Nebraska’s Behavioral Health Workforce
–2000 to 2014
June 2015
For Submission to the Nebraska Behavioral Health Education Center
Nebraska
Center
for
Rural
Health
Research
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
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
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
ii | P a g e
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 biannual 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

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
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

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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 psychiatristto-population ratio below 1:15,000. Of these, 38 were frontier counties, 31 were rural (nonfrontier) 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.
Advanced Practice Registered Nurses



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.
Physician Assistants



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
87 (11.1%) reported they would retire in the next 6-10 years.
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

Thirty (3.8%) of the 786 responding LIMHPs reported they would discontinue their practice
within 5 years and 58 (7.4%) reported they would do so in the next 6-10 years.
A total of 120 (14.7%) LIMHPs reported that they plan to relocate outside of Nebraska.
Licensed Mental Health Practitioners



Seventy-five (8.6%) of the 873 responding LMHPs reported they would retire within 5 years and
120 (13.7%) reported they would retire in the next 6-10 years.
Fifty-seven (6.5%) of the 873 responding LMHPs reported they would discontinue their practice
within 5 years and 54 (4.9%) reported they would do so in the next 6-10 years.
A total of 119 (13.0%) LMHPs reported that they plan to relocate outside of Nebraska.
Addiction Counselors



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:





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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.
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.
2
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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.
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.
4
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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)
2)
3)
4)
5)
6)
Supply of behavioral health professionals;
Regional distribution of behavioral health professionals;
Trends in the supply of behavioral health professionals;
Need for behavioral health professionals in Nebraska;
Telehealth practice among Nebraska behavioral health professionals; and
Retention of Nebraska behavioral health professionals.
9|Page
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
---98
---Psychiatry2
Physician Assistant Practicing Psychiatry 3
---16
---------SUBTOTAL
270
Independent Behavioral Health Professionals
Psychologist4
525
366
69.7
4,5
Independent Mental Health Practitioner
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
7
Addiction Counselor
238
143
60.1
SUBTOTAL
1,895
1,061
56.0
8
TOTAL
------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
Full- PartFull- PartFull- Part2010Total
Total
Profession Type
Total
Time Time
Time Time
Time Time
2014
Psychiatric Prescribers
Psychiatrist1
123
38
161
121
35
156
-3.1
125
31
156
Advanced Practice
Registered Nurses
61
17
78
71
27
98
+25.6
56
19
75
Practicing Psychiatry2
Physician Assistant
Practicing Psychiatry
6
3
9
11
5
16
+43.7
9
3
12
3
SUBTOTAL
190
58
248
190
Independent Behavioral Health Professionals
Psychologist4
237
81
318
256
Independent Mental
451
138
589
524
Health Practitioner4
Other Behavioral Health Professionals
Mental Health
679
312
991
684
Practitioner4
Addiction Counselor5
111
27
138
130
6
TOTAL
1,668 616 2,284 1,784
53
243
203
67
270
+8.9
79
335
282
84
366
+15.1
179
703
602
212
814
+38.2
347
1,031
609
309
918
-7.3
26
684
156
114
2,468 1,810
29
768
143
2,511
+3.6
+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
11 | P a g e
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-topopulation that was at or above the federal mental health professional shortage area (HPSA) shortage
designation ratio of 1:30,000.
15 | P a g e
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
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.
16 | P a g e
Figure 5. Race and Ethnicity 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. Data included 23 records with unknown race and ethnicity.
17 | P a g e
Table 3. Locations of Medical School of Psychiatrists, Nebraska 2014
Medical School Location
Number (N)
Nebraska
81
Other US State
34
Foreign
41
Total
156
Percent (%)
51.9
21.8
26.3
100.0
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.
Table 4. Locations of Residency Training of Psychiatrists, Nebraska 2014
Residency Training Location
Number (N)
Nebraska
87
Other US State
57
Unknown
12
Total
156
Percent (%)
55.8
36.5
7.7
100.0
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.
Table 5. Locations of Medical School of Psychiatry Residents, Nebraska 2014
Medical School Location
Number (N)
Nebraska
7
Other US State
8
Foreign
16
Total
31
Percent (%)
22.6
25.8
51.6
100.0
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time Advanced Practice Registered Nurses who identified psychiatry
as their primary or secondary specialty.
20 | P a g e
Figure 8. Age Distribution of Advanced Practice Registered Nurses Practicing Psychiatry,
Nebraska 2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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.
21 | P a g e
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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-tine physician assistants who identified psychiatry as their primary
or secondary specialty.
22 | P a g e
Figure 11. Age Distribution of Physician Assistants Practicing Psychiatry, Nebraska 2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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).
24 | 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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
25 | P a g e
Figure 15. Age Distribution of Psychologists, Nebraska 2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses. Data included 61 records
with unknown race and ethnicity.
26 | P a g e
Table 6. Training Locations of Psychologists, Nebraska 2014
Training Location
Number (N)
Nebraska
129
Other US State
229
Foreign
2
Unknown
6
Total
366
Percent (%)
35.2
62.6
0.6
1.6
100.0
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
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.
27 | P a g e
Figure 17. Gender Distribution of Licensed Independent Mental Health Practitioners, Nebraska
2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
Figure 18. Age Distribution of Licensed Independent Mental Health Practitioners, Nebraska 2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
28 | P a g e
Figure 19. Race and Ethnicity Distribution of Licensed Independent Mental Health Practitioners,
Nebraska 2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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
Training Location
Number (N)
Percent (%)
Nebraska
639
78.5
Other US State
174
21.4
Foreign
1
0.1
Unknown
0
0
Total
814
100.0
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
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.
29 | P a g e
Licensed Mental Health Practitioners
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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
30 | P a g e
Figure 21. Age Distribution of Licensed Mental Health Practitioners, Nebraska 2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
Figure 22. Race and Ethnicity Distribution of Licensed Mental Health Practitioners, Nebraska 2014
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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
Training Location
Number (N)
Percent (%)
Nebraska
722
78.6
Other US State
187
20.4
Foreign
1
0.1
Unknown
8
0.9
Total
918
100.0
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Includes full-time and part-time professionals with dual licenses.
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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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Addiction counselors include licensed as alcohol & drug counselors (LADCs). Includes
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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Note: Addiction counselors include licensed as alcohol & drug counselors (LADCs). Includes
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
Training Location
Number (N)
Percent (%)
Nebraska
101
70.6
Other US State
21
14.7
Foreign
1
0.7
Unknown
20
14
Total
143
100.0
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 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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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
Psychiatric Prescribers
Psychiatrist1
2
5
10
4
32
Advanced Practice Registered Nurse Practicing
4
1
17
4
34
Psychiatry2
Physician Assistant Practicing Psyhiatry3
0
0
1
3
4
6
6
28
11
70
SUBTOTAL
Independent Behavioral Health Professionals
Psychologist4
12
5
23
24
140
Independent Mental Health Practitioner4,5
18
48
101
38
232
Other Behavioral Health Professionals
Mental Health Practitioner4,6
24
20
116
73
228
7
Addiction Counselor
11
5
15
14
54
8
TOTAL
71
84
283
160
724
2.8
3.3
11.3
6.4
28.8
PERCENT BY REGION (%)
VI
103
38
8
149
162
377
457
44
1,189
47.4
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
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
36 | 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).
37 | P a g e
Table 11. Supply of Psychiatric Prescribers by Behavioral Health Region and Work Status,
Nebraska 2014
Region I
Advanced Practice
Psychiatrist
Physician Assistant
Registered Nurse
Full-Time
Part-Time
Full-Time
Part-Time
Full-Time
Part-Time
County Name
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
Advanced Practice
Psychiatrist
Physician Assistant
Registered Nurse
Full-Time
Part-Time
Full-Time
Part-Time
Full-Time
Part-Time
County Name
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)
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Psychiatrist excludes residents.
*Frontier county (<7 people per square mile). **Metropolitan county.
38 | P a g e
Table 11. Supply of Psychiatric Prescribers by Behavioral Health Region and Work Status, Nebraska
2014 (continued)
Region III
Advanced Practice
Registered Nurse
Psychiatrist
County Name
Adams
Blaine*
Buffalo
Clay
Custer*
Franklin*
Furnas*
Garfield*
Greeley*
Hall
Hamilton
Harlan*
Howard
Kearney
Loup*
Merrick
Nuckolls
Phelps
Sherman*
Webster*
Wheeler*
Valley
Physician Assistant
Full-Time
Part-Time
Full-Time
Part-Time
Full-Time
Part-Time
2
0
3
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
7
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
(Table 11 continues on the next page)
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
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 IV
Advanced Practice
Psychiatrist
Physician Assistant
Registered Nurse
Full-Time
Part-Time
Full-Time
Part-Time
Full-Time
Part-Time
County Name
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
(Table 11 continues on the next page)
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Psychiatrist excludes residents.
*Frontier county (<7 people per square mile). **Metropolitan county.
40 | P a g e
Table 11. Supply of Psychiatric Prescribers by Behavioral Health Region and Work Status,
Nebraska 2014 (continued)
Region V
Advanced Practice
Psychiatrist
Physician Assistant
Registered Nurse
Full-Time
Part-Time
Full-Time
Part-Time
Full-Time
Part-Time
County Name
Butler
Fillmore
Gage
Jefferson
Johnson
Lancaster**
Nemaha
Pawnee*
Polk
Otoe
Richardson
Saline
Saunders**
Seward**
Thayer
York
0
0
0
2
0
0
27
0
0
0
0
0
0
0
0
0
0
0
0
0
1
2
0
0
0
0
0
0
0
0
0
0
Psychiatrist
County Name
Cass**
Dodge
Douglas**
Sarpy**
Washington**
0
0
1
0
1
0
0
0
0
0
27
5
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
1
0
Region VI
Advanced Practice
Registered Nurse
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Physician Assistant
Full-Time
Part-Time
Full-Time
Part-Time
Full-Time
Part-Time
0
0
74
2
0
0
0
25
2
0
0
2
21
1
0
1
0
14
0
0
0
0
4
1
0
0
0
3
0
0
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
Psychiatrist excludes residents.
*Frontier county (<7 people per square mile). **Metropolitan county.
41 | 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 parttime 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,
42 | 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).
Licensed Mental Health Practitioners
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 fulltime 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).
Addiction Counselors
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
43 | 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 parttime 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
Addiction
Psychologist
LIMHP
LMHP
Counselor
County
FullPartFullPartFullPartFullPartTime
Time
Time
Time
Time
Time
Time
Time
Name
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
(Table 12 continues on the next page)
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
*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).
44 | P a g e
Table 12. Supply of Behavioral Health Professionals by Behavioral Health Region and Work
Status, Nebraska 2014 (continued)
Region II
Addiction
Psychologist
LIMHP
LMHP
Counselor
County
FullPartFullPartFullPartFullPartTime
Time
Time
Time
Time
Time
Time
Time
Name
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
(Table 12 continues on the next page)
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
*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 III
Addiction
Psychologist
LIMHP
LMHP
Counselor
County
FullPartFullPartFullPartFullPartTime
Time
Time
Time
Time
Time
Time
Time
Name
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
(Table 12 continues on the next page)
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
*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).
46 | P a g e
Table 12. Supply of Behavioral Health Professionals by Behavioral Health Region and Work
Status, Nebraska 2014 (continued)
Region IV
Addiction
Psychologist
LIMHP
LMHP
Counselor
County
FullPartFullPartFullPartFullPartlTime
Time
Time
Time
Time
Time
Time
Time
Name
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
(Table 12 continues on the next page)
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
*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).
47 | P a g e
Table 12. Supply of Behavioral Health Professionals by Behavioral Health Region and Work
Status, Nebraska 2014 (continued)
Region V
Addiction
Psychologist
LIMHP
LMHP
Counselor
County
FullPartFullPartFullPartFullPartTime
Time
Time
Time
Time
Time
Time
Time
Name
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
Psychologist
LIMHP
LMHP
Counselor
County
FullPartFullPartFullPartFullPartTime
Time
Time
Time
Time
Time
Time
Time
Name
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
Source: Health Professions Tracking Service, University of Nebraska Medical Center, 2014.
*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).
48 | 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-to100,000 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-to100,000 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 20002014
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 allopathic and osteopathic physicians specialized in psychiatry.
Excludes residents.
49 | P a g e
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.
50 | 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.
51 | 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.
52 | 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
Psychologist
Independent
Mental
Health
Practitioner
Mental
Health
Practitioner
Addiction
Counselors
TOTAL
267
327
6,679.5
5,453.9
290
497
6,195.2
3,614.9
318
589
5,743.2
3,100.7
335
703
5,500.4
2,621.1
366
814
2014
Ratio of
Population
to
Provider
5,105
2,295
860
2,073.8
938
1,915.4
991
1,842.9
1,031
1,787.2
918
1,761
102
17,484.6
138
13,019.0
132
13,835.9
152
12,207.4
143
13,066
1,556
1,146.2
1,863
964.4
2,030
899.7
2,221
835.4
2,241
833.7
N
2008
Ratio of
Population
to Provider
N
2009
Ratio of
Population
to Provider
N
2010
Ratio of
Population
to Provider
N
2012
Ratio of
Population
to Provider
N
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.
53 | 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 populationto-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 statedesignated 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.
54 | P a g e
Figure 30. Federally Designated Mental Health Professional Shortage Areas, Nebraska 2015
55 | P a g e
Figure 31. State-Designated Medical Shortage Area, Psychiatry and Mental Health, Nebraska 2013
56 | 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.
57 | 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
2
Box Butte
Arthur
Adams
Antelope
Butler
Dodge
2
2
Cheyenne
Chase
Blaine
Boone
Fillmore
Dawes2
Dundy2
Clay
Boyd2
Gage
2
2
2
2
Deuel
Frontier
Custer
Brown
Jefferson
2
2
2
Garden
Gosper
Franklin
Burt
Johnson
2
2
2
Kimball
Grant
Furnas
Cedar
Nemaha
Morrill2
Hayes2
Garfield2
Cherry2
Otoe
2
2
Scotts Bluff
Hitchcock
Greeley
Cuming
Pawnee2
Sheridan2
Hooker2
Hamilton
Dixon1
Polk
2
2
2
Sioux
Keith
Harlan
Holt
Richardson
2
Lincoln
Howard
Keya Paha
Saunders1
2
Logan
Kearney
Knox
Seward1
McPherson2
Loup2
Nance
Thayer
2
Perkins
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.
58 | 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-toPopulation Benchmark Ratio2
Need1
Low
Banner
Cass4
Colfax
Dakota4
Dawson
Hall
Antelope
Arthur3
Blaine3
Boone
BoxButte
Boyd3
Brown3
High Burt
Butler
Cedar
Chase3
Cherry3
Cheyenne
Clay
Cuming
Saline
Sarpy4
Stanton
Washington4
Wayne
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
At or Above
Psychiatrist-toPopulation
Benchmark
Ratio2
Buffalo
Douglas4
Lancaster4
Madison
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 5Year 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.
59 | 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.
60 | 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
120
Number of Providers
100
80
60
40
20
0
TOTAL
Don't
In less
know/No than one
t sure
year
In the
next 1-2
years
In the
In the
next 3-5 next 6-10
years
years
More
than 10
years
from
now
Plans to Retire
111
17
1
2
12
18
61
Plan to discontinue practice
99
10
1
3
8
7
19
No
51
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.
61 | P a g e
Table 15. Psychiatrists’ Reasons for Relocating Outside of Nebraska
Reason
Department Issues
Geography Rates
Insufficient Vacation Time
Lack of Appropriate Call Coverage
Malpractice Rates
Patient Load is too Heavy
Patient Load is too Light
Personal
3rd Party Payers
Other
Number
0
0
0
0
0
0
0
5
3
4
62 | 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%)
reported they would discontinue the practice within 5 years and in the next 6-10 years, respectively.
Figure 34. Psychologists Intentions to Retire or Discontinue Practice
400
350
Number of Providers
300
250
200
150
100
50
0
TOTAL
Don't
In less
know/No than one
t sure
year
In the
next 1-2
years
In the
In the
next 3-5 next 6-10
years
years
More
than 10
years
from
now
Plans to Retire
342
33
5
13
29
50
212
Plan to discontinue practice
341
42
3
8
23
32
75
No
158
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
Department Issues
Geography Rates
Insufficient Vacation Time
Lack of Appropriate Call Coverage
Malpractice Rates
Patient Load is too Heavy
Patient Load is too Light
Personal
3rd Party Payers
Other
Number
2
1
1
1
0
0
1
26
3
20
63 | P a g e
Advanced Practice Registered Nurses
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
80
70
Number of Providers
60
50
40
30
20
10
0
TOTAL
Don't
In less
know/No than one
t sure
year
In the
next 1-2
years
In the
In the
next 3-5 next 6-10
years
years
More
than 10
years
from
now
Plans to Retire
73
3
0
3
4
16
47
Plan to discontinue practice
61
12
0
2
2
8
10
No
27
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
Department Issues
Geography Rates
Insufficient Vacation Time
Lack of Appropriate Call Coverage
Malpractice Rates
Patient Load is too Heavy
Patient Load is too Light
Personal
3rd Party Payers
Other
Number
1
2
1
1
1
1
0
4
0
5
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Physician Assistants
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
16
14
Number of Providers
12
10
8
6
4
2
0
TOTAL
Don't
In less
know/No than one
t sure
year
In the
next 1-2
years
In the
In the
next 3-5 next 6-10
years
years
More
than 10
years
from
now
Plans to Retire
14
1
0
0
1
3
9
Plan to discontinue practice
9
3
0
0
1
1
4
No
0
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
Department Issues
Geography Rates
Insufficient Vacation Time
Lack of Appropriate Call Coverage
Malpractice Rates
Patient Load is too Heavy
Patient Load is too Light
Personal
3rd Party Payers
Other
Number
0
0
0
0
0
0
0
1
1
2
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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%)
reported they would discontinue the practice within 5 years and in the next 6-10 years, respectively.
Figure 37.LIMHPs’ Intentions to Retire or Discontinue Practice
900
800
Number of Providers
700
600
500
400
300
200
100
0
TOTAL
Don't
In less
know/No than one
t sure
year
In the
next 1-2
years
In the
In the
next 3-5 next 6-10
years
years
More
than 10
years
from
now
Plans to Retire
785
83
5
11
52
87
547
Plan to discontinue practice
786
78
3
5
22
58
129
No
491
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
Department Issues
Geography Rates
Insufficient Vacation Time
Lack of Appropriate Call Coverage
Malpractice Rates
Patient Load is too Heavy
Patient Load is too Light
Personal
3rd Party Payers
Other
Number
5
3
4
2
0
5
7
49
12
33
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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
1000
900
Number of Providers
800
700
600
500
400
300
200
100
0
TOTAL
Don't
In less
know/No than one
t sure
year
In the
next 1-2
years
In the
next 3-5
years
In the
next 610 years
More
than 10
years
from
now
Plans to Retire
873
90
3
18
54
120
588
Plan to discontinue practice
873
111
2
12
43
54
193
No
458
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
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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
160
140
Number of Providers
120
100
80
60
40
20
0
TOTAL
Don't
In less
know/No than one
t sure
year
In the
next 1-2
years
In the
In the
next 3-5 next 6-10
years
years
More
than 10
years
from
now
Plans to Retire
134
16
0
4
11
29
74
Plan to discontinue practice
135
24
0
1
10
14
18
No
68
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
Department Issues
Geography Rates
Insufficient Vacation Time
Lack of Appropriate Call Coverage
Malpractice Rates
Patient Load is too Heavy
Patient Load is too Light
Personal
3rd Party Payers
Other
Number
3
3
2
0
0
2
2
13
0
9
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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 maldistribution 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
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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.
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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:
http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html
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
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