Providing a Home for the Behavioral Health Workforce

Ron Manderscheid, PhD

Adjunct Professor

Johns Hopkins University

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University of Southern California

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Nature of the Crisis

The behavioral healthcare workforce crisis continues unabated. Currently, the workforce does not have the capacity or breadth to meet the treatment, rehabilitation, and recovery needs of those in the community with behavioral health conditions. At the same time, burnout is becoming much more prevalent as workloads and reporting requirements increase, and some practitioners even are leaving the field. A perfect storm is brewing.

This crisis is fueled by the fact that the behavioral healthcare workforce does not have any national home. Unlike 40 years ago, when the National Institute of Mental Health performed this function, no national entity currently provides overall leadership and guidance for the workforce. The behavioral healthcare workforce has become, in fact, an orphan.

Prior to the COVID-19 pandemic, about one-fourth of adults and one-fifth of children and adolescents experienced one or more behavioral health conditions. These numbers nearly doubled during the pandemic, yet little or no adaptation occurred in the capacity of the behavioral healthcare workforce. Even with the introduction of virtual care at the onset of the pandemic, caseloads have continued to grow, more practitioners have experienced burnout, and some have left the field. Thus, today, behavioral healthcare is only able to serve slightly more than one-quarter of those with behavioral health conditions.

Simultaneously, the number of peer support allied professionals has not expanded rapidly enough to mitigate excessive workloads. Further, like behavioral healthcare practitioners, the number of primary healthcare practitioners has remained quite constant, and other allied professional, such as community health workers and physician assistants, have not been enlisted to support behavioral healthcare practitioners. Thus, the latter healthcare groups have not been available in sufficient numbers to blunt the behavioral healthcare workforce crisis.

Recommended Actions

This crisis demands a complex and long-term response. Key steps are summarized below. Sustained, broad-based, ?national advocacy will be required to undertake these steps successfully. ??

Convene All Interested Parties. As a first step, the field must convene a gathering of interested persons to build consensus for initiating national action. To emphasize its importance, this meeting could be convened by the US Department of Health and Human Services, or even the White House. A primary desired outcome of this meeting would be to establish and launch a national advocacy effort. Equally desired would be the creation and empowerment of a blue ribbon panel to plan and oversee operational next steps.

Create a National Home. To develop a national home for the behavioral healthcare workforce will require the creation and appropriate staffing of a National Office on Behavioral Health Workforce Practice. Once established, this office would assume oversight and responsibility for behavioral health workforce development, planning, assessment, and financing activities. To ensure broad-based input from the behavioral health workforce field, the office would host an advisory group representing all key elements of the field.

Create a Center on Workforce Excellence. Once established, the national office would seek philanthropic and federal funding for a new National Center on Behavioral Health Workforce Excellence. This center would establish and update a national behavioral health workforce strategic plan; share best practices across states, counties, cities, tribes, programs, and practitioners; identify strategies to improve equity in practitioner composition and service delivery; make recommendations to improve current workforce data systems at all levels; and monitor the implementation of IT and AI in service delivery.?

Outreach to Key Partners. National advocacy efforts also must include outreach to key health and social service fields, as well as ?building support at the state, county, city and tribal levels. Primary issues to be addressed in this outreach will include consideration of how behavioral health can work more effectively with these entities; how joint endeavors might be undertaken with them; and how these entities might contribute to the resolution of the behavioral health workforce crisis.

Initiate Workforce Development and Innovation Grants. To support these outreach efforts, new grant programs must be conceptualized for workforce development and for workforce innovation. The former could identify key training needs; provide incentive support to retain key personnel, such as housing; recruit new staff; or even develop better integrated care that includes social supports; etc. The latter could explore the future roles of AI in behavioral healthcare; create peer led and operated community-based care and support programs; develop and expand self-directed care; foster foundational community support through better functioning communities; or even address negative social and physical determinants of health; etc.

Modernize and Transform Workforce Training. Equally important in the longer term is the need to improve behavioral health workforce training. Current training practices for professionals and allied professionals must be reviewed; gaps remedied, such as team-based practice for integrated care, implementation of social care, and direct community development; and steps identified to modernize and transform behavioral health workforce training at all levels.

Initiate Grants for Academic Institutions, Trainees, and Practitioner Entities. To support the efforts to modernize and transform behavioral health workforce training, two grant programs will be needed. The first will provide support to academic institutions seeking to transform their behavioral health workforce training. The second will provide individual grants to new trainees seeking to enter the field and organizational grants to state, county, city, and tribal entities, or nonprofit or for-profit behavioral health practitioner entities to update the training of their current staffs.

Conclusion

Although the steps outlined here will be both complex and difficult, it is essential that such actions be taken, and quickly. Throughout all of these steps, a core part of this effort will be concerted, continuous, and effective advocacy by the behavioral health community. We must develop consensus, and we must take common action to promote the wellbeing of all who are associated with the behavioral health field.

At the time of this writing, several new efforts are underway to define the behavioral health workforce crisis and to identify steps to remedy it. SAMHSA has convened a technical expert panel to provide input, and now is producing a series of playbooks on how to address the crisis. The National Academies of Science, Engineering, and Medicine is convening a Forum on this topic. And the Office of the Assistant Secretary for Planning and Evaluation at HHS is convening an expert workgroup on behavioral health workforce data. Initial results from these efforts should become available very soon.

Final 7-9-24

? 2024 RW Manderscheid ?

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