3 Necessary Steps to Address Our Human Resources Crisis

It now appears likely that Congress intends to appropriate funds as part of the fiscal year 2023 budget to help address our human resource crisis in behavioral healthcare. As discussed in earlier commentaries, the Biden administration originally requested $750 million for FY2023. As of now, the House has approved $135 million, and the Senate has not yet acted, but is considering a mental health bill.

Appropriation of these funds is a critical but not sufficient step to address our workforce shortages. The purpose of this commentary is to describe other essential steps that Congress must take to ensure these funds are spent in a manner that effectively targets our shortages.

First and foremost, Congress must designate funding for a federal behavioral health human resource program. This program must be staffed by persons with technical expertise in planning, program development, innovation, and implementation. Clear historical precedent exists for this. When the National Institute of Mental Health (NIMH) operated its clinical training program for mental health in the 1970s and 1980s with an annual budget of about $120 million (1970s dollars), the program was a separate division of the Institute, with a large, competent technical staff.

Further, this program must be located in and managed by the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal entity with responsibility for developing and implementing mental health and substance use prevention and treatment services. However, SAMHSA must also be designated as the federal entity to oversee and coordinate behavioral health human resource grant programs operated by the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).

Second, Congress must designate an expert task force to review all federal data on behavioral health human resources, including projections of shortages, to determine accuracy and utility for planning purposes, and to make recommendations for improvement. This task force also must be charged with reviewing previous strategic plans developed by SAMHSA to determine if they have utility for future implementation. Finally, the task force must develop a series of recommended short-term and longer-term action steps to guide the new SAMHSA program. To ensure a government-wide perspective and broad engagement by the administration, this task force should be convened and operated by the executive office of the president.

Third, Congress must create a new national advisory group for SAMHSA that incorporates and represents all the professional and paraprofessional disciplines that work in the behavioral healthcare field. Multiple problems have arisen in recent decades because these disciplines compete for attention and resources from Congress and do not represent the interests of the entire field. This advisory group must be charged with identifying fieldwide actions that will address our behavioral healthcare crisis. Again, precedent exists for this, since NIMH operated such a group for mental health.

Additional financial resources alone will not solve our behavioral health human resource crisis. Defined structure, expertise, and coordination also will be essential. Please help us work with Congress to achieve these objectives.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.