US Mental health crisis highlights access challenges

Poll finds many psychologists face capacity strains as patients present with increasingly severe symptoms

Reports and Proceedings

AMERICAN PSYCHOLOGICAL ASSOCIATION

The ongoing mental health crisis is causing significant challenges for many psychologists as they grapple with demand fueled by patients presenting with increasingly severe symptoms year after year, according to APA’s 2023 Practitioner Pulse Survey.

The survey, which was completed by 561 licensed practicing psychologists between Aug. 30 and Sept. 29, 2023, found that not only did more than half of psychologists (52%) say that they were seeing an increase in severity of symptoms among their patients, but 41% said that they were seeing an increase in the number of sessions spent treating each patient, which may reduce their capacity to accept new patients.

Similarly, more than half (56%) said that they had no openings for new patients. And more than two-thirds (69%) of psychologists who maintained a waitlist said that the average wait was up to three months for a first appointment, while 31% said average wait times were longer than three months. Psychologists reported increasing demand for treatment of certain mental health conditions, including anxiety disorders (68%) and trauma- and stressor-related disorders (50%), among those who treat those disorders.

"As the mental health crisis continues, psychologists are under pressure,” said APA CEO Arthur C. Evans Jr., PhD. "These findings underscore the sustained demand for care, led by increased severity of symptoms and extended treatment courses, compounded by increases year after year. This paints a clear picture of psychologists operating at the brink of their capacity. To better meet demand, it is essential that we develop comprehensive public health strategies that reach people throughout their lifespan and robustly address behavioral health alongside physical health.”

The survey found that the psychologist workforce is already adapting to meet the changing needs of the population -- for example, as part of integrated care teams or in medical settings. More than 4 in 5 psychologists (86%) said they have worked alongside other health care providers, with 59% saying they do so frequently or very frequently. Collaborating providers included psychiatrists (76% of psychologists said they worked with them, with 38% doing so frequently); other physicians (45%, with 17% doing so frequently); occupational therapists (30%, with 6% doing so frequently); physician assistants (41%, with 11% doing so frequently); community health workers (30%, with 4% doing so frequently); and speech language pathologists (28%, with 5% frequent collaborators). Alongside mental health concerns, psychologists reported treating patients with physical conditions, including 50% treating patients with chronic pain, 42% treating obesity or weight conditions, 27% some symptoms of cancer, and 25% high blood pressure.

“Integrated care, where psychologists work on health care teams with other providers, is one way that we can expand access to care, prioritize preventive care and find ways to better meet the biological, psychological and social needs of the patients,” said Evans. “We must also support and expand the mental health workforce, foster innovation and technology, and support psychologists in extending their reach in the communities in which they live and work.”

Psychologists have shown themselves to be adaptable, changing their work habits during the pandemic to include fully remote or hybrid practices. Only 21% are now offering fully remote practices (down from a peak of 64% in 2020), according to the poll, yet more than two-thirds (67%) are now working in hybrid practices seeing some patients in person and others remotely.

More than one-third (36%) of psychologists reported experiencing burnout and 1 in 5 psychologists (21%) said that they were planning to reduce their practice hours in the next 12 months. Yet nearly three-quarters (73%) said that they were able to practice self-care and nearly two-thirds (63%) said that they were able to maintain a positive work-life balance.

METHODOLOGY

APA’s 2023 Practitioner Pulse Survey is one in a series of surveys conducted annually since 2020. This year’s survey was distributed via email to a random sample of 16,557 licensed psychologists in the United States from Aug. 30 to Sept. 29, 2023. A total of 561 responded to the survey.

A full methodology is available.