Blog post authored by Dan Warner, Ph.D.
Through my volunteer work with the Pennsylvania Psychological Association (PPA), I recently worked with Dr. Kirby Wycoff of Thomas Jefferson University to produce the Pennsylvania Psychiatric Shortage Map. PPA currently advocates for psychologists’ ability to legally prescribe psychological medications (you can read about that here). I am a supporter of that effort (in fact, I’m working towards a post-doctoral master’s degree from Fairleigh Dickinson’s Clinical Psychopharmacology program) and am proud of how this map can (and should!) communicate the breadth of Pennsylvania’s psychiatric access crisis.
How does the Federal Government measure access to psychiatry?
The Health Resources & Services Administration (HRSA) is the federal bureau that calculates scores measuring quantity and quality of access to various medical services, including psychiatry, over designated geographic areas. The HRSA process is broad and implemented through various subsidiary programs. Thus it is difficult to establish a singular cohesive perspective on one or more communities. For instance, the HRSA has separate programs for facility deficits, geographic area deficits, and deficits affecting ‘special populations’ (elderly, children, impoverished groups, etc.). However, HRSA has yet to provide a complete assessment of any particular region’s total needs. While Pennsylvania relies on this data and its accompanying programs in many ways (see, for instance, this Joint Commission report that maps only some HRSA programs), no project in Pennsylvania has compiled all relevant HRSA data for a unified and actionable vision of the Commonwealth’s total psychiatric access needs.
With guidance and insight from CDR’s resident geographer, Meg Chellew M.S., we sought to visualize psychiatric access disparities in the Commonwealth. We combined various HRSA metrics for psychiatric need and delineated the data by Pennsylvania county. CDR identified a universal metric used by HRSA, the “Health Professional Shortage Area (HPSA) Score,” which calculates the level of need for each HRSA program. HRSA program calculations avoid data overlap (double counting), which enables our team to sum scores across an area, yielding a county HPSA score. For our calculations, we selected only programs that measure psychiatric physician time. The HPSA Score facilitates examination of: population-to-psychiatrist ratios, proportion of residents at or below federal poverty level, population percentage of elderly or youth, local substance abuse rates, and travel time to proximate and appropriate medical resources. The higher a HPSA score of a county, the greater the psychiatric access deficit.
A few important observations to consider while viewing this map:
Psychiatric service gaps are found across Pennsylvania:
Rural, urban, and suburban areas all struggle to provide sufficient psychiatric professionals to meet demand. There are two counties with the highest HPSA scores: Philadelphia (urban), and Potter county (rural). Meanwhile, suburban areas like Westmoreland County or Chester County have moderate scores, demonstrating insufficient psychiatric service provisions to meet local population needs. The PPA conducted a recent survey of clinical psychologists and found that over 41% of clients are required to wait 4 or more weeks for psychiatrist care, including active clients. It is evident that there are not enough psychiatrists to meet Pennsylvania’s needs.
Pennsylvania needs ~100 clinicians to meet Psychiatric Need:
Keeping pace with the HRSA Quarterly Reports reveals a pattern of demonstrated need; Pennsylvania continues to be approximately 100 clinicians shy of meeting the most rudimentary psychiatric access standards. I believe psychologist prescribers are essential to achieving this goal. The healthcare system is unable to support enough psychiatrists to cover the need gap; psychiatrists are expensive and rare. Even recent increases in psychiatry resident numbers are extremely insufficient compared to the state’s growing demand (view this article on psychiatry residencies for more information).
Psychiatric nurse practitioners (NPs) could, in theory, address this need, and in principle, this is true; psychiatric NPs do admirable work prescribing medications within Pennsylvania’s mental health system. However, another recent analysis I completed with Dr. Wycoff demonstrates there are inadequate numbers of psychiatric nurse practitioners in PA to address demand in a meaningful way. Check out “Prescriptive authority for psychologists could improve access to psychopharmacology across Pennsylvania – in more places than you might expect” By Dan Warner & Kirby Wycoff, The Pennsylvania Psychologist, July/August 2021, to learn more on this subject (email firstname.lastname@example.org if you would like a copy! 😉
Psychologist prescribers are uniquely positioned to directly impact the psychiatric access gap in Pennsylvania. A recent Pennsylvania Psychological Association survey found that 14% of PPA members would “likely” or “very likely” pursue the necessary training to become prescribers if permitted. With approximately 6,000 accredited psychologists in the state, PA could witness the addition of 840 psychologists to the prescribing bench. Furthermore, the distribution of these psychologists enables them to work with a wide range of Pennsylvania residents.
An invitation to Mental Health Advocates in Pennsylvania – Share this Map and Spread the Word!
Many of us in Pennsylvania are experiencing a workforce crisis, particularly within the mental healthcare field. The need for mental health care is greater than ever, though our workforce is shrinking at almost every level. Awareness of geographic areas with the highest gaps between need and care helps us direct our efforts appropriately. When viewing this map, please consider the following: Do you work or live in an area with a high HPSA (needs) score? Please share this resource with colleagues and other professionals. Let’s use our insights to develop the resources to support a flourishing population and positive mental health for Pennsylvanians and beyond.
Thanks to all the volunteers and staff at the Pennsylvania Psychological Association (PPA) who made this map happen. In particular: Executive Director Ann Marie Frakes, MPA, and volunteers Drs. Tony Ragusea, John Gavazzi, & Jennifer Collins.