Open Access Highly Accessed Research article

A needs-based method for estimating the behavioral health staff needs of community health centers

Bridget Teevan Burke1*, Benjamin F Miller2, Michelle Proser3, Stephen M Petterson4, Andrew W Bazemore4, Eric Goplerud5 and Robert L Phillips6

Author Affiliations

1 Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA

2 Department of Family Medicine, University of Colorado Denver School of Medicine, Mail Stop F496 Academic Office 1, 12631 East 17th Avenue, Room 3403, Aurora, CO 80045, USA

3 National Association of Community Health Centers, 1400 I Street, NW, Suite 910, Washington, DC 20005, USA

4 The Robert Graham Center, 1133 Connecticut Ave NW, Suite 1100, Washington, DC 20036, USA

5 Substance Abuse, Mental Health and Criminal Justice Studies, NORC at the University of Chicago, 4350 East West Highway 8th Floor, Bethesda, MD 20814, USA

6 The American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY 40511-1247, USA

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BMC Health Services Research 2013, 13:245  doi:10.1186/1472-6963-13-245

Published: 2 July 2013

Abstract

Background

Federally Qualified Health Centers are expanding to increase access for millions of more Americans with a goal of doubling capacity to serve 40 million people. Health centers provide a lot of behavioral health services but many have difficulty accessing mental health and substance use professionals for their patients. To meet the needs of the underserved and newly insured it is important to better estimate how many behavioral health professionals are needed.

Methods

Using health center staffing data and behavioral health service patterns from the 2010 Uniform Data System and the 2010 National Survey on Drug Use and Health, we estimated the number of patients likely to need behavioral health care by insurance type, the number of visits likely needed by health center patients annually, and the number of full time equivalent providers needed to serve them.

Results

More than 2.5 million patients, 12 or older, with mild or moderate mental illness, and more than 357,000 with substance abuse disorders, may have gone without needed behavioral health services in 2010. This level of need would have required more than 11,600 full time providers. This translates to approximately 0.9 licensed mental health provider FTE, 0.1 FTE psychiatrist, 0.4 FTE other mental health staff, and 0.3 FTE substance abuse provider per 2,500 patients. These estimates suggest that 90% of current centers could not access mental health services or provide substance abuse services to fully meet patients’ needs in 2010. If needs are similar after health center expansion, more than 27,000 full time behavioral health providers will be needed to serve 40 million medical patients, and grantees will need to increase behavioral health staff more than four-fold.

Conclusions

More behavioral health is seen in primary care than in any other setting, and health center clients have greater behavioral health needs than typical primary care patients. Most health centers needed additional behavioral health services in 2010, and this need will be magnified to serve 40 million patients. Further testing of these workforce models are needed, but the degree of current underservice suggests that we cannot wait to move on closing the gap.