Shortage Of Mental Health Providers Research Articles

Advancing Behavioral Health Equity Through Telehealth and Remote Training of Newly Certified Psychiatric-Mental Health Nurse Practitioners.

Rural communities are disproportionately impacted by acute shortages of mental health providers. This problem, combined with complex behavioral health conditions, elicited the need for a university-based, remote telepsychiatric traineeship for newly board certified psychiatric-mental health nurse practitioners (PMHNPs). The Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program was developed to advance behavioral health equity by increasing state-wide access to care, removing geographical barriers, and enhancing PMHNP workforce readiness by strengthening trainees' ability to manage complex behavioral health conditions. In a southeastern state over a period of 3 years, six PMHNPs cumulatively provided behavioral health services to 1,195 patients, managed >118 diagnoses, and completed 3,535 visits, with 95.6% of visits comprising provision of care to patients residing in rural areas. Care was provided through the implementation of a collaborative-interdisciplinary-care model provided by route of telehealth and comprising a partnership between PMHNPs and patients' primary care providers. The training program enhanced providers' clinical proficiency, improved patient outcomes, and increased the number of skilled providers trained to manage patients with complex behavioral health conditions. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

The evidence-based COPE program: Reducing the time between diagnosing and treating depression and anxiety in youth.

The soaring prevalence of depression and anxiety in children, teenagers, and young adults is now a public health epidemic, yet access to timely evidence-based mental health treatment is often lacking due to a severe shortage of mental health providers. This article provides an overview of the current state of depression and anxiety in children and adolescents as well as first-line evidence-based treatment. The Creating Opportunities for Personal Empowerment (COPE) program, a cognitive-behavioral skills-building intervention, is highlighted as an evidence-based intervention for timely treatment that can be delivered by NPs, physicians, and physician associates/assistants in primary care settings, school-based health centers, and chronic care clinics with reimbursement as well as in schools and universities as a preventive mental health intervention.

Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges.

Children and adolescents often do not receive mental healthcare when they need it. By 2021, the complex impact of the COVID-19 pandemic, structural racism, inequality in access to healthcare, and a growing shortage of mental health providers led to a national emergency in child and adolescent mental health in the United States. The need for effective, accessible treatment is more pressing than ever. Interdisciplinary, team-based pediatric integrated mental healthcare has been shown to be efficacious, accessible, and cost-effective. In response to the youth mental health crisis, Rady Children's Hospital-San Diego's Transforming Mental Health Initiative aimed to increase early identification of mental illness and improve access to effective treatment for children and adolescents. A stakeholder engagement process was established with affiliated pediatric clinics, community mental health organizations, and existing pediatric integrated care programs, leading to the development of the Primary Care Mental Health Integration program and drawing from established models of integrated care: Primary Care Behavioral Health and Collaborative Care. As of 2023, the Primary Care Mental Health Integration program established integrated care teams in 10 primary care clinics across San Diego and Riverside counties in California. Measurement-based care has been implemented and preliminary results indicate that patient response to therapy has resulted in a 44% reduction in anxiety symptoms and a 62% decrease in depression symptoms. The program works toward fiscal sustainability via fee-for-service reimbursement and more comprehensive payor contracts. The impact on patients, primary care provider satisfaction, measurement-based care, funding strategies, as well as challenges faced and changes made will be discussed using the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Preliminary results suggest that the Primary Care Mental Health Integration is a highly collaborative integrated care model that identifies the needs of children and adolescents and delivers brief, evidence informed treatment. The successful integration of this model into 10 primary care clinics over 3 years has laid the groundwork for future program expansion. This model of care can play a role addressing youth mental health and increasing access to care. Challenges, successes, and lessons learned will be reviewed.

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Challenges and Ethical Implications in Rural Community Mental Health: The Role of Mental Health Providers.

This manuscript reviews the unique challenges, barriers, and ethical implications of providing mental health services in rural and underserved areas. Community mental health centers in rural areas are often underserved due to shortages of mental health providers and limited resources. Individuals living in rural areas are at increased risk of developing mental health condition with limited access to mental health clinicians and healthcare facilities. These access to care issues are often exacerbated by geographical barriers as well as social, cultural, and economic challenges. A rural mental health professional may encounter several barriers to providing adequate care to individuals living in rural areas. For example, limited services and resources, geographic barriers, conflict between professional guidelines and community values, managing dual relationships, and challenges pertaining to confidentiality and privacy are several barriers to providing adequate care in rural areas. We will briefly summarize the primary ethical domains that are especially influenced by rural culture and the complex responsibilities of mental health providers in rural areas including barriers to care, crisis intervention, confidentiality, multiple relationships/dual roles, limits of competency, and rural mental healthcare practice implications.

Mental Health Excellence in Schools Act reintroduced

U.S. Senators Kevin Cramer (R‐N.D.), Jeanne Shaheen (D‐N.H.), and Todd Young (R‐Ind.) have reintroduced the Mental Health Excellence in Schools Act legislation to address the shortage of mental health providers in schools. Specifically, the bill would boost the pipeline of individ‐uals training to become school psychologists, counselors and social workers by authorizing the U.S. Department of Education to help cover students’ costs at certain graduate programs via partnerships with eligible academic institutions, according to a news release from Cramer's office. “Like so many fields across the state, there simply aren't enough school‐based mental health professionals. Ensuring our kids’ well‐being and academic success should be our first priority,” said Cramer. “Our bill will alleviate the financial strain of earning a graduate degree by encouraging more practitioners to work in schools across the state.” The National Association of School Psychologists recommends a ratio of one school psychologist per 500 students. However, the national average ratio is estimated to be approximately one school psychologist per 1,200 students, with wide variation among states. The senators’ legislation looks to bridge this gap. It is endorsed by the National Association of School Psychologists, the American School Counselor Association, the School Social Work Association of America, the American Counseling Association, and the American Psychological Association. Reps. Brian Fitzpatrick (R‐Pa.) and Jared Golden (D‐Maine) lead the companion bill in the House.

Wellbeing Wednesdays: a pilot trial of acceptance and commitment therapy embedded in a freshman seminar

Abstract University students face vast mental health challenges, and both attitudinal and structural barriers to seeking care. Embedding interventions in college courses is one solution. Acceptance and commitment therapy (ACT) is an ideal candidate intervention given its emphasis on values, context, and skill building from a transdiagnostic perspective. This study embedded a brief ACT intervention in a required freshman seminar that was delivered by trained but unlicensed graduate students. In two class sessions of the freshman seminar taught by the same instructor, one session was randomly assigned to receive the course as usual, and one session received the ACT intervention. ACT content was delivered to all students in the intervention course on five consecutive weekly class periods. Students in both classes who chose to participate in the study completed assessments before and after the intervention and at follow-up. There were no significant changes with tests that were run, including non-parametric tests given the small sample sizes. Descriptively, the intervention group had slight improvements in wellbeing and mindfulness and decreases in distress, and the control group had worsened wellbeing, mindfulness and distress. A moderate portion of intervention group students enjoyed the intervention and indicated use of ACT skills, particularly mindfulness. Results suggest that this classroom-based intervention was feasible and acceptable, but further study should occur given small sample sizes. Future work should continue course-based ACT interventions, and should also explore potential applications of student training to deliver interventions given the shortage of mental health providers on college campuses. Key learning aims (1) Can acceptance and commitment therapy content and skills be integrated into an existing freshman seminar curriculum? (2) Can acceptance and commitment therapy improve wellbeing and decrease distress amongst college students? (3) How will students engage with and practise acceptance and commitment therapy skills outside of the context of session delivery?

Behavioral Digital Therapeutics in Gastrointestinal Conditions: Where Are We Now and Where Should We Go?

Behavioral digital therapeutics represents a diverse range of health technology tools that can offer beneficial options for patients with gastrointestinal disorders, particularly with the shortage of mental health providers. Challenges to the uptake of behavioral digital interventions exist and can be addressed with mobile device applications, improved interoperability of technology platforms, and flexible integration into clinical practice.

Addressing the Need for Training More School Psychologists to Serve Toddlers and Preschoolers with Autism Spectrum Disorders.

The prevalence of autism spectrum disorder (ASD) has risen significantly in the past two decades. Unfortunately, there is a shortage of mental health providers who have specialized training in delivering evidenced-based services to this population. Early intensive behavioral intervention (EIBI) is an evidenced-based treatment recommended for toddlers with ASD, and school psychologists are uniquely positioned to help children with ASD receive it. However, many school psychologists do not receive adequate training in this subspecialty. This paper makes recommendations to school psychology training programs about how to add or improve training in this subspecialty based on the results of an Office of Special Education Programs grant-funded ASD training program which involved collaboration between a NASP-approved and APA-accredited school psychology training program and a community-based early intensive behavioral intervention (EIBI) clinic. The grant supported development of an interdisciplinary didactic and clinical training program to increase the ASD knowledge, skills, and competencies of school psychology graduate students, with the broader goals of developing a replicable training model and increasing the workforce of trained providers for this underserved population. Fifteen graduate students completed the training program. Outcomes related to trainee knowledge, skills, and competencies, trainee satisfaction, and lessons learned over time analyzed within a logic model that guided the project’s development and execution can be informative for other school psychology programs undertaking training in this subspecialty.

Artificial Intelligence and Chatbots in Psychiatry.

The utilization of artificial intelligence (AI) in psychiatry has risen over the past several years to meet the growing need for improved access to mental health solutions. Additionally, shortages of mental health providers during the COVID-19 pandemic have continued to exacerbate the burden of mental illness worldwide. AI applications already in existence include those enabled to assist with psychiatric diagnoses, symptom tracking, disease course prediction, and psychoeducation. Modalities of AI mental health care delivery include availability through the internet, smartphone applications, and digital gaming. Here we review emerging AI-based interventions in the form of chat and therapy bots, specifically conversational applications that teach the user emotional coping mechanisms and provide support for people with communication difficulties, computer generated images of faces that form the basis of avatar therapy, and intelligent animal-like robots with new advances in digital psychiatry. We discuss the implications of incorporating AI chatbots into clinical practice and offer perspectives on how these AI-based interventions will further impact the field of psychiatry.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11126-022-09973-8.

Developing a statewide network of coaches to support youth access to evidence-based practices.

Although youth face many barriers in accessing effective mental health care, schools are one setting where they can more easily receive treatment. Research shows that training and supports are needed for school mental health professionals to provide effective care. Coaching, which involves in vivo support for school mental health professionals, is one helpful strategy. We describe the process of recruiting and training community clinicians to become coaches. The Transforming Research into Action to Improve the Lives of Students (TRAILS) program successfully recruited and trained a network of 86 community clinicians to become coaches. Clinicians attended two day-long trainings and participated in 12 weeks of personalized consultation. Clients to whom these clinicians provided CBT showed significant symptom improvement. Clinicians also reported that they increased their knowledge and use of core CBT strategies, including psychoeducation, exposure, and behavioral activation. Community mental health professionals who are trained as coaches can address gaps in access to care for youth. We demonstrate one strategy for strengthening and leveraging clinicians' knowledge of CBT to support the school-based implementation of CBT.

VA Problem-Solving Training During COVID-19 for Clinicians of Patients With Complex Comorbidities

To address the shortage of mental health providers in geriatrics, VA has implemented clinician training in a VA Problem Solving Training (PST) protocol adapted to the needs of mostly older patients with complex comorbidities. This presentation will summarize PST implementation adaptations during COVID-19, and compare Veteran treatment outcomes before (2019) and during COVID-19 (2020). Sixty-one clinicians attended a workshop and small-group consultation for two training cases. Consultants provided ongoing feedback to program leadership about pandemic-related implementation challenges. Program adaptations during COVID-19 addressed challenges related to delivering treatment by telephone, video, or in-person and recruitment barriers. Veterans in both cohorts (N = 122) had significant reductions in mental health symptoms from baseline to posttreatment in paired t-test comparisons (ps < .01). Flexibilities afforded to clinicians in the training during the pandemic did not diminish the effectiveness of the intervention, thus supporting continued implementation of the training program with added flexibility.

Evaluation of an Advanced Topics Workshop in Geropsychology: The Value of Depth in Training

The Geriatric Scholars Program- Psychology Track (GSP-P) was implemented to address the dire shortage of mental health providers with geriatrics expertise within the VA, a large integrated healthcare system. One hundred and five psychologists participated in the GSP-P introductory geropsychology competencies course. Though they exhibited significant improvements in confidence, knowledge, and skills across geropsychology domains, increased depth (in addition to breadth) of training is needed. In 2019, GSP-P implemented an advanced workshop for graduates of the introductory course. Twenty-one psychologists participated in the workshop, which included 3.5 days of expert-led seminars followed by completion of an individualized learning plan over six months. Results from our evaluation indicated significant improvements in four of five geropsychology domains on the Pikes Peak Geropsychology Knowledge and Skill Assessment Tool. Our findings demonstrate continued enhancement of geropsychology competencies through advanced coursework is feasible and improves depth of training, particularly when combined with individualized learning plans.

Nursing, education partnership to train Montana MH providers

A collaboration between Montana State University's College of Nursing, the Montana Office of Rural Health and Area Education Center, MSU Billings and the Billings Clinic aims to help address a shortage of mental health providers in eastern Montana, a news release from Montana State University stated Aug. 9. The partnership, known as Montana Behavioral Health Workforce Education and Training — Eastern and North Central Montana, or BHWET‐East, will provide training opportunities and financial support for students working to become psychiatric mental health nurse practitioners, mental health counselors or psychiatrists. The work is supported by a four‐year, $1.8 million grant from the U.S. Health Resources and Services Administration. The partnership's goal is to increase access to high‐quality and culturally appropriate behavioral health services in 38 of Montana's counties in eastern and north central Montana. “Supporting behavioral health professional trainees through their academic careers, providing comprehensive integrated behavioral health education, and creating team‐based training opportunities in our communities is a successful model for growing Montana's health care workforce,” said Kailyn Mock, director of the Montana Office of Rural Health and Area Health Education Center at MSU.

The collaborative care model: Improving access to children's mental health care.

Current accessibility to child and adolescent mental health services is negatively affected by the shortage of mental health providers. The primary care provider or pediatrician is in a key position to identify behavioral health concerns, coordinate services, and provide treatment to the patient. This project aimed to improve access to children's mental health care by creating and implementing an educational course on the collaborative care model (CoCM), a model of integrated care that embeds mental health professionals into the primary care setting. Pre- and post-surveys were embedded in the online CoCMcourse to track course completion, identify clinical staff knowledge, and identify clinical staff interest in implementing the CoCMin practice. Following project implementation, clinical staffs' responses from the pre-and post-surveys represented an increase in knowledge and interest in implementing the CoCMin practice after taking the online course. This project suggests further exploration of funding and planning to implement a pilot of the CoCMin a primary care practice setting.

Validity of Psychiatric Evaluation of Asylum Seekers through Telephone

The goal of the psychiatric assessment of asylum seekers is to evaluate the asylum seeker's mental health and credibility. The shortage of mental health providers trained in this particular type of evaluation makes in-person evaluation not always feasible. Telephonic interview has been occasionally utilized to fill this void. The validity of such evaluations in assessing credibility has yet to be fully established. In the case of telephonic interviews, evaluators are limited with no access to facial or body language cues that can indicate deception or honesty. We will present a case of a client evaluated via telephone that was deemed credible and eventually released to pursue asylum in the US. Assessment of credibility relied solely on cues obtained from the client's narrative, reported symptoms, and their style of interaction with the evaluator. We will highlight the findings from the client's interview that supported credibility in the case and discuss the challenges of assessing asylum seeker's credibility via telephonic interview. Telephonic evaluation of credibility can be considered a valid method despite major challenges, but psychiatric evaluators should be aware of the limitations of telephonic evaluations given the high possibility of secondary gains and deception.

Banbury Forum Consensus Statement on the Path Forward for Digital Mental Health Treatment.

A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs.

Improving Geropsychology Competencies of Veterans Affairs Psychologists.

Older adults are more likely to seek mental health care through integrated care settings such as primary care. Currently, there exists a significant shortage of mental health providers trained in geropsychology and integrated care competencies. To address this need within the Veterans Health Administration, a national workforce development program was extended to include psychologists, which is called the Geriatric Scholars Program-Psychology Track (GSP-P). The GSP-P has two overarching educational program aims: (1) to improve geropsychology competencies of practicing VA psychologists, particularly those working within integrated settings (e.g., primary care) and (2) enrich psychologists' abilities to enact change in their clinical settings. Ninety-eight VA clinicians participated in the GSP-P, which includes a multi-day in-person course, from 2014 to 2018. Participants completed measures assessing confidence and self-reported knowledge in geropsychology and integrated care competencies pre-course and 3-months post-completion. Two-weeks post-course participants responded to open-ended survey questions regarding their perceptions of the course and potential applications of learning. Significant improvements in confidence in and knowledge of geropsychology and integrated care competencies emerged from pre-course to 3-months post-completion. Qualitative findings demonstrated that participants valued the face-to-face, integrated multimodal educational program. Findings provided insights regarding clinicians' planned application of the knowledge acquired, such as modifying treatments for older patients. Specialized workforce programs such as the GSP-P have a significant, positive impact on the care of older Veterans.

Suicide prevention efforts in the United States and their effectiveness.

Purpose of reviewSuicide is a serious public health problem in the United States, and suicide rates have been increasing for more than a decade. Rural areas are more impacted than urban areas, reinforcing that social, cultural, and economic factors contribute to risk. This article reviews recent work about these contributors to suicide and how they may inform prevention efforts.Recent findingsCurrent research has shown that suicide is more than a mental health problem with a psychiatric or medical solution. Universal screening and referral by gatekeepers target a large group with a low baseline risk, and there are few treatments proven to reduce death by suicide, as well as a severe shortage of mental health providers in the United States to provide them. Instead, suicide prevention polices can target various other factors that contribute to elevated suicide risk at the population level, including reducing socioeconomic deprivation and access to firearms, both of which are often higher in rural areas. Internet-based interventions also hold promise as they are highly scalable, accessible almost anywhere, and often anonymous.SummaryUnderstanding factors that increase suicide risk guide development of evidence-based policies targeted at high-risk groups. Population-level interventions should be developed in collaboration with the target audience for cultural appropriateness.

Pilot Community Mental Health Awareness Campaign Improves Service Coverage in India.

Low community awareness of mental health problems negatively impacts treatment-seeking for such problems. Despite a shortage of mental health providers, there is scope to improve coverage of mental health services in India. In this study, we examined the impact of a multi-statecommunity-based awareness campaign on knowledge, attitude, treatment-seeking behavior and acceptability. Campaign activities included educational materials, public meetings, musical announcements, quizzes, and street plays, followed by a mental health screening camp. A rapid, real-world evaluation was conductedusing post-intervention surveys (n = 693), field notes and telephonic interviews in five states. The campaign, implemented as a public-private partnership between government service providers and community-based organizations, reached ~ 3000 people in 20 new locations across five states. As a result of the campaign, 1,176 persons sought treatment servicesfor mental disorders and 66% received a preliminary diagnosis. Collectively, campaign activities were the first time that ~ 75% of participants reported learning about mental health problems. Participants expressed knowledge that mental disorders are treatable, listed common symptoms and location of available mental health services and attitudes supporting people with mental health problems. The campaign enabled improved coverage for mental health services, potentially by enhancing knowledge, attitude and treatment-seeking behavior. Future research may develop a quasi-experimental evaluation of the current campaign methodology.