nebraska - unmc.edu · this project provides an updated in-depth analysis of the current supply of...

Nebraska

Center

for

Rural

Health

Research

Nebraska’s Behavioral Health Workforce

–2000 to 2014

June 2015

For Submission to the Nebraska Behavioral Health Education Center

Shinobu Watanabe-Galloway, PhD

Kate Trout, MPH

Marlene Deras, B

Zaeema Naveed, MBBS, MSPH

Li-Wu Chen, PhD, MHSA

Nebraska Center for Rural Health Research

College of Public Health

University of Nebraska Medical Center

984350 Nebraska Medical Center

Omaha, NE 68198-4350

402-559-5260

www.unmc.edu/rural

http://www.unmc.edu/rural

Acknowledgements

The funding for this project was provided by the Nebraska Behavioral Health Education Center

(BHECN). The authors would like to thank the Health Professional Tracking Service (HPTS), College of

Public Health, UNMC for providing the data. The authors would also like to thank BHECN faculty and

administrators for their guidance and feedback throughout the project.

TABLE OF CONTENTS

LIST OF TABLES ........................................................................................................................... i

LIST OF FIGURES ........................................................................................................................ ii

EXECUTIVE SUMMARY ............................................................................................................ 1

INTRODUCTION .......................................................................................................................... 6

METHODS ..................................................................................................................................... 7

Definitions................................................................................................................................................. 7

Data Source ............................................................................................................................................... 8

Data Analysis ............................................................................................................................................ 9

RESULTS ..................................................................................................................................... 10

Supply of Behavioral Health Professionals, Nebraska 2014 .................................................................. 10

Supply of Psychiatric Prescribers, Nebraska 2014 ............................................................................. 11

Psychiatrists .................................................................................................................................... 15

Advanced Practice Registered Nurses (APRN) Practicing Psychiatry ........................................... 20

Physician Assistants Practicing Psychiatry ..................................................................................... 22

Supply of Independent Behavioral Health Professionals, Nebraska 2014 .......................................... 24

Psychologists ................................................................................................................................... 24

Licensed Independent Mental Health Practitioners ........................................................................ 27

Supply of Other Behavioral Health Professionals .............................................................................. 29

Licensed Mental Health Practitioners ............................................................................................. 30

Alcohol and Drug Counselors ......................................................................................................... 33

Regional Distribution of Behavioral Health Professionals ..................................................................... 36

Regional Distribution of Psychiatric Prescribers, Nebraska 2014 ...................................................... 36

Psychiatrists .................................................................................................................................... 36

Advanced Practice Registered Nurses Practicing Psychiatry ......................................................... 37

Physician Assistants Specialized in Psychiatry............................................................................... 37

Regional Distribution of Non-Prescribing Behavioral Health Professionals, ..................................... 42

Psychologists ................................................................................................................................... 42

Licensed Independent Mental Health Professionals ....................................................................... 42

Licensed Mental Health Practitioners ............................................................................................. 43

Addiction Counselors ...................................................................................................................... 43

Trends in the Supply of Behavioral Health Professionals, Nebraska 2000 to 2014 ............................... 49

Supply of Psychiatric Prescribers in Nebraska, 2000 to 2014 ............................................................ 49

Psychiatrists .................................................................................................................................... 49

Advanced Practice Registered Nurses Practicing in Psychiatry ..................................................... 51

Physician Assistants Practicing in Psychiatry ................................................................................. 52

Supply of Non-Prescribing Behavioral Health Professionals in Nebraska, 2008 to 2014 .................. 53

Need for Behavioral Health Professionals in Nebraska .......................................................................... 54

Mental Health Professionals Shortage Areas ...................................................................................... 54

Counties with High Needs for Mental Health Services ...................................................................... 57

TELEHEALTH PRACTICE ........................................................................................................ 60

RETENTION ................................................................................................................................ 61

Psychiatrists ............................................................................................................................................ 61

Psychologists........................................................................................................................................... 63

Advanced Practice Registered Nurses .................................................................................................... 64

Physician Assistants ................................................................................................................................ 65

LIMHPs .................................................................................................................................................. 66

LMHPs .................................................................................................................................................... 67

LADCs .................................................................................................................................................... 68

CONCLUSIONS........................................................................................................................... 69

REFERENCES ............................................................................................................................. 71

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LIST OF TABLES

Table 1. Licensed and Actively Practicing Behavioral Health Professionals, Nebraska 2014 ..... 10

Table 2. Supply of Actively Practicing Behavioral Health Professionals by Work Status,

Nebraska 2010, 2012 and 2014 ..................................................................................................... 11

Table 3. Locations of Medical School of Psychiatrists, Nebraska 2014 ...................................... 18

Table 4. Locations of Residency Training of Psychiatrists, Nebraska 2014 ................................ 18

Table 5. Locations of Medical School of Psychiatry Residents, Nebraska 2014 ......................... 18

Table 6. Training Locations of Psychologists, Nebraska 2014 .................................................... 27

Table 7. Training Locations of Licensed Independent Mental Health Practitioners, Nebraska

2014............................................................................................................................................... 29

Table 8. Training Locations of Licensed Mental Health Practitioners, Nebraska 2014 ............... 32

Table 9. Training Locations of Licensed Alcohol and Drug Counselors, Nebraska 2014 ........... 35

Table 10. Supply of Actively Practicing Behavioral Health Professionals by Behavioral Health

Region, Nebraska 2014 ................................................................................................................. 36

Table 11. Supply of Psychiatric Prescribers by Behavioral Health Region and Work Status,

Nebraska 2014 .............................................................................................................................. 38

Table 12. Supply of Non-Prescribing Behavioral Health Professionals by Behavioral Health

Region and Work Status, Nebraska 2014 ..................................................................................... 44

Table 13. Supply of Actively Practicing Non-Prescribing Behavioral Health Professionals,

Nebraska 2008-2014 ..................................................................................................................... 53

Table 14. Counties with Unusually High Needs for Mental Health Services, Nebraska 2014 .... 58

Table 15. Psychiatrists’ Reasons for Relocating Outside of Nebraska ......................................... 62

Table 16. Psychologists’ Reasons for Relocating Outside of Nebraska ....................................... 63

Table 17. APRNs’ Reasons for Relocating Outside of Nebraska ................................................. 64

Table 18. PAs’ Reasons for Relocating Outside of Nebraska ...................................................... 65

Table 19. LIMHPs’ Reasons for Relocating Outside of Nebraska ............................................... 66

Table 20. LMHPs’ Reasons for Relocating Outside of Nebraska ................................................ 67

Table 21. Addiction Counselors’ Reasons for Relocating Outside of Nebraska .......................... 68

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LIST OF FIGURES

Figure 1. Geographic Distribution of Psychiatric Prescribers, Nebraska 2014 ............................ 13

Figure 2. Primary and Satellite Practice Locations of Psychiatric Prescribers, Nebraska 2014 ... 14

Figure 3. Gender Distribution of Psychiatrists, Nebraska 2014 ................................................... 16

Figure 4. Age Distribution of Psychiatrists, Nebraska 2014 ........................................................ 16

Figure 5. Race and Ethnicity Distribution of Psychiatrists, Nebraska 2014 ................................. 17

Figure 6. Geographic Distribution of Psychiatrists, Nebraska 2014 ............................................ 19

Figure 7. Gender Distribution of Advanced Practice Registered Nurses Practicing Psychiatry,

Nebraska 2014 .............................................................................................................................. 20

Figure 8. Age Distribution of Advanced Practice Registered Nurses Practicing Psychiatry,

Nebraska 2014 .............................................................................................................................. 21

Figure 9. Race and Ethnicity Distribution of Advanced Practice Registered Nurses Practicing

Psychiatry, Nebraska 2014............................................................................................................ 21

Figure 10. Gender Distribution of Physician Assistants Practicing Psychiatry, Nebraska 2014 .. 22

Figure 11. Age Distribution of Physician Assistants Practicing Psychiatry, Nebraska 2014 ....... 23

Figure 12. Race and Ethnicity Distribution of Physician Assistants Practicing Psychiatry,

Nebraska 2014 .............................................................................................................................. 23

Figure 13. Numbers of Actively Practicing Non-Prescribing Behavioral Health Professionals

among Licensed Non-Prescribing Behavioral Health Professionals, Nebraska 2014 .................. 24

Figure 14. Gender Distribution of Psychologists, Nebraska 2014................................................ 25

Figure 15. Age Distribution of Psychologists, Nebraska 2014 ..................................................... 26

Figure 16. Race and Ethnicity Distribution of Psychologists, Nebraska 2014 ............................. 26

Figure 17. Gender Distribution of Licensed Independent Mental Health Practitioners, Nebraska

2014............................................................................................................................................... 28

Figure 18. Age Distribution of Licensed Independent Mental Health Practitioners, Nebraska

2014............................................................................................................................................... 28

Figure 19. Race and Ethnicity Distribution of Licensed Independent Mental Health Practitioners,

Nebraska 2014 .............................................................................................................................. 29

Figure 20. Gender Distribution of Licensed Mental Health Practitioners, Nebraska 2014 .......... 30

Figure 21. Age Distribution of Licensed Mental Health Practitioners, Nebraska 2014 ............... 31

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Figure 22. Race and Ethnicity Distribution of Licensed Mental Health Practitioners, Nebraska

2014............................................................................................................................................... 31

Figure 23. Gender Distribution of Addiction Counselors, Nebraska 2014................................... 33

Figure 24. Age Distribution of Addiction Counselors, Nebraska 2014 ........................................ 34

Figure 25. Race and Ethnicity Distribution of Addiction Counselors, Nebraska 2014 ................ 34

Figure 26. Supply of Psychiatrists by Geographic Location per 100,000 Population, Nebraska

2000-2014 ..................................................................................................................................... 49

Figure 27. Supply of Psychiatry Residents per 100,000 Population by Geographic Location,

Nebraska 2000-2014 ..................................................................................................................... 50

Figure 28. Supply of Advanced Practice Registered Nurses Practicing Psychiatry per 100,000

Population by Geographic Location, Nebraska 2000-2014 .......................................................... 51

Figure 29. Supply of Physician Assistants Specialized in Psychiatry per 100,000 Population by

Geographic Location, Nebraska 2000-2014 ................................................................................. 52

Figure 30. Federally Designated Mental Health Professional Shortage Areas, Nebraska 2015 ... 55

Figure 31. State-Designated Medical Shortage Area, Psychiatry and Mental Health, Nebraska

2013............................................................................................................................................... 56

Figure 32. Counties with High Need for Mental Health Services and Low Supply of Mental

Health Providers, Nebraska 2014 ................................................................................................. 59

Figure 33. Psychiatrists Intentions to Retire or Discontinue Practice .......................................... 61

Figure 34. Psychologists Intentions to Retire or Discontinue Practice ......................................... 63

Figure 35. APRNs Intentions to Retire or Discontinue Practice .................................................. 64

Figure 36. PAs’ Intentions to Retire or Discontinue Practice ....................................................... 65

Figure 37.LIMHPs’ Intentions to Retire or Discontinue Practice ................................................ 66

Figure 38. LMHPs’ Intentions to Retire or Discontinue Practice ................................................. 67

Figure 39. Addiction Counselors Intentions to Retire or Discontinue Practice ............................ 68

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EXECUTIVE SUMMARY

In June 2011, the Nebraska Center for Rural Health Research completed an assessment of

Nebraska’s behavioral health workforce from 2000 to 2010 (Nayar et al., 2011). The recommendations

included a continuation for the College of Public Health at the University of Nebraska Medical Center to

produce workforce analysis reports on the licensed behavioral health workforce in Nebraska on a bi-

annual basis. The purpose of conducting workforce analysis reports is to provide the Behavioral Health

Education Center of Nebraska with the information needed to guide the state’s behavioral health

workforce planning efforts to address the mental health needs of Nebraskans.

This project provides an updated in-depth analysis of the current supply of licensed behavioral

health professionals practicing in the state of Nebraska. This project uses data obtained from the

University of Nebraska Medical Center, College of Public Health, Health Professions Tracking Service

(HPTS) annual survey database for years 2000 to 2014.

Key Findings

Supply and Distribution of Behavioral Health Professionals, Nebraska 2014 According to

Data Provided by the HPTS

Psychiatrists

The number of actively practicing psychiatrists decreased by 3.1% from 161 in 2010 to 156 in

2014. Specifically, this decline occurred between 2010 and 2012. The number of psychiatrists

remained the same between 2012 and 2014.

In 2014, 138 psychiatrists were board certified and 18 were board eligible in psychiatry.

The ratio of population to actively practicing psychiatrists in Nebraska was estimated to be

11,978:1 in 2014.

Of Nebraska’s 93 counties, only 10 counties had a ratio of psychiatrist-to-population that was at

or above the federal mental health professional shortage area (HPSA) shortage designation ratio

of 1:30,000.

The majority (84.6%) of actively practicing psychiatrists were practicing in metropolitan

counties.

More than one-half (64.1%) of the actively practicing psychiatrists were older than 50 years of

age.

Advanced Practice Registered Nurses

The number of Advanced Practice Registered Nurses (APRNs) actively practicing psychiatry

increased by 25.6% from 78 in 2010 to 98 in 2014. There was a slight decrease of 3.8% between

2010 and 2012.

In 2014, of the 98 APRNs actively practicing psychiatry, 63 were board certified in psychiatry

and the remaining 35 were not board certified in psychiatry.

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In 2014, psychiatric APRNs were actively practicing in 17 of Nebraska’s 93 counties.

More than two-thirds (70.4%) of psychiatric APRNs were actively practicing in metropolitan

counties.

About 62% of APRNs practicing psychiatry were older than 50 years of age.

Physician Assistants

In 2014, there were 16 physician assistants (PAs) who identified psychiatry as their primary or

secondary practice specialty, an increase of 77.8% from 9 PAs in 2010.

PAs that identified psychiatry as their primary or secondary practice specialty were actively

practicing in only six of Nebraska’s 93 counties.

Three-fourths (75%) of psychiatric PAs were actively practicing in metropolitan counties.

Half (50%) of the PAs who identified psychiatry as their primary or secondary practice specialty

were over 50 years of age.

Psychologists

The number of actively practicing psychologists increased by 15.1% from 318 in 2010 to 366 in

2014.

The ratio of population to actively practicing psychologist in Nebraska was estimated to be

5,105:1 in 2014.

Psychologists were actively practicing in 24 of Nebraska’s 93 counties.

The majority (78.1%) of Nebraska’s psychologists were actively practicing in metropolitan

counties.

Over half (59.3%) of actively practicing psychologists were over 50 years of age.

Independent Mental Health Practitioners

The number of actively practicing licensed independent mental health practitioners (LIMHPs)

increased by 38.2% from 589 in 2010 to 814 in 2014.

LIMHPs were actively practicing in 45 of Nebraska’s 93 counties.

The majority (70.5%) of Nebraska’s LIMHPs were actively practicing in metropolitan counties.

Over one-half (52.8%) of the actively practicing LIMHPs in Nebraska were older than 50 years of

age.

Licensed Mental Health Practitioners

The number of actively practicing licensed mental health practitioners (LMHPs) declined by

7.4% from 991 in 2010 to 918 in 2014. This was likely due to the migration of LMHPs updating

their licenses to LIMHPs. The number of actively practicing LMHPs increased by 4.0% from 991

in 2010 to 1,031 in 2012, but there was a subsequent decline to 918 mental health practitioners in

2014.

LMHPs were actively practicing in 45 of Nebraska’s 93 counties.

The majority (71.8%) of Nebraska’s LMHPs were actively practicing in metropolitan counties.

Slightly more than one-half (52%) of the actively practicing LMHPs in Nebraska were older than

50 years of age.

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Addiction Counselors

The number of actively practicing licensed alcohol and drug counselors (LADCs), increased by

8.3% from 132 in 2010 to 143 in 2014. However, the number of addiction counselors in 2014 has

actually decreased from 152 in 2012.

Addiction counselors were actively practicing in 30 of Nebraska’s 93 counties.

More than half (56.6%) of Nebraska’s addiction counselors were actively practicing in

metropolitan counties.

More than two-thirds (71.3%) of actively practicing addiction counselors were over the age of 50

years.

Need for Behavioral Health Professionals in Nebraska

Mental Health Shortage Areas

In 2014, 48 counties did not have a Mental Health provider.

In 2014, all of Nebraska’s counties, with the exception of Adams, Buffalo, Douglas, Gage,

Johnson, Lancaster, Lincoln, McPherson, Scotts Bluff and Thurston, were designated as federal

mental health professional shortage areas.

The state-designation of shortage areas for psychiatry and mental health was last updated in 2010.

Eighty-one of Nebraska’s 93 counties were state-designated as shortage areas for psychiatrists

and mental health. Nine counties, including Butler, Cass, Dodge, Gage, Otoe Saunders, Saline,

Seward, and Washington, were state-designated as partial shortage areas. Only three counties,

including Douglas, Lancaster, and Sarpy, as well as areas within a 25 mile buffer surrounding the

cities of Lincoln and Omaha were not state-designated as shortage areas.

Counties with High Mental Health Needs

In 2014, the number of counties with unusually high needs for mental health services in Nebraska

remained the same as 2010. In 2014, 78 out of Nebraska’s 93 counties were identified as having

unusually high needs for mental health services based on the Health Resources and Services

Administration’s (HRSA) mental health professional shortage criteria. Of these, 38 were frontier

counties, 37 were rural (non-frontier) counties, and three were metropolitan counties.

In 2014, 72 out of the 78 Nebraska counties that were identified as having unusually high needs

for mental health services were also identified as having no psychiatrist or having a psychiatrist-

to-population ratio below 1:15,000. Of these, 38 were frontier counties, 31 were rural (non-

frontier) counties, and three were metropolitan counties.

Telehealth

Psychiatrists

In 2014, only 3 psychiatrists reported using telehealth in their practice as a specialist. The time

these psychiatrists spent using telehealth ranged from 2 to 3 hours per week. These psychiatrists

were located in Douglas and Scotts Bluff counties.

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Psychologists

In 2014, eight psychologists reported using telehealth in their practice as a specialist. The time

the 8 psychologists spent using telehealth as a specialist ranged from 1 to 3 hours per week.

These psychologists were located in the following counties: Lancaster, Hall, Douglas, and

Buffalo.

In 2014, two psychologists reported using telehealth to deliver care to patients in their practice.

The time the two psychologists spent using telehealth to deliver care to their patients ranged from

1 to 10 hours per week. These two psychologists were located in Sarpy and Scotts Bluff counties.

Retention

Psychiatrists

Fifteen (13.5%) of the 111 responding psychiatrists reported they would retire within 5 years and

18 (16.2%) reported they would retire in the next 6-10 years.

Twelve (12.1%) of the 99 responding psychiatrists reported they would discontinue their practice

within 5 years and 7 (7.1%) reported they would do so in the next 6-10 years.

A total of 12 (7.7%) psychiatrists reported that they plan to relocate outside of Nebraska.

Psychologists

Forty-seven (13.7%) of the 342 responding psychologists reported they would retire within 5

years and 50 (14.6%) reported they would retire in the next 6-10 years.

Thirty-four (10.1%) of the 341 responding psychologists reported they would discontinue their

practice within 5 years and 32 (9.4%) reported they would do so in the next 6-10 years.

A total of 55 (15.0%) psychologists reported that they plan to relocate outside of Nebraska.


Seven (9.6%) of the 73 responding APRNs reported they would retire within 5 years and 16

(21.9%) reported they would retire in the next 6-10 years.

Four (6.6%) of the 61 responding APRNs reported they would discontinue their practice within 5

years and 8 (13.1%) reported they would do so in the next 6-10 years.

A total of 16 (16.3%) APRNs reported that they plan to relocate outside of Nebraska.


One (7.1%) of the 14 responding PAs reported they would retire within 5 years and 3 (21.4%)

reported they would retire in the next 6-10 years.

One (11.1%) of the 9 responding PAs reported they would discontinue their practice within 5

years and 1 (11.1%) reported they would do so in the next 6-10 years.

A total of 4 (25%) PAs reported that they plan to relocate outside of Nebraska.

Independent Mental Health Practitioners

Sixty-eight (8.6%) of the 785 responding LIMHPs reported they would retire within 5 years and


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Thirty (3.8%) of the 786 responding LIMHPs reported they would discontinue their practice


A total of 120 (14.7%) LIMHPs reported that they plan to relocate outside of Nebraska.


Seventy-five (8.6%) of the 873 responding LMHPs reported they would retire within 5 years and


Fifty-seven (6.5%) of the 873 responding LMHPs reported they would discontinue their practice


A total of 119 (13.0%) LMHPs reported that they plan to relocate outside of Nebraska.


Fifteen (11.2%) of the 134 responding addiction counselors reported they would retire within 5

years and 29 (21.6%) reported they would retire in the next 6-10 years.

Eleven (8.1%) of the 135 responding addiction counselors reported they would discontinue the

practice within 5 years and 14 (10.4%) reported they would do so in the next 6-10 years.

A total of 34 (23.8%) addiction counselors reported that they plan to relocate outside of

Nebraska.

Conclusions

This study suggests that Nebraska continues to face critical shortages in the supply of behavioral health

providers based on the following key findings:

A decline in the supply of psychiatric prescribers from 2010 to 2012, which has been maintained

for the year 2014;

A significant geographical mal-distribution of the behavioral health workforce between rural and

urban areas;

An aging workforce with intentions to retire within the next 5 to 10 years;

An increase in the need for mental health services among Nebraska’s population;

Difficulty retaining behavioral health professionals, due to reported intentions of discontinuing

their practice or relocating outside of Nebraska;

A limited number of psychiatrists and psychologists reporting utilizing telehealth technologies,

despite the shortages and geographic mal-distribution of providers;

High mental health needs of populations.

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INTRODUCTION

In 2004, Nebraska’s public behavioral health system underwent a major reform with the passage

of legislative bill (LB) 1083. LB 1083 facilitated a transition from the institutionalized care to

community-based care resulting in a significant increase in the number of people with mental illness

living close to their home in both rural and urban communities (Substance Abuse and Mental Health

Services Administration [SAMHSA], 2011; SAMHSA, 2008). In 2009, the passage of LB 603 established

the Behavioral Health Education Center (BHECN) at the University of Nebraska Medical Center

(UNMC) to support the increase of recruitment, retention, and competency of the state’s behavioral health

workforce (BHECN, n.d.). One of the BHECN’s strategies is to “facilitate the collection, analysis, and

dissemination of behavioral health workforce data and the prioritization of training and recruitment of

behavioral health professional by type and region.”

In June 2011, the Nebraska Center for Rural Health Research conducted the first BHECN

workforce analysis (Nayar et al., 2011). Nayar et al. (2011) provided an assessment of Nebraska’s

behavioral health workforce from 2000 to 2010. The study concluded that Nebraska faces a critical

shortage of behavioral health providers with an aging workforce and many areas in Nebraska have a high

need for mental health services. Furthermore, many of these high mental health need areas have low

health care provider supply. The study also documented the graying of the workforce as well as a

significant geographic mal-distribution of the behavioral health workforce in rural and frontier areas as

compared to urban areas in Nebraska.

The Nayar (2011) report recommended that the College of Public Health at University of

Nebraska Medical Center continue to workforce analysis reports on the licensed behavioral health

workforce in Nebraska on a bi-annual basis. The purpose of conducting workforce analysis reports is to

provide the BHECN with the information needed to guide the state’s behavioral health workforce

planning efforts to address the mental health needs of Nebraskans.

Thus, this project provides an updated in-depth analysis of the current supply of licensed and

certified behavioral health professionals practicing in the state of Nebraska, using data obtained from the

University of Nebraska Medical Center, College of Public Health, Health Professions Tracking Service

(HPTS) annual survey database. More specifically, this report provides snapshot of the supply of

psychiatrists, Advanced Practice Registered Nurses and physician assistants practicing psychiatry,

psychologists, licensed independent mental health practitioners, licensed mental health practitioners, and

licensed alcohol and drug counselors in 2014 in Nebraska.

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METHODS

Definitions

The behavioral health professionals include: psychiatrists, psychologists, advanced practice

registered nurses (APRNs), physician assistants (PAs), licensed independent mental health practitioners

(LIMHPs), licensed mental health practitioners (LMHPs), and licensed alcohol and drug counselors.

Professionals listed in this report had to hold an active license to practice in Nebraska and have a primary

and/or satellite practice location in Nebraska. Behavioral health professionals who practice in the federal

and state institutions are not included in this report.

Psychiatric prescribers include psychiatrists, APRNs practicing psychiatry, and PAs practicing

psychiatry. Psychiatrists included in this report are those individuals board-certified by the American

Osteopathic Board of Neurology and Psychiatry or by the American Osteopathic Board of Neurology and

Psychiatry and board-eligible (i.e., has successfully completed an accredited program of graduate medical

or osteopathic education in psychiatry or child psychiatry) allopathic or osteopathic physicians specialized

in psychiatry.1 Residents and house officers were excluded from the analysis. APRNs practicing

psychiatry include those who self-identify psychiatry as their primary or secondary practice specialty.

Thus, APRNs practicing psychiatry include both those who are and are not board-certified in psychiatry.

APRNs that are board certified in psychiatry hold a national board certification from the American Nurses

Association (ANA). PAs practicing psychiatry include those who self-identified psychiatry as their

primary or secondary practice specialty.

Independent behavioral professionals include psychologists and independent mental health

practitioners. Independent behavioral professionals may hold more than one license. Psychologists

included in this report are those who hold a license to practice psychology and are actively practicing

psychology. Services to individuals, families, groups, organizations, institutions, and/or the public

provided by licensed psychologists may include: psychological testing and the evaluation or assessment

of personal characteristics such as intelligence, personality, abilities, interests, aptitudes, and

psychophysiological and neuropsychological functioning; counseling, psychoanalysis, psychotherapy,

hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and

emotional disorders, alcoholism and substance abuse, disorders of habit or conduct, and the psychological

aspects of physical illness, accident, injury, or disability; psycho-educational evaluation, therapy,

remediation, and consultation; and supervision of qualified individuals performing services specified in

172 NAC 155.2 Independent mental health practitioners include those who are licensed and actively

practicing as an independent mental health practitioner. Services to individuals, couples, families, and/or

groups provided by licensed independent mental health practitioners include providing treatment,

assessment, psychotherapy, counseling, or equivalent activities for behavioral, cognitive, social, mental,

1 http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html. Accessed on December 26, 2012. 2 http://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-172/Chapter-155.pdf.

Accessed on December 26, 2012.

http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html

http://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-172/Chapter-155.pdf

8 | P a g e

or emotional disorders, including interpersonal or personal situations with or without consultation with a

qualified physician or licensed psychologist.3

Other behavioral health professionals include: licensed mental health practitioners and alcohol

and drug counselors. Other behavioral professionals may hold more than one license. Mental health

practitioners include those who are licensed and actively practicing as a mental health practitioner.

Services to individuals, couples, families, or groups provided by a licensed mental health practitioner

include providing treatment, assessment, psychotherapy, counseling, or equivalent activities for

behavioral, cognitive, social, mental, or emotional disorders, including interpersonal or personal

situations; and initial assessment of organic mental or emotional disorders for the purpose of referral or

consultation.4 Addiction counselors include licensed alcohol drug counselors (LADCs), and could have a

duel license to include LADC and Certified Compulsive Gambling Counselor (CCGC). However,

individuals with solely CCGC licenses were excluded. The scope of practice of LADCs include the

application of general counseling theories and treatment methods adapted to specific addiction theory and

research for the express purpose of treating any alcohol or drug abuse, dependence, or disorder.5 The

scope of practice of CCGCs include rendering counseling services under clinical supervision to

compulsive gambling clients for remuneration.6

Some providers have more than one license, but each provider is counted once. If the provider has

more than one license, the first license will be counted from the following list: physician (MD/DO) (i.e.,

psychiatrist), psychologist, APRN, PA, LIMHP, LMHP, and LADC. We included providers who have a

primary or satellite practice location in Nebraska. If the provider practices in more than one location, the

first Nebraska practice location county provided in the survey was used.

Data Source

This study uses data obtained from the University of Nebraska Medical Center, College of Public

Health, Health Professions Tracking Service (HPTS) database for years 2000 to 2014. The HPTS

maintains a database of Nebraska’s licensed healthcare professionals including behavioral health

professionals. Using Nebraska licensure data as the foundation, the HPTS database expands beyond the

scope of the data Nebraska licensure receives during the bi-annual licensure renewal process.

Using the Nebraska licensure database as the sampling frame, annually HPTS surveys healthcare

and behavioral health professionals practicing in Nebraska, located in Nebraska with an “unknown”

status, and newly licensed in Nebraska (regardless of location). The surveys for professionals practicing

in Nebraska, prepopulated with previously identified practice information, provide professionals the

opportunity to update their information. In addition, practice locations for physicians, advanced practice

registered nurses and physician assistants are surveyed semi-annually. HPTS verifies non-respondents to

the semi-annual practice location surveys by contacting the practice locations to verify and document the

3 http://dhhs.ne.gov/crl/mhcs/mental/mentalhealth.htm. Accessed on December 26, 2012. 4 http://dhhs.ne.gov/crl/mhcs/mental/mentalhealth.htm#continued. Accessed on December 26, 2012. 5 http://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-172/Chapter-015.pdf.

Accessed on December 26, 2012. 6 http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-201/Chapter-1.pdf.

Accessed on December 26, 2012.

http://dhhs.ne.gov/crl/mhcs/mental/mentalhealth.htm

http://dhhs.ne.gov/crl/mhcs/mental/mentalhealth.htm#continued

http://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-172/Chapter-015.pdf

http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-201/Chapter-1.pdf

9 | P a g e

practitioners and contact information. At this time, the practice locations of psychologists, LIMHPs,

LMHPs and LADCs are not surveyed and those results rely on cumulative responses to the individual

survey.

Professionals’ current and historical cumulative responses to the HPTS surveys provide data more

comprehensive and current than what is available through the Nebraska licensure bi-annual licensure

renewal process. Examples of data made available for analysis through the HPTS survey process include

professionals’ employment status (full time, part time, retired, inactive, disabled and not practicing in

Nebraska), education, practice specialties, practice locations, practice hours, treatment modalities, patient

characteristics, languages, etc.

Other secondary databases used in this study to obtain population estimates and demographic

characteristics for Nebraska include the US Census Bureau’s 2013 estimates and US Census Bureau’s

2000-2013 five-year American Community Survey.

Data Analysis

The data were descriptively summarized mainly using frequencies, percentages, and ratios. The

data were analyzed using SAS 9.2 software (SAS Institute Inc, Cary, NC). The methodology for

determining the areas with an unusually high need for mental health services were obtained from Nayar et

al.’s (2011) workforce analysis report. Nayar et al.’s (2011) defined areas with unusually high needs for

mental health services using three of the five Health Resources and Services Administration’s (HRSA)

criteria, including (Health Resources and Services Administration, n.d.):

a) 20 percent or more of the population (or of all households) in the area have incomes below the

poverty level;

b) the youth ratio, defined as the ratio of the number of children under 18 to the number of adults of

ages 18 to 64, exceeds 0.6; and

c) The elderly ratio, defined as the ratio of the number of person aged 65 and over to the number of

adults of ages 18 to 64, exceeds 0.25.

The results from the analysis are organized by the following sections:

1) Supply of behavioral health professionals;

2) Regional distribution of behavioral health professionals;

3) Trends in the supply of behavioral health professionals;

4) Need for behavioral health professionals in Nebraska;

5) Telehealth practice among Nebraska behavioral health professionals; and

6) Retention of Nebraska behavioral health professionals.

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RESULTS

Supply of Behavioral Health Professionals, Nebraska 2014

Behavioral health professionals are categorized as psychiatric prescribers, independent behavioral

health professionals, and other behavioral health professionals. Table 1 shows the supply of licensed and

actively practicing behavioral health professionals in Nebraska in 2014. Table 2 shows the change in the

supply of licensed and actively practicing behavioral health professionals from 2010 to 2014 by work

status in Nebraska.

Table 1. Licensed and Actively Practicing Behavioral Health Professionals, Nebraska 2014

Licensed Actively Practicing

Profession Type Number Number % of Total Licensed

Psychiatric Prescribers

Psychiatrist1 ---- 156 ----

Advanced Practice Registered Nurses Practicing

Psychiatry2 ---- 98 ----

Physician Assistant Practicing Psychiatry 3 ---- 16 ----

SUBTOTAL ---- 270 ----

Independent Behavioral Health Professionals

Psychologist4 525 366 69.7

Independent Mental Health Practitioner4,5 1,165 814 69.9

SUBTOTAL 1,690 1,180 69.8

Other Behavioral Health Professionals

Mental Health Practitioner4,6 1,657 918 54.4

Addiction Counselor7 238 143 60.1

SUBTOTAL 1,895 1,061 56.0

TOTAL8 ---- 2,511 ----

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.

1. Includes allopathic and osteopathic physicians. Among the 156 actively practicing psychiatrists in Nebraska, 138 were board

certified and 18 were board eligible. Excludes 31 residents and 2 fellows.

2. 98 Advanced Practice Registered Nurses identified psychiatry as their primary or secondary practice specialty. Among the

98 Advanced Practice Registered Nurses who identified psychiatry as their specialty, 63 were board certified in psychiatry,

and 35 were not identified as board certified in psychiatry (M. Rice, personal communication, December 7, 2012).

3. 16 physician assistants identified psychiatry as their primary or secondary practice specialty.

4. A practitioner may hold more than one license type. Individuals are counted only once in the highest level category.

5. Among the 814 actively practicing licensed independent mental health practitioners, 40 were licensed as a family marriage

therapist, 222 were licensed as a Master Social Worker; and 3 were licensed as both a family marriage therapist and Master

Social Worker.

6. Among the 918 actively practicing licensed mental health practitioners, 15 were licensed as a family marriage therapist, 283

were licensed as a Master Social Worker, and 2 were licensed as both a family marriage therapist and Master Social

Worker.1 was certified as master social worker. Among the 143 actively practicing licensed addition counselors, 142 were

licensed as alcohol & drug counselors (LADCs), and 1 was dually licensed as a CCGC and LADC.

7. Includes only unduplicated counts of all professionals; although, some professionals may hold more than one license type.

Individuals are counted only once in this table in the highest level category.

Note: All behavioral health professional counts include full-time and part-time professionals.

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Table 2. Supply of Actively Practicing Behavioral Health Professionals by Work Status, Nebraska

2010, 2012 and 2014

2010 2012 2014 %

Change

2010-

2014

Profession Type Full-

Time

Part-

Time Total

Full-

Time

Part-

Time Total

Full-

Time

Part-

Time Total


Psychiatrist1 123 38 161 125 31 156 121 35 156 -3.1

Advanced Practice

Registered Nurses

Practicing Psychiatry2

61 17 78 56 19 75 71 27 98 +25.6

Physician Assistant

Practicing Psychiatry

3

6 3 9 9 3 12 11 5 16 +43.7

SUBTOTAL 190 58 248 190 53 243 203 67 270 +8.9


Psychologist4 237 81 318 256 79 335 282 84 366 +15.1

Independent Mental

Health Practitioner4 451 138 589 524 179 703 602 212 814 +38.2


Mental Health

Practitioner4 679 312 991 684 347 1,031 609 309 918 -7.3

Addiction Counselor5 111 27 138 130 26 156 114 29 143 +3.6

TOTAL6 1,668 616 2,284 1,784 684 2,468 1,810 768 2,511 +9.9

Source: Health Professions Tracking Service, University of Nebraska Medical Center 2014

1. Includes allopathic and osteopathic physicians. Excludes residents.

2. Includes Advanced Practice Registered Nurses who identified psychiatry as their primary or secondary practice specialty.

3. Includes physician assistants who identified psychiatry as their primary or secondary practice specialty.

8. A practitioner may hold more than one license type. Individuals are counted only once in this table in the highest level

category.

4. Addiction counselors include licensed as alcohol & drug counselors (LADCs).

9. Includes only unduplicated counts of all professionals; although, some professionals may hold more than one license type.

Individuals are counted only once in this table in the highest level category.

Supply of Psychiatric Prescribers, Nebraska 2014

Psychiatric prescribers include: psychiatrists, Advanced Practice Registered Nurses practicing

psychiatry, and physician assistants practicing psychiatry. In 2014, there were a total of 270 actively

practicing psychiatric prescribers in Nebraska (Table 1). The ratio of population to psychiatry prescribers

was 6,920.4:1 in 2014. Of the 270 actively practicing prescribers, 203 were working on a full-time basis

and 67 on a part-time basis (Table 2). From 2010 to 2014, the number of actively practicing prescribers

increased by 8.9% (Table 2). Figure 1 shows the geographic distribution of the primary practice locations

of psychiatric prescribers in 2014. In 2014, 73 of Nebraska’s 93 counties did not have an actively

practicing psychiatric prescriber. More specifically, 81 of Nebraska’s 93 counties did not have an actively

practicing psychiatrist; however, among these 81 counties, eight counties, including Box Butte, Cass,

Cuming, Dodge, Fillmore, Holt, Platte and Richardson had an Advanced Practice Registered Nurse and/or

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physician assistant actively practicing psychiatry. Figure 2 shows the primary and satellite practice

locations of the actively practicing psychiatric prescribers in Nebraska in 2014.

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Figure 1. Geographic Distribution of Psychiatric Prescribers, Nebraska 2014

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Figure 2. Primary and Satellite Practice Locations of Psychiatric Prescribers, Nebraska 2014

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Psychiatrists

The number of actively practicing psychiatrists slightly decreased by 3.1% from 161 in 2010 to

156 in 2014 (Table 2). However, the actual decline occurred between 2010 and 2012 and the number

remained at 156 from 2012 to 2014.The ratio of population to actively practicing psychiatrists in

Nebraska was estimated to be 11,978:1 in 2014. Among the 156 actively practicing psychiatrists, 138

were board certified and 18 were board-eligible in psychiatry (Table 1); and 121 worked on a full-time

basis, and 35 worked on a part-time basis (Table 2).

In 2014, among the 156 actively practicing psychiatrists, more than one-third (38.5%) were

female and nearly two-thirds (61.5%) were male (Figure 3). More than one-half (64.1%) of the

psychiatrists were older than 50 years of age (Figure 4). Of the psychiatrists with available race and

ethnicity data, 76.7% identified themselves as white, 19.4% as Asians, and 2.3% as African American

(Figure 5).

More than one-half (51.9%) of the psychiatrists attended medical school in Nebraska, 21.8%

attended medical school in another state, and 26.3% in a foreign country (Table 3). More than one-half

(55.8%) of psychiatrists also completed their residency training in Nebraska and 36.5% completed their

residency training in another state (Table 4). More than one-half of psychiatry residents (51.6%) were

foreign medical graduates; meanwhile, only 22.6% received their medical training in Nebraska and 25.8%

in another state (Table 5).

Figure 6 shows the geographic distribution of psychiatrists in Nebraska in 2014. The majority

(84.6%) of actively practicing psychiatrists were practicing in metropolitan counties in 2014. In 2010, 78

of Nebraska’s 93 counties had no practicing psychiatrist (Nayar et al., 2011). This number remained the

same in 2012 and increased to 81 in 2014. Ten counties, including Adams, Buffalo, Douglas, Gage,

Johnson, Lancaster, Lincoln, McPherson, Scotts Bluff and Thurston had a ratio of psychiatrist-to-

population that was at or above the federal mental health professional shortage area (HPSA) shortage

designation ratio of 1:30,000.

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Figure 3. Gender Distribution of Psychiatrists, Nebraska 2014

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014

Note: Includes full-time and part-time allopathic and osteopathic physicians specialized in

psychiatry. Excludes residents.

Figure 4. Age Distribution of Psychiatrists, Nebraska 2014


Note: Includes full-time and part-time allopathic and osteopathic physicians specialized in psychiatry.

Excludes residents.

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Figure 5. Race and Ethnicity Distribution of Psychiatrists, Nebraska 2014



Excludes residents. Data included 23 records with unknown race and ethnicity.

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Table 3. Locations of Medical School of Psychiatrists, Nebraska 2014

Medical School Location Number (N) Percent (%)

Nebraska 81 51.9

Other US State 34 21.8

Foreign 41 26.3

Total 156 100.0


Note: Includes full-time and part-time allopathic and osteopathic physicians specialized in psychiatry. Excludes residents.

Table 4. Locations of Residency Training of Psychiatrists, Nebraska 2014

Residency Training Location Number (N) Percent (%)

Nebraska 87 55.8


Unknown 12 7.7

Total 156 100.0


Note: Includes full-time and part-time allopathic and osteopathic physicians specialized in psychiatry. Excludes residents.

Table 5. Locations of Medical School of Psychiatry Residents, Nebraska 2014

Medical School Location Number (N) Percent (%)

Nebraska 7 22.6


Foreign 16 51.6

Total 31 100.0


Note: Includes residents specializing in psychiatry at the end of 2014. These residents were excluded from actively practicing

psychiatrists.

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Figure 6. Geographic Distribution of Psychiatrists, Nebraska 2014

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Advanced Practice Registered Nurses (APRN) Practicing Psychiatry

In 2014, there were 98 Advanced Practice Registered Nurses (APRNs) actively practicing

psychiatry in Nebraska (Table 1). APRNs actively practicing psychiatry include those who identified

psychiatry as their primary or secondary specialty. From 2010 to 2014, the number of APRNs actively

practicing psychiatry increased by 25.6% (Table 2). Among the 98 APRNs actively practicing psychiatry

in 2014, 71 were full-time APRNs, and 27 were part-time APRNs (Table 2). Among the 98 actively

practicing APRNs actively practicing psychiatry, 63 were board certified in psychiatry, and 35 were not

board certified in psychiatry (M. Rice, personal communication, December 7, 2012).

Among the 98 APRNs actively practicing psychiatry, 85.7% were female, and 14.3% were male

(Figure 7). Among the APRNs with available age data, 62.2% were older than 50 years of age (Figure 8).

Among the APRNs with available race and ethnicity data, the majority (94.5 %) were white, 2.7% were

African American, and 2.7% were Asian (Figure 9).

Seventeen of Nebraska’s 93 counties had APRNs actively practicing psychiatry (Figure 1). The

17 counties include: Adams, Box Butte, Buffalo, Cuming, Cass, Dodge, Douglas, Fillmore, Hall, Holt,

Lancaster, Lincoln, Madison, Platte, Richardson, Sarpy and Scotts Bluff. In 2014, 70.4% of APRNs

practicing psychiatry were actively practicing in metropolitan counties.

Figure 7. Gender Distribution of Advanced Practice Registered Nurses Practicing Psychiatry,

Nebraska 2014


Note: Includes full-time and part-time Advanced Practice Registered Nurses who identified psychiatry

as their primary or secondary specialty.

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Figure 8. Age Distribution of Advanced Practice Registered Nurses Practicing Psychiatry,

Nebraska 2014


Note: Includes full-time and part-time Advanced Practice Registered Nurses who identified

psychiatry as their primary or secondary specialty. Data included one record with unknown age.

Figure 9. Race and Ethnicity Distribution of Advanced Practice Registered Nurses Practicing

Psychiatry, Nebraska 2014


Note: Includes full-time and part-time Advanced Practice Registered Nurses who identified

psychiatry as their primary or secondary specialty. Data included 12 records with unknown race

and ethnicity.

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Physician Assistants Practicing Psychiatry

In 2014, there were 16 physician assistants (PAs) who were actively practicing psychiatry in

Nebraska (Table 1). PAs include full-time and part-time PAs who identified psychiatry as their primary or

secondary practice specialty. In 2010, there were only nine PAs actively practicing psychiatry in

Nebraska (Nayar et al., 2011). Among the 16 PAs actively practicing psychiatry in Nebraska in 2014,

eleven were working on a full-time basis, and five were working on a part-time basis (Table 2).

Of the 16 PAs actively practicing psychiatry, eight were male, and eight were female (Figure 10).

Eight of the 12 PAs were over 50 years of age (Figure 11). All twelve of the PAs practicing psychiatry

whom race and ethnicity data were available were white in 2014 (Figure 12).

Only six of Nebraska’s 93 counties had PA(s) practicing psychiatry in 2014 (Figure 1). The five

counties include: Douglas, Hall, Lancaster, Platte, Sarpy and Madison. In 2014, 75% of PAs practicing

psychiatry was actively practicing in metropolitan counties.

Figure 10. Gender Distribution of Physician Assistants Practicing Psychiatry, Nebraska 2014


Note: Includes full-time and part-tine physician assistants who identified psychiatry as their primary

or secondary specialty.

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Figure 11. Age Distribution of Physician Assistants Practicing Psychiatry, Nebraska 2014


Note: Includes full-time and part-tine physician assistants who identified psychiatry as their

primary or secondary specialty.

Figure 12. Race and Ethnicity Distribution of Physician Assistants Practicing Psychiatry, Nebraska

2014


Note: Includes full-time and part-tine physician assistants who identified psychiatry as their

primary or secondary specialty. Data included two records with unknown race and ethnicity.

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Supply of Independent Behavioral Health Professionals, Nebraska 2014

Non-prescribing behavioral health professionals include independent behavioral health

professionals and other behavioral health professionals. Figure 13 show the numbers of actively

practicing non-prescribing behavioral health professionals among the licensed non-prescribing behavioral

health professionals. In 2014, there were a total of 3,585 licensed non-prescribing behavioral health

professionals in Nebraska; however, only 2,241 (62.5%) were reported as actively practicing in Nebraska.

Independent behavioral professionals include: psychologists and independent mental health

practitioners. In 2014, there were a total of 1,690 psychologists and independent mental health

practitioners that were licensed in the state of Nebraska; however, only 1,180 (69.8%) were actively

practicing in Nebraska (Table 1). The ratio of population to independent behavioral health professionals

was 1,579:1 in 2014.

Figure 13. Numbers of Actively Practicing Non-Prescribing Behavioral Health Professionals among

Licensed Non-Prescribing Behavioral Health Professionals, Nebraska 2014


Psychologists

In 2014, there were 366 actively practicing psychologists in Nebraska (Table 1). Although there

were 525 psychologists that were licensed in the state of Nebraska, only 69.7% were actively practicing in

Nebraska (Figure 13). The ratio of population to actively practicing psychologist was 5,105:1 in 2014.

From 2010 to 2014, the number of actively practicing psychologists increased by 15.1% (Table 2).

Among the 366 actively practicing psychologists in 2014, 282 were working on a full-time basis and, 84

were working on a part-time basis (Table 2).

25 | P a g e

Slightly more than one-half (55.7%) of actively practicing psychologists were female, and 44.3%

were male in 2014 (Figure 14). Over half (59.3%) of actively practicing psychologists in Nebraska were

over 50 years of age (Figure 15). Age data was missing for one psychologist. Among the psychologists

with available race and ethnicity data, almost all (98.3%) identified themselves as white, 1.3% as African

American, and 0.3% as Asian (Figure 16). Over one-half (62.6%) of actively practicing psychologists in

Nebraska were trained in another state, while 35.2% were trained in the state (Table 6).

Psychologists were actively practicing in 24 of Nebraska’s 93 counties. The majority (78.1%) of

Nebraska’s psychologists were actively practicing in metropolitan counties.

Figure 14. Gender Distribution of Psychologists, Nebraska 2014


Note: Includes full-time and part-time professionals with dual licenses.

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Figure 15. Age Distribution of Psychologists, Nebraska 2014


Note: Includes full-time and part-time professionals with dual licenses. Data included one record with

unknown age.

Figure 16. Race and Ethnicity Distribution of Psychologists, Nebraska 2014


Note: Includes full-time and part-time professionals with dual licenses. Data included 61 records

with unknown race and ethnicity.

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Table 6. Training Locations of Psychologists, Nebraska 2014

Training Location Number (N) Percent (%)

Nebraska 129 35.2


Foreign 2 0.6

Unknown 6 1.6

Total 366 100.0



Licensed Independent Mental Health Practitioners

In 2014, there were 814 licensed independent mental health practitioners (LIMHPs) actively

practicing in Nebraska (Table 1). Although there were 1,165 independent mental health practitioners

licensed in the state of Nebraska in 2014, only 69.9% were actively practicing (Figure 13). Among the

814 LIMHPs that were actively practicing, 40 were also licensed as a family marriage therapist (LMFT),

222 as a licensed master social worker (LMSW), and three as both a LMFT and LMSW (Table 1). From

2010 to 2014, the number of LIMHPs actively practicing in Nebraska, increased by 38.2% (Table 2).

Furthermore, among the 814 actively practicing LIMHPs, 602 were working on a full-time basis, while

212 were working on a part-time basis (Table 2).

Figure 17 shows that 78.6% of the actively practicing LIMHPs were female, and 21.4% were

male. Over one-half (52.8%) of the actively practicing LIMHPs in Nebraska were older than 50 years of

age (Figure 18). Among the actively practicing LIMHPs with available race and ethnicity data, almost all

(96.8%) identified themselves as white, 1.9% African American, 0.3% Asian and 0.7% American Indian

(Figure 19). Race and ethnicity data were missing for 16.1% of all the actively practicing LIMHPs. Table

7 shows that 78.5% of the actively practicing LIMHPs were trained in Nebraska, and 21.4% were trained

in another state.

LIMHPs were actively practicing in 45 of Nebraska’s 93 counties. The majority (70.5%) of

Nebraska’s LIMHPs were actively practicing in metropolitan counties.

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Figure 17. Gender Distribution of Licensed Independent Mental Health Practitioners, Nebraska

2014



Figure 18. Age Distribution of Licensed Independent Mental Health Practitioners, Nebraska 2014



29 | P a g e

Figure 19. Race and Ethnicity Distribution of Licensed Independent Mental Health Practitioners,

Nebraska 2014


Note: Includes full-time and part-time professionals with dual licenses. Data included 131 records with unknown race

and ethnicity.

Table 7. Training Locations of Licensed Independent Mental Health Practitioners, Nebraska 2014


Nebraska 639 78.5


Foreign 1 0.1

Unknown 0 0

Total 814 100.0



Supply of Other Behavioral Health Professionals

Other behavioral professionals include: mental health practitioners and LAOC counselors. In

2014, there were a total of 1,895 mental health practitioners and addiction counselors that were licensed

in Nebraska; however, only 1,061 (56%) were actively practicing in Nebraska (Table 1). The ratio of

population to other behavioral health professional was 1,761:1 in 2014.

30 | P a g e


In 2014, there were 918 licensed mental health practitioners (LMHPs) (including professionals

dually licensed as an LMHP and another type of behavioral health professional) that were actively

practicing in Nebraska (Table 1). Although there were 1,657 mental health practitioners that were

licensed in the state of Nebraska, only 54.4% were actively practicing (Figure 13). Among the 918

LMHPs that were actively practicing in Nebraska, 15 were also licensed as a LFMT, 283 as a LMSW,

and two as both a LFMT and LMSW (Table 1). From 2010 to 2014, the number of LMHPs actively

practicing in Nebraska decreased by 7.4% (Table 2). After the state began licensing LIMHPs, many

former LMHPs transferred to the independent license which helps explain the decline in LMHPs. Among

the actively practicing LMHPs in 2014, 609 were working on a full-time basis, and 309 were working on

a part-time basis (Table 2).

Figure 20 shows that 82.5% of the actively practicing LMHPs in Nebraska were female and

17.5% were male. Slightly more than one-half (52%) of the actively practicing LMHPs in Nebraska were

older than 50 years of age (Figure 21). Race and ethnicity data were missing for 19.7% of the actively

practicing LMHPs. Among those with available race and ethnicity data, almost all (96.2%) identified

themselves as white, 2% as African American, 0.67% as Asian and 0.67% as American Indian (Figure

22). Table 8 shows that 78.6% of the actively practicing LMHPs were trained in the state, while 20.4%

were trained in another state.

LMHPs were actively practicing in 45 of Nebraska’s 93 counties. The majority (71.8%) of

Nebraska’s LMHPs were actively practicing in metropolitan counties.

Figure 20. Gender Distribution of Licensed Mental Health Practitioners, Nebraska 2014



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Figure 21. Age Distribution of Licensed Mental Health Practitioners, Nebraska 2014



Figure 22. Race and Ethnicity Distribution of Licensed Mental Health Practitioners, Nebraska 2014


Note: Includes full-time and part-time professionals with dual licenses. Data included 217 records with

unknown race and ethnicity.

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Table 8. Training Locations of Licensed Mental Health Practitioners, Nebraska 2014


Nebraska 722 78.6


Foreign 1 0.1

Unknown 8 0.9

Total 918 100.0



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Alcohol and Drug Counselors

In 2014, there were a total of 143 licensed alcohol and drug counselors (LADCs) actively

practicing in Nebraska (Table 1). While there were 238 addiction counselors that were licensed in the

state of Nebraska, only 60.1% were actively practicing (Figure 13). Among the 143 actively practicing

addiction counselors, 142 as LADCs, and one was dually licensed as a CCGC and LADC (Table 1). From

2010 to 2014, the number of actively practicing addiction counselors increased by 8.3% (Table 2) but the

highest increase was seen in 2012 when the number increased by 15.2% from that of 2010. Among the

143 actively practicing addition counselors, 114 were working on a full-time basis, and 29 were working

on a part-time basis (Table 2). In 2014, more than half (56.6%) of Nebraska’s addiction counselors were

actively practicing in metropolitan counties. It is important to note that the profession was only counted

once, which impacts the LADCs the most because they are often dual licensed with LMHP, which may

lead to an underestimation of LADCs.

Among the 143 actively practicing addiction counselors in Nebraska, almost two-thirds (62.9%)

were female, and 37.1% were male (Figure 23). Among the actively practicing addiction counselors for

whom age data was available, almost two-thirds (71.3%) were over the age of 50 years (Figure 24). Race

and ethnicity data was missing for 14.7% of the actively practicing addiction counselors. Among those

with available race and ethnicity data, the majority (87.7%) were white, 4.1% were African American and

5.7% were American Indian (Figure 25). Almost two-thirds of the actively practicing addiction

counselors in Nebraska obtained their training in the state, while 14.7% obtained their training in another

state (Table 9).

Figure 23. Gender Distribution of Addiction Counselors, Nebraska 2014


Note: Addiction counselors include licensed as alcohol & drug counselors (LADCs). Includes

full-time and part-time professionals with dual licenses.

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Figure 24. Age Distribution of Addiction Counselors, Nebraska 2014



full-time and part-time professionals with dual licenses. Data included one record with unknown

age.

Figure 25. Race and Ethnicity Distribution of Addiction Counselors, Nebraska 2014



full-time and part-time professionals with dual licenses. Data included 20 records with unknown

race and ethnicity.

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Table 9. Training Locations of Licensed Alcohol and Drug Counselors, Nebraska 2014


Nebraska 101 70.6


Foreign 1 0.7

Unknown 20 14

Total 143 100.0


Note: Addiction counselors include licensed as alcohol & drug counselors (LADCs).Includes full-time and part-time

professionals with dual licenses.

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Regional Distribution of Behavioral Health Professionals

Table 10 shows the supply of actively practicing behavioral health professionals by behavioral

health region in Nebraska in 2014. Almost one-half (47.4%) of all the actively practicing health

professionals were located in Region VI, followed by 28.8% in Region V, 11.3% in Region III, 6.4% in

Region IV, 3.3% in Region II, and 2.8% in Region I.

Table 10. Supply of Actively Practicing Behavioral Health Professionals by Behavioral Health

Region, Nebraska 2014

Region

Profession Type I II III IV V VI


Psychiatrist1 2 5 10 4 32 103

Advanced Practice Registered Nurse Practicing

Psychiatry2 4 1 17 4 34 38

Physician Assistant Practicing Psyhiatry3 0 0 1 3 4 8

SUBTOTAL 6 6 28 11 70 149


Psychologist4 12 5 23 24 140 162

Independent Mental Health Practitioner4,5 18 48 101 38 232 377


Mental Health Practitioner4,6 24 20 116 73 228 457

Addiction Counselor7 11 5 15 14 54 44

TOTAL8 71 84 283 160 724 1,189

PERCENT BY REGION (%) 2.8 3.3 11.3 6.4 28.8 47.4


Regional Distribution of Psychiatric Prescribers, Nebraska 2014

In 2014, there were a total of 270 psychiatric prescribers, including psychiatrists, APRNs, and

PAs, actively practicing in Nebraska (Table 10). More than one-half (55.2%) were located in Region VI,

followed by 25.9% in Region V, 10.4% in Region III, 4.1% in Region IV, 2.2% in Region I, and 2.2% in

Region II. Table 11 shows the supply of psychiatric prescribers by behavioral health region and work

status in Nebraska in 2014.

Psychiatrists

Two-thirds (66%%) of the actively practicing psychiatrists were located in Region VI, followed

by 20.5% in Region V, 6.4% in Region III, 3.2%% in Region II, 2.6% in Region IV, and 1.3% in Region

I (Table 10). In Region I, there were only two full-time psychiatrists actively practicing in one county

(i.e., Scotts Bluff). In Region II, there were only three full-time and two part-time psychiatrists actively

practicing in one county (i.e., Lincoln). In Region III, there were a total of seven full-time psychiatrists

actively practicing in Adams, Buffalo and Hall counties. There were a total of three part-time

psychiatrists actively practicing in Adams County. In Region IV, there were four full-time psychiatrists

actively practicing in Madison and Thurston counties. In Region V, there were a total of 29 full-time and

37 | P a g e

three part-time actively practicing psychiatrists. The majority of the full-time actively practicing

psychiatrists were located in Lancaster County. Gage County had only two full-time actively practicing

psychiatrists. The part-time psychiatrists were actively practicing in Johnson and Lancaster counties. In

Region VI, there were a total of 76 full-time and 27 part-time actively practicing psychiatrists. The

majority of the full-time psychiatrists were actively practicing in Douglas County, and only two were

actively practicing in Sarpy County. The part-time psychiatrists were actively practicing in Douglas

County with two in Sarpy County (Table 11).

Advanced Practice Registered Nurses Practicing Psychiatry

More than one-third (38.8%) of the actively practicing psychiatric APRNs were located in Region

VI, followed by 34.7% in region V, 17.3% in region III, 4.1% in region IV, and 4.1% in region I (Table

10). In Region I, there were only three full-time APRNs and one part-time APRN actively practicing

psychiatry in Box Butte and Scotts Bluff counties. There was one psychiatric APRN that was actively

practicing in Region II. In Region III, there were a total of 12 full-time and five part-time APRNs actively

practicing psychiatry. The full-time psychiatrics APRNs were actively practicing in Adams, Buffalo, and

Hall counties. The part-time psychiatric APRNs were actively practicing in Adams County. In Region IV,

there were a total of four psychiatric APRNs actively practicing in three counties, including Cuming,

Holt, Madison, and Platte. In Region V, there were 29 full-time and five part-time APRNs actively

practicing psychiatry located in the following counties: Fillmore, Lancaster, and Richardson. In Region

VI, there were 24 full-time and fifteen part-time APRNs actively practicing psychiatry in Cass, Dodge,

Douglas, and Sarpy Counties (Table 11).

Physician Assistants Specialized in Psychiatry

Half (50.0 %) of the actively practicing psychiatric APRNs were located in Region VI, followed

by 25.0% in Region V, 18.8%% in Region IV and 6.3% in Region III (Table 10). In 2014, there were no

PAs actively practicing psychiatry in Regions I and II. In Region III, there was one part-time PA actively

practicing in Hall County. In Region IV, there were two full-time PAs and one part time actively

practicing psychiatry in Madison and Platte Counties. In Region V, there were four full-time PAs in

Lancaster County. In Region VI, there were five full-time PAs and three part-time PAs actively

practicing psychiatry in Douglas and Sarpy Counties (Table 11).

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Nebraska 2014

Region I

Psychiatrist

Advanced Practice

Registered Nurse Physician Assistant

County Name Full-Time Part-Time Full-Time Part-Time Full-Time Part-Time

Banner* 0 0 0 0 0 0

Box Butte 0 0 1 0 0 0

Cheyenne 0 0 0 0 0 0

Dawes* 0 0 0 0 0 0

Deuel* 0 0 0 0 0 0

Garden* 0 0 0 0 0 0

Kimball* 0 0 0 0 0 0

Morrill* 0 0 0 0 0 0

Scotts Bluff 2 0 2 1 0 0

Sheridan* 0 0 0 0 0 0

Sioux* 0 0 0 0 0 0

Region II

Psychiatrist

Advanced Practice



Arthur* 0 0 0 0 0 0

Chase* 0 0 0 0 0 0

Dawson 0 0 0 0 0 0

Dundy* 0 0 0 0 0 0

Frontier* 0 0 0 0 0 0

Gosper* 0 0 0 0 0 0

Grant* 0 0 0 0 0 0

Hayes* 0 0 0 0 0 0

Hitchcock* 0 0 0 0 0 0

Hooker* 0 0 0 0 0 0

Keith 0 0 0 0 0 0

Lincoln 3 2 1 0 0 0

Logan* 0 0 0 0 0 0

McPherson* 0 0 0 0 0 0

Perkins* 0 0 0 0 0 0

Red Willow 0 0 0 0 0 0

Thomas* 0 0 0 0 0 0

(Table 11 continues on the next page)


Psychiatrist excludes residents.

*Frontier county (<7 people per square mile). **Metropolitan county.

39 | P a g e

Table 11. Supply of Psychiatric Prescribers by Behavioral Health Region and Work Status, Nebraska

2014 (continued)

Region III

Psychiatrist

Advanced Practice



Adams 2 3 1 5 0 0

Blaine* 0 0 0 0 0 0

Buffalo 3 0 7 0 0 0

Clay 0 0 0 0 0 0

Custer* 0 0 0 0 0 0

Franklin* 0 0 0 0 0 0

Furnas* 0 0 0 0 0 0

Garfield* 0 0 0 0 0 0

Greeley* 0 0 0 0 0 0

Hall 2 0 4 4 0 1

Hamilton 0 0 0 0 0 0

Harlan* 0 0 0 0 0 0

Howard 0 0 0 0 0 0

Kearney 0 0 0 0 0 0

Loup* 0 0 0 0 0 0

Merrick 0 0 0 0 0 0

Nuckolls 0 0 0 0 0 0

Phelps 0 0 0 0 0 0

Sherman* 0 0 0 0 0 0

Webster* 0 0 0 0 0 0

Wheeler* 0 0 0 0 0 0

Valley 0 0 0 0 0 0





40 | P a g e


Nebraska 2014 (continued)

Region IV

Psychiatrist

Advanced Practice



Antelope 0 0 0 0 0 0

Boone 0 0 0 0 0 0

Boyd* 0 0 0 0 0 0

Brown* 0 0 0 0 0 0

Burt 0 0 0 0 0 0

Cedar 0 0 0 0 0 0

Cherry* 0 0 0 0 0 0

Colfax 0 0 0 0 0 0

Cuming 0 0 0 1 0 0

Dakota** 0 0 0 0 0 0

Dixon** 0 0 0 0 0 0

Holt* 0 0 1 0 0 0

Keya Paha* 0 0 0 0 0 0

Knox 0 0 0 0 0 0

Madison 3 0 1 0 1 1

Nance 0 0 0 0 0 0

Pierce 0 0 0 0 0 0

Platte 0 0 1 0 1 0

Rock* 0 0 0 0 0 0

Stanton 0 0 0 0 0 0

Thurston 1 0 0 0 0 0

Wayne 0 0 0 0 0 0





41 | P a g e


Nebraska 2014 (continued)

Region V

Psychiatrist

Advanced Practice



Butler 0 0 0 0 0 0

Fillmore 0 0 1 0 0 0

Gage 2 0 1 0 0 0

Jefferson 0 0 0 0 0 0

Johnson 0 1 0 0 0 0

Lancaster** 27 2 27 5 4 0

Nemaha 0 0 0 0 0 0

Pawnee* 0 0 0 0 0 0

Polk 0 0 0 0 0 0

Otoe 0 0 0 0 0 0

Richardson 0 0 1 0 0 0

Saline 0 0 0 0 0 0

Saunders** 0 0 0 0 0 0

Seward** 0 0 0 0 0 0

Thayer 0 0 0 0 0 0

York 0 0 1 0 0 0

Region VI

Psychiatrist

Advanced Practice



Cass** 0 0 0 1 0 0

Dodge 0 0 2 0 0 0

Douglas** 74 25 21 14 4 3

Sarpy** 2 2 1 0 1 0

Washington** 0 0 0 0 0 0




42 | P a g e

Regional Distribution of Non-Prescribing Behavioral Health Professionals,

In 2014, there were a total of 1,180 independent behavioral health professionals, including

licensed psychologists and independent mental health practitioners, actively practicing in Nebraska (Table

10). Almost one-half (45.7%) were located in Region VI, followed by 31.5% in Region V, 10.5% in

Region III, 5.3% in Region IV, 4.5% in Region II, and 2.5% in Region I. In 2014, there were a total of

1,051 other behavioral health professionals, including licensed mental health practitioners and alcohol and

drug counselors, actively practicing in Nebraska (Table 10). Almost one-half (47.2 %) were located in

Region VI, followed by 26.6%% in Region V, 12.3% in Region III, 8.2% in Region IV, 2.4% in Regions

I and II. Table 12 shows the supply of non-prescribing behavioral health professionals by behavioral

health region and work status in Nebraska in 2014.

Psychologists

Almost one-half (44.3%) of the actively practicing psychologists were located in Region VI,

followed by 38.3% in Region V, 6.6% in Region IV, 6.3% in Region III, 3.3% in Region I, and 1.4% in

Region II (Table 10). In 2014, there were eight full-time and four part-time psychologists actively

practicing in Region I. Eight full-time psychologists were actively practicing in Scotts Bluff and

Sheridan, and four part-time psychologists were actively practicing in Box Butte and Scotts Bluff. In

Region II, there were five full-time psychologists in Lincoln County. No part-time psychologists are

actively practicing in this Region. In Region III, there were 18 full-time and five part-time actively

practicing psychologists. The full-time psychologists were actively practicing in the following counties:

Adams, Buffalo, Hall and Kearney. The part-time psychologists were actively practicing in Buffalo and

Hall counties. In Region IV, there were 17 full-time and seven part-time actively practicing psychologists.

The full-time psychologists were actively practicing in three counties, including Burt, Colfax, and

Madison. The part-time actively practicing psychologists were located in five counties, including Dakota,

Holt, Knox, Madison, and Platte. In Region V, there were a total of 112 full-time and 28 part-time

actively practicing psychologists. The full-time psychologists were actively practicing in six counties,

including Gage, Jefferson, Lancaster, Otoe, Saline, and York. The part-time actively practicing

psychologists were located in the following counties: Gage, Lancaster, Polk, Otoe, and York. In Region

VI, there were a total of 122 full-time and 40 part-time actively practicing psychologists located in

Douglas and Sarpy Counties (Table 12).

Licensed Independent Mental Health Professionals

Almost one-half (46.3%) of the actively practicing LIMHPs were located in Region VI, followed

by 28.5% in Region V, 12.4% in Region III, 5.8% in Region II, 4.7% in Region IV, and 2.2% in Region I

(Table 10). In 2014, there were 12 full-time and six part-time LIMHPs actively practicing in Region I.

The full-time LIMHPs were actively practicing in Scotts Bluff, and the part-time LIMHPs were actively

practicing in Box Butte, Cheyenne, and Scotts Bluff. In Region II, there were 33 full-time and 15 part-

time actively practicing LIMHPs. The full-time LIMHPs were actively practicing in the following

counties: Dawson, Gosper, Keith, Lincoln, and Red Willow. The part-time LIMHPs were actively

practicing in the following counties: Dawson, Keith, Lincoln, and Red Willow. In Region III, there were

78 full-time and 23 part-time actively practicing LIMHPs. The full-time LIMHPs were actively practicing

in the following counties: Adams, Buffalo, Clay, Custer, Franklin, Hall, Merrick, Phelps, and Valley. The

part-time LIMHPs were actively practicing in the following counties: Adams, Buffalo, Custer, Hall,

43 | P a g e

Hamilton, Howard, Nuckolls, and Phelps. In Region IV, there were 30 full-time and eight part-time

actively practicing LIMHPs. The full-time LIMHPs were actively practicing in the following counties:

Antelope, Cherry, Cuming, Dakota, Holt, Madison, Platte, Thurston, and Wayne. The part-time actively

practicing LIMHPs were located in five counties, including Cedar, Cuming, Holt, Madison, and Platte. In

Region V, there were a total of 168 full-time and 64 part-time actively practicing LIMHPs. The full-time

LIMHPs were actively practicing in the following counties: Fillmore, Gage, Lancaster, Nemaha, Otoe,

Saline, Seward, and York. The part-time actively practicing LIMHPs were located in the following

counties: Fillmore, Gage, Lancaster, Nemaha, Richardson, Saline, Saunders, Seward, and York. In

Region VI, there were a total of 281 full-time and 96 part-time actively practicing LIMHPs located in all

the counties. (Table 12).


Almost one-half (49.8%) of the actively practicing LMHPs were located in Region VI, followed

by 24.8% in Region V, 12.6% in Region III, 8.0% in Region IV, 2.2% 2.6% in Region I and in Region II

(Table 10). In 2014, there were 22 full-time and three part-time LMHPs actively practicing in Region I.

The full-time LMHPs were actively practicing in Box Butte, Cheyenne, Dawes, Scotts Bluff, and

Sheridan. The part-time LMHPs were actively practicing in Dawes, Scotts Bluff, and Sheridan. In Region

II, there were eight full-time and 12 part-time LMHPs actively practicing LMHPs. The full-time LMHPs

were actively practicing in the following counties: Dawson, Lincoln, and Red Willow. The part-time

LMHPs were actively practicing in the following three counties: Dawson, Lincoln, and Red Willow. In

Region III, there were 83 full-time and 33 part-time actively practicing LMHPs. The full-time LMHPs

were actively practicing in the following counties: Adams, Buffalo, Custer, Hall, Hamilton, Phelps,

Valley, and Webster. The part-time LMHPs were actively practicing in the following counties: Adams,

Buffalo, Custer, Hall, and Phelps. In Region IV, there were 43 full-time and 30 actively practicing

LMHPs. The full-time psychologists were actively practicing in the following counties: Brown, Dakota,

Dixon, Holt, Knox, Madison, Platte, Thurston, and Wayne. The part-time psychologists were actively

practicing in the following counties: Boone, Cuming, Dakota, Holt, Madison, Pierce, Platte, and Wayne.

In Region V, there were a total of 151 full-time and 77 part-time actively practicing LMHPs. The full-

time LMHPs were actively practicing in the following counties: Gage, Jefferson, Johnson, Lancaster,

Nemaha, Saunders, and Seward. The part-time actively practicing LMHPs were located in the following

counties: Fillmore, Gage, Johnson, Lancaster, Nemaha, Otoe, Richardson, Seward, Thayer, and York. In

Region VI, there were a total of 303 full-time and 154 part-time actively practicing LMHPs located in all

of the counties (Table 12).


More than one-third (37.8%) of the actively practicing addiction counselors were located in

Region V, followed by 30.8% in Region VI, 10.5% in Region III, 9.8% in Region IV, 7.7% in Region I,

and 3.5% in Region II (Table 10). In Region I, there were nine full-time addiction counselors actively

practicing in five counties, including Box Butte, Cheyenne, Scotts Bluff, and Sheridan. There were two

part-time additional participating actively in Scotts Bluff. In Region II, there were five full-time addiction

counselors actively practicing in four counties, including Dawson, Keith, Lincoln, and Red Willow. In

Region III, there were 16 full-time addiction counselors actively practicing in the following counties:

Adams, Buffalo, Hall, Nuckolls, and Valley. In Region IV, there were 13 full-time and two part-time

actively participating addiction counselors. The full-time addiction counselors were actively practicing in

44 | P a g e

the following counties: Holt, Knox, Madison, Platte, and Thurston. The one part-time actively practicing

addiction counselors was located in Cuming. In Region V, there were a total of 41 full-time and 13 part-

time actively practicing addiction counselors. The full-time addiction counselors were actively practicing

in the following counties: Butler, Gage, Johnson, Lancaster, Seward, and York. The part-time actively

practicing addiction counselors were located in the following counties: Jefferson, Lancaster, Richardson,

and Seward. In Region VI, there were a total of 31 full-time and 13 part-time actively practicing addiction

counselors located in all the counties, except Washington County (Table 12).

Table 12. Supply of Non-Prescribing Behavioral Health Professionals by Behavioral Health Region

and Work Status, Nebraska 2014

Region I

Psychologist LIMHP LMHP

Addiction

Counselor

County

Name

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Banner* 0 0 0 0 0 0 0 0

Box Butte 0 1 0 3 1 0 2 0

Cheyenne 0 0 0 1 1 0 1 0

Dawes* 0 0 0 0 6 1 0 0

Deuel* 0 0 0 0 0 0 0 0

Garden* 0 0 0 0 0 0 0 0

Kimball* 0 0 0 0 0 0 0 0

Morrill* 0 0 0 0 0 0 0 0

Scotts Bluff 7 3 12 2 12 1 4 2

Sheridan* 1 0 0 0 2 1 2 0

Sioux* 0 0 0 0 0 0 0 0



*Frontier county (<7 people per square mile).

**Metropolitan county.

Note: Includes professionals with dual licenses. LIMHP includes licensed independent mental health practitioners.

LMHP includes licensed mental health practitioners. Addiction counselors include licensed alcohol and drug

counselors (LADCs).

45 | P a g e

Table 12. Supply of Behavioral Health Professionals by Behavioral Health Region and Work

Status, Nebraska 2014 (continued)

Region II


Addiction

Counselor

County

Name

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Arthur* 0 0 0 0 0 0 0 0

Chase* 0 0 0 0 0 0 0 0

Dawson 0 0 5 2 1 6 1 0

Dundy* 0 0 0 0 0 0 0 0

Frontier* 0 1 0 0 0 0 0 0

Gosper* 0 0 1 0 0 0 0 0

Grant* 0 0 0 0 0 0 0 0

Hayes* 0 0 0 0 0 0 0 0

Hitchcock* 0 0 0 0 0 0 0 0

Hooker* 0 0 0 0 0 0 0 0

Keith 0 0 1 4 0 0 1 0

Lincoln 5 0 25 4 4 3 2 0

Logan* 0 0 0 0 0 0 0 0

McPherson* 0 0 0 0 0 0 0 0

Perkins* 0 0 0 0 0 0 0 0

Red Willow 0 0 1 5 3 3 1 0

Thomas* 0 0 0 0 0 0 0 0







counselors (LADCs).

46 | P a g e



Region III


Addiction

Counselor

County

Name

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Adams 4 0 15 3 17 4 4 0

Blaine* 0 0 0 0 0 0 0 0

Buffalo 6 3 20 6 21 20 1 0

Clay 0 0 1 1 0 0 0 0

Custer* 0 0 1 0 1 3 0 0

Franklin* 0 0 1 0 0 0 0 0

Furnas* 0 0 0 0 0 0 0 0

Garfield* 0 0 0 0 0 0 0 0

Greeley* 0 0 0 0 0 0 0 0

Hall 7 2 37 8 34 5 9 0

Hamilton 0 0 0 1 1 0 0 0

Harlan* 0 0 0 0 0 0 0 0

Howard 0 0 0 1 0 0 0 0

Kearney 1 0 0 0 0 0 0 0

Loup* 0 0 0 0 0 0 0 0

Merrick 0 0 1 0 0 0 0 0

Nuckolls 0 0 0 1 0 0 1 0

Phelps 0 0 1 2 4 1 0 0

Sherman* 0 0 0 0 0 0 0 0

Webster* 0 0 0 0 1 0 0 0

Wheeler* 0 0 0 0 0 0 0 0

Valley 0 0 1 0 4 0 1 0







counselors (LADCs).

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Region IV


Addiction

Counselor

County

Name

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Partl-

Time

Antelope 0 0 1 0 0 0 0 0

Boone 0 0 0 0 0 1 0 0

Boyd* 0 0 0 0 0 0 0 0

Brown* 0 0 0 0 1 0 0 0

Burt 1 0 0 0 0 0 0 0

Cedar 0 0 0 1 0 0 0 0

Cherry* 0 0 1 0 0 0 0 0

Colfax 1 0 0 0 0 0 0 0

Cuming 0 0 1 1 0 1 0 1

Dakota** 0 1 5 0 4 3 0 1

Dixon** 0 0 0 0 1 0 0 0

Holt* 0 2 3 1 3 2 5 0

Keya Paha* 0 0 0 0 0 0 0 0

Knox 0 1 0 0 1 0 1 0

Madison 15 2 9 2 23 17 3 0

Nance 0 0 0 0 0 0 0 0

Pierce 0 0 0 0 0 1 0 0

Platte 0 1 7 3 6 1 1 0

Rock* 0 0 0 0 0 0 0 0

Stanton 0 0 0 0 0 0 0 0

Thurston 0 0 1 0 2 0 3 0

Wayne 0 0 2 0 2 4 0 0







counselors (LADCs).

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Region V


Addiction

Counselor

County

Name

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Butler 0 0 0 0 0 0 1 0

Fillmore 0 0 1 1 0 2 0 0

Gage 5 3 5 2 2 3 2 0

Jefferson 1 0 0 0 1 0 0 1

Johnson 0 0 0 0 2 1 4 0

Lancaster** 102 21 147 53 141 61 27 10

Nemaha 0 0 1 1 1 1 0 0

Pawnee* 0 0 0 0 0 0 0 0

Polk 0 1 0 0 0 0 0 0

Otoe 1 2 3 0 0 1 0 0

Richardson 0 0 0 1 0 1 0 1

Saline 1 0 2 2 0 0 0 0

Saunders** 0 0 0 1 1 0 0 0

Seward** 0 0 4 2 3 2 1 1

Thayer 0 0 0 0 0 1 0 0

York 2 1 5 1 0 4 6 0

Region VI


Addiction

Counselor

County

Name

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Full-

Time

Part-

Time

Cass** 0 0 0 1 1 1 1 1

Dodge 0 0 11 4 6 7 1 1

Douglas** 112 37 240 78 274 136 27 10

Sarpy** 10 3 29 11 21 8 2 1

Washington** 0 0 1 2 1 2 0 0






counselors (LADCs).

49 | P a g e

Trends in the Supply of Behavioral Health Professionals, Nebraska 2000 to

2014

Supply of Psychiatric Prescribers in Nebraska, 2000 to 2014

Psychiatrists

Figure 26 shows that the psychiatrist-to-100,000 population ratio in Nebraska remained fairly

constant from 2000 to 2014, ranging from 8.3 to 8.9. The ratio of psychiatrist-to-100,000 population in

Nebraska slightly decreased from 8.4 in 2010 to 8.3 in 2014. In urban counties, the psychiatrist-to-

100,000 population ratio in Nebraska also remained fairly constant from 2000 to 2014, ranging from 11.5

to 12.5. The ratio of psychiatrist-to-100,000 population in urban areas slightly decreased from 12.3 in

2010 to 11.8 in 2014. Rural counties in Nebraska had consistently lower psychiatrist-to-population ratios

than their urban counterparts from 2000 to 2014, ranging from 3.2 to 5.1. The ratio of psychiatrist-to-

100,000 population in rural counties slightly decreased from 4.0 in 2010 to 3.2 in 2014.

Nayar et al. (2011) showed that the ratio of psychiatric residents-to-100,000 population increased

from 0.3 in 2005 to 1.6 per 100,000 population in 2006. The ratio has since remained fairly constant.

From 2000 to 2012, all psychiatric residents were based in Douglas county (Figure 27), with short

rotations to Hall, Adams, or Buffalo counties.

Figure 26. Supply of Psychiatrists by Geographic Location per 100,000 Population, Nebraska 2000-

2014

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014; US Census

Bureau, 2013 Population Estimates; Nayar et al., 2011.


Excludes residents.

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Figure 27. Supply of Psychiatry Residents per 100,000 Population by Geographic Location,

Nebraska 2000-2014

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014; US Census Bureau, 2013 Population

Estimates; Nayar et al., 2011.

51 | P a g e

Advanced Practice Registered Nurses Practicing in Psychiatry

Figure 28 shows the supply of Nebraska’s psychiatric APRN-to-100,000 population ratio from

2000 to 2014. The ratio of psychiatric APRN-to-100,000 population in Nebraska increased from 4.3 in

2010 to 5.2 in 2014. Although the ratio of psychiatric APRN-to-100,000 population in urban areas

increased noticeably from 4.7 in 2010 to 6.2 in 2014, the ratio in rural areas only slightly increased from

3.7 in 2010 to 3.8 in 2012 and then remained constant in 2014. Urban counties had consistently higher

supply of APRNs than rural counties from 2000 to 2014. However, it is worth noting that supply of

APRNs in rural counties steadily increased between 2000 and 2014.

Figure 28. Supply of Advanced Practice Registered Nurses Practicing Psychiatry per 100,000

Population by Geographic Location, Nebraska 2000-2014

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014; US Census Bureau, 2013

Population Estimates; Nayar et al., 2011.

Note: Includes full-time and part-time Advanced Practice Registered Nurses practicing psychiatry.

52 | P a g e

Physician Assistants Practicing in Psychiatry

Figure 29 shows the supply of Nebraska’s psychiatric PA-to-100,000 population ratio from 2000

to 2014. The ratio of psychiatric PA to 100,000 populations in Nebraska slightly increased from 0.5 in

2010 to 0.9 in 2014. In urban areas, the ratio of psychiatric PA-to-100,000 population increased from 0.5

in 2010 to 1.1 in 2014. However, in rural areas, the ratio of psychiatric PA to 100,000 population reached

the same value of 0.5 as in 2010 after an increase to 0.8 in 2014.

Figure 29. Supply of Physician Assistants Specialized in Psychiatry per 100,000 Population by

Geographic Location, Nebraska 2000-2014

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014; US Census Bureau, 2013

Population Estimates; Nayar et al., 2011.

Note: Includes full-time and part-time physician assistants specialized in psychiatry.

53 | P a g e

Supply of Non-Prescribing Behavioral Health Professionals in Nebraska, 2008 to 2014

Table 13 shows the supply of actively practicing non-prescribing behavioral health professionals

in Nebraska from 2008 to 2014. The ratio of population to all non-prescribing behavioral health provider

(excluding psychiatric prescribers) decreased from 1,146.2 in 2008 to 833.7 in 2014, indicating an

increase in supply of all categories of behavioral health professionals (Table 13). In particular, supply of

LIMHPs more than doubled between 2008 and 2014.

Table 13. Supply of Actively Practicing Non-Prescribing Behavioral Health Professionals, Nebraska

2008-2014

Profession

Type

2008 2009 2010 2012 2014

N Ratio of

Population

to Provider

N Ratio of

Population

to Provider

N Ratio of

Population

to Provider

N Ratio of

Population

to Provider

N Ratio of

Population

to

Provider

Psychologist 267 6,679.5 290 6,195.2 318 5,743.2 335 5,500.4 366 5,105

Independent

Mental

Health

Practitioner

327 5,453.9 497 3,614.9 589 3,100.7 703 2,621.1 814 2,295

Mental

Health

Practitioner

860 2,073.8 938 1,915.4 991 1,842.9 1,031 1,787.2 918 1,761

Addiction

Counselors

102 17,484.6 138 13,019.0 132 13,835.9 152 12,207.4 143 13,066

TOTAL 1,556 1,146.2 1,863 964.4 2,030 899.7 2,221 835.4 2,241 833.7

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014; US Census Bureau,

2013 Population Estimates; Nayar et al., 2011.

Note: Includes full-time and part-time professionals.

54 | P a g e

Need for Behavioral Health Professionals in Nebraska

Mental Health Professionals Shortage Areas

Federal Designation

The Nebraska Office of Rural Health updates the information on mental health HPSAs using a

tiered process. Mental health HPSAs are designated based on geography- and facility-level

characteristics, or service to special populations. The federal shortage area designation uses a population-

to-psychiatrist ratio greater than or equal to 30,000:1 (Health Resources and Services Administration,

2012). In 2014, 48 counties did not have a Mental Health provider. From 2012 to 2015, the federal mental

HPSAs in Nebraska have not changed. In 2014, 88 of Nebraska’s 93 counties, with the exception of

Mental Health Catchment area 6 (Cass, Dodge, Douglas, Sarpy, and Washington), were designated as

federal mental health HPSAs (Figure 30).

State Designation

The Rural Health Advisory Commission is a governor-appointed commission that designates

state shortage areas for psychiatry and mental health. The state-designation of shortage areas for

psychiatry and mental health was last updated in 2013. It is updated every three years. The information is

used to administer the state’s rural incentive programs. The state shortage area designation uses a service

area population-to-psychiatrist ratio greater than or equal to 10,000:1. Figure 31 shows Nebraska’s state-

designated shortage areas for psychiatrists and mental health. In 2013, 79 of Nebraska’s 93 counties were

state-designated as shortage areas for psychiatrists and mental health. Nine counties, including Butler,

Cass, Dodge, Gage, Otoe Saunders, Saline, Seward, and Washington, were state-designated as partial

shortage areas. Three counties, including Douglas, Lancaster, and Sarpy, as well as areas within a 25 mile

buffer surrounding the cities of Lincoln and Omaha were not state-designated as shortage areas.

However, Thurston and Fillmore counties were not state-designated as shortage areas in 2013 that were

previously shortage areas in 2010.

55 | P a g e

Figure 30. Federally Designated Mental Health Professional Shortage Areas, Nebraska 2015

56 | P a g e

Figure 31. State-Designated Medical Shortage Area, Psychiatry and Mental Health, Nebraska 2013

57 | P a g e

Counties with High Needs for Mental Health Services

The methodology for determining the areas with an unusually high need for mental health

services were obtained from Nayar et al.’s (2011) workforce analysis report. Counties were identified as

having unusually high needs for mental health services if one of the following criteria was met: (1) 20

percent of the population (or of all households) in the area have incomes below the poverty level; (2) the

youth ratio, defined as the ratio of the number of children under 18 to the number of adults of ages 18 to

64, exceeds 0.6; and (3) the elderly ratio, defined as the ratio of the number of persons aged 65 and over

to the number of adults of ages 18 to 64, exceeds 0.25 (HRSA, n.d.).

Table 14 shows the counties in Nebraska with unusually high needs for mental health services in

2014. In 2010, the number of counties with unusually high needs for mental health services in Nebraska

increased by four counties since 2009 (Nayar et al., 2011). In 2014, 78 out of Nebraska’s 93 counties

were identified as having unusually high needs for mental health services. Of these, 75 counties were

rural and three were metropolitan, including Dixon, Seward and Saunders. Of the 75 rural counties, 38

were frontier counties. Thus, there were 37 rural, non-frontier counties that were identified as having

unusually high needs for mental health services. These include: Adams, Antelope, Box Butte, Boone,

Burt, Butler, Cedar, Cheyenne, Clay, Cuming, Dodge, Fillmore, Gage, Hamilton, Howard, Jefferson,

Johnson, Kearney, Keith, Knox, Lincoln, Merrick, Nance, Nemaha, Nuckolls, Otoe, Phelps, Pierce,

Platte, Polk, Red Willow, Richardson, Scotts Bluff, Thayer, Thurston, Valley, and York.

Figure 32 highlights the counties in Nebraska with an unusually high need for mental health

services and a low supply of mental health providers. The number of counties with unusually high needs

for mental health services and a low supply of mental health providers in Nebraska increased by one

county since 2009 (Nayar et al., 2011). In 2014, 72 out of the 78 Nebraska counties that were identified as

having unusually high needs for mental health services were also identified as having no psychiatrist or

the ratio of psychiatrist-to-population was below 1:15,000. Of these, 38 were frontier counties, 31 were

non-frontier rural counties, and three were metropolitan counties. The 33 non-frontier rural counties

identified as having unusually high needs for mental health services and a low supply of mental health

providers: Antelope, Blaine, Boone, Box Butte, Burt, Butler, Cedar, Cheyenne, Clay, Cuming, Dodge,

Fillmore, Hamilton, Howard, Jefferson, Kearney, Keith, Knox, Madison, Merrick, Nance, Nemaha,

Nuckolls, Otoe, Phelps, Pierce, Platte, Polk, Red Willow, Richardson, Thayer, Valley and York. The

three metropolitan counties included Dixon, Seward and Saunders.

58 | P a g e

Table 14. Counties with Unusually High Needs for Mental Health Services, Nebraska 2014

Region I Region II Region III Region IV Region V Region VI

Box Butte Arthur2 Adams Antelope Butler Dodge

Cheyenne Chase2 Blaine2 Boone Fillmore

Dawes2 Dundy2 Clay Boyd2 Gage

Deuel2 Frontier2 Custer2 Brown2 Jefferson

Garden2 Gosper2 Franklin2 Burt Johnson

Kimball2 Grant2 Furnas2 Cedar Nemaha

Morrill2 Hayes2 Garfield2 Cherry2 Otoe

Scotts Bluff Hitchcock2 Greeley2 Cuming Pawnee2

Sheridan2 Hooker2 Hamilton Dixon1 Polk

Sioux2 Keith Harlan2 Holt2 Richardson Lincoln Howard Keya Paha2 Saunders1

Logan2 Kearney Knox Seward1

McPherson2 Loup2 Nance Thayer

Perkins2 Merrick Pierce York

Red Willow Nuckolls Platte

Thomas2 Phelps Rock2

Sherman2 Thurston

Valley

Webster2

Wheeler2

Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey

Note: An area was considered to have unusually high needs for mental health services if one of the following criteria was met: (a)

20 percent or more of the population (or of all households) in the area have incomes below the poverty level; (b) the youth ratio,

defined as the ratio of the number of children under 18 to the number of adults of ages 18 to 64, exceeds 0.6; and (c) the elderly

ratio, defined as the ratio of the number of person aged 65 and over to the number of adults of ages 18 to 64, exceeds 0.25

(Health Resources and Services Administration, n.d.). 1 Metropolitan county. Federal Office of Management and Budget designation, 2009. 2 Frontier county (< 7 persons/square mile). National Center for Frontier Communities definition, US Census Bureau 2010

Intercensal Estimates.

59 | P a g e

Figure 32. Counties with High Need for Mental Health Services and Low Supply of Mental Health

Providers, Nebraska 2014

Supply

No Psychiatrist or Below Psychiatrist-to-

Population Benchmark Ratio2

At or Above

Psychiatrist-to-

Population

Benchmark

Ratio2

Nee

d1

Low

Banner

Cass4

Colfax

Dakota4

Dawson

Hall

Saline

Sarpy4

Stanton

Washington4

Wayne

Buffalo

Douglas4

Lancaster4

Madison

High

Antelope

Arthur3

Blaine3

Boone

BoxButte

Boyd3

Brown3

Burt

Butler

Cedar

Chase3

Cherry3

Cheyenne

Clay

Cuming

Custer3

Dawes3

Deuel3

Dixon4

Dodge

Dundy3

Fillmore

Franklin3

Frontier3

Furnas3

Garden3

Garfield3

Gosper3

Grant3

Greeley3

Hamilton

Harlan3

Hayes3

Hitchcock3

Holt3

Hooker3

Howard

Jefferson

Kearney

Keith

KeyaPaha3

Kimball3

Knox

Logan3

Loup3

McPherson3

Merrick

Morrill3

Nance

Nemaha

Nuckolls

Otoe

Pawnee3

Perkins3

Phelps

Pierce

Platte

Polk

RedWillow

Richardson

Rock3

Saunders4

Seward4

Sheridan3

Sherman3

Sioux3

Thayer

Thomas3

Webster3

Wheeler3

York

Valley

Adams

Gage

Johnson

Lincoln

Scotts Bluff

Thurston

Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014; US Census Bureau 2009-2013 5-

Year American Community Survey.

1. “High” need was defined based on an index created using the Health Resources and Services Administration's (HRSA) mental

health Health Professional Shortage Area (HPSA) designation criteria.

2. For counties identified as having “high” need for mental health services, 1:15,000 was used as the psychiatrist-to-population

benchmark ratio. For counties identified as not having high need for mental health services, 1:20,000 was used as the

psychiatrist-to-population benchmark ratio.

3. Frontier county (< 7 persons/square mile). National Center for Frontier Communities definition, US Census Bureau 2010

Intercensal Estimates.

4. Metropolitan county. Federal Office of Management and Budget designation, 2009.

60 | P a g e

TELEHEALTH PRACTICE

The results in this section are based on the 2014 survey for behavioral health professionals that included

the questions about telehealth practice. Telehealth questions were only included in the behavioral health

professionals; therefore, a comparison with other professional groups cannot be made at this time. Of the

156 psychiatrists, 11 psychiatrists responded to the question of number of hours per week utilizing

telehealth as a specialist (distant site). Out of these 11 psychiatrists, 8 reported using telehealth 0

hours/week as a specialist (distant site). 3 out of the 11 psychiatrist reported using telehealth in their

practice as a specialist (distant site), ranging from 2 to 3 hours/week. The two of the three psychiatrists

were from Douglas County and one psychiatrist was from Scotts Bluff County.

7 psychiatrists responded to the question of number of hours per week utilizing telehealth to provide care

to the patient (origin site). All 7 reported using telehealth 0 hours/week to provide care to patients (origin

site).

Of the 366 psychologists who completed the 2014 survey, 70 psychologists responded to the question of

number of hours per week utilizing telehealth as a specialist (distant site).Out of these 70 psychologists,

62 reported using telehealth 0 hours/week of as a specialist (distant site). 8 out of the 70 psychiatrist

psychologists reported using telehealth in their practice as a specialist (distant site), ranging from 1 to 3

hours/week. These psychologists were located in the following counties; Lancaster (n=1), Hall (n=1),

Douglas (n=5), and Buffalo (n=1).

62 psychologists responded to the question of number of hours per week utilizing telehealth to provide

care to their patient (origin site). Out of these 62 psychologists, 60 reported using telehealth 0 hours/week

to provide care to their patients (origin site). 2 out of the 62 psychiatrist psychologists reported using

telehealth in their practice to provide care to their patients (origin site), ranging from 1 to 10 hours/week.

These two psychologists were located in Sarpy and Scotts Bluff counties.

61 | P a g e

RETENTION

Psychiatrists

Of the 111 psychiatrists who completed the question about the retirement 15 (13.5%) reported they would

retire within 5 years and 18 (16.2%) reported they would retire in the next 6-10 years. Of the 99

psychiatrists who completed the question about the practice discontinuation, 12 (12.1%) and 7 (7.1%)

reported they would discontinue the practice within 5 years and in the next 6-10 years, respectively.

Figure 33. Psychiatrists Intentions to Retire or Discontinue Practice

A total of 12 psychiatrists reported that they plan to relocate outside of Nebraska. Five of them cited a

personal reason, 3 cited the third party payers’ issue, and the remaining 5 cited reasons not listed in the

questionnaire.

TOTALDon't

know/Not sure

In lessthan one

year

In thenext 1-2

years

In thenext 3-5

years

In thenext 6-10

years

Morethan 10

yearsfromnow

No

Plans to Retire 111 17 1 2 12 18 61

Plan to discontinue practice 99 10 1 3 8 7 19 51

0

20

40

60

80

100

120

Nu

mb

er o

f P

rovi

der

s

62 | P a g e

Table 15. Psychiatrists’ Reasons for Relocating Outside of Nebraska

Reason Number

Department Issues 0

Geography Rates 0

Insufficient Vacation Time 0

Lack of Appropriate Call Coverage 0

Malpractice Rates 0

Patient Load is too Heavy 0

Patient Load is too Light 0

Personal 5

3rd Party Payers 3

Other 4

63 | P a g e

Psychologists

Of the 342 psychologists who completed the question about the retirement 47 (13.7%) reported they

would retire within 5 years and 50 (14.6%) reported they would retire in the next 6-10 years. Of the 341

psychologists, who completed the question about practice discontinuation, 34 (10.1%) and 32 (9.4%)


Figure 34. Psychologists Intentions to Retire or Discontinue Practice

A total of 55 psychologists reported that they plan to relocate outside of Nebraska. The most common

reason was personal (26 psychologists).

Table 16. Psychologists’ Reasons for Relocating Outside of Nebraska

Reason Number

Department Issues 2

Geography Rates 1



Malpractice Rates 0



Personal 26

3rd Party Payers 3

Other 20

TOTALDon't

know/Not sure

In lessthan one

year

In thenext 1-2

years

In thenext 3-5

years

In thenext 6-10

years

Morethan 10

yearsfromnow

No

Plans to Retire 342 33 5 13 29 50 212


0

50

100

150

200

250

300

350

400

Nu

mb

er o

f P

rovi

der

s

64 | P a g e


Of the 73 APRNs who completed the question about the retirement 7 (9.6%) reported they would retire

within 5 years and 16 (21.9%) reported they would retire in the next 6-10 years. Of the 61 APRNs who

completed the question about the practice discontinuation, 4 (6.6%) and 8 (13.1%) reported they would

discontinue the practice within 5 years and in the next 6-10 years, respectively.

Figure 35. APRNs Intentions to Retire or Discontinue Practice

A total of 16 APRNs reported that they plan to relocate outside of Nebraska. The most common reason

was personal (4 APRNs).

Table 17. APRNs’ Reasons for Relocating Outside of Nebraska

Reason Number

Department Issues 1

Geography Rates 2



Malpractice Rates 1



Personal 4

3rd Party Payers 0

Other 5

TOTALDon't

know/Not sure

In lessthan one

year

In thenext 1-2

years

In thenext 3-5

years

In thenext 6-10

years

Morethan 10

yearsfromnow

No

Plans to Retire 73 3 0 3 4 16 47


0

10

20

30

40

50

60

70

80

Nu

mb

er o

f P

rovi

der

s

65 | P a g e


Of the 14 PAs who completed the question about the retirement 1 (7.1%) reported they would retire

within 5 years and 3 (21.4%) reported they would retire in the next 6-10 years. Of the 9 PAs who

completed the question about the practice discontinuation, 1 (11.1%) and 1 (11.1%) reported they would

discontinue the practice within 5 years and in the next 6-10 years, respectively.

Figure 36. PAs’ Intentions to Retire or Discontinue Practice

A total of 4 PAs reported that they plan to relocate outside of Nebraska. Reasons include personal and

third party payer issues.

Table 18. PAs’ Reasons for Relocating Outside of Nebraska

Reason Number

Department Issues 0

Geography Rates 0



Malpractice Rates 0



Personal 1

3rd Party Payers 1

Other 2

TOTALDon't

know/Not sure

In lessthan one

year

In thenext 1-2

years

In thenext 3-5

years

In thenext 6-10

years

Morethan 10

yearsfromnow

No

Plans to Retire 14 1 0 0 1 3 9


0

2

4

6

8

10

12

14

16

Nu

mb

er o

f P

rovi

der

s

66 | P a g e

LIMHPs

Of the 785 LIMHPs who completed the question about the retirement 68 (8.6%) reported they would

retire within 5 years and 87 (11.1%) reported they would retire in the next 6-10 years. Of the 786

LIMHPs who completed the question about the practice discontinuation, 30 (3.8%) and 58 (7.4%)


Figure 37.LIMHPs’ Intentions to Retire or Discontinue Practice

A total of 120 LIMHPs reported that they plan to relocate outside of Nebraska. The most common reason

was personal (49 LIMHPs) followed by third party payer issues (12 LIMHPs).

Table 19. LIMHPs’ Reasons for Relocating Outside of Nebraska

Reason Number

Department Issues 5

Geography Rates 3



Malpractice Rates 0



Personal 49

3rd Party Payers 12

Other 33

TOTALDon't

know/Not sure

In lessthan one

year

In thenext 1-2

years

In thenext 3-5

years

In thenext 6-10

years

Morethan 10

yearsfromnow

No

Plans to Retire 785 83 5 11 52 87 547


0

100

200

300

400

500

600

700

800

900

Nu

mb

er o

f P

rovi

der

s

67 | P a g e

LMHPs

Of the 873 LMHPs who completed the question about the retirement 75 (8.6%) reported they would retire

within 5 years and 120 (13.7%) reported they would retire in the next 6-10 years. Of the 873 LMHPs,

who completed the question about the practice discontinuation, 57 (6.5%) and 54 (4.9%) reported they

would discontinue the practice within 5 years and in the next 6-10 years.

Figure 38. LMHPs’ Intentions to Retire or Discontinue Practice

A total of 119 LMHPs reported that they plan to relocate outside of Nebraska. The most common reason

was personal (44 LMHPs) followed by third party payer issues (10 LMHPs).

Table 20. LMHPs’ Reasons for Relocating Outside of Nebraska

Reason Number Department Issues 2 Geography Rates 6 Insufficient Vacation Time 4 Lack of Appropriate Call Coverage 4 Malpractice Rates 1 Patient Load is too Heavy 4 Patient Load is too Light 5 Personal 44 3rd Party Payers 10 Other 39

TOTALDon't

know/Not sure

In lessthan one

year

In thenext 1-2

years

In thenext 3-5

years

In thenext 6-

10 years

Morethan 10

yearsfromnow

No

Plans to Retire 873 90 3 18 54 120 588


0

100

200

300

400

500

600

700

800

900

1000

Nu

mb

er o

f P

rovi

der

s

68 | P a g e

LADCs

Of the 134 addiction counselors who completed the question about the retirement 15 (11.2%) reported

they would retire within 5 years and 29 (21.6%) reported they would retire in the next 6-10 years. Of the

135 addiction counselors, who completed the question about the practice discontinuation, 11 (8.1%) and

14 (10.4%) reported they would discontinue the practice within 5 years and in the next 6-10 years,

respectively.

Figure 39. Addiction Counselors Intentions to Retire or Discontinue Practice

A total of 34 addiction counselors reported that they plan to relocate outside of Nebraska. The most

common reason was personal (13 addiction counselors).

Table 21. Addiction Counselors’ Reasons for Relocating Outside of Nebraska

Reason Number

Department Issues 3

Geography Rates 3



Malpractice Rates 0



Personal 13

3rd Party Payers 0

Other 9

TOTALDon't

know/Not sure

In lessthan one

year

In thenext 1-2

years

In thenext 3-5

years

In thenext 6-10

years

Morethan 10

yearsfromnow

No

Plans to Retire 134 16 0 4 11 29 74


0

20

40

60

80

100

120

140

160

Nu

mb

er o

f P

rovi

der

s

69 | P a g e

CONCLUSIONS

The findings from this study indicate that Nebraska continues to face a critical shortage in the

supply of behavioral health providers. Geographic mal-distribution of providers continue to exist as a

problem in Nebraska based on the health needs of the populations. However, the number of providers has

slightly increased or remained constant in 2014. More specifically, the shortage of psychiatric prescribers

remained constant from 2012 to 2014. From 2010 to 2014, the number of Advanced Practice Registered

Nurses (APRNs) actively practicing psychiatry increased by 25.6%. Furthermore, the number of actively

practicing psychologists slightly increased by 15.1% from 2010 to 2014. Across all the professions, there

has been slight increase from 2010 to 2014. Despite the slight increases, there remains a retention

challenge due to discontinuation or practice and retirement. Although the response rate for these questions

was low, 13.5% (n=15/111) of psychiatrists reported they would retire within 5 years, 16.2% (n=18/111)

reported they would retire in the next 6-10 years, 12.1% (n=12/99) reported they would discontinue the

practice within 5 years, and 7.1% (n=7/99) and in the next 6-10 years. Additionally, 12 psychiatrists

reported that they plan to relocate outside of Nebraska. Strategic plans for the behavioral health workforce

in Nebraska needs to address negating the future inevitable workforce shortages due to retirement, and

other plans to retain providers practicing in Nebraska.

The majority of Nebraska’s counties still had no psychologists or was below the federal mental

health professional shortage area (HPSA) shortage designation ratio. The mal-distribution of psychiatric

prescribers has also persisted with the majority of psychiatric prescribers still found to be practicing in

metropolitan areas. In fact, the proportion of psychiatric prescribers actively practicing in rural counties

has decreased from 2010 to 2014. There is also an increase in number of actively practicing psychiatric

prescribers that were older than 50 years of age and thus likely to retire in the next ten to 15 years. For

instance, 29.7% (n=33/111) psychiatrists reported they would retire within the next 5-10 years.

Geographic shortage areas may be further impacted in the future by retention of psychologists, where 55

psychologists reported that they plan to relocate outside of Nebraska.

With regards to the independent and other behavioral health professionals, while the supply of

actively practicing professionals has increased from 2012 to 2014, there is a significant geographic mal-

distribution of behavioral health professionals. Similarly to psychiatric prescribers, the majority of

psychologists, LIMHPs, LMHPs, and LADCs are found to be actively practicing in Region VI. In fact,

almost one-half of all licensed psychologists LIMHPs, LMHPs, and LADCs were actively practicing in

Region VI in 2014. Furthermore, there is also an issue of the aging of the workforce. Over half of the

behavioral health professionals are over the age of 50 years suggesting that they will likely retire within

the next ten to 15 years.

Nebraska’s shortages in the supply of all categories of behavioral health professionals are also

likely to get worse given the increase in the need for mental health services among the Nebraska

population. From 2010 to 2014, the number of counties in Nebraska with unusually high needs for mental

health services and a low supply of mental health providers have slightly increased. There were 72

70 | P a g e

counties that were identified as having unusually high needs for mental health services and identified as

having no psychiatrist or the ratio of psychiatrist-to-population was below 1:15,000, as compared to 71

counties in 2010. This suggests that proactive steps need to be taken to address the needs of the

population as well as the shortages due to the geographic mal-distribution of supply.

Despite the provider shortages and high health needs, a limited number of physiatrists and

psychologists reported utilizing telehealth technologies. Telehealth technologies have the capabilities to

reach providers and appropriate care across distances, especially in provider shortage areas. Only 3

psychiatrists identified using telehealth as a specialist with limited use ranging from 2-3 hours per week.

Additionally, only 10 psychologists reported utilizing telehealth technologies, with 8 psychologists using

telehealth as a specialist and 2 psychologists used telehealth to deliver care to their patients. These results

suggest that Nebraska’s behavioral health providers have not widely utilized telehealth. More efforts need

to be made to expand the use of these technologies among behavioral health providers, given the high

needs for mental health services and geographic shortages.

Overall, based on the findings of this study, it is clear that Nebraska continues to face critical

shortages in the supply of behavioral health providers given the following issues:

A decline in the supply of psychiatric prescribers was seen in 2012, but has been maintained for

the year 2014;

A significant geographical mal-distribution of the behavioral health workforce;

An aging workforce with intentions to retire within the next 5 to 10 years;

An increase in the need for mental health services among Nebraska’s population;

A retention challenge due to reported intentions of relocating outside of Nebraska;

A limited number of physiatrists and psychologists reported utilizing telehealth technologies,

despite the provider shortages and high mental health needs of populations.

71 | P a g e

REFERENCES

Behavioral Health Education Center of Nebraska. (n.d.). Background. Available from URL:

http://unmc.edu/bhecn/background.htm.

Health Resources and Services Administration. (2012). HRSA Health Workforce. Available from URL:


Nayar, P., Nguyen, A.T., Apenteng, B., Shaw-Sutherland, K. (2011). Nebraska's Behavioral Health

Workforce - 2000 to 2010. Nebraska Center for Rural Health Research, College of Public Health,

University of Nebraska Medical Center, Omaha, NE.

Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. (2011).

2010 CMHS uniform reporting system output tables. [serial online]. Available from URL:

http://www.samhsa.gov/dataoutcomes/urs/urs2010.aspx.

Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. (2008).

SAMHSA 2007 uniform reporting system (URS) output tables. [serial online]. Available from URL:

http://www.samhsa.gov/dataoutcomes/urs/urs2007.aspx

http://unmc.edu/bhecn/background.htm




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