---
type: source
title: "40% of US population (137 million) live in mental health shortage areas — HRSA projects 136,350 additional psychologists needed by 2038, with shortage worsening across all categories"
author: "HRSA (Health Resources and Services Administration)"
url: https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/Behavioral-Health-Workforce-Brief-2025.pdf
date: 2025-01-01
domain: health
secondary_domains: []
format: government-report
status: null-result
priority: high
tags: [mental-health, workforce-shortage, rural-health, psychiatry, HPSA, access]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

**Source:** HRSA State of the Behavioral Health Workforce 2025. Data as of December 31, 2025.

**Key statistics:**

**Scale of shortage:**
- 4,212 designated Mental Health Professional Shortage Areas (HPSAs) in rural areas
- ~40% of the US population — approximately **137 million Americans** — live in areas with designated mental health provider shortages
- 1,797 additional practitioners needed just to remove rural HPSA designations

**2025 HRSA workforce shortfall projections (additional providers needed):**
- 16,940 mental health and substance abuse social workers
- 13,740 school counselors
- 8,220 psychologists
- 6,080 psychiatrists
- 2,440 marriage and family therapists

**Long-term projection:** 136,350 additional psychologists needed by 2038 to meet all unmet need (under current utilization-based estimates; true gap is larger if latent unmet demand is included)

**Rural-urban disparity (severe and persisting):**
- 22% of rural counties have no social workers (vs. 5% of urban counties)
- Rural counties are 3x more likely to have no psychologist than urban counties
- 70% of US counties have no child/adolescent psychiatrist at all
- Psychiatrist density: 17.5/100K in metro areas vs. **5.8/100K in non-metro areas** (3x gap)
- Patient-to-provider ratios reach 5,000:1 in some rural areas

**Emergency system failure signal:**
- Emergency department visits for suicide attempts/intentional self-harm more than tripled (0.6% → 2% of ED visits, 2015-2020) — interpreted as a proxy for the mental health system failing at the access layer (patients presenting to EDs when primary mental health care is unavailable)

**Provider Medicaid participation compounds scarcity:**
- Many mental health providers won't accept Medicaid due to low reimbursement rates, making the effective provider-to-Medicaid-patient ratio substantially worse than the raw numbers suggest

## Agent Notes

**Why this matters:** This is the most specific and comprehensive workforce shortage data available. The 137 million Americans (40% of the population) in shortage areas figure provides the scale argument that the supply gap is not a marginal problem but a majority problem. The specific shortage counts by category (6,080 psychiatrists, 8,220 psychologists, etc.) are precise enough to support strong claims.

The 136,350 additional psychologists needed by 2038 figure is striking — that's roughly equivalent to tripling the entire current US psychologist workforce. The shortage is not a gap that can be closed by policy changes or technology deployment alone; it would require a fundamental expansion of training pipelines, which takes decades.

**What surprised me:** The 70% of US counties with no child/adolescent psychiatrist is the most alarming single statistic. Mental health conditions predominantly emerge in adolescence — and 70% of counties have no specialist provider for this population. The shortage is worst precisely where early intervention matters most.

**What I expected but didn't find:** Evidence of significant shortage improvement trends. The HRSA data shows the shortage worsening, not improving, across all categories.

**KB connections:**
- [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]] — this is the definitive quantification of the supply-side gap: 137 million Americans in shortage areas, specific shortfall counts by category
- [[social isolation costs Medicare 7 billion annually and carries mortality risk equivalent to smoking 15 cigarettes per day making loneliness a clinical condition not a personal problem]] — social isolation → untreated mental illness → ED presentation; the tripling of self-harm ED visits is the outcomes signal of this failure

**Extraction hints:**
- Update the existing mental health supply gap claim with HRSA 2025 quantification: 137 million Americans in shortage areas; 6,080 more psychiatrists, 8,220 more psychologists needed as of 2025
- The ED self-harm tripling (0.6% → 2% of ED visits, 2015-2020) is independently extractable as a system failure signal
- The 70% no child/adolescent psychiatrist finding may be extractable as a standalone structural failure claim
- Confidence: proven (HRSA government data, December 31, 2025)

## Curator Notes

PRIMARY CONNECTION: [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]]

WHY ARCHIVED: Definitive HRSA 2025 quantification of the mental health workforce shortage — 137 million Americans, specific shortfall by provider category, rural-urban disparity, and the ED self-harm tripling as outcomes evidence of system failure.

EXTRACTION HINT: The 137 million / 40% figure should be the lead for any extraction. The ED self-harm tripling (0.6% → 2%) is the most emotionally resonant proxy for system failure.
