America’s behavioral health crisis is worsening, new statistics suggest

The demand for behavioral therapy services continues to outstrip the supply of services.

In particular, demand for treatment for eating disorders and anxiety disorders has increased significantly since 2019, according to a new report from Trilliant Health.

For example, visit volume for eating disorders increased 52.6% from 2019 to 2022. Additionally, visitation volume for anxiety disorders increased by 47.9% and for substance use disorders by 27.4%.

At the same time, the supply of psychiatrists fell by 1.3%; The offer for doctoral psychologists has remained flat. While the supply of clinicians, social workers, and psychiatric nurses at the master’s level is increasing, it still lags behind demand.

“No matter how you slice and dice it, demand exceeds supply,” Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, told Behavioral Health Business.

Based in Brentwood, Tennessee, Trilliant Health is a market research and predictive analytics company that helps organizations build an evidence-based healthcare strategy.

The emergence of more virtual behavioral health services complicates the calculus of supply and demand, Jain explained. Digital solutions make behavioral healthcare seem readily available when it is not always the case, depending on a person’s needs.

Photo credit: Trilliant Health

“You can speak to a therapist right away or get treatment on your phone. It’s great from an access perspective,” Jain said. “Nevertheless, we still see it [supply-and-demand] mismatch. … If eating disorders increase, you will receive the appropriate treatment via a [nurse practitioner] Talking to a virtual care app or need more specialized therapy?”

One of the forces affecting the supply of psychiatrists is the aging workforce. Trilliant’s report found that more than a third of practicing psychiatrists in 22 states are 60 or older, with the average age of psychiatrists in the states ranging from 50 to 53.

The psychiatric staff is not equally disturbed. There is a concentration of psychiatric residency programs with 50.8% of all residency positions in six states. In addition, the number of residency positions will remain unchanged.

Looking ahead, looking at needs by area and evaluating the type of care providers needed is crucial, Jain said.

“In some zip codes, you may have a higher proportion of substance use disorders than in other zip codes, where you may have higher rates of anxiety and depression,” Jain said. “The question arises, what kind of caregivers do you need because of the illness?”

Primary care providers (PCPs) fill some of these gaps. The report found that in 2021, 42.3% of mental health medications were prescribed by GPs and behavioral health providers prescribed 34.6%.

“One notable change that we’ve seen during the pandemic, and one that makes intuitive sense, is that we’ve seen that much of the behavioral health prescribing activity is done through primary care physicians, including NPs and PAs, so not just physicians,” called Jains. “That makes sense when you think about access and availability. When we have a shortage of psychiatrists and specialists, primary care is usually your line of defense.”

Young people are having a hard time

Behavioral health problems have increased significantly among youth in the US Eating disorder diagnoses have increased by 107.4% in the population under 18 years of age. Depression rates have also increased by 44% in pediatric patients.

“That’s something we probably haven’t paid enough attention to: How are youth in America affected?” Jain said. “I’m not a clinician, but the starting point for me is that we need to recognize that children in their developmental prime are forced to be at home and learn remotely and don’t have the same level of social interaction as most children are used to, there will probably be generational consequences.”

Photo credit: Trilliant Health

Pediatric patients are not the only demographic whose needs are not being met.

Trilliant’s report also found that 84% of patients who presented to the emergency room for an alcohol or substance abuse disorder did not receive inpatient or inpatient treatment at a treatment center within 60 days.

The report also found that 10% of patients with alcohol or SUD have a repeat emergency department visit within 30 days.

Invest in solutions

Although demand for behavioral health services remains high, investment in the behavioral health sector, including for technology-enabled point solutions, declined in 2021-2022.

Trilliant’s report concluded that private equity investments in behavioral health totaled $2.6 billion last year — down 52.9% year over year.

And again, while investing in virtual health could help meet the need for more mental health services, that may not be the case for all populations.

“I think some of the investments have been helpful in meeting growing demand,” Jain said. “But I don’t think the solution is as simple as just investing more in digital health, based on what we know in the data about what the conditions are like and what populations need care.”

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