The United States has enough behavioral health providers to meet 27.3% of national need, according to Trilliant Health's 2026 Behavioral Health Report. Demand grew 62.6% between 2018 and 2024, and the report projects a 36,780-FTE shortfall in adult psychiatry and a 99,780-FTE shortfall in mental health counseling by 2038.

For a practice that refers patients out for psychiatric care, or is weighing whether to add a behavioral health service line, these numbers explain why referrals sit unanswered for weeks and why negotiated payer rates for therapy vary so widely from one contract to the next.

Why the supply side is stuck

Trilliant Health counts fewer than 10% of behavioral health providers nationally as MD or DO psychiatrists. Most of the workforce is made up of master's-level clinicians, whose scope of practice in most states limits prescribing and management of more complex cases to a physician or a nurse practitioner.

Psychiatry residency positions grew from 1,556 in 2018 to 2,388 in 2025, and the match rate for those positions has stayed near 100% the whole time. Trilliant Health reads that as a funding constraint rather than a lack of interest: every added slot filled immediately, and the slots did not grow fast enough to close the gap.

The shortage is not evenly spread

National averages hide the local picture a practice manager actually deals with. Trilliant Health's adequacy model puts the U.S. at roughly one psychiatrist for every 10,000 people, and finds 56.9% of large metro areas, those with populations over 1 million, facing a documented psychiatrist shortage.

State-level adequacy runs from 5.7% in West Virginia to 52.3% in New Jersey, a nine-fold spread that changes how long a referral takes depending on where a practice sits. Even within well-supplied metros, the split can run the other way: Trilliant Health finds a 541-provider psychiatrist surplus in San Francisco against a 348-provider deficit in Atlanta.

Demand keeps climbing while the workforce shifts

Utilization data in the report shows where the added demand is landing. Applied behavior analysis visit volume grew 309.2% in 2025 alone. The number of patients taking stimulant medications rose 53.3% between 2018 and 2024, and antipsychotic prescriptions rose 45.4% over the same period, both categories that typically require an ongoing prescriber relationship rather than a one-time visit.

With psychiatrists in short supply, prescribing has shifted toward other license types. Allied health providers, meaning nurse practitioners and physician assistants working in behavioral health, wrote 34.3% of behavioral health medication prescriptions in 2024, up from 20.7% in 2018. Trilliant Health also reports 83% of behavioral health providers described symptoms of burnout in 2023, a retention risk sitting on top of a workforce that is already too small.

Telehealth absorbed the gap, then plateaued

Telehealth became the pressure valve for behavioral health access faster than for any other specialty. Trilliant Health's report shows behavioral health accounted for 65.6% of all telehealth visit volume in 2024, up from 18.4% in 2018. A practice deciding whether a telehealth behavioral health contract or partnership is worth the setup cost is looking at a channel that already carries roughly two out of three virtual visits nationwide, a share the report describes as leveling off rather than continuing to climb.

What the rate variance means for contracts

The shortage also shows up on the reimbursement side. Trilliant Health found a 7-fold variance in commercial negotiated rates for the same psychotherapy CPT code, CPT 90837, across different payer contracts. The median negotiated rate for that code, a 60-minute individual psychotherapy session, was $147, with a reported range of $78 to $542 depending on the contract.

That spread matters for any practice negotiating its own behavioral health rates or evaluating a partnership with an outside group. A group billing at the low end of that range for the identical CPT code is being paid a fraction of what another contract pays for the same session, and the gap has nothing to do with the clinical work performed. A practice that has not repriced its behavioral health fee schedule in the past year has no way to know which side of that range its own contracts sit on without checking each payer individually.

What this means for practice planning

None of these figures point to a quick fix. Psychiatry residency slots grow slowly and are capped by funding, not applicant demand, so the 36,780-FTE gap projected for 2038 is not one a single practice or even a single health system can close. What a practice can act on is narrower: check where its own behavioral health referral network sits against the 56.9%-of-large-metros shortage figure, review its own negotiated rate for CPT 90837 against the $78-to-$542 range Trilliant Health reports, and weigh a telehealth behavioral health partnership against a channel that already carries the majority of behavioral telehealth volume nationally.

MetricFigureSource
National mental health professional adequacy rate (2025)27.3%Trilliant Health
Behavioral health utilization growth, 2018-202462.6%Trilliant Health
Projected adult psychiatry FTE shortfall by 203836,780Trilliant Health
Projected mental health counseling FTE shortfall by 203899,780Trilliant Health
Share of behavioral health providers who are MD/DO psychiatristsUnder 10%Trilliant Health
State adequacy rate range (West Virginia to New Jersey)5.7% to 52.3%Trilliant Health
Median negotiated rate, CPT 90837$147Trilliant Health
Negotiated rate range, CPT 90837$78 to $542Trilliant Health

Sources

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