succeed in this rapidly changing, multiple priorities environment Recruitment and retention must be focused on the new world of health care reform

27 Collaboration Models Clearly must change the way we do business Primary Care Physicians with Consulting Psychiatrist Advanced Practice Nurse Practitioners as LIPs with Collaborating Psychiatrists (practice agreements or prescriptive agreements) Psychologists with Supervising Psychiatrists Physician Assistants as psychiatrists extenders

28 Over-Arching Concerns Small pool to draw from Sites for clinical experiences/coaching in preparation for licensure Loan repayment - graduate education required Lower paying than many other specialties Tuition reimbursement to retain current Stigma of working with these populations Lack of diversity in providers A major issue in all areas