Mental Health Professionals in Delaware 

2005 

prepared for 
Delaware Department of Health and Social Services 
Division of Public Health 

by 
Tibor Tóth 
Center for Applied Demography & Survey Research 
College of Human Services, Education and Public Policy 
University of Delaware 

Newark, Delaware 19716 
Tel: 302-831-3320 
August 2006
 
The University of Delaware is committed to assuring equal opportunity to all persons and does not 
discriminate on the basis of race, color, gender, religion, ancestry, national origin, sexual preference, 
veteran status, age, or disability in its educational programs, activities, admissions, or employment 
practices as required by Title IX of the Educational Amendments of 1972, Title VI of the Civil 
Rights Act of 1964, the Rehabilitation Act of 1973, the Americans with Disabilities Act, other 
applicable statutes, and University policy. Inquiries concerning these statutes and information 
regarding campus accessibility and Title VI should be referred to the Affirmative Action Officer, 
305 Hullihen Hall, 302/831-2835 (voice), 302/831-4552(TDD). 
ACKNOWLEDGEMENT 
       This report was primarily funded by the Delaware Department of Health and Social 
Services. 
       The author would also like to acknowledge the Delaware Division of Professional 
Regulation for providing the licensure data that served as the basis for the survey. 
TABLE OF CONTENTS 

Page 
List of Figures .......................................................................................... v 
Overview ................................................................................................. 1 
Demographics ............................................................................................. 4 
Practice Characteristics ................................................................................. 13 
Spatial Distribution ..................................................................................... 28 
Observations ............................................................................................. 33 
APPENDIX ................................................................................................. 35 

LIST OF FIGURES 

Figure Page
 1.1 Mental Health Professionals by County................................................................ 2 

 1.2 Full-time Equivalent Mental Health Professionals by County........................................... 3 

 2.1 Gender of Mental Health Professionals by County ..................................................... 4 

 2.2 Race of Mental Health Professionals by County ....................................................... 5 

 2.3 Hispanic Origin of Mental Health Professionals by County............................................. 6 

 2.4 Languages Spoken by County .......................................................................... 7 

 2.5 Age of Mental Health Professionals by County ........................................................ 8 

 2.6 Active Five Years from Now by County ................................................................ 9 

 2.7 State of High School Graduation by County ........................................................... 10 

 2.8 State of College/University Graduation by County..................................................... 11 

 3.1 Primary Employment by Mental Health Professional Class............................................... 13 

 3.2 Self-Employment Type by Mental Health Professional Class............................................. 14 

 3.3 Salaried Type by Mental Health Professional Class ................................................... 15 

 3.4 Clinical Setting by Mental Health Professional Class................................................. 16 

 3.5 Work Hours by Activity............................................................................... 17 

 3.6 Length of Practice at Current Location by County..................................................... 18 

 3.7 Number of Patient Encounters by County .............................................................. 19 

 3.8 Seeing Pediatric Patients by County.................................................................. 20 

 3.9 Offering Saturday Hours by County.................................................................... 21 

 3.10 Offering Evening Hours by County.................................................................... 22 

 3.11 Currently Accepting New Patients by County.......................................................... 22 

 3.12 Type of Referrals Provided ......................................................................... 23 

 3.13 Insurance Plan Participation by County.............................................................. 24 

 3.14 Type of Insurance Accepted ......................................................................... 25 

 3.15 Current Form of Bill Submission .................................................................... 26 

 3.16 Liability Insurance by County ...................................................................... 26 

 4.1 Number of Psychiatrist FTE’s by Census County Division .............................................. 29 

 4.2 Number of Mental Health Specialist FTE’s by Census County Division................................... 30 

 4.3 Number of Persons per Psychiatrist by Census County Division......................................... 31 

 4.3 Number of Persons per Mental Health Specialist by Census County Division ............................ 32 

Overview 

       In 2005, Delaware’s Division of Public Health began an effort to measure the number and 
spatial distribution of mental health professionals practicing in Delaware. Through collaboration 
with the Delaware Division of Professional Regulation, all mental health professionals licensed to 
practice in Delaware received a survey.  This included all licensed psychiatrists, psychologists, 
social workers, and professional counselors of mental health and chemical dependency care 
specialists. Mental health professionals who did not respond to the initial mail survey received three 
additional mailings in an attempt to boost the response rate. 
       A total of 1,050 mental health professionals were contacted.  The response rate for the 
survey was 55.4%. Based on the results, which were adjusted for non respondents, the number of 
mental health professionals with an active practice in Delaware is approximately 7631. This total is 
used to produce all estimates presented throughout this report. The data on mental health 
professionals is separated into the following two subgroups for the purposes of this report: 
psychiatrists and mental health specialists. Psychiatrists include all who indicated their mental health 
profession as a psychiatrist. Mental health specialists include psychologists, social workers, and 
professional counselors of mental health/chemical dependency care specialists. 
       As the survey responses indicated that not all mental health professionals deliver direct 
patient care on a full-time basis, a full-time equivalent (FTE) was calculated. In accordance with 
federal regulations, a mental health professional engaged in delivering care directly to patients 40 or 
more hours per week was defined as a full-time physician. A mental health professional working 
less than 40 hours was considered as less than full-time (for each four hours less than 40 hours, 0.1 
FTE was deducted).2 In other words, a mental health professional delivering 50 hours per week of 
primary care was counted as 1.0 FTE. A mental health professional working 36 hours per week was 
counted as 0.9 FTE. This methodology is in accordance with the federal guidelines for calculating 
provider capacity and shortage designations. 
1 On occasion, the data in the tables may not add to the total of 763 mental health professionals because not  
all respondents provided information for all questions. 
2 Federal Register/Vol.45, No.223/ Monday, November17, 1980, Part IV Department of Health and Human Services, 
42 CFR Part 5, p.76002. 

       In addition to the supply of the mental health professionals, this report provides 
demographic information, practice characteristics, and the spatial distribution of the mental health 
professionals at the sub-county level.  
Mental Health Professionals 
900 
800 
700 
600 
500 
400 
300 
200 
100 
0 
                             Kent Mental Health Specialists 
                              96 Psychiatrists 
                              28 Total 
124 
 
New Castle 
434 
93 
527 

Sussex 
Delaware 
101 
631 
11 
132 
112 
763 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       Figure 1.1 summarizes the mental health professionals in Delaware by county of practice. 
The proportion of psychiatrists to all mental health professionals is similar in Kent and New Castle 
counties with 23% and 18% respectively.  The proportion is significantly lower  in Sussex County at 
10%.  The overall proportion of psychiatrists to all mental health professionals in the State of 
Delaware is 17%. 
 
                    Source: Center for Applied Demography & Survey Research, University of Delaware 
       The number of full-time equivalent mental health professionals is provided in Figure 1.2. 
Given Delaware’s population of 843,7823, the statewide ratio of psychiatrist to population is 1:7,075 
persons. The estimates are 1:5,146 for Kent County and 1:6,253 for New Castle County. Sussex 
County has a significantly higher ratio of 1:22,983 persons served by each FTE psychiatrist. 
       Although there are no overall standards for mental health specialists relative to the 
population, it appears the ratios are more balanced than for psychiatrists. The statewide ratio of each 
FTE mental health specialist is 1:2,000 persons. The Kent County ratio of mental health specialists 
to population is 1:2,409 persons; the Sussex County ratio is 1:2,802, and New Castle County had the 
most favorable ratio with 1:1,786 persons. 
3 Center for Applied Demography, Population projection at Census County Division level, 2005 
Demographics 

The topic of demographic diversity within the mental health profession community is important as 
changes occur in the population of Delaware. 
Percent Male 
Figure 2.1 
Gender of Mental Health Professionals 
by County 

90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Kent 
New Castle 
Sussex 
Delaware 
Mental Health Specialists 
29.8 
27.8 
26.3 
27.9 
Psychiatrists 
40.0 
76.3 
63.6 
68.2 

Source: Center for Applied Demography & Survey Research, University of Delaware 
       The psychiatrist community in Delaware is about 70% male. There is, however, some 
variation between the counties. New Castle County (76%) and Sussex County (64%) both have 
significantly more male psychiatrists than does Kent County (40%). A very different pattern appears 
among mental health specialists across the state where only 28% is male.  The variation of males 
among mental health specialists across counties is less pronounced with a range of 26% in Kent 
County to 30% in New Castle County. 
by County 
Percent 
100% 80% 60% 40% 20% 
0% 
 KC: MHS 
Other % 
                     3.2 Asian % 
                     2.1 African American % 
                     5.3 Caucasian % 
89.4 
 
KC:  
P 

18.5 
29.6 
14.8 
37.0 
NCC:  
MHS 

1.9 
1.2 
5.5 
91.5 
NCC:  
P 

6.6 
28.6 
0.0 
64.8 
SC:  
MHS 

2.1 
1.0 
3.1 
93.8 
SC: 
DE: 
DE: 
P 
MHS 
P 
50.0 
2.1 
11.9 
0.0 
1.3 
27.0 
0.0 
5.1 
3.2 
50.0 
91.5 
57.9 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       The racial distribution of mental health professionals by county is shown in Figure 2.2. 
There are no African American psychiatrists reported in New Castle County or Sussex County.  
There are few African American mental health specialists in Sussex County (3%) and the 
preponderance of Asian psychiatrists in Kent (30%) and New Castle (29%) counties. The scarcity of 
African American mental health specialists in Sussex County, and the lack of African American 
psychiatrists in New Castle and Sussex counties is puzzling. 
       Hispanic origin has taken on a particular interest in Delaware with the rapid growth of 
that population in the 1990s, particularly in Sussex County. The distribution of mental health 
professionals by Hispanic origin is found in Figure 2.3. 
 
       Source: Center for Applied Demography & Survey Research, University of Delaware 
       Delaware’s population is nearly 5% Hispanic, and the overall Hispanic mental health 
professionals essentially mirror that population. However, significant differences exist between 
psychiatrists and mental health specialists, and across counties.  The highest proportion of Hispanic 
psychiatrists is found in Sussex County (36%), the smallest proportion of psychiatrists is found in 
New Castle County (7%). There are no Hispanic mental health specialists reported in Kent County. 
       The population of Delaware is becoming more diverse. For example, there has been a 
significant increase in the number of Hispanic Delawareans, particularly in Sussex County. For 
many, English is a second language or is not spoken at all. This presents a challenge for the mental 
health community as they try to provide service to this population. Respondents were asked if 
languages other than English were spoken at their practice site. The results are detailed in Figure 
2.4. 
       Across the state, 64% of psychiatrists and about 44% of mental health specialists have 
someone in their office who can speak a language other than English. Sussex County’s psychiatrists 
and mental health specialists are least likely to have the capability to communicate in a language 
other than English. Spanish was by far the most frequently mentioned language. Thirty eight percent 
of Delaware’s mental health professionals indicated that someone in their office spoke Spanish.  The 
ability to communicate in Spanish by someone in the office was indicated by 35% of mental health 
professionals in Kent County, 40% of mental health professionals in New Castle County and 36% 
by mental health professionals in Sussex County. Ability to communicate using sign language was 
indicated by 9% of Delaware’s mental health professionals. Asian languages are spoken by 8% of 
the mental health professionals; French is spoken by 6% and Arabic by 2%.  Seven percent of 
mental health professionals indicated ability to communicate using other languages. 
       Figure 2.4 Languages Spoken by County 
100.0 
90.0Percent Speaking Foreign Languages
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Kent 
New Castle 
Sussex 
Delaware
Mental Health Specialists 
43.3 
45.3 
39.6 
44.1 
Psychiatrists 
60.7 
67.7 
36.4 
63.6 

Source: Center for Applied Demography & Survey Research, University of Delaware 
       The age of mental health professionals is ultimately a factor in their availability. The age 
distribution of mental health professionals is found in Figure 2.5. There are several points of interest 
in this display. First, the smallest proportion of psychiatrists under 50 is found in New Castle 
County (29%). In Delaware, about 45% of psychiatrists are under the age of 50. Second, the highest 
proportion of psychiatrists aged 60 and above is again in New Castle County (35%), while no 
psychiatrists are reported for this age group in Kent and Sussex counties. Third, Sussex County, the 
fastest growing county with the oldest residents on average, has the highest proportion (30%) of 
mental health specialists 60 and older. Overall, in Delaware, about 20% of mental health 
specialists are 60 and older. 
100% 
80% 
60% 
40%Percent 
20% 
0% 
KC: 

MHS 
65+ 
8.1 
60-64 
14.0 
50-59 
32.6 
40-49 
22.1 
Under 40 
23.3 

by County 
 
KC:  
P 

0.0 
0.0 
32.0 
24.0 
44.0 
NCC:  
MHS 

6.9 
10.4 
40.8 
26.2 
15.6 
NCC:  
P 

21.8 
12.8 
35.9 
25.6 
3.8 
SC:  
MHS 

14.4 
15.6 
25.6 
30.0 
14.4 
SC:  
P 

0.0 
0.0 
0.0 
81.8 
18.2 
DE: 
DE: 
MHS 
P 
8.3 
14.9 
11.7 
8.8 
37.2 
31.6 
26.2 
30.7 
16.6 
14.0 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       Mental health professionals were asked if they planned to be active in their chosen 
profession five years from now. Those answers are summarized in Figure 2.6 below. In general, 
82% of mental health professionals expect to be active in five years. The lowest proportion is found 
among psychiatrists in New Castle County (75%). 
The 40-49 age group has the highest proportion (95%) of mental health professionals 
indicating that they will be active in the next 5 years.  That proportion drops to 87% for the 50-59 
age group, 67% for those between the age of 60-64 and 44% for those already of age 65 and 
       over. 
100% 
90% 
80% 
70% 
60% 
50% 
40% 
30% 
20% 
10% 

0% KC: KC: NCC: NCC: SC: SC: DE: 
                                                             DE: 
MHS 
P MHS P MHS P MHS P 
6.5 
0.0 
14.4 
15.1 
16.3 
0.0 
13.5 
                                                                         10.9 NO 
UNSURE 5.4 
0.0 
4.5 
9.7 
5.1 
0.0 
4.7 
                                                                         7.0 
YES 
88.0 
100.0 
81.1 
75.3 
78.6 
100.0 
81.8 
82.2 
 
Percent 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       The data for New Castle County shows a large group of psychiatrists and mental health 
specialists who are unsure about whether they will remain active in five years. Increased levels of 
uncertainty can also be observed in Sussex County among mental health specialists.  This 
undoubtedly relates to the large group in the 60-64 and 65+ age groups shown in Figure 2.4. In 
contrast, psychiatrists and mental health specialists in Kent County are more positive and less unsure 
than those practicing in the other counties. These results serve to increase the concern about the 
aging of both psychiatrists and mental health specialists in New Castle County and the future 
adequacy of mental health specialists in Sussex County. 
       It is necessary to analyze why some mental health professionals choose to practice in 
Delaware and some choose other states.  The way this choice is made determines the adequacy of 
the supply for serving Delaware’s residents. Several factors determine this choice. The first factor is 
where a mental health professional originally resides as indicated by the state from which they 
graduated high school. The second factor is the state the mental health professional attended 
college/university. 
       Figure 2.7 shows the distribution of the state of mental health professionals’ high school 
graduation. The first interesting aspect of this figure is that 68% of Delaware’s mental health 
professionals grew up in the region and about 29% are from Delaware. While about 34% of the 
mental health specialists are from Delaware, only 7.5% of psychiatrists are from Delaware. 
Pennsylvania is the main source of psychiatrists with 17%, New York provides 13.5% and 
Delaware provides 7.5%.  The second interesting aspect of the figure is that about 57% of all 
psychiatrists in Delaware come from high schools outside of the region while only 26.5% of 
mental health specialists come from outside the region. 
Figure 2.7 
State of High School Graduation 
by County 
 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       There appears to be a significant orientation to locate in a specific county depending on 
the state of high school graduation. Mental health professionals who grew up in Maryland are 
more likely to locate in Sussex County while those who grew up in New Jersey, New York and 
Pennsylvania tend to locate in New Castle County. This holds true for both psychiatrists and 
mental health specialists. 
100% 
80% 
60% 
40%Percent 
20% 
0% 
KC: 
MHS 
OTHER PA NY 
NJ MD DE 
45.3 
12.6 
3.2 
0.0 
4.2 
34.7 

by County 
 
KC:  
P 

86.2 
0.0 
13.8 
0.0 
0.0 
0.0 
NCC:  
MHS 

36.4 
30.0 
4.4 
2.8 
4.8 
21.7 
NCC:  
P 

67.7 
24.7 
7.5 
0.0 
0.0 
0.0 
SC:  
MHS 

38.6 
13.9 
5.0 
3.0 
16.8 
22.8 
SC:  
P 

63.6 
18.2 
0.0 
18.2 
0.0 
0.0 
DE: 
DE: 
MHS 
P 
38.1 
71.4 
24.8 
18.8 
4.3 
8.3 
2.4 
1.5 
6.7 
0.0 
23.8 
0.0 
     Source: Center for Applied Demography & Survey Research, University of Delaware 
       The pattern observed for the state of high school graduation is replicated in part for the state 
of university/college graduation (Figure 2.8). Overall, 56% of Delaware’s mental health 
professionals graduated from colleges/universities in the region. About 19% of mental health 
professionals graduated from a college/university in Delaware.  The majority of Delaware’s 
psychiatrists (71%) graduated from colleges/universities outside of the region. As far as the regional 
source of psychiatrists in Delaware’s counties is concerned, the highest proportion of psychiatrists in 
Kent County (14%) graduated from a college/university in New York, Sussex County’s psychiatrists 
(18%) graduated from a college/university in New Jersey and Pennsylvania respectively. The 
primary source of psychiatrists in New Castle County (25%) is Pennsylvania.  In contrast to 
psychiatrists, mental health specialists mainly (62%) come from colleges/universities in the region. 
The prominent regional source of mental health specialists for Kent (35%) and Sussex (23%) 
counties is Delaware. Thirty percent of New Castle County’s mental health specialists come from 
colleges/universities in Pennsylvania. 
Practice Characteristics 
       Mental health professionals may practice in a variety of settings, including self employed, 
salaried or both. Some differences between psychiatrists and mental health specialists are apparent, 
while other differences are surprisingly small. 
       One of the key decisions a mental health professional will make is whether to become 
self-employed or to join an existing practice as a salaried employee. While one would tend to 
think that this decision is an either/or decision, that is not supported in Figure 3.1. 
Percent 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Mental Health Specialists 
38.6
Self employed 
35.8
Salaried 
25.6
Both 
 
Psychiatrists
49.2 
26.6 
24.2 
                     Source: Center for Applied Demography & Survey Research, University of Delaware 
       When mental health professionals were asked about their primary employment they could 
choose more than one answer. One quarter of mental health professionals indicated that they were 
involved in both primary types of employment (see Figure 3.1). Presumably this suggests that they 
are salaried but are engaged in consulting activities outside of their primary employment. 
Psychiatrists are more likely (49%) to indicate that their primary form of employment is self 
employed compared to mental health specialists of whom 39% indicates self employment. 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Mental Health Specialists 
                                                            PsychiatristsSolo 
43.0 
                                                                63.2 
Partner in Group 
20.8 
                                                                7.9 
Professional Corporation 
20.1 
                                                                19.3 
Other 
16.1 
9.6 
Percent 
 
       Source: Center for Applied Demography & Survey Research, University of Delaware 
       Just as differences exist as to the type of employment chosen by mental health 
professionals, differences also exist within the self employed group. This is shown in Figure 3.2, 
above. Clearly psychiatrists are more oriented toward a solo practic e (63%) than mental health 
specialists (43%). 
       Mental health professionals employed as a salaried employee have a wide spectrum of 
employment options (Figure 3.3). Most mental health professionals work for a non-governmental 
employer (43% of psychiatrists and 33% of mental health specialists).  Around 14% of both 
psychiatrists and mental health specialists work for state government.  No psychiatrists indicated 
that they are employed by the federal government or a federally qualified health center, while about 
4% of mental health specialists work for these employers. 
 
        Source: Center for Applied Demography & Survey Research, University of Delaware 
       Mental health professionals were also asked to describe the setting of their employment 
within three broad categories: clinical care, federal health facility (VA hospitals or other federal 
health facilities excluding Federally Qualified Health Centers), and school. About 87% percent of 
the mental health professionals responding selected only the clinical care settings. About 5% of the 
respondents did not select the clinical care setting. The detailed responses within the clinical care 
setting are shown in Figure 3.4. 
       First of all, it is important to note that these categories are not mutually exclusive. Many 
mental health professionals selected more than one. Most psychiatrists (68%) and many mental 
health specialists (57%) indicated that the clinical setting of their primary employment is a 
practitioner’s office.  Psychiatrists (33%) are more likely to work in a hospital than mental health 
specialists (9.5%). About 13% of psychiatrists work in freestanding clinics, while about 10% of 
mental health specialists indicated this setting for their primary employment. The two groups select 
all of the other settings with similar frequencies. 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Mental Health Specialists 
                                                          PsychiatristsPracti
tioner's Office 
56.9 
                                                               68.2 
Hospital 
9.5 
                                                               33.1 
Nursing Home 
0.6 
                                                               2.3 
Freestanding Clinic 
10.3 
	12.9 FQHC 
	0.6 
2	Treatment Facility 

0.5 
                                                               0.0 
Public Health Cinic 
0.5 
                                                               3.0 
Other 
21.6 
15.9 
 
Percent 
 
       Source: Center for Applied Demography & Survey Research, University of Delaware 
       In order to calculate full-time equivalencies, mental health professionals were asked to 
describe the way they distributed their time over a typical week. The categories included direct 
patient care, administration, teaching, research, and other. In general, the responding psychiatrist’s 
work week on average was slightly over 46 hours and mental health specialist’s work week was 
about 38 hours. 
       The breakdown for the detailed categories is shown in Figure 3.5. Not surprisingly, both 
groups of mental health professionals spend the majority of their week on direct care. Psychiatrists 
spend about 87% of the week on direct care, while mental health specialists spend about 78% of 
their week on direct patient care. The time spent on administrative activities clarifies this difference 
between the two groups.  Mental health specialists spend about 17% of their work hours on 
administrative duties while psychiatrists spend about 6%. 
Figure 3.5 
Work Hours 
by Activity 
 
                    Source: Center for Applied Demography & Survey Research, University of Delaware 
       Mental health professionals were asked to indicate the length of time they have practiced at 
their current location. The responses are tabulated in Figure 3.6. Overall, about 40% of all mental 
health professionals have been practicing at the same location for 1-4 years.  Only 15% have 
practiced at the current location for more than 15 years. Only marginal differences exist among 
counties for mental health specialists.  Across counties, about the same proportion of mental health 
specialists fall within the same group.  However, significant differences exist among psychiatrists in 
Delaware’s counties. Most striking is the fact that only about 30% of psychiatrists in New Castle 
County have been practicing at their current location for 1-4 years, compared to Kent (72%) and 
Sussex (64%) counties. Also, no psychiatrists from Sussex County have indicated length of practice 
to be 15 years and above.  This is very likely related to the low number of psychiatrists in Sussex 
County. 
 
        Source: Center for Applied Demography & Survey Research, University of Delaware 
       The survey asked respondents to indicate the number of patient encounters they have in a 
week. Detailed tabulation of answers is provided in Figure 3.7. Looking at the State of Delaware and 
both mental health profession groups together, one would conclude that about 50% of respondents 
see 10-29 patients a week.  However, there are significant differences between the two groups. 
About 60% of mental health specialists see 10-29 patients but only 21% of psychiatrists see this 
number of patients a week.  Forty percent of psychiatrists see 70 or more patients in a week while 
only 1% of all mental health specialists see this many patients in a week. 
       The proportion of patient encounters for mental health specialists varies minimally across 
counties. On the other hand, the variation of patient encounters by psychiatrists across counties is 
significant.  Psychiatrists in Kent County are most likely (46%) to see 50-69 patients and New 
Castle County’s psychiatrists are most likely (43%) to see 70 or more patients.  Interestingly 
psychiatrists practicing in Sussex County are most likely (40%) to see only 10-29 patients.  This 
information seems to contradict some of the observations made previously about Sussex County’s 
psychiatrists. There are at least two plausible explanations. First, the demand for psychiatrists in 
Sussex County may be significantly lower. The second explanation is that the demand for 
psychiatrists in Sussex County is comparable to the demand Kent and New Castle counties, but, due 
to a perceived shortage of psychiatrists, patients chose not to see a psychiatrist at all or see 
one outside of Sussex County. 
by County 
Percent 
100% 80% 60% 40% 20% 
0% 
 KC: MHS 
70+ 
               0.0 50-69 
               2.2 30-49 
               23.1 10-29 
               60.4 Less than 10 
14.3 
 
KC:  
P 

39.3 
46.4 
0.0 
14.3 
0.0 
NCC:  
MHS 

1.0 
4.4 
23.3 
58.3 
13.0 
NCC:  
P 

43.0 
15.1 
20.4 
21.5 
0.0 
SC:  
MHS 

3.1 
1.0 
20.6 
59.8 
15.5 
SC:  
P 

20.0 
20.0 
20.0 
40.0 
0.0 
DE: 
DE: 
MHS 
P
1.2 
40.5 
3.5 
22.1 
22.8 
16.0 
58.9 
21.4 
13.6 
0.0 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       In order to understand the availability of mental health services to pediatric patients, the 
survey asked respondents to indicate if they see patients under age 21.  Tabulation of the responses 
is presented in Figure 3.8. Kent County has the highest proportion of both mental health specialists 
(88%) and psychiatrists (100%) indicating that they see pediatric patients.  A significantly lower 
percentage of psychiatrists in New Castle (66%) and Sussex County (64%) see patients less than 21 
years of age. 
Figure 3.8 
Seeing Pediatric Patients 
by County 
100.0 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Kent New Castle Sussex Delaware
88.2 
77.9 
73.7 
                                                                     78.8 
Psychiatrists Mental Health Specialists 100.0 
66.3 
63.6 
73.3 
Percent Seeing Pediatric Patients 
 
             Source: Center for Applied Demography & Survey Research, University of Delaware 
       Accessibility to mental health services has a number of dimensions. One of those 
dimensions is flexible office hours, i.e. hours other than the typical hours that people are working. 
The survey asked respondents if they provided either Saturday or evening office hours. Their 
responses are tabulated in Figure 3.9 and 3.10. Mental health specialists are more likely to offer 
flexible office hours than psychiatrists. Offering evening hours is roughly twice as popular as 
providing Saturday hours. Mental health specialists in Kent and Sussex counties are more likely to 
offer evening and Saturday hours than mental health specialists in New Castle County. Psychiatrists 
in New Castle County are more likely to offer Saturday hours but less likely to offer evening hours 
than their colleagues in Kent and Sussex counties. 
100.0 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Kent New Castle Sussex Delaware 
27.2 
18.6 
28.9 
                                                                      21.6 
Psychiatrists Mental Health Specialists 0.0 
6.7 
0.0 
4.7 
Percent Offering Saturday Hours 
 
Source: Center for Applied Demography & Survey Research, University of Delaware 
Percent Accepting New Patients Percent Offering Evening Hours 
100.0 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Kent New Castle Sussex 
                                                                    DelawareMental Health 
Specialists 
86.0 
67.3 
77.3 
                                                                      71.9 Psychiatrists 
68.0 
41.4 
50.0 
47.5 
 
Source: Center for Applied Demography & Survey Research, University of Delaware 
Figure 3.11 
Currently Accepting New Patients 
by County 

100.0 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Kent New Castle Sussex 
                                                                    DelawareMental Health 
Specialists 
93.2 
87.9 
92.7 
                                                                      89.5 Psychiatrists 
79.3 
81.7 
81.8 
81.2 
 
             Source: Center for Applied Demography & Survey Research, University of Delaware 
       The survey asked mental health professionals if they are accepting new patients. Results 
are found in Figure 3.11. Almost all mental health specialists (around 90%) accept new patients. 
The percentage of psychiatrists accepting new patients is a bit lower (around 80%). 
       Even though the majority of mental care professionals across Delaware are accepting new 
patients, there are some who do not see new patients or cannot make emergency appointments. To 
learn what happens to these patients, the survey asked to identify the types of referrals they provide. 
Around 90% of mental health professionals who do not see new patients or cannot accommodate an 
emergency appointment indicated that they provide referrals.  Detailed tabulation of the types of 
referrals is presented in Figure 3.12.  Mental health specialists are most likely (42%) to refer a 
patient to a private practice, while psychiatrists are most likely (52%) to refer a patient they can’t 
see to a hospital emergency room. 
100.0 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
HospitalPrivate Practice 
OtherEmergency Room 
42.2 
36.3 
                                                                    21.6 
Psychiatrists Mental Health Specialists 40.7 
51.9 
7.4 
Percent 
 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       Access to mental health services can be affected by the acceptance of insurance plans. The 
survey asked if mental health professionals participated in such plans. The responses are 
found in Figure 3.13. Overall, around 20% of psychiatrists and little more than 12% of mental health 
specialists do not participate in insurance plans.  There are differences between the counties. Kent 
County psychiatrists and mental health specialists are more likely to accept insurance plans than 
their counterparts located in New Castle County or Sussex County. Both psychiatrists and mental 
health specialists in Sussex County are least likely (by a small margin) to participate in insurance 
plans. 
100.0 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Kent New Castle Sussex Delaware 
84.3 
78.5 
77.3 
                                                                      79.2 
Psychiatrists Mental Health Specialists 92.9 
87.8 
81.8 
88.4 
Percent Participating 
 
Source: Center for Applied Demography & Survey Research, University of Delaware 
       Access to mental health services is impacted by the insurance coverage that a patient 
presents to the mental health professional. Acceptance of insurance plans can allow a mental health 
professional to extend services to a wider range of patients. Mental health professionals were asked 
to identify the type of insurance plans they participate in.  The options included capitation, reduced 
fee for service, Medicaid and traditional insurance with balance billing. The responses to this 
question are found in Figure 3.14. Those who participate in insurance plans most commonly accept 
insurance plans are traditional plans with balance billing. Reduced fee for service is accepted by 
46% of mental health specialists compared to 28% of psychiatrists. Medicaid is accepted by 78% of 
mental health specialists and by 75% of psychiatrists. 
100.0 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Mental Health Specialists Psychiatrists
10.6 
                                                             10.4 
Reduced Fee 
Capitation 46.2 
                                                             27.8 
Medicaid 
77.9 
                                                             74.8 
Traditional 
85.2 
89.6 
 
Percent Accepting Insurance 
       Source: Center for Applied Demography & Survey Research, University of Delaware 
       Mental health professionals were asked to indicate how they currently submit bills and 
related paperwork to the insurance companies.  As shown in Figure 3.16, more than half of the 
mental health specialists (78%) and psychiatrists (82%) submit their bills to insurance companies by 
mailing them. Less than half of mental health professionals submit their bills electronically. 
Percent Carrying Liability Insurance Percent Form of Bill Submission 
90.0 
80.0 
70.0 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
Mental Health Specialists 
                                                           PsychiatristsMail Bills 
Directly to 
78.1 
81.6 
Insurance Companies Electronic 
Transfer 
39.5 
                                                               41.8 Other 
17.2 
9.2 
 
Source: Center for Applied Demography & Survey Research, University of Delaware 
        Figure 3.16 Liability Insurance by County 
100.0 
95.0 
90.0 
85.0 
80.0 
75.0 
Kent 
New Castle 
Sussex 
Delaware 
94.4 
91.6 
84.2 
90.8
Mental Health Specialists 
100.0 
100.0 
100.0 
100.0
Psychiatrists 
 
Source: Center for Applied Demography & Survey Research, University of Delaware 
Mental health professionals were asked to indicate if they carry liability insurance. Figure 
3.16 shows their responses.  All psychiatrists in Delaware indicated that they carry liability 
insurance. Kent County’s mental health specialists are most likely (94%) to carry liability 
insurance, while those in Sussex County are least likely (84%) to carry liability insurance. 
Spatial Distribution 
       The spatial distribution of FTE psychiatrists is shown in Figure 4.1. In Figure 4.2, the spatial 
distribution of FTE mental health specialists is depicted. Responses were received from 24 of the 27 
census county divisions. 
       Figures 4.3 and 4.4 show the number of persons served by a psychiatrist or a mental 
health specialist given the responses to the survey. 
       It is imperative to note that the census county divisions that indicate “No psychiatrists 
reporting” or “No mental health specialists reporting” really indicate one of two plausible reasons: 
a)	there are some psychiatrists/mental health specialists in these CCDs but none 
responded to the survey OR 
b)	there are no psychiatrists/mental health specialists in these CCDs thus no 
responses were received 
Consequently, the adequacy of mental health care in census county divisions indicating “No 
psychiatrists reporting” or “No mental health specialists reporting” needs to be evaluated along 
with the data shown for adjacent CCDs. 
Figure 4.1 
Number of Psychiatrist FTEs  
by Census County Division 

 
Source: Center for Applied Demography & Survey Research, University of Delaware 
Figure 4.2 
Number of Mental Health Specialist FTEs 
by Census County Division 

 
Source: Center for Applied Demography & Survey Research, University of Delaware 
Figure 4.3 
Number of Persons per Psychiatrist 
by Census County Division 

 
Source: Center for Applied Demography & Survey Research, University of Delaware 
Figure 4.4 
Number of Persons per Mental Health Specialist 
by Census County Division 

 
Source: Center for Applied Demography & Survey Research, University of Delaware
 
Observations
 
This survey of mental health professionals in Delaware is in its first year and is intended 
to provide information that will be useful to policymakers in Delaware. Even without a complete 
reporting the observations about mental health professionals in Delaware collected and analyzed in 
this study are statistically sound and a number of findings can be drawn from the data:
 
-Based on the survey results, adjusted for non-respondents, the number of mental health 
professionals with an active practice in Delaware is 763; this represents 534 full time 
equivalent mental health professionals.
 
-About 17% of all mental health professionals are psychiatrists, while 83% are mental health 
specialists (psychologists, social workers, professional counselors of mental health, and 
chemical dependency care specialists).
 
-Sussex County has the least favorable ratio of 22,983 persons served by one full time 
equivalent psychiatrist compared to 1:5,146 in Kent County and 1:6,253 in New Castle 
County.  The statewide ratio of full time equivalent psychiatrist to population is 1:7,075. 

-Mental health specialists are more likely to be female in all counties, while psychiatrists are 
more likely to be female only in Kent County. 

-About 27% of all psychiatrists in Delaware are Asian, compared to 1% of mental health 
specialists indicating Asian as their race. 

-The highest proportion (36%) of psychiatrists with Hispanic origin can be found in Sussex 
County.  This compares to Kent County with 24% and New Castle County with 7%. 

-Sussex County, the fastest growing county with the oldest residents on average, has the 
highest proportion of mental health specialists 60 years and above.
 
-Almost 10% of psychiatrists in New Castle County indicated that they do not expect to be 
active five years from now.  The highest level (16%) of uncertainty can be observed in 
Sussex County among mental health specialists.
 
-The majority (68%) of Delaware’s mental health professionals grew up in the region; 29% 
of them in Delaware. One-third of mental health specialists are from Delaware while 
only 7.5% of psychiatrists are from Delaware.

-Mental health professionals who grew up in Maryland are more likely to locate in Sussex 
County, while those who grew up in New Jersey, New York and Pennsylvania tend to 
locate within New Castle County.
 
-Over 70% of psychiatrists practicing in Delaware graduated from colleges/universities 
outside of the region while 62% of mental health specialists practicing in Delaware 
graduated from colleges/universities in the region (PA, NY, NJ, MD, DE).
 
-Delaware’s psychiatrists are more likely to be self employed (49%) than mental health 
specialists (39%). 

-Psychiatrists spend about 87% of their work week on direct patient care while mental health 
specialists spend about 78% on direct patient care. The reminder of their time is spent 
mostly on administration.
 
-About 30% of psychiatrists in New Castle County have been practicing at their current 
location for less than 5 years compared to 72% in Kent and 64% in Sussex counties.
 
-About 60% of mental health specialists see 10-29 patients a week but only 21% of psychiatrists 
see this number of patients. Forty percent of psychiatrists see 70+ patients a week while 
only 1% of mental health specialists see this many patients.
 
-Kent County has the highest proportion of mental health specialists (88%) and  
psychiatrists (100%) indicating that they see pediatric patients. 

-Mental health specialists are more likely to offer flexible hours than psychiatrists.   
Offering evening hours is roughly twice as popular as providing Saturday hours. 

-Almost all mental health specialists (90%) accept new patients.  The percentage of 
psychiatrists accepting new patients is 80%. 

-Mental health specialists are most likely (42%) to refer a patient to a private practice, while 
psychiatrists are most likely (52%) to refer a patient they cannot see to a hospital 
emergency room. 

-Kent County’s mental health specialists are most likely (84%) to participate in insurance plans 
compared to Sussex County’s mental health specialists who are least likely (77%) to 
participate in insurance plans.  Kent County’s psychiatrists are most likely (93%) to 
participate in insurance plans compared to Sussex County’s psychiatrists who are least 
likely (82%) to accept insurance plans from their patients. 

-Traditional plans with balance billing are the most commonly accepted (87%) insurance 
plans among mental health professionals. Capitation plans are the least likely (10%) 
accepted type of insurance. 

-All psychiatrists in Delaware indicated that they carry liability insurance.  Kent County’s 
mental health specialists are most likely (94%) to carry liability insurance, while those in 
Sussex County are least likely (84%) to carry liability insurance. 
The database, while not complete, is substantial. The survey instrument may be refined prior to 
conducting it again to better measure the key items and eliminate those items that add to the 
burden of the respondents without adding to needed knowledge. 

APPENDIX 

DELAWARE MENTAL HEALTH SURVEY 
2005 

 
1.	Indicate your mental health profession: 

1[ ] Psychiatrist 
2[ ] Psychologist 
3[ ] Social Worker 
4[ ] Professional Counselor of Mental Health 
5[ ]Chemical Dependency Professional 

2.	Are you currently active in any of the described mental health professions 
(i.e.: seeing patients and/or doing tasks necessary for the care of patients): 
1[ ] Yes, in training  
2[ ] Yes, working full time  
3[ ] Yes, working part time (less than 30 hours per week) 
4[ ] No, retired
5[ ] No, inactive
6[ ] No, other(please specify):_________________ 
 
IF YOU ARE NOT CURRENTLY ACTIVE (I.E. RETIRED, INACTIVE OR OTHER) PLEASE SKIP TO QUESTION 26 (PAGE 5)

3.	On average, how many hours per week do you spend on each of the following activities: 
_______ Hours - Direct patient care or services and related paperwork 
_______ Hours - Direct management and related paperwork 
_______ Hours - Teaching 
_______ Hours - Research 
_______ Hours - Other (please specify):_______________________________________ 

4.	What is the setting of your primary employment (please check all that apply): 
1[ ] Clinical Care Setting: 
1[ ] Practitioner’s Office (solo, member of group practice...) 
2[ ] Hospital (except federal) 
3[ ] Nursing Home 
4[ ] Freestanding Clinic (administratively distinct from a hospital, nursing home, etc.) 
5[ ] Federally Qualified Health Center 
6[ ] Treatment Facility for the Handicapped or Disabled 
7[ ] Public Health Clinic 
8[ ] Other (please specify):_____________________________________________
 
2[ ] Federal Health Facility: 
1[ ] Veterans’ Administration (VA hospital) 
2[ ] Other (please specify):_____________________________________________ 

3[ ] School: 
1[ ] University or College 
2[ ] Other (please specify):_____________________________________________ 
 
4[ ] What kinds of services do you provide (check all that apply)? 
1[ ] Addiction Counseling 
2[ ] Family Counseling 
3[ ] Group Therapy 
4[ ] Individual Counseling 
5[ ] Other (please specify):____________________________________________ 

5.	What is the form of your primary employment: 
1[ ] Self-Employed/Principal (please check all that apply): 
1[ ] Solo Practice 
2[ ] Partner in Group Practice 
3[ ] Professional Corporation 
4[ ] Other (please specify):_____________________________________________ 

2[ ] Salaried, Employed by (please check all that apply): 
1[ ] Commissioned Associate 
2[ ] Partnership of Group Practitioners 
3[ ] Other Non-Government Employer (hospital, school, etc.) 
4[ ] Federal Government 
5[ ] Federally Qualified Health Center 
6[ ] State Government 
7[ ] Other (please specify):______________________________________________ 
 
6.	What is the facility name, address and zip code of your primary DELAWARE-BASED practice 
site? 
(Facility Name) 
(Street Address) 
(City)	(State) (Zip Code)
 
7.	How long have you been practicing at this location? _______________ 

8.	What type of site is this? 
1[ ] Private Office 
2[ ] Clinic 
3[ ] Hospital 
4[ ] Other____________ 

9. How many other types and number of Mental Health providers currently practice at this site? 
Type Amount 
1[ ] Psychiatrist 
2[ ] Psychologist 
3[ ] Social Worker 
4[ ] Professional Counselors of Mental Health 
5[ ] Chemical Dependency Professionals 

10.	About how many patient encounters do you have in a week? ________ 

11.	Do you see pediatric patients (under 21 years)? 1[ ] Yes 2[ ] No 
a. If YES to above, beginning at what age do you see patients? ______ 

12.	Do you offer Saturday or evening hours? 
 	a. Offer Saturday appointments: 1[ ] Yes 2[ ] No 
 	b. Offer evening hours: 1[ ] Yes 2[ ] No 

13.	When a patient calls your office to request a routine (non-emergency) appointment, what is the 
usual elapsed time between the request and the resulting appointment for new and 
established patients (please provide the number of days OR weeks): 
 	a. New patients:	_____ Days _____ Weeks 
 	b. Established patients: _____ Days _____ Weeks 

14.	When a patient calls your office with a true emergency, what is the usual elapsed time between 
the request and the resulting treatment for new and established patients (please check one 
box): 
 	a. New patients:	[ ] Hours [ ] Days 
 	b. Established patients: [ ] Hours [ ] Days 

15.	Are you currently accepting new patients? 1[ ] Yes 2[ ] No
 
16.	If you are NOT accepting new patients or at times are unable to make emergency 
appointments, do you provide any type of patient referral? 1[ ] Yes 2[ ] No 
 	a. If YES to above, to what source(s)? (check all that apply) : 
1[ ] Private Practice 
2[ ] Hospital Emergency Room 
3[ ] Other (please specify)_____________ 

17.	Do you participate in insurance plans? 1[ ] Yes 2[ ] No 
 	a. 	 If YES to above, please indicate which plans you participate in (check all that apply): 
1[ ] Capitation 
2[ ] Reduced fee for service 
3[ ] Medicaid 
4[ ] Traditional insurance with balance billing 

18.	What are the three biggest problems your practice encounters when dealing with insurance 
companies? 

1.________________________________________________________________________________ 
2.________________________________________________________________________________ 
3.________________________________________________________________________________

19.	How do you currently submit bills and other related paperwork to your patients’ insurance 
companies? (Check all that apply): 
1[ ] Mail bills directly to insurance companies 
2[ ] Electronic transfer 
3[ ] Other (please specify):_______________________________________ 

20.	Do you have liability insurance? 1[ ] Yes 2[ ] No 
a. 	 If YES to above, please indicate what type and amount of liability insurance you 
currently have: Type 
Amount 

21.	Are there people at your site who have the ability to communicate with 
patients in a language other than English? 1[ ] Yes 2[ ] No 
a. If YES to above, please check all that apply: 1[ ] Spanish 4[ ] Asian (please 
specify):_____________ 2[ ] French 5[ ] Sign Language 3[ ] Arabic 6[ ] Other (please 
specify):______________ 

22.	What percentage of your practice’s gross fees are unreimbursed (includes uncollectables, not 
charity or discounts)? (Circle one number below): 
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 

23.	Do you provide charity care (no fee expected) inside your office? 1[ ] Yes 2[ ] No 
a. If NO to above, what is your ranges of fees charged: 
1[ ] $0 – $50 
2[ ] $50 - $100 
3[ ] $100-$150 
4[ ] $150-$200 
5[ ] Other (please specify): ______________________________ 

24.	Do you provide charity care (no fee expected) outside your office? 1[ ] Yes 2[ ] No 
a. If NO to above, what is your ranges of fees charged: 
1[ ] $0 – $50 
2[ ] $50 - $100 
3[ ] $100-$150 
4[ ] $150-$200 
5[ ] Other (please specify): ______________________________ 

25.	Do you offer flexible or installment payment plans, which would allow patients to pay for 
services over a period of months: 1[ ] Yes 2[ ] No

ALL RESPONDENTS: PLEASE COMPLETE THE FOLLOWING QUESTIONS

26.	Do you expect to be active in your chosen profession 5 years from now? 
1[ ] Yes 
2[ ] No 
3[ ] Unsure
 
27.	State of residence at time of high school graduation:___________________________________________
 
28.	From which college/university did you graduate:_________________________________ Year___________
 	In what state is the college/university located: _______________________________________________ 

29.	Did you complete a residency? 1[ ] Yes 2[ ] No 
 	a. 	If YES to above, what type of residency was it? (check all that apply): 
1[ ] General or Family Residency 
2[ ] Hospital Residency 
3[ ] Specialized Residency (please specify):_______________ 
4[ ] Military Service 
5[ ] Other (please specify):__________________________________ 

 	b. If YES to above, please indicate the state(s) where you did your residency: 
State: _______________________ 
State: _______________________ 
State: _______________________ 

30.	In which states are you currently licensed to practice?  (Please specify below): 

 
State: _______________________ 
State: _______________________ 
State: _______________________ 

31.	What is your race: 
1[ ] Caucasian or White
2[ ] African American or Black
3[ ] Native American or Alaskan Native 
4[ ] Asian or Pacific Islander 
5[ ] Multi-Racial 
6[ ] Other (please specify):___________________
 
32.	Are you of Hispanic origin: 1[ ] Yes 2[ ] No
 
33.	Gender: 1[ ] Male 2[ ] Female
 
34.	Date of Birth: _____/_____/_____ (month/day/year) 

35.	Do you have a Delaware business license? 1[ ] Yes 2[ ] No 

IF YOU HAVE ANY ADDITIONAL COMMENTS, PLEASE FEEL FREE TO INCLUDE THEM IN THE SPACE BELOW.

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

THANK YOU FOR YOUR TIME AND COOPERATION IN COMPLETING THIS FORM.