The demand for behavioral health services continues to outpace the supply of services.
In particular, the demand for eating disorder and anxiety disorder treatment has grown significantly since 2019, according to a new report by Trilliant Health.
For example, the visit volume for eating disorders has increased by 52.6% from 2019 to 2022. Additionally, visit volume has increased by 47.9% for anxiety disorders and 27.4% for substance use disorders.
At the same time, the supply of psychiatrists has declined by 1.3%; supply has remained flat for doctorate-level psychologists. While there is a rise in the supply of master’s-level clinicians, social workers and psychiatric nurse practitioners, it still lags behind demand.
“No matter how you slice it and dice it, the demand outpaces supply,” Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, told Behavioral Health Business.
Brentwood, Tennessee-based Trilliant Health is a market research and predictive analytics firm that helps companies build an evidence-based strategy for health care.
Somewhat complicating the supply-and-demand calculus is the emergence of more virtual behavioral health services, Jain explained. Digital solutions make it seem like behavioral health care is readily available, when that’s not always the case, depending on an individual’s needs.
“You can talk to a therapist or get care with your cell phone instantly. That’s great from an access perspective,” Jain said. “Even so, we’re still seeing this [supply-and-demand] mismatch. … If eating disorders are increasing, will you get the appropriate treatment via a [nurse practitioner] you’re talking to on a virtual care app, or do you need more specialized therapy?”
One of the forces impacting the psychiatrist supply is the aging workforce. Trilliant’s report found that more than a third of practicing psychiatrists are 60 or older in 22 states, with states’ average age for psychiatrists ranging from 50 to 53.
The psychiatric workforce is not evenly disturbed. There is a concentration of psychiatric residency programs, with 50.8% of all residency positions in six states. Moreover, the number of residency positions remains flat.
Going forward, it’s crucial to look at the need by area and assess the type of care providers required, Jain said.
“In some zip codes, you might have a higher proportion of substance abuse disorders versus in another zip code, where you might have a higher rate of anxiety and depression,” Jain said. “It begs the question of what type of care providers do you need by the condition?”
Primary care providers (PCPs) are filling in some of those gaps. The report found that, in 2021, 42.3% of mental health medications were prescribed by PCPs, and behavioral health providers prescribed 34.6%.
“One notable shift that we saw during the pandemic, and this intuitively makes sense, is that we’ve seen a lot of the behavioral health prescribing activity happen via primary care providers, including NPs and PAs, so not even just physicians,” Jain said. “That makes sense if you think about access and availability. If we have a shortage of psychiatrists and specialists, primary care tends to be your frontline of defense.”
Youth are struggling
Behavioral health conditions have risen significantly among youth in the U.S. Eating disorder diagnoses have grown by 107.4% in the under-18 population. Rates of depression have also increased by 44% among pediatric patients.
“That’s something that we probably haven’t paid enough attention to: How have the youth in America been affected?” Jain said. “I’m not a clinician, but the starting point for me is we have to realize that when children in their prime developmental years are being forced to be at home and learn remotely, and not have the same level of social interaction that most children are used to, that is probably going to have generational consequences.”
Pediatric patients aren’t the only population not having their needs met.
Trilliant’s report also found that 84% of patients who went to the emergency department for alcohol or substance use disorder did not receive follow-up inpatient or residential treatment center care within 60 days.
The report also found that 10% of patients with alcohol or SUD have a return visit to the emergency department within 30 days.
Investing in solutions
Although the demand for behavioral health services remains elevated, investment in the behavioral health sector, including for tech-enabled point solutions, dropped from 2021 to 2022.
Trilliant’s report concluded that, last year, private equity investments in the behavioral health sector totaled $2.6 billion – a 52.9% decline year over year.
And again, while virtual health investment could help address the need for more mental health services, it may not be for all populations.
“I think some of the investments have been helpful in meeting the growing demand,” Jain said. “But I don’t think the solution is as simple as just more investment in digital health, either, based on what we know, in the data of what the conditions are, and which populations are needing the care.”
Companies featured in this article:
