Shortage Of Psychiatrists Research Articles

Perspectives on the Practice of Collaborative Care: Topical Themes and Future Directions From the Lens of a Collaborative Care Child Psychiatrist.

The increasing shortage of psychiatrists in the workforce is a well-documented and alarming trend. In light of this workforce shortage, psychiatrists bear a professional and ethical responsibility to identify strategies to increase access to mental health treatment and thereby reduce the impact of the psychiatrist shortage on patients and on the greater health system. One such strategy is the collaborative care model (CoCM), which has demonstrated efficacy in the mental health treatment of both pediatric and adult populations. In this article, the CoCM is presented as one effective strategy to address the behavioral workforce shortage. Current themes observed from the clinical practice of psychiatric collaborative care in a pediatric collaborative care setting are discussed with contemplation of future directions.

Migration in psychiatry trainees in the United Kingdom: results from a cross-sectional survey

Background The shortage of psychiatrists in the UK is a pressing issue, yet the factors influencing the mobility of psychiatric trainees within the country remain poorly understood. Objective This study aimed to investigate the migratory patterns of psychiatry trainees in the UK, examining both their past experiences and future intentions. Methods A cross-sectional survey was conducted as part of the Brain Drain study, directed by the European Federation of Psychiatric Trainees. Results A total of 166 responses were collected. 37% of the surveyed trainees were born overseas. 33% reported short-mobility experiences abroad for 3 to 12 months, and 29% for over 1 year. While academia emerged as the biggest ‘pull’ factor for trainees who had migrated to the UK, amongst all trainees personal factors were most important. 69% of trainees had ‘ever’ considered leaving the UK, and this was associated with previous short-mobility experience. Only 13%, however, were currently planning toward emigration. Conclusions These findings present the UK as a major destination for overseas psychiatry trainees. Previous mobility experiences may influence psychiatry trainees in the UK on future migratory decisions.

Tele-Psychiatry to address Severe Persistent Mental Illness in Rural Communities: An Economic and Break-Even Analysis

Background: People living in rural communities experience significant barriers accessing mental health care, including a shortage of psychiatrists and other behavioral health specialists. Telemedicine has the ability to improve access for these populations by allowing psychiatrists in urban settings to treat rural patients over video. However, start-up costs may hinder implementation of new tele-psychiatry programs. Materials and Methods: We created a model to estimate the point at which tele-psychiatry would financially break even based on estimates of improved access to outpatient care for people with schizophrenia and bipolar disorder. We demonstrate how our model can be used with an example of a tele-psychiatry program serving five rural Indian Health Services clinics in California. Results: When reimbursement for psychiatric services provided over telemedicine is relatively low compared to reimbursement for hospitalization visits, changes in the ratio of hospitalizations to telemedicine visits have very little impact on required hospitalization improvement. Conclusions: Tele-psychiatry programs are likely to break even within the first three years when providing psychiatry services to a rural community with a scarcity of mental health services. Our findings are important because they indicate that the cost of improving access to tele-psychiatry services is likely low compared to the potential cost savings associated with reduced hospitalizations for people with severe persistent mental illness.

The changing psychiatry workforce in Australia: Still lacking in rural and remote regions.

There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.

Workforce migration and brain drain – A nationwide cross-sectional survey of early career psychiatrists in Nigeria

Abstract Background Nigeria’s shortage of psychiatrists is exacerbated due to health worker migration. Aim This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria. Methods We conducted a cross-sectional survey covering Nigeria’s six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29. Results Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had ‘ever’ considered migration, 69.2% were planning to leave ‘now’, and 52.9% had taken ‘practical migration steps’. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05–4.88) predicted planning to leave ‘now’, while being in a relationship (OR = 3.46, 95%CI = 1.06–11.30) predicted taking ‘practical migration steps’. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested. Conclusions Systemic changes to address psychiatrists’ migration from Nigeria are needed.

Acoustic and Text Features Analysis for Adult ADHD Screening: A Data-Driven Approach Utilizing DIVA Interview.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder commonly seen in childhood that leads to behavioural changes in social development and communication patterns, often continues into undiagnosed adulthood due to a global shortage of psychiatrists, resulting in delayed diagnoses with lasting consequences on individual's well-being and the societal impact. Recently, machine learning methodologies have been incorporated into healthcare systems to facilitate the diagnosis and enhance the potential prediction of treatment outcomes for mental health conditions. In ADHD detection, the previous research focused on utilizing functional magnetic resonance imaging (fMRI) or Electroencephalography (EEG) signals, which require costly equipment and trained personnel for data collection. In recent years, speech and text modalities have garnered increasing attention due to their cost-effectiveness and non-wearable sensing in data collection. In this research, conducted in collaboration with the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, we gathered audio data from both ADHD patients and normal controls based on the clinically popular Diagnostic Interview for ADHD in adults (DIVA). Subsequently, we transformed the speech data into text modalities through the utilization of the Google Cloud Speech API. We extracted both acoustic and text features from the data, encompassing traditional acoustic features (e.g., MFCC), specialized feature sets (e.g., eGeMAPS), as well as deep-learned linguistic and semantic features derived from pre-trained deep learning models. These features are employed in conjunction with a support vector machine for ADHD classification, yielding promising outcomes in the utilization of audio and text data for effective adult ADHD screening. Clinical impact: This research introduces a transformative approach in ADHD diagnosis, employing speech and text analysis to facilitate early and more accessible detection, particularly beneficial in areas with limited psychiatric resources. Clinical and Translational Impact Statement: The successful application of machine learning techniques in analyzing audio and text data for ADHD screening represents a significant advancement in mental health diagnostics, paving the way for its integration into clinical settings and potentially improving patient outcomes on a broader scale.

Psychotherapy training in postgraduate psychiatry training in Nigeria - Are we doing enough?

Nigeria, with an estimated 40 million people living with mental disorders, faces a critical shortage of psychiatrists to address the significant burden. Despite psychotherapy being integral to psychiatric training, it lacks structure, consistency and adequate supervision. This is alarming, particularly given the substantial demand for specialized psychotherapeutic support among those with mental illness. A cross-sectional study utilised an online survey targeting early career psychiatrists recruited from the Early Career Psychiatrists section of the Association of Psychiatrists in Nigeria. The questionnaire was distributed to 252 early career psychiatrists across Nigeria, with a 42.9% response rate, of which 50% were male, with 73.2% trainees and 26.8% early career psychiatrists. While 52.8% had received some psychotherapy training, only 2.8% were qualified psychotherapists. Notably, only 27.6% of those with psychotherapy training had over 100 hours of training. Factors such as receiving psychotherapy training during postgraduate training and having supervised psychotherapy training were found significant for having independent psychotherapy training. There is little emphasis on psychotherapy training in the postgraduate training in Nigeria. Those who had full training in psychotherapy were self-sponsored. Structured, supervised and mandatory psychotherapy within psychiatry training curriculum is recommended.

A retrospective comparison of pharmacist and psychiatrist‐led medication management clinics in an outpatient setting

AbstractIntroductionThe need for mental health care continues to outpace available providers in the United States. Clinical pharmacists trained in mental health are an available resource for mental health care delivery. To our knowledge, studies have not compared patient outcomes between pharmacist and psychiatrist medication management clinics. The aim of this study is to assess if a significant difference exists between pharmacist and psychiatrist medication management clinics with regard to escalation of care, evidence‐based medication prescribing, and medication adherence.MethodsThis study was a retrospective chart review of patients who received an outpatient prescription from a mental health provider between January 1, 2017 to July 1, 2018 at an urban Veterans Affairs (VA) medical center. The primary outcome was a composite of hospital admissions and emergency department visits due to a psychiatric or substance use condition. Secondary outcomes assessed in this study included treatment aspects related to escalation of care, medication prescribing, and adherence to treatment.ResultsIn this study, 111 patients were included in the pharmacist group and 110 patients in the psychiatrist group with patients matched based on diagnoses. The primary outcome was similar between groups (p = 0.646). The pharmacist clinic had a significantly higher medication possession ratio (p < 0.00001) and laboratory monitoring (p = 0.0015). The psychiatrist clinic had a significantly higher ratio of clinic appointments attended (p = 0.0025).DiscussionPsychiatric pharmacists may serve as an additional resource to provide evidence‐based medication management and improve medication adherence without the need for escalation of care. Increased utilization of psychiatric pharmacists can help improve access to quality care with the psychiatrist shortage.

Propensity of US Military Personnel to Seek Mental Health Care When Community Psychiatric Capacity Changes

Understanding how the active duty military population's mental health care use is associated with local military and civilian psychiatrist capacity is critical in designing the optimal allocation of mental health resources from both sectors to improve the mental health of military personnel. To evaluate whether the probability of mental health care visits by military personnel changes when psychiatrist capacity changes in their communities, when capacity is measured separately for military treatment facilities and civilian sectors. This cohort study of active duty US military service members between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census. Data were collected and analyzed from June 2022 to July 2023. The main outcome was the probability of making at least 1 mental health care visit in a given quarter at military treatment facilities and in civilian settings. Linear probability models with 2-dimensional fixed effects at individual and community levels were implemented to estimate changes in individual outcomes when community psychiatrist capacity changed. This study includes 1 958 421 US service members (83% men; mean [SD] age at baseline, 28.4 [8.0] years). Thirteen percent of service members did not have military treatment facility psychiatrists available within a 30-minute driving time, and 66% lived in communities with a psychiatrist shortage (<1 psychiatrist per 20 000 relevant population), while 9% lived in communities with high (>3 psychiatrists per 20 000 relevant population) military treatment facility psychiatrist capacity. Five percent of service members lived in communities with no civilian psychiatrists within a 30-minute driving time, while 66% lived in communities with high civilian psychiatrist capacity. The mean quarterly mental health care visit rates to military treatment facilities and civilian settings were 7% and 2%, respectively. The probability of a mental health care visit to a military treatment facility increased by 0.95 percentage points (95% CI, 0.79-1.10 percentage points; equivalent to 14%) when the individual experienced a change in military treatment facility capacity from no psychiatrist to high capacity. The probability of a mental health care visit to a civilian setting increased by 0.57 percentage points (95% CI, 0.38-0.76 percentage points; equivalent to 32%) when civilian capacity changed from no psychiatrist to high capacity. The magnitude of responses to military treatment facility capacity changes remained similar in communities that already had high civilian capacity. This cohort study of the US military population suggests that active duty military personnel rely largely on military treatment facilities for their mental health care and that there are meaningful responses to military treatment facility psychiatrist capacity changes even in communities with high civilian psychiatric capacity. Realigning military treatment facility psychiatrists across communities with shortages and high-capacity military treatment facilities, as well as addressing nongeographical barriers in the civilian sector, remain critical to achieve the optimal balance between military and civilian care provision.

A BRIGHTER TOMORROW: PRIORITIZING CHILD AND ADOLESCENT MENTAL HEALTH IN PAKISTAN

ABSTRACT There is a crucial need for recognising children and adolescents as an integral part of society, especially in a nation with a significant youth demographic. Pakistan's 280 million population, includes 100 million youth, and require urgent investment in mental well-being, particularly addressing psychiatric disorders like depression and anxiety, especially for women, whose welfare is often neglected.At present, Pakistan has an alarming shortage of psychiatrists, with one of the lowest numbers in the WHO Eastern Mediterranean Region. Despite existing policies, there is a clear lack of tailored laws addressing the specific needs of children and adolescents. The efforts made by organisations like the College of Physicians and Surgeons Pakistan and Sindh Mental Health Authority are acknowledged, but nonetheless, there is a pressing need for a robust policy. The progress made by neighbouring countries in formulating and implementing mental health policies, particularly emphasising the importance of mental health within a holistic healthcare system, is noteworthy.An emphasis has been laid on the urgency of the situation, advocating for prompt action, comprehensive policies, and unwavering commitment. The proposed future directions include a call to actively prioritise the mental well-being of youth to shape a brighter future for Pakistan.

The role of trauma services in intentional self-harm at a regional level 1 trauma center

IntroductionSuicide claims many lives globally, each year. For every person that dies by suicide, multitudes more attempt it. A national shortage of psychiatrists may prevent many individuals from receiving timely mental health care. For many individuals, the primary entry point into the healthcare system is through the emergency department. The trauma service frequently treats patients with severe self-inflicted injuries and for many this is not the first time. This represents an opportunity for intervention to disrupt the cycle and prevent future death. MethodsWe conducted a retrospective chart review of all patients with self-inflicted injuries, admitted to the trauma surgery service between 2012 and 2021. All patients above 10 years old were included. ResultsFour hundred forty-one patients were admitted due to self-injurious behavior in the period under study. The majority of patients (71.9%) had a pre-existing mental health disorder. Fifty six patients suffered fatal injuries; the majority were White (78.6%), males (80.3%), and were inflicted by gunshot (71.4%). Nearly one third of patients with self-inflicted injuries had a history of self-injurious behavior with the average number of attempts being 2.7 (SD: ±3.8). ConclusionsWe need interdisciplinary and innovative solutions for this public health crisis. Perhaps telemedicine can be used to buttress the access to adequate mental health care. More research needs to be done to better identify the barriers individuals encounter in accessing mental health care, both pre- and post-crisis. The goal is that, by identifying the gaps, we can collaboratively bridge them to prevent a preventable death.

Study finds scant mental health care coverage for older adults

Amid heightened demand for mental health care, a new study finds that nearly two‐thirds of Medicare Advantage psychiatrist networks contain less than 25% of all psychiatrists in a given service area, according to new research published July 6 in Health Affairs. “This means that many people who have coverage through Medicare Advantage plans may not actually have access to psychiatrists, given how few are considered in‐network,” lead author Jane Zhu, M.D., assistant professor of medicine (general internal medicine and geriatrics) in the School of Medicine at Oregon Health &amp; Science University, stated in an OHSU news release. Medicare Advantage, which covers 28 million Americans through private insurance plans backed by Medicare, has an even narrower network of psychiatrists available to patients than those covered by Medicaid managed care or by insurance plans in the Affordable Care Act. Insurance plans often contract with sets of providers — considered “in‐network” — to deliver services to their enrollees. The researchers built a nationwide data set of health plan networks, their service areas and their participating providers in 2019. The new study is the latest in a series of findings highlighting a lack of coverage and access to mental health care nationwide. Provider networks are one important lever of access, and Zhu noted that the new study likely understates the problem. That's because even if a psychiatrist is technically in‐network, Zhu said an overall national shortage of psychiatrists means that many are fully booked already and aren't accepting new patients. She said this may translate to higher out‐of‐pocket costs, delays in care or foregone treatment. For Zhu, these findings suggest that it's necessary for insurers to incentivize more psychiatrists and mental health professionals to accept health insurance, or to expand coverage of services delivered by other health care professionals such as psychologists, counselors or primary care physicians who provide mental health care.

Psychiatry for all: enhancing medical practice and patient outcomes through psychiatric education for all doctors

This article emphasizes the importance of studying psychiatry for all medical professionals. Psychiatry deals with mental, emotional, and behavioural disorders, and a strong understanding of the field leads to more holistic, effective, and empathetic patient care. Key reasons for doctors to study psychiatry include adapting a biopsychosocial model of care, early identification and intervention for psychiatric disorders, improved health outcomes, better communication skills, combating stigma surrounding mental health, multidisciplinary collaboration, personal growth and self-care, and a more comprehensive approach to chronic illness management. Integrating psychiatry into medical education prepares doctors for the challenges they will face in their careers, ultimately improving the quality of patient care. The practice of offering internships in psychiatry, as seen in countries like UK and Australia, should be encouraged globally to create a cohort of doctors knowledgeable in the basics of psychiatry, ultimately reducing the impact of a shortage of psychiatrists and improving overall healthcare.

Study finds training in ASD and ID at psychiatry programs deficient

The journal Autism recently published a study about the quality of training that psychiatric program residents receive in autism spectrum disorder and intellectual disability, as measured by lectures and patient contact. Psychiatrists are one of the care professionals with whom students with autism and ID frequently interact. However, the study concludes that there is a shortage of psychiatrists to treat such conditions — and a lack of adequate training/education on these conditions in many psychiatric residency programs.

Medicaid rates to psychiatrists lag, with wide variation among states

Medicaid payment rates for psychiatric services continue to lag behind comparable Medicare reimbursement in most states, with wide variation in rates across the country, a newly published study reported. While low payment rates are thought to contribute to a shortage of psychiatrists treating low‐income patients, the study's researchers suggest that simply increasing reimbursement rates might not be enough to shore up the workforce.

APA’s Government, Policy, and Advocacy Update (April 2023)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (April 2023)Search for more papers by this authorPublished Online:23 Mar 2023https://doi.org/10.1176/appi.pn.2023.04.4.16APA Expresses Support for SAMHSA Expanding Access To Outpatient Treatment ProgramsThe Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed a rule to make permanent some regulatory flexibilities for opioid treatment programs to provide patients with extended take-home doses of methadone. APA provided comments on the rule, supporting several of its provisions while also offering recommendations.“Methadone is a particularly effective form of MOUD [medications for opioid use disorder],” APA’s letter stated. “Unfortunately, the regulations governing methadone access have created significant barriers to care for many of those who need and want treatment.” The flexibilities for prescribing methadone that SAMHSA has allowed during the COVID-19 public health emergency “served as a starting point for reimagining methadone access in this time of vital need,” the letter continued.Specifically, APA expressed support for SAMHSA’s efforts to change regulatory language to reduce stigma toward people who use drugs or have an opioid use disorder (OUD); SAMHSA’s collaboration with the Drug Enforcement Administration to facilitate mobile medication units and increase methadone treatment for underserved populations; and SAMHSA’s proposal to eliminate the requirement that patients must have a one-year history of OUD to qualify for methadone treatment.Further, APA questioned some provisions, including limiting methadone treatment to people with moderate to severe OUD and excluding those with mild OUD. In the letter, APA also suggested that SAMHSA provide guidance on methods to ensure quality counseling services through, or coordinated with, the opioid treatment program.APA’s Letter to SAMHSA in Response to SAMHSA’s Proposed Rule on Methadone Access APA, AMA Urge CMS to Finalize Prior Authorization ReformsIn a letter to Chiquita Brooks-LaSure, M.P.P., the administrator of the Centers for Medicare and Medicaid Services (CMS), the AMA, APA, and nearly 120 organizations representing physicians across the country expressed their strong support for proposed rules that would reform the prior authorization process for Medicare Advantage plans and Medicare Part D.In particular, the organizations expressed support for provisions that improve the coverage criteria for medical necessity determinations and protect access to care. Other provisions that the organizations support would protect patients from care interruptions, treatment delays, and unanticipated medical costs.“Recent [AMA] survey data show that 93 percent of physicians report care delays or disruptions associated with [prior authorization],” the letter stated. “AMA data also show that 34 percent of physicians report that [prior authorization] has led to a serious adverse event (e.g., hospitalization, permanent impairment, or even death) for a patient in their care. … Moreover, the Office of Inspector General 2022 report found that 13 percent of [prior authorization] requests denied by Medicare Advantage plans met Medicare coverage rules.”APA, AMA’s Letter to CMS on Prior Authorization APA Responds to CMS’s Request for Information on Essential Health BenefitsCMS recently released a request for information on essential health benefits (EHB) established under the Affordable Care Act. In its response, APA highlighted barriers that patients face to accessing mental and substance use disorder (SUD) services, the importance of telehealth in improving access to these EHB services, and the potential for the Collaborative Care Model to address gaps in coverage.APA noted administrative barriers such as prior authorization, workforce issues, and lack of parity. “Patients often experience a delay in accessing care due to the persistent shortage of psychiatrists and coverage across the country,” APA’s letter, addressed to Brooks-LaSure, stated. “As demand for their services increase, psychiatrists continue to meet capacity limitations.”Further, APA signed a coalition letter urging CMS to consider children’s needs when addressing EHBs. The letter emphasized that children require services and care specifically suited to their unique developmental needs.“Amid the children’s mental health emergency, there is a strong need to reduce the current gaps in coverage related to pediatric mental health services,” the coalition’s letter stated. “EHB requirements can play an important role in addressing these coverage gaps by incorporating coverage of pediatric mental health services in the ‘pediatric services’ category.” ■APA’s Letter on Mental Health and SUD EHBsThe Coalition’s Letter on EHBs for Children ISSUES NewArchived

A qualitative investigation of healthcare professionals’ viewpoints of the healthcare process of persons with a serious mental illness in prisons with a traditional model for mental health care provision in Spain

IntroductionHealthcare delivery in prisons depends on the national Ministry of Interior in 14 of 17 autonomous regions in Spain. A traditional model for health and mental health care provision prevails.ObjectivesTo increase understanding of the mental health care process of imprisoned persons with a serious mental illness (SMI) in Spanish prisons with a traditional model of health care provision.Methods10 healthcare professionals (6 physicians, 3 nurses, 1 pharmacist) working in small (&lt;450 imprisoners), middle size (450-1,000) and big (&gt;1,000) prisons took part in 3 online focus groups between 31st May and 2nd June 2022. The moderator used open-ended questions to research into the healthcare process (diagnosis, treatment, follow up, prevention) of imprisoners with SMI. Focus groups lasted 2 hours, and were audiotape recorded and transcribed. Transcripts were analysed applying constant comparative method and theoretical saturation.ResultsMental healthcare provision varies across prisons, but commonalities exist. Healthcare professionals reported that about 60% of SMI are diagnosed by the correctional general practice physician (GP) at incarceration. Severe cases are assessed by an external psychiatrist. Once a week (average) the psychiatrist visits the prison to either confirm diagnoses or adjust treatments. One third of imprisoners who would benefit from a psychiatric assessment has it. Follow up occurs in the prison infirmary for close supervision. If addiction concurs, referral to therapeutic modules happen. Polypharmacy and overmedication are common. Simplification of therapies and slow-release injectable formulations of antipsychotics are desirable. Everyday mental health care and rehabilitation take place throughout a specific, little equipped, psycho-social support programme implemented in most prisons but restricted to the most disabled SMI persons. Acute psychiatric episodes occur due to treatment interruptions or deviations and are managed by the correctional GP. Hospital referrals are problematic without protocols. Prevention of relapses relies on imprisoners supervision and staff observation. Healthcare records are only available to healthcare professionals working in prisons. Outside prisons, continued care needs of mental health and social support in the community. Due to healthcare services modest readiness to respond to needs and poor social networks, SMI persons are prone to relapse and recidivism.ConclusionsFocus groups found that working in isolation from the public healthcare system, shortage of psychiatrists, poorly implemented therapeutic and rehabilitation programmes, and lack of mental health and social care services in the community negatively affect the care of imprisoners with SMI in Spain.Disclosure of InterestNone Declared

Diverse Geriatric Workforce Education History, Needs, and Opportunities: Focus on Psychiatric Advanced Practice Nurses

Primary TopicAdvanced Practice Nursing History and Current State of Education Update Secondary TopicExploration of opportunities for filling educational gaps for subspecialty geriatric psychiatry training in Diverse WorkforceThis symposium is sponsored by the AAGP IDEA Committee.Advanced practice nurses are continuing to grow as partners of care for the geriatric psychiatry patient population. With increasing specialty workplace shortages across acute, ambulatory, and long-term care settings and growing numbers of geriatric psychiatrists retiring and less coming into the field, there is need to increase interprofessional collaboration with advanced practice nurses. The variety of advanced practice nurses practicing in the field has led to understandable confusion surrounding educational standards and experience from physician colleagues.Advanced nursing education has evolved over decades adapting to the needs of the ever-changing healthcare system and patient needs. Advanced practice nurses came in existence to assist in providing care to the underserved and often rural populations that struggled to maintain physician employment. The first advanced practice nurse specializing in the field of psychiatry was the certified nurse specialist. This role originally encompassed a larger focus on psychotherapy. Over decades and changes in healthcare, there was a larger call for psychiatric prescribers due to psychiatrist shortage, leading to the development of the psychiatric nurse practitioner role. Psychiatric nurse practitioners are board certified to provide psychiatric healthcare across the lifespan but are considered generalists until provided experience and training in specialty areas. Psychiatric nurse practitioners specializing in geriatric psychiatry do not currently have any additional academic institution driven training, but become specialists through mentorship from geriatric psychiatrists, nurse practitioners, or physician assistants within depth knowledge in geriatric mental healthcare. They also engage with continuing medical education, professional organization involvement, and gain clinical experience at bedside and in advanced practice nursing. Some advanced practice psychiatric nurses come into geriatric psychiatry practice from a calling and passion for this population, while others find their career gravitates towards this population as a response to a call from the community in need of care. There is desire and need for increased standardized educational opportunities for advanced practice nurses who are passionate about caring for the mental health needs of older people, and a hope that geriatric psychiatrists may offer assistance and guidance with the interprofessional united goal to improve access to quality care to our geriatric patients.

Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families

Military service members and their families have greater mental health care needs compared with their civilian counterparts. Some communities have inadequate access to psychiatrists for this population. To identify geographic variations in the availability of military and civilian psychiatrists within a 30-minute driving time of TRICARE (the US military's health care program) beneficiaries' communities and compare the likelihood of living in areas with inadequate access to psychiatrists for historically underserved and other communities. This retrospective cohort study of all zip code communities in the continental US, Hawaii, and Alaska with at least one TRICARE beneficiary between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census to estimate a logistic regression to compare differences between communities with and without a psychiatrist shortage. Data were analyzed from September 2021 to November 2022. A community's likelihood of having a shortage of military and civilian psychiatrists within a 30-minute driving time and a community's likelihood of having no psychiatrists. Odds ratios were calculated to estimate likelihood of the outcomes. This study includes 39 487 unique communities where 13% of the population is Black and 14% of the population is Hispanic. During the study period, 35% of TRICARE beneficiaries lived in communities with a shortage of both military and civilian psychiatrists, and 6% lived in communities with no access to military or civilian psychiatrists. Low-income communities with high income inequality were 1.64 (95% CI, 1.30-2.07) times more likely to have inadequate access to psychiatrists and 2.59 (95% CI, 1.82-3.69) times more likely to have no access to psychiatrists, compared with reference communities (average income without high income inequality); low-income communities without high income inequality were 1.37 (95% CI, 1.05-1.78) times more likely to have inadequate access to psychiatrists and 1.93 (95% CI, 1.28-2.89) times more likely to have no access to psychiatrists. Rural communities were 6.65 (95% CI, 5.09-8.69) times more likely to have inadequate access to psychiatrists than urban communities. In this cohort study of US communities, 35% of TRICARE beneficiaries lived in communities with inadequate access to psychiatrists. Psychiatric capacity was structurally inequitable along 2 separate dimensions: the income gradient and rurality. Developing targeted strategies for these shortage areas could alleviate disparities.

The methodology to estimate the demand and supply of national psychiatric services in Taiwan from 2005 to 2030.

The transformation from institutionalization to community-based mental healthcare may increase the difficulty of psychiatric workforce estimation and change the role of psychiatrists in hospitals and private clinics. This study aimed to estimate the growth and forecast psychiatric services in hospitals and private clinics in Taiwan from 2005 to 2030. We first examined the correlation between the number of psychiatrists and several indicators of psychiatric services. The forecast of the national demand for psychiatrists was based on projected outpatient psychiatrist visits from historical data. We also estimated the supply of psychiatrists by the number of psychiatrists practicing in hospitals or private clinics from Taiwan's Medical Affairs System and examined the supply and demand of the psychiatrist workforce through 2030. Outpatient visit was the most relevant indicator of psychiatric services to psychiatrist workforce. Growth rates in private clinics were higher than the hospital counterparts within the following decade (172.3 % vs. 37.7 %) and in the following decade (42.3 % vs. 13.3 %). The hospital-clinic disparity in the growth of psychiatric services also reflects the shortage of psychiatrists in private clinics but not in hospitals through 2030. The supply of 1158 psychiatrists in hospitals would nearly equal the clinical-based demand of 1156 psychiatrists in 2030. By contrast, the supply of 514 psychiatrists in private clinics would be lower than the clinical-based demand of 636 psychiatrists in 2030. The hospital-clinic disparity in the growth of psychiatric services reflects the transformation from hospital-based to community-based mental healthcare in Taiwan.