Geriatric mental health workforce faces a growing shortage

A recent report by the Institute of Medicine (IOM) shows that with the increase in the number of baby boomers reaching 65, there is an increasing shortage of professionals who provide geriatric mental health services.

Currently there are about 1,700 board-certified geriatric psychiatrists in the United States – one for every 23,000 older Americans. That ratio is estimated to diminish to one geriatric psychiatrist for every 27,000 individuals 65 and older by 2030.

The IOM committee concluded that at least 5.6 to 8 million older adults have at least one mental health or substance use condition that can have substantial negative effects – about 14 to 20 percent of the overall elderly population. Anxiety and depressive disorders along with dementia-related behavioral and psychiatric symptoms are the most prevalent conditions.

The reasons for the shortfall are many. Of the 125 to 150 geriatric psychiatry fellowship training slots nationwide, less than half of them are filled. Specific training to treat older adults is necessary to meet their specific needs and also to better manage the connection between mental health and adherence to treatment regimens for specific physical conditions.

"Just like children are not small adults, older adults are not merely chronologically older people, but they have distinct needs that differ from those of younger or middle-age adults," said Dilip Jeste, MD, a geriatric psychiatrist and president of the American Psychiatric Association.

But in order to become trained in geriatric psychology many doctors who have completed their residency need to take an additional year of residency – often at a rate of pay roughly one-third of what their counterparts will earn who go directly into practice.

Initiatives that can be undertaken to help increase the number of doctors entering geriatric psychiatry include providing greater exposure to doctors during regular psychiatric residency to the specific mental health needs of the elderly and getting more residents interested in entering fellowship programs, Jeste said. He also suggested that the federal government could become involved by offering loan forgiveness programs for doctors who practice in the field, as the pressure to pay off what are often significant educational debts – as high as $200,000 –  can also prevent doctors from entering the field.

Further, like other healthcare workers, salaries and reimbursement rates from Medicare and Medicaid are creating significant income gaps. The IOM report recommends the redesign of Medicare and Medicaid payment rules to guarantee payment for such things as counseling care management and associated services for treating mental health conditions and substance use problems so that clinicians are willing to provide this care.

The IOM committee also suggested a concerted national effort is needed by the U.S. Department of Health and Human Services to build national attention and to promote building a national workforce of sufficient size to provide geriatric mental health and substance abuse care.

"There is a conspicuous lack of national attention to ensuring that there is a large enough healthcare work force trained to care for older adults with mental health and substance use conditions," said committee chair Dan G. Blazer, J.P. Gibbons Professor of Psychiatry and Behavioral Sciences and vice chair for faculty development, Duke University Medical Center, in a statement announcing the IOM's findings. "These conditions are relatively common, they can be costly, and they can have profound negative impacts on people's health and well-being. This report is a wake-up call that we need to prepare now or our older population and their extended families will suffer the consequences."