NH Public Policy
New Hampshire Center for Public Policy Studies

Few and Far Between? Children's Mental Health Providers in NH

Executive Summary

Date: September 1st, 2007

According to the 1999 U.S. Surgeon General report, one in five children has a diagnosable mental health disorder, and the vast majority of these youth – even those with the most severe impairments – receive no or inappropriate care.[1]  In New Hampshire, mental health practitioners have pointed to a shortage of providers, particularly child psychiatrists, as a primary cause of these unmet needs. These practitioners have described long waiting lists for appointments and the need for children living in rural areas to travel long distances for treatment. This paper provides an overview of the currently available data on mental health providers across the state. 
The Availability of Mental Health Providers
The data presented here raises questions regarding whether the current state of the mental health workforce is sufficient to meet the needs of children. Half of all child psychiatrists – potentially the providers best qualified to serve the broadest set of children’s mental health needs, including the provision of prescriptions – are located in the two southeastern counties of the state. 
Conversely, the two northeastern counties – Carroll and Coos - do not have a child psychiatrist in practice. Not surprisingly, a significant part of Northern New Hampshire has been designated a mental health professional shortage area by the Health Resources Services Administration, in large part due to the absence of psychiatrists.  
Furthermore, New Hampshire has the fewest child psychiatrists per child of the four most northern New England states.   In fact, when you look at all the primary providers of mental health prescriptions to children – psychiatrists, family practitioners and pediatricians – New Hampshire ranks the lowest in Northern New England. 
However, a larger – albeit poorly documented – pool of mental health providers other than psychiatrists exists, most commonly child psychologists, school psychologists, and clinical social workers and mental health counselors. 
Based on the data available, it is clear that schools are a critical component of the mental health workforce for children. While there is less than one child psychiatrist per 10,000 children and fewer than four psychologists in the state per 10,000 residents, on average, there are more than 10 school psychologists per 10,000 students. 
Workforce Data is Limited
The data on the mental health work force is limited. Data on psychiatrists, pediatricians and family practitioners is collected by the American Medical Association each year and counts are available for every county in the state. A survey of providers in a number of communities in New Hampshire demonstrated that this data, while providing comparable estimates across geographic areas, may over-estimate the numbers of these types of providers due to the lack of precision of the data.  
Moreover, information on other providers – clinical social workers and school psychologists among others – is limited in scope and of limited use to policy makers. As the practice patterns of the field change, focusing more on the critical role that providers other than psychiatrists play in mental health, more accurate data will need to be collected for information investments in, and policies involving, the Mental Health workforce. The data that do exist – mainly from state licensing authorities – have several significant limitations, among them, that they were not collected for the purpose of estimating workforce adequacy. 
At a minimum, these data raise questions as to whether there are shortages of some or all types of children’s mental health providers. However, there is limited research on what the most effective number of mental health providers is to meet treatment demands. This makes it difficult to draw any definitive conclusions regarding sufficient workforce capacity. To better understand the supply of and demand for the mental health care workforce, additional information is needed about mental and behavioral health care professions and issues.

[1] U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General—Children and Mental Health. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. Hereafter referred to as, Surgeon General’s Report, 1999.

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