Behavioral Health Providers, Encounters, and Diagnoses in California’s Hospital Inpatient and Emergency Department Settings

Why are Behavioral Health Providers, Encounters, and Diagnoses Important?#

According to HCAI data for 2022, patients with Behavioral Health (BH) diagnoses accounted for approximately one third of all Inpatient (IP) hospitalizations and one sixth of all Emergency Department (ED) visits in California. The Health Resources and Services Administration reported that more than one third (122 million) of the U.S. population lives in a Mental Health Professional Shortage Area as of August 2024.

The visualizations below can help identify counties that may need additional specialized providers to care for patients with BH conditions in the IP and ED settings of California’s hospitals. These visualizations present the ratio of the number of encounters with a BH diagnosis, per provider license with a specialty in BH. Larger ratios may indicate a greater need for providers specializing in BH. Smaller ratios may indicate a lower need for providers specializing in BH. Additionally, information about BH diagnoses that were present during the encounters can help identify which types of BH providers may be needed in these hospital settings by county.

The visualizations offer a snapshot of the current burden in hospital IP and ED settings and do not capture care delivered in other parts of the healthcare system. While they do not show how many patients were seen by individual providers, they offer insight into the potential burden on groups of providers. Additionally, this analysis is distinct from HCAI’s forthcoming supply and demand projections, which estimate future workforce gaps.

How HCAI Created this Product#

Data on Patient Encounters and Diagnoses#

• This product used the 2023 Inpatient Discharge Data and 2023 Emergency Department Data to determine the number of encounters with a BH diagnosis.
• Definitions for BH categories were adopted from the Massachusetts Center for Health Information and Analysis, which consulted with clinicians and the Agency for Healthcare Research and Quality.
• Clinical Classification Software Refined (CCSR V2023.1) codes were used to define the diagnosis categories (e.g., mood disorders; anxiety disorders; alcohol-related disorders).
• Patient encounters included those that had a BH condition present as a primary or secondary diagnosis. Encounters with multiple BH diagnoses were counted for each separate diagnosis. The counts may still be under-represented due to undiagnosed BH conditions.
• To protect patient personal information, the California Health and Human Services Agency has adopted a policy of statistically masking or de-identifying sensitive data (CalHHS Data De-identification Guidelines). For these visualizations, a county is grouped with at least one other county if it had a population of less than 20,000 individuals or had one hospital. Only the top ten BH diagnoses within counties or county groups are shown. The top BH diagnoses numbers represent approximately 96% of all BH diagnoses present during IP and ED encounters.

Data on Provider Licenses#

• Licensure data was collected by the Department of Consumer Affairs; all data presented represents a snapshot of the active licensee population as of December 3, 2024. Numbers of provider licenses are not equivalent to the numbers of providers because a provider may hold more than one license.
• This product is based on responses to the HCAI Health Workforce License Renewal Survey data. To capture survey responses from licensees who were active in 2023, the Health Workforce data as of December 3, 2024, was used due to data collection lag. The responses to these surveys were adjusted using cell-based weighting to create estimates of the full population. Decline to State answers were excluded from the data for each visualization.  
• The data was limited to survey respondents who reported their primary practice setting or their secondary practice setting was in the “Hospital – Inpatient” or “Hospital – Emergency Department.”
• Licenses were defined as having a specialization in BH based on the licensing board and the primary area of practice (i.e., specialty) that they reported in the survey, as listed below: