In the United States about 60 million people, or nearly one person in five, have some sort of mental health condition, according to the Journal of the American Medical Association.  There are 28,000 psychiatrists in the United States, but that number continues to rapidly decline since those practicing are aging.  Most psychiatrists (3 out of 5) are 55 years of age or older.*  Even at this point it is still only one psychiatrist for every 2,100 people with a mental health condition.  More than half the counties in the United States have no psychiatrists whatsoever, according to a 2016 health affairs report. A Harvard University study recently found that only 17% of phone calls placed to get an appointment with a mental health counselor were successful.  Mental health needs in communities across the country are continuing to be critical with limited response and practical strategic plans to fill the void are not in sight.   Behavioral health facilities, hospitals and addiction centers cannot find enough trained behavioral health professionals or psychiatrists to meet their needs.    About 123 million people live in areas where there is a shortage of mental health professionals, according to the U.S. Department of Health and Human Services. Two out of three primary care physicians report difficulty referring patient for mental health care, twice the number reported for any other specialty, according to the Journal of Health Affairs.  The number of cases going to emergency departments for psychiatric services over a recent 3-year period increased 42%, the National Council for Behavioral Health reports.  The impact of a health problem as measured by financial cost, death rates, disability and other measures of mental health and substance use disorders was higher than any other condition in 2015, according to the Journal of the American Medical Association.  A 2016 report released by the Health Resources and Services Administration projected that the supply of workers in selected behavioral health professions  to be approximately 250,000 workers short of the projected demand in 2025.   The review of physicians and advanced practice recruiting initiatives in a 2017 report from the physician search firm Merritt-Hawkins states that the shortage of psychiatrists is an escalating crisis of more severity than shortages faced in any other specialty.  There are many reasons for the supply of mental health professionals falling short.  Historically the demand has not been as strong due to higher levels of stigma and lower rates of treatment being sought.  With demand now growing as the social stigma lessens, the supply has not caught up.  Also there is a perception that inadequate pay is discouraging some students from choosing mental health as a specialty.  The problem is especially acute in rural areas because most mental health professionals, like professionals in other fields, tend to cluster in urban areas.  In addition, behavioral health professionals, like other health care providers, are spending more and more time on paperwork for insurance companies and government agencies.  Many behavioral health professionals are reaching retirement age with too few young graduates to replace them.  The average age of psychologist is in their late 50s, and the average psychiatrist's age is in their late 60s.  Another major cause of the shortage is compensation.  Many of these professionals report that they leave the mental health profession because it is not lucrative enough.  Substance abuse counselors, on average, earn about $40,000 a year.  In this field 20% leave their jobs each year due to the low pay.   There is an increased understanding and acceptance that all health care has a behavioral health component, however primary care physicians often do not have the time or the training to conduct brief interventions.  What has begun to occur is primary care doctors will refer patients to behavioral health specialists, which can result in long wait times for an appointment while the condition festers or worsens.  These barriers add to the overall problems with long wait times, which will increase the likelihood of the patient delaying or even postponing treatment, according to a 2015 report by the Institute of Medicine.  This delay of treatment, in turn, increases the use of health care and emergency health care services and raises the overall cost of care.  This can put many patients on a downward spiral, eventually resulting in a crisis that can have them enter an emergency room, urgent care facility, and often admission to a hospital room on an in-patient basis.  *AAMC data