Headline Finding
Eighteen of Florida’s 67 counties have no psychiatrist with a primary practice address inside the county, according to 2026 Florida Department of Health licensure data published by the Florida Center for Behavioral Health Workforce (FCBHW) at the University of South Florida [1].
Key Findings Summary
- 18 of Florida's 67 counties — home to 488,359 people — have no psychiatrist with a primary practice address in the county (FDOH licensure data via FCBHW, 2026) [1]
- 3 counties (Dixie, Glades, Lafayette; combined population 40,104) have no specialist psychiatric prescriber (psychiatrist or PMHNP) — zero of either profession (FDOH licensure data via FCBHW, 2026) [1]
- Florida's psychiatrist workforce is shrinking: active licensed psychiatrists fell from 1,857 in 2016 to 1,649 in 2026, an 11% decline over a decade in which Florida's population grew substantially (FDOH licensure data via FCBHW) [1]
- Over the same decade, Florida's PMHNP workforce nearly quadrupled, from 1,408 to 5,541 — psychiatric nurse practitioners are now the state's largest specialist prescriber group in behavioral health by a wide margin [1]
- Florida has 249 federally designated Mental Health Professional Shortage Areas (HPSAs) with a reported designated population of 13.3 million — a figure that can count some residents more than once where designations overlap — as of March 31, 2026 [2]
- Only 23.2% of Florida's mental health workforce need is currently met; 740 additional practitioners would be required to remove the state's mental health HPSA designations entirely (HRSA, as of March 31, 2026) [2]
- More than 40% of Florida's current psychiatrist workforce is at or beyond retirement age, and replacement is not keeping pace with attrition (FCBHW, 2025) [3]
- Nationally, suicide rates rise as counties become more rural: in 2017, the age-adjusted suicide rate in the most rural (noncore) counties was 1.8 times the rate in the most urban counties (20.0 vs. 11.1 per 100,000) (CDC/NCHS) [5]
Methodology & Definitions
“Psychiatric care desert” has no single federal definition. This study uses three distinct, non-interchangeable metrics and labels each wherever it appears:
No psychiatrist
No psychiatrist (MD/DO) holds a primary practice address in the county. Source: Florida Department of Health active licensure records, 2026 data year, published through the interactive dashboard of the Florida Center for Behavioral Health Workforce (FCBHW), an entity established by the Florida Legislature in 2024 and housed at the University of South Florida. County-level counts were retrieved directly from the FCBHW dashboard dataset on July 3, 2026 [1].
No specialist psychiatric prescriber
Mental Health HPSA designation
A note on changing counts. Earlier FCBHW communications referenced different counts as licensure data changed. Licensure counts move as providers enter, relocate, and retire; this page reports the current published data and is updated annually against the same source.
Limitations. Licensure address data can lag real-world practice patterns; a provider may hold a license address in one county and see patients in another, and telehealth-only care is not captured by county-of-address analysis. In particular, out-of-state providers registered to serve Florida patients under the state’s telehealth registry (Section 456.47, Florida Statutes) hold no Florida practice address and are not counted in any county’s totals [17]. HPSA population totals may count some individuals more than once where designations overlap [2]. County-level mortality data are suppressed by CDC when counts fall below reporting thresholds; where suppression applies, this study says so rather than estimating.
The County-Level Data
The 18 Florida counties with zero psychiatrists, ranked by specialist prescriber availability. All figures are 2026 FDOH licensure counts via FCBHW [1].
Two related patterns stand out in the data:
The geography is concentrated. Fifteen of the 18 counties sit in rural North Florida — the Panhandle and the Suwannee Valley — with Glades, Hendry, and Hardee forming a second cluster in the rural interior south of Lake Okeechobee [1]. These are the same regions where federal HPSA designations cluster [2].
Where any psychiatric specialist exists in these counties, it is a nurse practitioner. In all 18 zero-psychiatrist counties combined, every one of the 69 specialist psychiatric prescribers present is a PMHNP [1]. Psychiatric nurse practitioners have become the sole local specialist workforce across nearly half a million Floridians’ home counties.
An additional related gap: two more counties, Franklin and Union, have exactly one psychiatrist and no PMHNP — a single psychiatric specialist serving 13,029 and 16,250 residents respectively [1].
Why This Is Worsening
Three workforce dynamics are moving in the same direction at once.
Florida's psychiatrist workforce is shrinking in absolute terms
Nurse practitioners are absorbing the gap — but unevenly
The shortage spans every behavioral health profession
FCBHW’s 2025 analysis found statewide shortfalls in all six licensed professions it tracks — including roughly 3,500 licensed clinical social workers, nearly 3,000 PMHNPs, and about 1,500 psychologists — and its 2025 retention survey of about 330 licensed Florida professionals found 36% planning to leave the field within a year, with 48% reporting burnout [4]. When specialists are scarce, the surrounding therapy workforce cannot absorb the demand; in Florida’s shortage counties, that surrounding workforce is often absent too.
Rural recruitment compounds all three. Nationally, 65% of nonmetropolitan counties have no psychiatrist, a disparity documented in peer-reviewed workforce research that decades of loan-repayment and recruitment incentives have narrowed only modestly [7].
What the Data Correlates With
Important note on interpretation: the associations below are correlations. They do not establish that provider shortages cause these outcomes, and communities identified in shortage data should not be characterized by them. Many factors — income, insurance coverage, broadband access, transportation, and regional demographics — travel together with provider scarcity.
With that stated plainly:
- Suicide rates rise with rurality. CDC data show the age-adjusted suicide rate in the most rural (noncore) U.S. counties was 1.8 times the rate in the most urban counties in 2017 (20.0 vs. 11.1 per 100,000) [5]. In 2020, the most rural counties again recorded the highest rate of any urbanization level, at 20.6 per 100,000 [8]. Between 2000 and 2020, suicide rates increased 46% in non-metropolitan areas compared with 27.3% in metropolitan areas, and rural residents visit emergency departments for nonfatal self-harm at 1.5 times the rate of urban residents [9].
- Counties without psychiatric access show worse outcomes even after statistical adjustment. A 2023 peer-reviewed study identified 596 U.S. counties (19% of all counties, 10.5 million residents) with neither psychiatrists nor broadband coverage — meaning neither in-person nor video-based care was locally practical — and found worse county-level mental health outcomes, including higher rates of poor mental health days, drug overdose deaths, and suicide, after adjusting for county socioeconomic characteristics [6].
- The same finding underscores a limit worth naming: telehealth closes the access gap only where broadband service, insurance networks, and digital literacy allow [6]. That is why physical provider deserts still matter — and why the options below include both virtual and in-person pathways.
- Data suppression note: county-level suicide counts for the smallest counties in the table above are frequently suppressed in CDC mortality data because CDC does not report counts below its reporting threshold — a direct consequence of these populations being small. This study does not estimate suppressed values, and per-county suicide rates for the identified counties are therefore not presented [5] [8].
None of this means a resident of a shortage county is destined for a worse outcome. It means the data consistently associate distance from care with higher population-level risk — which is why the practical options below matter.
What Residents of These Counties Can Do
How does telehealth psychiatry work in Florida?
Florida law authorizes licensed providers to deliver psychiatric care by secure video statewide under Section 456.47, Florida Statutes, which also allows qualifying out-of-state providers to register to serve Florida patients [10]. A telehealth psychiatric visit works like an office visit: evaluation, diagnosis, treatment planning, and, where clinically appropriate, prescribing — conducted from a phone, tablet, or computer. For a resident of a county with no local psychiatric specialist, telehealth converts a multi-hour round trip into an appointment from home.
Does insurance cover telehealth psychiatric care?
Most major commercial plans in Florida cover telehealth behavioral health visits, though coverage details vary by plan — always confirm in-network status and telehealth benefits with the insurer before booking. Florida Medicaid covers telehealth delivered by real-time, two-way video; see AHCA’s Medicaid telehealth page for coverage details [11].
What should someone ask a telehealth provider before booking?
Reasonable screening questions include: Is the provider licensed in Florida or registered as an out-of-state telehealth provider? Does the platform meet HIPAA security and Florida telehealth confidentiality standards [10]? Does the practice accept the person’s insurance, and is it in-network? How are prescriptions sent to a local pharmacy? What happens if a medication requires an in-person evaluation? What is the plan for after-hours or urgent concerns?
What free and low-cost options exist?
- Federally Qualified Health Centers (FQHCs) provide primary care and, at many sites, behavioral health services on a sliding fee scale regardless of ability to pay. HRSA’s Find a Health Center tool locates the nearest site by ZIP code: findahealthcenter.hrsa.gov [12]
- Community mental health centers, funded through Florida’s Department of Children and Families managing entity system, provide safety-net behavioral health services in every region of the state [13]
- 211 connects callers with local health and social services, including low-cost mental health resources, by dialing 2-1-1 from anywhere in Florida [14]
- SAMHSA’s treatment locator at findtreatment.gov lists licensed mental health and substance use treatment providers nationwide, filterable by payment options [15]
What about a crisis?
If there is immediate danger, call 911. For crisis support, call or text 988 (the Suicide & Crisis Lifeline) any time. Dialing 2-1-1 connects Floridians with local crisis information and referrals in many communities [14].
About This Study
This study was conducted by Twelve Oaks Psychiatry, a psychiatric practice located in Cooper City, Florida, led by Michael Hernandez, APRN, PMHNP-BC, a board-certified psychiatric nurse practitioner. The practice provides HIPAA-compliant telehealth psychiatry available to residents of every Florida county, including those identified above [16]. Media inquiries and data questions: (954) 947-1130 or michael@twelveoaks.co.
If this is a medical emergency, please call 911.
Disclaimer
This blog is general education, not medical advice, diagnosis, or treatment. Reading this does not create a clinician-patient relationship.
If you feel you might harm yourself or someone else, or you are in immediate danger, call 9-1-1 right away.
For crisis support, you can call or text 988. Florida lists 2-1-1 as a resource for crisis information and referrals in many communities.
Privacy note: Do not share sensitive personal health information through public comments, unsecured email, or social media. For care questions, use a secure patient portal or call an office line so your information can be handled privately, consistent with HIPAA expectations for health information privacy.
Citations
[1] Florida Center for Behavioral Health Workforce (FCBHW), University of South Florida — Interactive Data Dashboard (Florida Department of Health active licensure records), data years 2016 and 2026; county-level dataset retrieved July 3, 2026
https://fcbhw.org/dashboard
[2] Health Resources and Services Administration (HRSA), Designated HPSA Quarterly Summary, Second Quarter of Fiscal Year 2026, as of March 31, 2026
https://data.hrsa.gov/topics/health-workforce/shortage-areas
[3] University of South Florida, College of Behavioral and Community Sciences — “Statewide center at USF launches Florida’s first-of-its-kind interactive dashboard addressing behavioral health workforce shortage,” October 2025
https://www.usf.edu/cbcs/news/2025/florida-launches-interactive-dashboard-to-address-behavioral-health-workforce-shortage.aspx
[4] WUSF Public Media (University of South Florida), reporting FCBHW dashboard data — “USF launches dashboard showing mental health worker shortage,” October 2025
https://www.wusf.org/health-news-florida/2025-10-21/usf-launches-dashboard-mental-health-worker-shortage
[5] Centers for Disease Control and Prevention, National Center for Health Statistics — Data Brief No. 330, “Suicide Mortality in the United States, 1999–2017,” data year 2017
https://www.cdc.gov/nchs/products/databriefs/db330.htm
[6] JAMA Network — “Mental Health Outcomes Among Patients Living in US Counties Lacking Broadband Access and Psychiatrists,” peer-reviewed cross-sectional study, data year 2020, published 2023
https://pmc.ncbi.nlm.nih.gov/articles/PMC10502528/
[7] Andrilla CHA, et al. — “Geographic Variation in the Supply of Selected Behavioral Health Providers,” American Journal of Preventive Medicine, published 2018 (October 2015 NPI data)
https://www.ajpmonline.org/article/S0749-3797(18)30005-9/fulltext
[8] Centers for Disease Control and Prevention — MMWR, “Changes in Suicide Rates — United States, 2019 and 2020,” data year 2020
https://www.cdc.gov/mmwr/volumes/71/wr/mm7108a5.htm
[9] Centers for Disease Control and Prevention — “Suicide in Rural America,” data years 2000–2020
https://www.cdc.gov/rural-health/php/public-health-strategy/suicide-in-rural-america-prevention-strategies.html
[10] Section 456.47, Florida Statutes — Telehealth
https://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/Sections/0456.47.html
[11] Florida Agency for Health Care Administration — Medicaid Telehealth (Rule 59G-1.057, F.A.C.)
https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care/medicaid-telehealth
[12] Health Resources and Services Administration — Find a Health Center
https://findahealthcenter.hrsa.gov/
[13] Florida Department of Children and Families — Managing Entities
https://www.myflfamilies.com/services/samh/providers/managing-entities
[14] 988 Suicide & Crisis Lifeline; 211 Florida
https://988lifeline.org/
https://www.211.org/
[15] Substance Abuse and Mental Health Services Administration — FindTreatment.gov
https://findtreatment.gov/
[16] Twelve Oaks Psychiatry — Telehealth Psychiatry Services
https://twelveoaks.co/telehealth-psychiatry/
[17] Florida Department of Health — Out-of-State Telehealth Provider Registration (public registry)
https://flhealthsource.gov/telehealth/
Citing This Study?
- According to a 2026 analysis by Twelve Oaks Psychiatry of Florida Department of Health licensure data, 18 of Florida’s 67 counties have no psychiatrist with a primary practice address in the county.
- A 2026 Twelve Oaks Psychiatry data study found that three Florida counties — Dixie, Glades, and Lafayette are without a local psychiatric specialist for medication care, affecting more than 40,000 residents.
- Per a 2026 Twelve Oaks Psychiatry analysis, Florida’s licensed psychiatrist workforce shrank 11% between 2016 and 2026 from 1,857 to 1,649, while the state’s psychiatric nurse practitioner workforce nearly quadrupled to 5,541.
- A 2026 Twelve Oaks Psychiatry study found that in all 18 Florida counties without a psychiatrist, every remaining specialist psychiatric prescriber is a nurse practitioner.
- A 2026 Twelve Oaks Psychiatry data study notes that Florida’s 249 federal mental health shortage designations cover a reported 13.3 million residents, per HRSA data as of March 31, 2026.