Workforce Shortages in Rural America

Complicating the shortage of mental health practitioners in the United States is the unequal distribution of this workforce. Data from 2015 revealed dramatic urban versus rural disparities in the supply of psychiatrists, psychologists, and psychiatric nurse practitioners. For example, only 6% of counties in the highly urban New England Census Division were without a psychiatrist, while 69% of counties in the highly rural West North Central Census Division of the country lacked a psychiatrist (Holly et al., 2018). 

A comprehensive HRSA-funded assessment of supply, demand, and shortages of mental health providers found that small increases in the rurality of an area and small decreases in per capita income were both associated with increased shortages of mental health professionals. The shortage of mental health prescribers in rural and low-income areas was particularly severe (Thomas et al., 2009). 

Rural Workforce Strategies

A broad range of strategies has been used to address mental health workforce development in rural and underserved areas. Strategies are listed immediately below and links to relevant resources follow. 

• Loan repayment programs to attract professionals to these communities. These loan programs are sponsored federally by the Health Resources and Services Administration (HRSA). 
• Development of career ladders in a rural area or state so that local residents can enter the mental field and advance without having to leave the area for education and training. 
• Grow Your Own strategies that focus on recruiting and fostering the career development of individuals native to an area, since they are more likely to remain in the area. Such individuals are sometimes referred to as “place committed.” 
• Workforce development within tribal healthcare systems, which provide a large portion of mental health services in many rural parts of the country.
• Recruitment, retention, and competency development initiatives with direct care paraprofessional workers, who constitute a large segment of the rural mental health workforce. 
• Increased use of telehealth to extend the reach of mental health professionals in rural and other underserved areas.
• Promotion of integrated care models that increase the role and skills of primary care providers in meeting the mental health needs of local residents.
• Training community members to be mental health first responders through programs such as Mental Health First Aid, which has a rural version.
• Focused workforce development in state hospitals, which play a major role in the service system of rural states.

Resources

General

Roberts, L., Smith, J., McFaul, M., Paris, M., Speer, N., Boeckmann, M., & Hoge, M. A. (2011). Behavioral health workforce development in rural and frontier Alaska.  Journal of Rural Mental Health, 35(1), 10-16.
https://psycnet.apa.org/record/2013-03893-003

Behavioral Health Aides

Alaska Native Tribal Health Consortium, Behavioral Health Aide Program
https://anthc.org/behavioral-health-aide-program/

Career Ladders

Alaska Health Workforce Development Plan
https://www.alaska.edu/research/wp/plans/health/HealthWFDPlan.pdf

California Institute for Behavioral Health, Behavioral Health Services Career Ladder
https://www.cibhs.org/sites/main/files/file-attachments/calaveras_wet_pr_packet_0.pdf

Competencies

Alaska Native Tribal Health Consortium, Behavioral Health Aide/Practitioner, Knowledge & Skills Checklist
https://anthc.org/wp-content/uploads/2018/02/FINAL-Knowledge-and-Skills-Checklist-Secs.-Added2.pdf

Hoge, M. A., & McFaul, M. (2016). Alaska core competencies for direct care workers in health and human services (Version 1.1.). Anchorage, AK: The Alaska Mental Health Trust Authority.
http://files.aktc.org/ACC%202016%20Booklet.pdf

Data on the Rural Mental Health Workforce

Holly, C., Andrilla, A., Patterson, D. G., et al. (2018). Geographic variation in the supply of selected behavioral health providers. American Journal of Preventative Medicine, 54(6S3), S199-S207.

Thomas, K. C., Ellis, A. R., Konrad, T. R., et al. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60(10), 1323-1328. 

Loan Repayment

HRSA Loan Repayment Programs
https://www.hrsa.gov/loan-scholarships/repayment/index.html

Recruitment

Addressing Rural Behavioral Health Workforce Shortages: Lessons Learned from a Rural Psychology Internship Initiative- Mountain Plains MHTTC
https://mhttcnetwork.org/centers/mountain-plains-mhttc/addressing-rural-behavioral-health-workforce-shortages-lessons

Johnson, I. M. (2017). A rural “Grow Your Own” strategy: Building providers from the local workforce. Nursing Administration Quarterly, 41(4), 346-352. doi: 10.1097/NAQ.0000000000000259.
https://www.ncbi.nlm.nih.gov/pubmed/28859003

Technical Assistance on Rural Mental Health

Mental Health First Aid – Rural
https://www.mentalhealthfirstaid.org/take-a-course/find-a-course/

Mountain Plains MHTTC, Rural Mental Health Area of Focus
https://mhttcnetwork.org/centers/mountain-plains-mhttc/area-focus

National Association for Rural Mental Health
http://www.narmh.org/ 

Suicide Prevention Resource Center, Suicide Prevention Toolkit for Primary Care Practices (with a focus on rural settings)
http://www.sprc.org/settings/primary-care/toolkit

Western Interstate Commission on Higher Education, Behavioral Health Program
https://www.wiche.edu/mentalhealth

Telemental Health

Mamoud, H., Sers, M., & Tuite, J. (2019) Enhancing telemental health for rural and remote communities. Becker’s Health IT & CIO Report. Accessed August 15, 2019:
https://www.beckershospitalreview.com/healthcare-information-technology/enhancing-telemental-health-for-rural-and-remote-communities.html