Identifying unmet need for mental health services

Unmet need was calculated as the difference between the workforce need and supply estimates described in preceding presentations. The challenge in identifying a shortage is finding a reasonable balance between widespread under use of mental health services (currently less than half of those who need care get any) and high normative standards (assertive community treatment requires a team of providers for each individual with SMI). We chose a normative standard, basing need on SMI service users and all individuals without SMI (users and nonusers). We accounted for commuting of providers and patients across geographic areas with a smoothing technique. Three shortages were calculated: for prescribers, nonprescribers and all mental health providers. Two forms of shortage scores were developed. An absolute need score provides the score standardized per 100,000 population. A relative need score provides the shortage as a proportion of total need. The absolute score ranks high population counties higher and gives priority to inner city urban states. The relative score ranks low populations higher and gives priority to rural states. A hybrid score was developed based on both scoring approaches, that allows a single ranking of shortage in the U.S. Overall, 97% of counties have a shortage of prescribers and 56% have a shortage of nonprescribers. In counties with shortages, preliminary findings indicate a mean (s.d.) overall level of absolute shortage of 18(44) and of relative shortage of 51%(30). The policy implications of these shortage measurements for state and federal mental health workforce policies, e.g., MHPSA designation, are discussed.