67 of Michigan’s 83 counties have at least one federal mental health professional shortage designation

Picture a family in Lake County trying to find a therapist for a teenager, and a family in Pontiac doing the same on a Medicaid plan. Both may live in a federal mental health shortage area, but for different reasons. One is short of clinicians across a whole rural region; the other lives near plenty of offices that are hard to reach for people with low incomes. HRSA’s designations try to capture both kinds of gap.

67 of Michigan’s 83 counties have at least one mental health shortage designation

In the Health Resources and Services Administration (HRSA) mental health HPSA file retrieved October 8, 2026, 67 Michigan counties have at least one designation with “Designated” status. Only 16 have none: Allegan, Alpena, Barry, Branch, Clinton, Eaton, Grand Traverse, Ingham, Lapeer, Leelanau, Livingston, Marquette, Monroe, Ottawa, Van Buren and Washtenaw.

Wayne County has seven, more than any other, all covering low-income populations in parts of Detroit and nearby communities, and it carries the state’s highest score, 21. Every other designated county has one.

Geographic, population and facility designations, and what an HPSA score means

Federal law defines three kinds of shortage area (Federal Register, January 14, 2015):

• Geographic HPSA: a whole area, often a county or group of counties, where the population as a whole has too few providers. HRSA also flags some as “high needs” geographic HPSAs.
• Population HPSA: a specific group within an area, such as low-income or Medicaid-eligible residents, who face a shortage even if the area overall does not.
• Facility HPSA: a particular facility with a shortage, such as a health center or correctional facility. The detail file we used contains no facility-type rows for Michigan, so facility designations are not reflected here; check HPSA Find for those.

Each designation is scored. For mental health, HRSA adds points for the population-to-provider ratio, the share of residents below the federal poverty level, travel time to the nearest care outside the area, the proportions of children and older adults, and alcohol and substance use prevalence. The score is the sum of those points, up to 25, and a higher score means greater need; HRSA uses it to prioritize placements such as National Health Service Corps clinicians. The provider ratio counts “core mental health professionals,” which federal rules define as psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse specialists and marriage and family therapists (42 CFR Part 5, Appendix C).

What the Michigan data shows

Geographic designations dominate rural Michigan. In 42 counties the designation is geographic, from the Upper Peninsula to the northern Lower Peninsula and the Thumb. The other 25 counties have population designations, nearly all for low-income residents, and they include the counties with the most marriage and family therapists: Oakland (its Pontiac service area, score 17), Kent (10) and Kalamazoo (13). That is not a contradiction. A county can have many therapists while low-income residents in one part of it still struggle to find care they can use.

The highest scores after Wayne cluster in mid-Michigan. Eight counties score 19: Clare, Gladwin, Isabella, Lake, Mecosta, Midland, Osceola and Saginaw, covering Saginaw, Midland and Mount Pleasant. The lowest scores, 8, belong to the shared Bay and Arenac counties designation. The median score is 14 for counties with geographic designations and 17 for those with population designations.

The overlap with the therapist map is strong. Of the 29 counties with no individual MFT on record, 28 are designated; only Alpena is not. Our report on counties without a marriage and family therapist lists them.

Highest-scoring and notable Michigan mental health HPSA counties

Methodology

We downloaded HRSA’s mental health HPSA detail file (BCD_HPSA_FCT_DET_MH) on October 8, 2026, kept Michigan rows with status “Designated,” and counted each distinct HPSA once per county it touches, using the county FIPS code in the file. Designations marked “Proposed for Withdrawal” or “Withdrawn” are excluded. That matters for Marquette County, whose only mental health record in the file is a low-income designation proposed for withdrawal, so it appears here with none. “Type” is HRSA’s designation type, with high-needs geographic HPSAs counted as geographic. “Highest score” is the largest score among designations in the county; a multi-county geographic HPSA shares one score across its counties. MFT counts are individual NPPES records with taxonomy 106H00000X, assigned to counties by practice ZIP centroid. Medians are our own calculation from the county table.

Limitations

• Counting designations per county is our simplification. A population HPSA may cover only part of a county.
• Designations are reviewed and updated on HRSA’s schedule, and many Michigan records were pending withdrawal at retrieval, so the map can change quickly.
• HPSA status describes provider supply for a population, not anyone’s mental health.
• Licensed professional counselors are not among the federal core mental health professionals, so local capacity can be larger than the ratio suggests.

What this means for couples and families

A shortage designation is a planning tool. It does not mean people in a county are struggling more, and it should not be read as a judgment about any family. It does help explain why waitlists can be long or why the nearest family therapist may be a county away.

For people located in Michigan, video sessions with a Michigan-licensed therapist can add options, since licensure follows where the client is and you need to be in the state during each session. Iryna Morhunova-Sutton, LLMFT, works with individuals, couples and families online only, anywhere in Michigan; see how online therapy in Michigan works, and compare supply county by county in our therapist density report.

Update schedule

We refresh HPSA data quarterly with the NPI pull, and county populations with each new ACS 5-year release.