The Licensed Mental Health Workforce in NYS Carol Barth Lanzara, Research Scientist, NYSOMH Office of Evaluation Research 19th Annual Symposium on Health Care Services in NY: Research & Practice, November 19, 2008 Introduction and Objectives Results Findings and Recommendations Introduction: Access to effective mental health (MH) treatment depends on the availability of a qualified MH workforce. The following challenges influencing access have been identified as critically important to State Mental Health Authorities: Decline in experienced MH clinicians entering public sector. Acute shortage of child, forensic, and geriatric psychiatrists. Imminent shortage of psychiatric nurses. Shortage of non-Anglo and multilingual staff. Aging of MH workforce. Objectives: The NYS Office of Mental Health (OMH) has conducted an initial study of the State’s MH workforce to: 1) assess its size and geographic distribution; and 2) to inform data needs regarding recruitment, retention, and cultural competence issues. FINDINGS Size: Estimated size of licensed MH workforce in NYS is in excess of 50,090. Distribution: Licensed MH workers in NYS are clustered in urban/suburban areas, leaving rural areas understaffed. 58% of psychiatrists and 38% of psychologists practice in NYC, where 43% of State’s population resides. In contrast, 11% of both psychiatrists and psychologists practice in more rural Central & Western regions, where 26% of State’s population resides. Approximately 2.3 million people live in 31 NYS counties designated as Federal and/or State MH professional shortage areas. Aging: Age distribution in MH workforce identifies an imminent recruitment/retention crisis. In most disciplines, more than half of clinically trained professionals are > age of 50, raising concerns about whether the pipeline of young professionals will be adequate to compensate for both growing service demand and approaching retirement of large segments of workforce. Ethnic Diversity/Cultural Expertise: Complete race/ethnicity data are unavailable for members of NYS licensed MH workforce. Race/ethnicity data for U.S. MH workforce provides insight into NYS MH workforce. Available national data describe a MH workforce that is overwhelmingly White and where minorities are generally under-represented across disciplines. There is a lack of data regarding what is required to build a culturally competent, qualified and adequately trained MH workforce in NYS. RECOMMENDATIONS Statewide Mental Health Workforce Survey: Statewide survey of MH providers is needed to assess: 1) workforce size, occupational composition, race/ethnicity, and language proficiency; 2) additional workforce needed to meet current/estimated public MH needs; 3) additional workforce needed to be proficient in non-English languages to meet current needs; 4) vacancy rates and recruitment/retention needs and barriers; 5) specifically designated positions for individuals with consumer and/or family member experience in the MH system; and 6) additional clients and family members in specifically designated positions needed to meet current public MH needs. Data from this survey would be used to better assess what is needed to build a culturally competent, qualified and adequately trained NYS MH workforce. Establish Office of Professional Recruitment and Retention: In 2007, OMH concluded that the crisis in professional recruitment/ retention now threatens access and quality of care throughout OMH and community MH agencies, and that a State Office of Professional MH Recruitment/Retention should be established to ensure that a structure and process exist to provide an ongoing response to the many MH workforce issues that call for attention. Workforce Size The estimated size of the licensed mental health workforce in NYS is in excess of 50,000. Workforce Distribution There are dramatic differences in the distribution of the MH workforce by region. Methods OMH identified the following barriers to estimating the size of the mental health workforce and each profession within it: 1) No national or state registry/entity has the capacity and authorization to coordinate MH workforce assessments across disciplines. 2) The size of each profession in the MH workforce is complicated by ambiguous boundaries and overlapping scopes of practice. 3) Data of key national organizations of professions/regulatory boards can be imprecise, duplicative, and difficult to obtain and interpret. 4) The population of psychiatric-MH nurses in NYS cannot be identified because all nursing specialties (except nurse practitioners) are combined in both State licensing data and data collected by professional nursing organizations. 5) There are no data available regarding the unlicensed and voluntary MH workforce, which plays a substantial and important role in care provision. Use of Available Data: The OMH study of the MH workforce in NYS therefore includes only those providers: 1) whose training and practice are dedicated to mental and behavioral health care; and 2) who are licensed by the State to provide that care. Mental Health Profession Shortage Areas Half of NY’s 62 counties are designated as MH professional shortage areas and 12% of the State’s population lives in those areas. Data Sources Used NYS Education Dept. profession licensing data. SUNY Center for Workforce Studies profession-specific data. US DHHS mental health professional shortage area data. NYS DOH Regents psychiatrist shortage area data. SAMHSA national MH workforce data. Workforce Demographics Contact Information Aging: Statewide, 60% of psychologists, LCSWs, nurse practitioners – psychiatry, marriage and family therapists, MH counselors, psychoanalysts, and creative arts therapists are over 50 years of age; 23% are aged 62 years or older; and only 15% are under the age of 39. More than half (52%) of psychiatrists in the State are aged 55 or older, and 25% are aged 62 years or older. Race/Ethnicity: National race/ethnicity data describe a MH workforce that is overwhelmingly White and where minorities are generally under-represented across disciplines. Language Proficiency: There are no data regarding language proficiency in the MH workforce in NYS. Carol Barth Lanzara, MS, JD - Research Scientist NYS Office of Mental Health 44 Holland Avenue Albany, NY 12229 T: 518.408.2042 F: 518.474.7361 E: coevcbl@omh.state.ny.us