Ivey S L, Scheffler R, Zazzali J L
Center for Family and Community Health, University of California, Berkeley 94720, USA.
Milbank Q. 1998;76(1):25-58. doi: 10.1111/1468-0009.00078.
The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.
美国的心理健康专业人员队伍多样且灵活。从心理学家到社会工作者和护士专家等“中级”专业人员等非医师心理健康专业人员供应的强劲增长，有助于抵消进入精神病学领域的医学毕业生数量的减少。初级保健医生经常诊治患有某种形式精神疾病的患者，但他们并不总是接受过识别和治疗这些疾病的培训。关于几位专科医生——精神科医生、临床心理学家和临床社会工作者——供应情况的数据表明，心理健康专业人员的分布在各州差异很大。该领域工作人员的构成、供应和分布也会影响弱势群体的护理。更广泛的政策问题，包括心理健康保险覆盖范围与身体健康保险覆盖范围之间缺乏平等以及非医师职业的准入障碍，可能会限制这支多样化且充满活力的劳动力队伍进行具有成本效益的扩张。
