The behavioral health demand in the United States has been growing at an unprecedented pace, and recent research shows that the supply of providers is struggling to keep up. According to a report by Trilliant Health, certain behavioral health conditions, including eating disorders and anxiety disorders, have seen particularly sharp increases in visit volume since 2019. Specifically, visits for eating disorders rose by 52.6% between 2019 and 2022, while anxiety disorder visits increased by 47.9%. Substance use disorder visits also grew by 27.4% during the same period, reflecting a sustained need for treatment across multiple areas of behavioral health.
Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, emphasized the magnitude of the issue, stating, “No matter how you slice it and dice it, the behavioral health demand outpaces supply.” This growing behavioral health demand is putting immense pressure on healthcare systems, providers, and patients alike, highlighting a gap that requires strategic solutions and investment.
Supply Constraints: A Workforce Under Pressure
While behavioral health demand continues to rise, the supply of providers has not expanded proportionally. The number of psychiatrists has declined by 1.3%, and the supply of doctorate-level psychologists has remained flat. Although master’s-level clinicians, social workers, and psychiatric nurse practitioners are increasing, they still fall short of meeting the rising behavioral health demand.
Part of the supply challenge stems from the aging workforce. Trilliant’s report found that in 22 states, more than a third of practicing psychiatrists are over the age of 60, and the average age of psychiatrists in most states ranges from 50 to 53. The uneven distribution of psychiatric residency programs further exacerbates the problem, with over half of residency positions concentrated in just six states. Even as these programs train the next generation of providers, the total number of positions remains largely unchanged, limiting the ability to meet nationwide behavioral health demand.
Virtual Behavioral Health: A Double-Edged Sword
The emergence of virtual behavioral health services has provided new avenues for access, allowing patients to connect with therapists and nurse practitioners via smartphones or computers. While this expansion of digital care can help meet behavioral health demand, it is not a complete solution. Virtual care may not suffice for complex conditions like eating disorders, which often require in-person treatment or highly specialized therapy.
“You can talk to a therapist or get care with your cell phone instantly. That’s great from an access perspective,” Jain explained. “Even so, we’re still seeing this mismatch. If eating disorders are increasing, will you get the appropriate treatment via a [nurse practitioner] you’re talking to on a virtual care app, or do you need more specialized therapy?”
Primary Care Providers Step In
Primary care providers have increasingly become a critical part of the behavioral health system, particularly in areas with limited access to specialists. In 2021, primary care providers prescribed 42.3% of mental health medications, compared with 34.6% prescribed by behavioral health providers. Nurse practitioners and physician assistants within primary care settings have also played a growing role, particularly during the pandemic, when access to psychiatrists and other specialists was limited.
Jain noted that this shift makes sense: “If we have a shortage of psychiatrists and specialists, primary care tends to be your frontline of defense.” While this approach helps bridge the gap, it also raises questions about whether patients are receiving the most appropriate level of care for their specific conditions. Addressing behavioral health demand requires careful planning to ensure patients receive the right care at the right time.
Youth Behavioral Health in Crisis
The behavioral health crisis is particularly acute among children and adolescents. Diagnoses of eating disorders in patients under 18 have skyrocketed by 107.4%, while rates of pediatric depression have increased by 44%. Jain highlighted the long-term implications, noting that disruptions to social interaction and normal developmental routines could have generational consequences.
“Youth in America have been profoundly affected,” she said. “When children in their prime developmental years are forced to learn remotely and are deprived of typical social interactions, it impacts their mental health in ways we are only beginning to understand.” This trend also contributes to rising behavioral health demand, particularly in pediatric populations.
Gaps in Post-Emergency Care for Adults
Adults with behavioral health needs are also facing significant gaps in care. Trilliant’s report found that 84% of patients who visited the emergency department for alcohol or substance use disorders did not receive follow-up inpatient or residential treatment within 60 days. Additionally, 10% of these patients returned to the emergency department within 30 days, highlighting a lack of continuity in care that can exacerbate both substance use and mental health challenges.
These statistics underscore the urgent need for strategic planning to address behavioral health demand across adult populations, particularly for those with acute needs.
Investment Trends: A Mixed Picture
Despite the growing behavioral health demand, investment in the sector has seen a notable decline. Private equity investments in behavioral health totaled $2.6 billion in 2022, a 52.9% decrease compared with 2021. While tech-enabled solutions such as virtual care platforms can help expand access, they do not fully address the underlying workforce shortages or the need for specialized treatment.
Jain emphasized that while investment in digital health is important, it cannot be the sole solution. “Some of the investments have been helpful in meeting the growing behavioral health demand, but the solution isn’t as simple as just more investment in digital health,” she said. Instead, a multifaceted approach that considers the specific needs of different populations and conditions is critical.
Looking Ahead: Strategic Solutions Required
Meeting the growing behavioral health demand in the U.S. requires more than technology, investment, or short-term fixes. It demands a strategic approach that combines workforce development, care coordination, targeted investment, and innovative delivery models. Understanding the geographic and condition-specific nuances of demand is essential to ensure that patients receive the right type of care in the right locations.
“In some zip codes, you might have a higher proportion of substance use disorders versus another zip code where you might have a higher rate of anxiety and depression,” Jain explained. “It begs the question of what type of care providers do you need by the condition?”
Ultimately, addressing behavioral health demand will require coordinated efforts among policymakers, healthcare organizations, and providers to close the gap between supply and need, ensuring equitable and effective care for all patients.
