In the Journals

Majority of counties in the US have no child psychiatrists

Ryan K. McBain

Although the number of child psychiatrists in the United States increased 21.3% from 2007 to 2016, 70% of U.S. counties had no child psychiatrists during this period, according to results of a retrospective time-series analysis published in Pediatrics.

We have significantly more child psychiatrists today than we did a decade ago, and that is excellent,Ryan K. McBain, PhD, MPH, of the RAND Corporation in Boston, told Healio Psychiatry. "However, the improvement is much slower than we need, with roughly half of children with a mental health condition not getting the care they need from a mental health professional. As supply of care has gone up, so has demand. Establishing mental health parity laws, insurance mandates and the like aren’t useful to families if no one is there to provide the care."

According to McBain and colleagues, a historical shortage of child psychiatrists has resulted in more than half of children in the U.S. with a treatable mental health disorder not receiving treatment from a mental health professional. The researchers sought to update trends in the distribution and growth of child psychiatrists over the past decade.

They analyzed data from the Area Health Resource Files to compare the number of child psychiatrists per 100,000 children aged 0 to 19 between 2007 and 2016 by state and county. Further, they used negative binomial multivariable models to examine sociodemographic characteristics that influenced the density of child psychiatrists at the county level over this period.

The researchers found that the number of child psychiatrists increased from 6,590 to 7,991 for a 21.3% gain. The number of child psychiatrists per 100,000 children increased 21.7% from 8.01 to 9.75. Growth varied widely by county and state, with six states experiencing a decline in the ratio of child psychiatrists — Idaho, Indiana, Kansas, North Dakota, South Carolina and South Dakota. Six states — Alaska, Arkansas, New Hampshire, Nevada, Oklahoma and Rhode Island — experienced an increase greater than 50%. However, 70% of counties had no child psychiatrists in both 2007 and 2016. High-income counties (P < .001), counties with higher levels of postsecondary education (P < .001) and metropolitan counties compared with those adjacent to metropolitan regions (P < .001) were significantly more likely to have child psychiatrists.

“Counties with few or no child psychiatrists may need to look to alternative or complementary frameworks to address child mental health needs, including integration of behavioral health in pediatric primary care settings, school-based mental health services, child psychiatry telephone consultation access programs, and new models of telepsychiatry,” the researchers wrote.

In a related editorial, David Axelson, MD, of the department of psychiatry and behavioral health at Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, Ohio, offered potential paths to mitigating this shortage, including additional investment.

“Investment in developing better systems of care with thoughtful integration of child psychiatrists is more likely to lead to the best outcomes for our children rather than focusing only on increasing the number of psychiatrists,” Axelson wrote. “We need to start making this investment and be open to change and innovation to improve our children’s mental health.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures

Ryan K. McBain

Although the number of child psychiatrists in the United States increased 21.3% from 2007 to 2016, 70% of U.S. counties had no child psychiatrists during this period, according to results of a retrospective time-series analysis published in Pediatrics.

We have significantly more child psychiatrists today than we did a decade ago, and that is excellent,Ryan K. McBain, PhD, MPH, of the RAND Corporation in Boston, told Healio Psychiatry. "However, the improvement is much slower than we need, with roughly half of children with a mental health condition not getting the care they need from a mental health professional. As supply of care has gone up, so has demand. Establishing mental health parity laws, insurance mandates and the like aren’t useful to families if no one is there to provide the care."

According to McBain and colleagues, a historical shortage of child psychiatrists has resulted in more than half of children in the U.S. with a treatable mental health disorder not receiving treatment from a mental health professional. The researchers sought to update trends in the distribution and growth of child psychiatrists over the past decade.

They analyzed data from the Area Health Resource Files to compare the number of child psychiatrists per 100,000 children aged 0 to 19 between 2007 and 2016 by state and county. Further, they used negative binomial multivariable models to examine sociodemographic characteristics that influenced the density of child psychiatrists at the county level over this period.

The researchers found that the number of child psychiatrists increased from 6,590 to 7,991 for a 21.3% gain. The number of child psychiatrists per 100,000 children increased 21.7% from 8.01 to 9.75. Growth varied widely by county and state, with six states experiencing a decline in the ratio of child psychiatrists — Idaho, Indiana, Kansas, North Dakota, South Carolina and South Dakota. Six states — Alaska, Arkansas, New Hampshire, Nevada, Oklahoma and Rhode Island — experienced an increase greater than 50%. However, 70% of counties had no child psychiatrists in both 2007 and 2016. High-income counties (P < .001), counties with higher levels of postsecondary education (P < .001) and metropolitan counties compared with those adjacent to metropolitan regions (P < .001) were significantly more likely to have child psychiatrists.

“Counties with few or no child psychiatrists may need to look to alternative or complementary frameworks to address child mental health needs, including integration of behavioral health in pediatric primary care settings, school-based mental health services, child psychiatry telephone consultation access programs, and new models of telepsychiatry,” the researchers wrote.

In a related editorial, David Axelson, MD, of the department of psychiatry and behavioral health at Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, Ohio, offered potential paths to mitigating this shortage, including additional investment.

“Investment in developing better systems of care with thoughtful integration of child psychiatrists is more likely to lead to the best outcomes for our children rather than focusing only on increasing the number of psychiatrists,” Axelson wrote. “We need to start making this investment and be open to change and innovation to improve our children’s mental health.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures