Strategy to Address Field's Workforce Crisis Must Include Short- and Long-Term Vision

Twenty years ago, the word “issue” frequently was associated with the behavioral health workforce; 10 years ago, the word “problem”; today, “crisis” is most apt. The latter was true even before COVID-19, which simply has made this crisis much, much worse. In fact, the number of Americans with behavioral health problems has doubled during the pandemic, while the behavioral health workforce has remained relatively constant. The net effect is that only about one-quarter of those with behavioral health conditions are receiving care today.

This movement toward a crisis has been fueled by several factors. For almost 20 years, baby boomers, a very large component of the behavioral health workforce, have been retiring in progressively larger numbers. At the opposite end, far too few members of Generation Y are entering the behavioral health workforce, while millennials are having difficulty establishing careers for themselves in the field. And in between, some Generation Xers are having difficulty moving from the role of clinician to that of manager because they lack appropriate training. At the same time, the “Great Resignation” has diminished the workforce. Finally, very little change has occurred in the past 2 decades in our college and university training programs. Today, they function much as they did in 2000, with little regard for the changing dynamic of the national behavioral health problem.

The uncomfortable fact is that our current behavioral health workforce no longer can cope with the volume of clients presenting for care, let alone the increasing numbers who are never seen. At the same time, the problems being presented are becoming more complex (co-occurring mental illness and opioid addiction is quite common, as is a behavioral health condition with a chronic physical disease). For many of our providers, burnout is imminent or just a short step away.

We must identify an effective strategy forward that includes both short-term actions and long-term systemic changes. As a first step, we should revisit the human resource action plan that SAMHSA developed and published in 2007. Much of the strategy outlined in that plan still is valid today.

Short-term actions are available to us. These include, among others, outreach to baby boomers to return on a part-time or volunteer basis; much, much better use of our peer support workforce; and better use of technology, including virtual care, self-directed apps, artificial intelligence, and social media. In fact, during the pandemic, virtual care, both through video and voice, has been essential for almost all our behavioral health providers.

Over the longer term, several developments will help to alleviate our human resource crisis. We must accelerate the emergence of integrated care systems between primary care and behavioral health, with better access to primary care physicians, nurses, and physician and nurse assistants. We also must accelerate integration of public health and behavioral health, with better access to public health interventions and local public health departments, to reduce crises and the need for care. The emergence of self-determination and self-management strategies must be accelerated throughout the entire field. Finally, we must accelerate and expand our college and university training programs.

However, each of these short-term and longer-term developments is likely to be muted without appropriate ongoing federal leadership. Clearly, the US Department of Health and Human Services, including three of its agencies—the Substance Abuse and Mental Health Administration (SAMHSA), Health Resources and Services Administration (HRSA), and the Centers for Disease Control and Prevention (CDC)—must be involved, and the latter 3 agencies must be working in concert.

We also must engage in vigorous advocacy to the Biden administration and to Capitol Hill. Nothing at scale will happen without their intervention. The area of human resource development in behavioral health has been starved for resources for years, other than small funding for minority fellowships, the SAMHSA clinical training program ended in 1994, and the leadership training program in 1981. The HRSA National Health Service Corps has helped, but we need additional slots for many more trainees who can be supported in their education. We also need resources to retool colleges and universities so that they are prepared to train our workforce of the future.

An immediate step that President Joe Biden could take would be to declare a national behavioral health emergency. This would immediately free federal resources that could be applied to the short- and long-term human resource strategies identified above.

What can you do? You can engage in active advocacy with the White House and with your Congressional representatives. Please do so today. We have an emergency.

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.