By Bart Magee, Ph.D.
The contemporary mental healthcare crisis encompasses so many dimensions, with an alarming component being the shortage of available psychiatric care. And the future presents a troubling challenge, as the demand for psychiatric medication services continues to surge while the number of psychiatrists diminishes. The American Psychiatric Association projects 20% decline in the psychiatrist workforce by the year 2030. Numerous factors contribute to this issue, chief among them being reimbursement rates that fall below those of other medical fields, coupled with a deficiency in available residency slots. These and other circumstances combine to deter medical practitioners from pursuing psychiatry as a specialty.
This scarcity of psychiatrists is further compounding the preexisting mental health crisis, leaving a substantial portion of the population—especially those who face economic disadvantages—bereft of accessible services.
In the context of this crisis in care, Access Institute is excited to announce the expansion of affordable psychiatry services including medication evaluations and follow up care. Before I say more about this expansion, it’s important to understand what the psychiatry shortage means to individuals impacted and to our society at large. The very real and devastating impact is this: Too many patients with major mental health and substance use disorders are forced to delay or seek substandard care. The ones who are impacted the most are those with limited resources and inadequate or no insurance coverage. The individual and social implications of this shortage are vast and include:
1. Diminished Treatment Outcomes: Inadequate access to appropriate medication care hampers treatment outcomes, particularly for patients with severe mental illness.
2. Social Burden: Untreated severe mental illness leads to increased social burden (family stress, unemployment, substance abuse, incarceration, homelessness) and higher burden on available social services.
3. Emergency Room Overload: Increased burden on emergency rooms as more patients end up in crisis or seek last resort care at the ER.
4. Escalating Costs: Fees for psychiatric care have skyrocketed— many hundreds of dollars for an evaluation with insurance often providing only partial coverage.
5. Substandard Care Risk: Limited options prompt individuals to seek medication from providers without proper psychiatry training, leading to substandard care.
6. Future Acuity: Delaying or forgoing care necessitates more intensive and costly treatments, including hospitalizations.
Access Institute has recently established a partnership with the Psychiatric/Mental Health Nurse Practitioner (PMHNP) Program at the UCSF School of Nursing. Commencing in September 2023, Access Institute will proudly serve as the newest training hub for this program. This collaboration immediately expands the availability of affordable care throughout San Francisco, but also facilitates vital training in alignment with Access Institute's rigorous, patient-centered, and holistic treatment framework.
Nurse practitioner (NP) trainees will have the privilege of being under the direct supervision of Access Institute’s staff psychiatrist, Dr. Samuel Tucker. Leveraging his extensive experience delivering care within community mental health contexts, Dr. Tucker will mentor these practitioners as they gain applied experience. Additional training and supervision within the program will be overseen by Dr. Halleli Toder, our Director of Fellowship Training.
This expansion is poised to open up nearly 600 additional service hours in the upcoming year. The expanded program will serve up to 100 individuals of low-income backgrounds, offering crucial medication evaluations and subsequent follow-up care. These individuals will have their psychiatry needs met and will be able to utilize the array of therapy and assessment offerings at our Hayes Valley Outpatient Clinic. The integration of psychiatry and psychotherapy services paves the way for seamless care coordination, bolstering service delivery and ultimately enhancing outcomes.
The program was designed to be scalable and funding to support future growth is being sought.
With mental health needs of low-income individuals so chronically neglected, the augmentation Access Institute’s psychiatry care comes at an ideal time. Furthermore, the expansion of mental health provider training is imperative for meeting these evolving needs in the long term. Importantly, Access Institute's program empowers nurse practitioners with an unparalleled level of training. They are not only equipped with psychiatry care expertise, but are also immersed in a comprehensive program that cultivates essential assessment and psychotherapy skills. This holistic training approach molds them into fully-rounded mental health providers poised to effect real change in our diverse community.
Information about how to apply for services is available on the Access Institute’s services page. For training program information, you can visit our training page. Financial support for the program was provided by the California Healthcare Foundation.