Many U.S. Counties Have No Child Psychiatrists, Study Finds

Though the total number of child psychiatrists in the United States increased between 2007 and 2016, a shortage remains in large swaths of the country, particularly in lower-income areas, according to a study published in Pediatrics.

“More than half of the children in the United States with a treatable mental health disorder do not receive treatment from a mental health professional,” wrote Ryan K. McBain, Ph.D., M.P.H., of the RAND Corporation and colleagues. “One of the driving factors contributing to this unmet need is a shortage in child psychiatrists.”

McBain and colleagues examined data from the Area Health Resource Files of the Department of Health and Human Services to compare the numbers of child psychiatrists by county between 2007 and 2016. The researchers relied on data from U.S. Census Bureau to calculate the ratios of child psychiatrists per 100,000 children (youth aged 0 to 19) for the 10-year period. Additionally, they compiled county-level data on sociodemographic characteristics of the population, including income, education, and employment.

“Between 2007 and 2016, the number of practicing child psychiatrists in the United States increased from 6,590 to 7,991: a 21.3% gain,” the authors wrote. Additional findings included the following:

• The ratio of child psychiatrists grew from 8.01 per 100,000 children in 2007 to 9.75 per 100,000 children in 2016.
• State-level growth in the number of child psychiatrists varied, with the number of child psychiatrists per 100,000 children increasing by more than 50% in six states (Alaska, Arkansas, Nevada, New Hampshire, Oklahoma, and Rhode Island) and declining in six other states (Idaho, Indiana, Kansas, North Dakota, South Dakota, and South Carolina).
• Child psychiatrists were significantly more likely to practice in counties with higher levels of income and college graduates.

“Although the density of child psychiatrists has increased from 2007 to 2016, there remain ∼70% of counties in the United States with no child psychiatrists,” McBain and colleagues wrote. “The distribution of child psychiatrists also remains inequitable, with a state like Massachusetts having as many child psychiatrists as Oklahoma, Indiana, Georgia, Mississippi, and Tennessee combined, despite these latter states having 5 times as many children ages 0 to 19.”

They concluded, “[C]ounties 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.”

For related information, see the American Journal of Psychiatry Resident’s Journal article “The Winding Road to Training in Child Psychiatry: Considering a New Path” and the Psychiatric Services article “Impact of Child Psychiatry Access Programs on Mental Health Care in Pediatric Primary Care: Measuring the Parent Experience.”

(Image: iStock/izusek)

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