Psychiatric Services 'Crisis' Spurs Call for Reform

Recommendations from the National Council for Behavioral Health include payment reform, workforce expansion, training reforms, and more widespread use of telemedicine.

Psychiatric services are in a state of crisis nationwide, and stakeholders across the healthcare industry have roles to play in fixing the multifaceted problem, the National Council for Behavioral Health (NCBH) says.

A report released this week was prepared by the nonprofit's Medical Director Institute and a 27-member expert panel drawn from providers, payers, government agencies, and psychiatric organizations.

During a conference call Tuesday with members of the media, Joseph Parks, MD, medical director of the NCBH, said there is a national shortage of psychiatrists that is threatening to spiral out of control.

In 77% of U.S. counties, healthcare officials are reporting a severe psychiatrist shortage, and the aging psychiatrist workforce also poses a daunting challenge, he said.

"The average age of a practicing psychiatrist is in the mid-50s. This is compared to the average age of other medical specialists and primary-care physicians in their mid-40s. They will be aging out rapidly."

The shortage imposes a nightmare scenario on many psychiatric patients and the healthcare providers trying to serve them, said Parks, who is chairman of the NCBH Medical Director Institute.

"Two-thirds of primary care physicians report that they have trouble getting psychiatric services for their patients. So, they go to the emergency room. There has been a 42% increase in the number of patients going to the emergency room for psychiatric services in the past three years, but most of them are not staffed with psychiatrists."

"People end up stuck in emergency rooms for hours and at times days." Parks said.

"Finally, they try to get into an inpatient psychiatric bed, but hospitals have been closing their psychiatric units because they can't find psychiatrists to hire and staff to run them. It is truly becoming a crisis."

A Call for Six Reform Efforts
The NCBH report calls for healthcare providers, payers, government agencies, and psychiatric organizations to focus on six essential reform efforts:

1. Expansion of the psychiatric workforce, especially psychiatrists, advanced practice registered nurses, physician assistants, and board-certified psychiatric pharmacists
    
2. Greater efficiency of service delivery, including reform of regulations that block care coordination and impede access to clinical information
    
3. Adoption of care innovations such as integrated delivery of primary-care and psychiatric-care services in more settings

4. Training psychiatric professionals to deliver new models of care
    
5. Payment reform that adequately reimburses psychiatric services and rewards care based on patient outcomes
    
6. More options and financial incentives for psychiatric-service providers to leave cash-only practices and change care settings

Financing Needs an Overhaul
The financing of psychiatric services needs an overhaul, he said. "There is a misalignment if the commercial and governmental fees result in a loss for 75% of organizations and 40% of psychiatrists choose to go cash-only to make up for that reimbursement problem."

In addition to payment reform, the report's recommendations include training reforms, increased use of telepsychiatry, and widespread adoption of new care models.

Parks highlighted the need to redesign the way psychiatric-service providers work with other medical professionals and support staff.

"Psychologists need to be used more as expert consultants. People needing care need to be identified using data analytics as opposed to waiting for patients to complain. And staff need to be working more in teams, so psychiatrists are doing the essential things that only a psychiatrist can do, and delegating other parts of care and follow-up."