The growing impact of the mental health consumer movement on federal policy
and an increased emphasis on health information technology were among
influences highlighted in a recently issued compendium of mental health
The report, "Mental Health, United States, 2004," was released
by the Substance Abuse and Mental Health Services Administration's (SAMHSA)
Center for Mental Health Services (CMHS) in March. It aims to provide a
snapshot of the federal government's understanding of current mental health
services, trends, and statistics that affect the nearly 44 million Americans
who suffer from a mental illness in any given year.
Although the biennial compendium is dated 2004, the trends it identifies
have continued into this year, said Ken Thompson, M.D., associate director of
medical affairs for CMHS.
"This volume does carry with it an important view of the mental
health world as seen from CMHS and SAMHSA," Thompson told
Part of that view is the increasingly important role that mental health
consumer advocates play in setting federal policy and determining funding. The
compendium reported that the number of mental health consumer organizations
doubled to about 2,100 from 1990 to 2002.
"Consumer organizations are in a unique position among the
organizations serving people with mental illnesses," stated the report.
The observation echoed that of the President's New Freedom Commission on
Mental Health, which believes that such groups will take on a larger role in
providing information and coordinating services for people with mental
The report said that by their very nature, consumer organizations help to
overcome each of the six barriers to mental health care, which it said are
stigma, fragmented services, costs, workforce shortages, lack of available
services, and not knowing where and how to get care.
Although these organizations many limitations and frequent funding
shortfalls, according to the report, they may be the only entities in the
community that interact with each of the disparate federal, state, and local
agencies and provide integrated services, supports, and opportunities for
recovery in one location.
"This is important because the evolution of the consumer movement has
a tremendous impact on federal policy," Thompson said.
Another area in which the report identified changes is in the increasingly
influential role that health information technology (HIT) plays in psychiatric
care, concluding that increased, and "thoughtful" adoption of HIT
will be critical to expanding access to care and the quality of care patients
"An urgent need exists to apply modern HIT to these problems,"
according to the report. "Our future health may well depend on
Barriers to greater HIT adoption are the need for increased training for
health care clinicians who were "educated in the pre-IT era" and
data that suggest the public sector lags far behind the private sector in
integrating modern IT into leadership and operations.
Although primary care physicians were increasingly sought over the last
decade to treat mental disorders, the intensity and adequacy of those
treatments remain poor, according to the compendium.
The relationship of psychiatry to primary care is a key trend to track,
according to Selby Jacobs, M.D., chair of APA's Committee on Public Funding
for Psychiatric Services.
The report, Jacobs said, offers a useful perspective on the issue of
primary care mental health care by describing phases in the development of
models of collaboration and the importance of chronic care models that
originally were developed and tested for depression but now extend to
addictions and severe mental illnesses.
"Part of the problem in development of such models is creating
appropriate incentives and reimbursement for all the participants, including
the psychiatrist," Jacobs said. "This is an area we might pay
attention to on our committee."
Among the many statistics that the compendium collected was extensive
information on the state of the U.S. psychiatric profession, including data
that showed a decline in recent years in the growth of psychiatry. Although
there was a 38 percent increase in the number of U.S. psychiatrists from 1983
to 2002, the rate of growth slowed to less than 1 percent from 2000 to 2002,
the most recent year evaluated in the report.
The compendium reported that the increase in the number of new
psychiatrists slowed in recent years from a growth spurt during the 1980s. The
number of medical students entering psychiatric residencies increased by
almost 25 percent in the 1980s, "plateaued" in the 1990s, and decreased
by about 8 percent by 2003, according to APA data included in the
Separate data found similar results more recently, including a slight drop
in the number of U.S. medical students matching into psychiatry from 643 in
2006 to 633 in 2007, according to data from the National Resident Matching
Program (Psychiatric News, April 6).
Another of the report's findings is that the psychiatric workforce
continues to age, with 64 percent of psychiatrists having completed their
highest professional degree more than 21 years ago. Psychiatrists under age 45
constituted 46 percent of the psychiatric workforce in 1990, for example, but
only 30 percent in 2002, according to data from the AMA.
The compendium also noted changes in the ways psychiatrists have worked in
recent years. The segment of psychiatrists working in more than one setting
during the course of a week decreased from 76 percent in 1988 to 45 percent in
In 2002 psychiatrists spent 45 percent of their patient-care time in either
an individual or group practice, while hospitals were previously one of the
major work settings for psychiatrists. Psychiatrists who reported hospitals as
their primary work setting declined from 28 percent in 1988 to 11 percent in
The report's authors wrote that the increasing administrative role of
psychiatrists is "of particular concern, given its impact in decreasing
the available psychiatric workforce for direct patient care, especially in
light of the increased demand for psychiatric services."
Despite the decreases in the growth of physicians choosing psychiatry, no
reduction has occurred in federal officials' assessment that the field should
have a leading role in establishing federal mental health policy, according to
Thompson, a psychiatrist.
"From CMHS's and SAMHSA's perspective, we want to maximize the public
service that psychiatrists provide," Thompson said.