Health Disparities & Mental/Behavioral Health Workforce
Two main issues related to health disparities and the mental/behavioral health workforce that should be considered in the context of public policy includes: increasing the number of racial and ethnic minority mental/behavioral health professionals and creating a culturally competent workforce to meet the needs of the expanding minority population of the United States.
The SAMHSA commissioned, Annapolis Coalition, a group of mental/behavioral health experts and stakeholders published an action plan for the mental/behavioral health workforce in 2007 that found not only a need to address the workforce size in general and its inadequate geographic distribution but also the notable lack of racial and cultural diversity among mental health disciplines. Currently the only federal programs for addressing the diversity of the mental/behavioral health workforce development are SAMHSA’s Minority Fellowship Program funded at approximately $4 million and the Health Resources and Service Administration’s (HRSA) Graduate Psychology Education Program funded at $2 million. The American Psychological Association (APA) has played a critical role in the establishment and continuation of each of these important programs.
One of the most significant challenges our nation’s mental health care workforce faces is the increasing gap in health care access and health outcomes for racial and ethnic minorities. According to the Annapolis Coalition report, a large majority (approximately 90%) of mental/behavioral health professionals are non-Hispanic White; while, according to the 2004 U.S. Census Bureau, racial and ethnic minorities make up 30% of the U.S. population. It is projected that by 2060, ethnic minorities will have become the majority, constituting 50.4% of the resident population of the United States (Hispanic 26.6%, African American 13.3%, Asian American/Pacific Islander 9.8%, American Indian .08%).
The percentage of racial and ethnic minorities (i.e., Hispanic, Black, Asian, and American Indian) in the mental/behavioral workforce according to SAMHSA’s Mental Health USA 2004 was estimated to be as follows: 6.2% for psychology, 8.7% for social work, 24.2% for psychiatry, 17.5% for psychiatric nursing, 15.4% for counseling, 5.5% for marriage and family therapists, and 5.3% for school psychology. Some of the disciplines included non-specific populations that boost their percentages. Nevertheless, these data reveal the need to increase the pipeline of racial and ethnic minorities in mental/behavioral health professions. In fact this is occurring in psychology according to 2006 data, 25% of new Ph.D.s were racial and ethnic minorities (Hoffer, et al, 2007). The psychology data show that the pipeline is diversifying; however, the percentage of racial and ethnic minorities is still inadequate given the rate of growth in minority communities – and the mental and behavioral health need present in those communities.
The same discrepancy exists for racial and ethnic minorities social and behavioral researchers. According to NSF (2007) individuals from racial and ethnic groups are underrepresented among doctoral recipients in 2005. In neuroscience for example, 77.5 % of the doctorates were awarded to non-Hispanic white, 5.4 % to Hispanic persona and only 1.9% to African Americans.
Not only are there less racial and ethic minority mental/behavioral health professionals qualified to treat a wide range of needs, the demand these professionals is growing dramatically. As of September, 2008, there were 3,059 Mental Health Professional Shortage Areas with 77 million people living in them according to HRSA Office of Shortage Designation. It would take 5,145 practitioners to meet the need for a population to practitioner ratio of 10,000:1. These startling statistics are derived from communities that self-reported their shortages; the need is likely much greater. Within these shortage areas there is a high population of racial and ethnic minorities.
While the need for more mental and behavioral health professionals is documented and clear, there is also a pressing need for a higher level of cultural competency of all mental and behavioral health professionals, regardless of their race. According to the 2007 Annapolis Coalition report new healthcare professionals are less than ready to meet the behavioral health needs of an increasingly diverse population. This is a crisis point for communities of color. The Annapolis Coalition Report (page 191) states: “The issue is not only one of access but also, in many cases, of a profound lack of culturally and linguistically competent care because of the dearth of providers who are grounded in diverse languages and cultures.” In an effort to better meet the mental and behavioral health needs of our nation and ensure adequate preparation in cultural competencies, public policies much target investments that address this deficit and which span from early collegiate education through the early careers of the trained mental and behavioral health workforce.
The projected national demographic changes create an urgent need for better representation of racial and ethnic minorities in the profession of psychology and other mental/behavioral health professions. Further, the growing multiculturalism of those seeking mental and behavioral help across the nation demands , an improved level of cultural competence of future and current mental and behavioral health professionals. The improvement of care and the transformation of systems of care depend entirely on a workforce that is adequate in size and effectively trained and supported.
American Psychological Association, Office of Ethnic Minority Affairs. (2008). A portrait of success and challenge—Progress report: 1997-2005. Washington, DC: Author. Retrieved from http://www.apa.org/pi/oema/programs/recruitment/draft-report-2007.aspx
Annapolis Coalition. (2007). An action plan for behavioral health workforce development: A framework for discussion. Substance Abuse and Mental Health Administration. Shortage Designation: HPSAs, MUAs & MUPs. Retried on December 5, 2008 from http://bhpr.hrsa.gov/shortage
Hoffer, T.B., M. Hess, V. Welch,Jr., and K. Williams. 2007. Doctorate Recipients from United States Universities: Summary Report 2006. Chicago: National Opinion Research Center. U.S. Department of Health and Human Services. (2004). Mental health, United States, 2004. Substance Abuse and Mental Health Administration.