Marriage and family therapists (MFTs) comprise 11 percent of the clinically trained mental health personnel in the United States, according to a recent report from the U.S. Public Health Service’s Center for Mental Health Services. Counseling and psychology are at comparable rates (14 percent and 16 percent, respectively). Social work and psychosocial rehabilitation comprise the highest rates of 22 percent each, while the lowest rates are shared among psychiatry (8 percent), school psychology (5 percent) and psychiatric nursing (2 percent).
The report, “An Update On Human Resources In Mental Health” in Mental Health United States, 1996, provides for the first time comparative data on the mental health professional disciplines. Included are data on changes in the supply of clinically trained mental health personnel, sex, age, race, geographic distribution, years since completion of highest professional degree, employment status, primary and secondary employment settings, type of work activity, and number of trainees.
The report is an expansion and update of a 1990 report that provided data only for psychiatry, psychology, psychiatric nursing and social work. Just as with the four disciplines covered in the 1990 report, the eight disciplines in the 1996 report do not represent the entire professional workforce in mental health, but only those for which comparable data are available. Future reports plan to include other disciplines, such as pastoral counseling, sociology and master-level psychology.
The distribution between genders varies greatly by discipline. MFTs and psychologists are the most balanced between the genders. 53 percent of MFTs are female and 47 percent are male. In psychology 44 percent are female, 56 percent male. Psychiatrists are primarily male (75 percent), while psychiatric nurses, social workers and counselors are primarily female (psychiatric nurses 95 percent, social workers 77 percent, and counselors 78 percent).
Psychiatrists and counselors are at opposite ends of the age/experience spectrum. Psychiatrists are primarily older males, 60 percent of whom have been in practice for over 20 years. Counselors, on the other hand, are primarily younger females, 65 percent of whom have been in practice for less than 5 years. MFTs, psychiatric nurses, social workers and psychologists have comparable levels of experience. The majority of each discipline has been in practice for over 10 years.
No discipline has the number of minority members comparable to their ratio in the total U.S. population. The ratios vary greatly between males and females for each discipline.
African American females are most prevalent among social work (5.2 percent), followed by psychiatry (3.8 percent). African American males are most prevalent among psychosocial rehabilitation professionals (20.8 percent), followed by social work (4.2 percent).
Female Asian/Pacific Islanders are most prevalent among psychiatry (13.4 percent), followed by social work (1.7 percent). Asian/Pacific Islander males are most prevalent among psychiatry (7.5 percent), followed by psychosocial rehabilitation (2.0 percent).
Females of Hispanic descent are most prevalent among psychiatry (4.2 percent), followed by psychology, social work and school psychology (2.7 percent, 2.5 percent, and 2.0 percent, respectively). Males of Hispanic descent are found primarily among psychosocial rehabilitation professionals (6.4 percent) and psychiatry (4.4 percent).
American Indian/Alaska Native females are most prevalent among marriage and family therapists (1.1 percent), followed by psychology (0.6 percent), social work (0.5 percent), and psychiatric nursing (0.5 percent). Male American Indian/Alaska Natives are most prevalent among psychiatric nursing (3.1 percent), followed by marriage and family therapy (0.9 percent) and school psychology (0.7 percent).
Work Settings And Activities
The data on primary and secondary work settings from Mental Health United States, 1996 provide insight into the composition of the clinical workforce in the major mental health work settings. Included are data on employment in hospitals, clinics, private practice, and other settings such as nursing homes and schools.
According to Mental Health United States, 1996, social workers, marriage and family therapists, and counselors are the primary clinical staff of mental health and other health clinics. Approximately 50,000 clinically trained professionals are employed in clinics, either as their primary or secondary work setting.
Approximately 40,000 clinically trained professionals are employed in mental health or other health hospitals, either as their primary or secondary work setting. The primary disciplines in hospitals are psychiatry, social work and psychology.
Psychologists and marriage and family therapists predominate the approximately 140,000 clinically trained mental health personnel who work in private practice, either as their primary or secondary work setting. They are followed by social workers and counselors. Psychiatrists and psychiatric nurses represent the lowest percentage of clinically trained mental health personnel who work in private practice settings.
Clinically trained mental health personnel can also be found in universities and schools (the primary work settings for school psychologists and the second highest work settings for psychologists and counselors), social service agencies (the second highest work setting for social workers), and nursing homes.
The primary work activities reported in Mental Health United States, 1996 are: patient care/direct service, research, teaching, and administration. The vast majority of all disciplines are involved in direct patient care, ranging from 67 percent for school psychologists to 96.1 percent for psychosocial rehabilitation professionals. 88.4 percent of marriage and family therapists are involved in direct patient care.
There is great variance among the disciplines, however, in the other work activities. The disciplines with the highest rates of personnel involved in research are: psychiatric nursing (25.1 percent), psychology (19.7 percent), psychiatry (17.4 percent) and marriage and family therapy (16.5 percent). Counseling, social work and school psychology have the lowest rates of personnel involved in research (0.1 percent, 1.3 percent, and 4.0 percent, respectively).
Teaching is a very common activity among psychiatric nurses (58.9 percent), psychiatrists (49 percent), marriage and family therapists (46.7 percent), and psychologists (31.7 percent). Only 11.1 percent of social workers and 8.9 percent of counselors are involved in teaching activities. No school psychologists were reported to be in teaching activities, and no data were available for psychosocial rehabilitation professionals.
The majority of marriage and family therapists, psychiatrists and psychiatric nurses are involved in administration activities (56 percent, 52.5 percent, and 51.9 percent, respectively). Social workers and psychologists also have high rates of involvement in administration activities (34.9 percent and 27.4 percent, respectively). Conversely, psychosocial rehabilitation professionals, counselors, and school psychologists have low rates of involvement in administration activities (10.1 percent, 6.8 percent, and 5 percent, respectively).
The distribution of marriage and family therapists varies considerably across the states. The rates range from under three per 100,000 resident population in West Virginia, Delaware, Ohio, North Dakota, Louisiana and Arkansas to more than 20 per 100,000 in Oklahoma, Indiana, Texas and Nevada, to over 73 per 100,000 population in California. Generally, more states in the West and the Northeast have rates over 10 marriage and family therapists per 100,000 population, than do states in the South and Central United States. The national average is 17.6 marriage and family therapists per 100,000 population.
The other disciplines also experience a wide variance in distribution across the states, but not to the extent of marriage and family therapists. The highest single state concentration of the other disciplines is 15 percent, while for marriage and family therapists 49 percent reside in California. This concentration in California (there known as Marriage, Family and Child Counselors (MFCC)) can be attributed to at least two factors. In 1963 California was the first state to license marriage and family therapists, and an extensive infrastructure of 77 schools and universities with MFCC programs has developed in the state.
Most people being trained in the mental health disciplines are being trained in social work or counseling with 30,000 plus trainees each. Training in psychology follows with more than 18,000 trainees, with MFTs and psychiatry having 6,000-7,000 trainees each. Psychiatric nursing has only 2000 trainees.
In 1995 an estimated 6,776 individuals were in training to be marriage and family therapists. This includes 4,646 students in pre-degree academic programs, and 2,130 graduates who are still completing their required supervised face-to-face contact with individuals, couples and families.