Federal Manpower Shortage Areas

Relevance to Underserved Issue

The Health and Rehabilitative Services (HRSA) professional shortage area guidelines (HPSA) for mental health provide the criteria needed to determine locations that are underserved.

HPSA by State & County Shortage (interactive)

Summary of Key Information
  • Purpose of the Guidelines
    To provide criteria for identifying areas that have a deficit of mental health providers.    
  • Program Authority
    The Public Health Service Act section 332 amended by public law 101-597 requires the Secretary of Health of HHS to establish, by regulation, criteria for the designation of HPSAs. Program RequirementsThe program requires that the core mental health providers who may offer mental health services consist of psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse specialists and marriage and family therapists.    
  • Identified Need for Providers
    HRSA has defined three types of shortage designations consisting of
      1. Geographic area
      2. Population based
      3. Facility based  

Criteria necessary to be designated as a mental health shortage area under these categories:

A.  Geographic Area Based Manpower Shortage Designations

    1. The geographic area is a rational area for the delivery of mental health services.
    2. One of the following conditions exists in the area:
      •  The population ratio to core psychiatrists and/or non-physician mental health professionals is disproportionate using HRSA defined ratios as defined in the summary table below.
      • The area has unusually high needs for mental health services (i.e., poverty, children, elderly, high amount of substance abuse and alcoholism) and the ratio of population to core mental health clinicians is disproportionate to meet this need.

Contiguous area considerations: Mental health professionals near the areas that are being identified as HPSAs will be considered extremely far away, over-utilized or unavailable to the HPSAs if they meet the following criteria: (1) it is more than 40 minutes from the main population center of the area being considered, (2) if the core mental health professionals in that area are overutilized and con not be expected to fill the void (3) there is a cultural, language or geographical barrier and/or because of residency restrictions.

B.  Population Based Manpower Shortage Designations

    1. Population groups in specific service areas are deemed as shortage areas if access barriers prevent the population group from using mental health services.
    2. The ratio of the number of individuals per population group is disproportionate to the number of full-time equivalent (FTE) mental health professionals or FTE psychiatrists.

C.  Facility Based Manpower Shortage Designations

Types of facilities that fall under this designation include: federal and state correctional institutions, state and county mental hospitals, community mental health centers and other public or nonprofit private facilities.

 Facilities can be deemed manpower shortage areas based on HRSA defined criteria that take into account variables such as the ratio of mental health professional to the defined population, average length of stay, average daily inpatient census, etc.

Summary Table, Guidelines for Mental Health Care Designation

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