Guidelines
for Mental Health HPSA Designation
Also see:
A. Background
Reauthorization of
the National Health Service Corps (NHSC) in 1990 brought
about a concurrent change in the designation of psychiatric
health professional shortage areas (HPSAs) to mental
health HPSAs. This legislative change authorized the
utilization of clinical psychologists, clinical social
workers, marriage and family therapists, and psychiatric
nurse specialists to provide mental health services,
in addition to psychiatrists. With this legislative
change there is the need to designate mental health
HPSAs, rather than psychiatric HPSAs.
B. Overview
This guidance will
define and describe mental health HPSAs and core mental
health providers.
The purpose of the
mental health designation is:
1. to assure that mental
health services are available and accessible to underserved
populations;
2. to assist in the
retention and recruitment of mental health providers
in designated areas;
3. to assist in the
determination of unusually high mental health needs.
A. Program Authority
Section 332 of the
Public Health Service Act amended by Public Law 101-597
requires the Secretary to establish, by regulation,
criteria for the designation of HPSAs. The regulation
setting forth these criteria is codified at 42 CFR
part 5. Appendix C of this regulation was amended
to revise the criteria for designation of HPSAs (formerly
Health Manpower Shortage Areas) having shortages of
psychiatric manpower, transforming them into criteria
for designation of HPSAs having shortages of core
mental health professionals. Core mental health professionals
include: psychiatrists; clinical psychologists; clinical
social workers; psychiatric nurse specialists; and
marriage and family therapists.
B. Availability of
Federal Funds
There are no federal
funds available.
1. Core mental
health professionals or core professionals
include those psychiatrists, clinical psychologists,
clinical social workers, psychiatric nurse specialists,
and marriage and family therapists who meet the definitions
below
(a) Psychiatrist
means a doctor of medicine (M.D.) or doctor of osteopathy
(D.O.) who
(1) is certified
as a psychiatrist or child psychiatrist by the
American Medical Specialties Board of Psychiatry
and Neurology or by the American Osteopathic Board
of Neurology and Psychiatry, or if not certified,
is "board-eligible" (i.e., has successfully
completed an accredited program of graduate medical
or osteopathic education in psychiatry or child
psychiatry); and
(2) practices patient
care psychiatry or child psychiatry, and is licensed
to do so, if required by the State of practice.
(b) Clinical
psychologist means an individual (normally
with a doctorate in psychology) who is practicing
as a clinical or counseling psychologist and is
licensed or certified to do so by the State of practice;
or, if licensure or certification is not required
in the State of practice, an individual with a doctorate
in psychology and two years of supervised clinical
or counseling experience. (School psychologists
are not included).
(c) Clinical
social worker means an individual who
(1) is certified
as a clinical social worker by the American Board
of Examiners in Clinical Social Work, or is listed
on the National Association of Social Workers
Clinical Register, or has a master's degree in
social work and two years of supervised clinical
experience; and
(2) is licensed/certified
to practice as a social worker, if required by
the State of practice.
(d) Psychiatric
nurse specialist means a registered nurse
(R.N.) who
(1) is certified
by the American Nurses Association as a psychiatric
and mental health clinical nurse specialist, or
has a master's degree in nursing with a specialization
in psychiatric/mental health and two years of
supervised clinical experience; and
(2) is licensed to
practice as a psychiatric or mental health nurse
specialist, if required by the State of practice.
(e) Marriage
and family therapist means an individual
(normally with a master's or doctoral degree in
marital and family therapy and at least two years
of supervised clinical experience) who is practicing
as a marital and family therapist and is licensed
or certified to do so by the State of practice;
or, if licensure or certification is not required
by the State of practice, is eligible for clinical
membership in the American Association of Marriage
and Family Therapy.
A geographic area will
be designated as having a shortage of mental health
professionals if the following criteria are met:
1. The area is a rational
area for delivery of mental health services
2. One of the following
conditions exists within the area:
(a) population-to-core
mental health professional ratio greater than or
equal to 6,000:1 and a population-to-psychiatrist
ratio greater than or equal to 20,000:1, or
(b) a population-to-core-professional
ratio greater than or equal to 9,000:1, or
(c) a population-to-psychiatrist
ratio greater than or equal to 30,000:1;
3. The area has unusually
high needs for mental health services, and has:
(a) a population-to-core
mental health professional ratio greater than or
equal to 4,500:1, and a population-to-psychiatrist
ratio greater than or equal to 15,000:1, or
(b) a population-to-core
professional ratio greater than or equal to 6,000:1,
or
(c) a population-to-psychiatrist
ratio greater than or equal to 20,000:1.
4. An area will be
considered to have unusually high needs for mental
health services if one of the following criteria is
met:
(a) 20 percent of the
population (or of all households) in the area have
incomes below the poverty level;
(b) the youth ratio,
defined as the ratio of the number of children under
18 to the number of adults of ages 18 to 64, exceeds
0.6;
(c) the elderly ratio,
defined as the ratio of the number of persons aged
65 and over to the number of adults of ages 18 to
64, exceeds 0.25;
(d) a high prevalence
of alcoholism in the population, as indicated by
prevalence data showing the area's alcoholism rates
to be in the worst quartile of the nation, region,
or State;
(e) a high degree of
substance abuse in the area, as indicated by prevalence
data showing the area's substance abuse to be in
the worst quartile of the nation, region, or State.
1. Mental health professionals
in contiguous areas to an area being considered for
designation will be considered excessively distant,
overutilized or inaccessible to the population of
the area under consideration if one of the following
conditions prevails in each contiguous area:
(a) core mental health
professionals in the contiguous area are more than
40 minutes travel time from the closest population
center of the area being considered for designation.
(b) the population-to-core
mental health professional ratio in the contiguous
area is in excess of 3,000:1 and the population-to-psychiatrist
ratio there is in excess of 10,000:1 (if data on
core mental health professionals other than psychiatrists
are not available for the contiguous area, a population-to-psychiatrist
ratio there in excess of 20,000:1 may be used to
demonstrate overutilization).
(c) mental health professionals
in contiguous areas are inaccessible to the population
of the requested area due to geographic, cultural,
language or other barriers or because of residency
restrictions or programs or facilities providing
such professionals.
1. Criteria
Population groups within
particular rational service areas will be designated
as having a mental health professional shortage if
the following criteria are met:
(a) access barriers
prevent the population group from using those core
mental health professionals which are present in
the area; and
(b) one of the following
conditions prevails:
(1) the ratio of
the number of persons in the population group
to the number of FTE core mental health professionals
serving the population group is greater than or
equal to 4,500:1 and the ratio of the number of
persons in the population group to the number
of FTE psychiatrists serving the population group
is greater than or equal to 15,000:1; or
(2) the ratio of
the number of persons in the population group
to the number of FTE core mental health professionals
serving the population group is greater than or
equal to 6,000:1; or
(3) the ratio of
the number of persons in the population group
to the number of FTE psychiatrists serving the
population group is greater than or equal to 20,000:1.
2. Determination of
degree of shortage
Designation of population
groups will be assigned to degree-of-shortage groups
according to the following table, depending on the
ratio of population to number of FTE core-mental-health-service
providers; the ratio of population to number of FTE
psychiatrists; and the presence or absence of high
needs:
High Needs
not indicated:
Group 1 - there are
no FTE psychiatrists or core mental health providers
Group 2 - the ratio
of population to the number of FTE core mental health
providers is greater than or equal to 6,000:1 and
there are no FTE psychiatrists
Group 3 - the ratio
of population to the number of FTE core mental health
providers is greater than or equal to 6,000:1 and
the ratio of population to the number of FTE psychiatrists
is greater than or equal to 20,000:1
Group 4 -
(a) for psychiatrists
only: all other areas with no FTE psychiatrists
or the ratio of the population to the number of
FTE psychiatrists is greater than or equal to 30,000:1
(b) for other mental
health providers: all other areas with the ratio
of population to number of FTE core-mental health-service-providers
is greater than or equal to 9,000:1.
High Needs
indicated:
Group 1 - there are
no FTE psychiatrists or core mental health providers
Group 2 - the ratio
of population to the number of FTE core mental health
providers is greater than or equal to 4,500:1 and
there are no FTE psychiatrists
Group 3 - the ratio
of population to the number of FTE core mental health
providers is greater than or equal to 4,500:1 and
the ratio of population to FTE psychiatrists is greater
than or equal to 15,000:1
Group 4 -
(a) for psychiatrists
only: all other areas with no FTE psychiatrists
or the ratio of population to FTE psychiatrists
is greater than or equal to 20,000:1
(b) for other mental
health providers: all other areas with the ratio
of population to number of FTE core-mental health
providers greater than or equal to 6,000:1.
3. Determination of
size of shortage
Size of shortage will
be computed as follows:
For areas without
unusually high need:
Core professional
shortage = area population/6,000 - number of
FTE core professionals
Psychiatrist shortage
= area population/20,000 - number of FTE psychiatrists
For areas with
unusually high need:
Core professional
shortage = number of persons in population group/4500
- number of core professionals
Psychiatrist shortage
= number of persons in population group/15,000
- number of FTE psychiatrists
A facility will be
considered to have insufficient capacity to meet the
mental health service needs of the area of population
it serves if:
1. there are more than
1,000 patient visits per year per FTE core mental
health professional on staff of the facility, or
2. there are more than
3,000 patient visits per year per FTE psychiatrist
on staff of the facility, or
3. no psychiatrists
are on the staff and this facility is the only facility
providing (or responsible for providing) mental health
services to the designated area or population.
|
