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Last August I wrote about the long wait times for individuals in need of mental health services. Soon after that post, the American Psychological Association published survey results in November 2022 showing that 60% of psychologists cannot accept new patients, while 72% have longer wait lists than before the pandemic. A 2023 survey report by the National Association of Counties found a similar result, declaring behavioral health conditions have reached crisis levels.
The current behavioral health crisis in the US is driven by a major workforce shortage among behavioral health professionals. Factors like low pay, long hours, heavy caseloads, lack of support from employers, and stigma make the field of behavioral health unattractive to workers. Like other industries, behavioral health workers are demanding better quality of work life and are willing to “job hop” to find it or leave the industry altogether.
Many state agencies and organizations are taking note. I wrote in November 2021 about the federal government’s health workforce strategic plan which includes a major goal to offer financial support and incentives to expand and diversify the workforce with increased training opportunities. Federal funding opportunities over the last 18 months reflect this plan.
Just last month, during Mental Health Awareness Month, the White House shared their budget proposal to expand the integration of behavioral healthcare into school settings. Although the proposal includes funding for crisis center and community mental health centers, the integrated school center funding is the largest and will include $8.4 million to support 16 awards to recruit and train providers to support children and adolescents. HRSA will announce that funding later this summer.
Members of the CFHA community should look for opportunities to take their integration skills into the school setting. It will feel like the rugged frontier, for a bit, until schools and service providers learn how to integrate and find reliable funding sources. But integration at the school level has to succeed; the current mental health youth crisis is severe and pervasive.
Looking at individual states, Midland College in Texas is creating a new training program to fill 300 positions for a new 200-bed behavioral health center, while Indiana is undertaking an intense study to understand root causes of workforce shortages in their state. In Colorado, the state behavioral health administration started the Hummingbird Initiative to expand training and employment opportunities using certifications and entry-level placements. The state agency is partnering with the University of Colorado Anschutz Medical Campus and following a successful model called FACES for the Future.
New training programs will increase the supply of workers in behavioral healthcare. I hope to see more of these stories percolate in the future. But we also need to see legislation and policies that expand worker rights through better compensation and regulated caseloads. Management needs help too. Reimbursement rates should go up and billing for telehealth and supporting services (e.g., peer workers) should be made available.
Without large system changes, the training programs will send new graduates into a system designed to chew and spit them out. Then, we will be right back to where we started. Employers in behavioral healthcare need the support and regulation to make their staff positions attractive and sustainable.
Complex problems like the current workforce shortage require a plethora of targeted solutions across the country. The federal government is leading with a strategic vision and funding opportunities; it is up to individual states and organizations to follow the lead.
If successful, then we should see hiring delays go down and retention rates go up. We should see behavioral healthcare become a rewarding and long-term career choice for workers. That success will translate into greater service access for individuals who are suffering. That is the goal.
Dr. Martin,
Thank you for this blog. Our health system, which spans 4 states in the upper Midwest, has also been experiencing severe BH workforce with extreme difficulties in hiring all types and levels of BH practitioners. One of our rural BHC positions went unfilled for >1000 days before we snagged a great clinician. We also deal with a great deal of retention issues (job hopping, per your article). The three most commonly noted reasons that our departing BHCs tell me are: money, flexibility, desire for professional growth. We are looking to address the shortage in a variety of ways including setting up social work, counseling, and psychology internships, directly working with local universities to create a pipeline to our organization, offering stipends to students still in school to offset their tuition in exchange for working in our organization, virtual care options to promote family/work balance, incentivizing good “citizenship” (supervising, presenting at conferences, etc.), provider feedback sessions to learn what keeps people coming to work, and many more. Despite this, the waiting list for BH services of any kind, remains obscenely long. The NY Times recently reported that In 2021, 42 million adults in the United States sought mental-health care of one form or another, up from 27 million in 2002. We cannot keep up. Our workforce has not risen as dramatically. Interested in any other perspectives on what other systems are doing to address this problem.
Jeff: You have a great perspective on the current landscape. Glad your organization is making these careers more attractive. That seems like the right direction to go. Perhaps the challenge in your neck of the woods is the supply line from local training institutions. There just are not enough graduates coming out of colleges. I’d like to hear what others are trying too.