Worsening Behavioral Health Workforce Shortage Poses Persistent Threat to Providers

The stigma surrounding mental health and addiction assistance isn’t what it once was when it comes to people seeking treatment. Nonetheless, obstacles remain for many who need help — and the behavioral health providers who want to assist them.

One such obstacle is the continued shortage of qualified and licensed professionals in the field, which poses a threat to provider and industry growth nationwide.

“Every time we have a very invigorating conversation about what can happen in the field of behavioral health, the conversation comes to a screeching halt as soon as somebody mentions the issue of workforce,” Pam Rodriguez, president and CEO of Treatment Alternatives for Safe Communities (TASC) Inc., told Behavioral Health Business.

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Chicago-based TASC is a substance use and mental health advocacy group serving Illinoisians. It’s not the only organization grappling with the workforce shortage.

The scarcity is causing significant problems industry-wide, considering the majority of Americans – 56%, according to research co-conducted by the National Council for Behavioral Health – are seeking mental health assistance for themselves or their loved ones.

The U.S. Department of Health and Human Services projects the workforce shortage will only worsen over the next decade, with 43 states projected to have a dearth of psychiatrists by 2030. That equates to a nationwide deficit of more than 17,000 psychiatrists alone — up almost double from 2016.

In fact, the reduction in stigma towards mental health assistance has only made it more difficult for people to make psychiatrist appointments, as the supply of counselors has not kept up with the increased public demand for their services, Joe Parks, the National Council’s medical director, told BHB.

“In the case of psychiatrists, the supply per capita is less than it was 10 years ago,” he said. “The absolute number has increased, but the [general] population has increased faster.”

Those numbers don’t take into account shortages among lower level behavioral health workers, such as social workers and paraprofessionals, which also persist.

Contributing factors

A number of factors have contributed to the insufficient growth of behavioral health workers, Mark Covall, president and CEO of the National Association for Behavioral Healthcare, told BHB.

One of those is pay. At the psychiatric level, jobs for nurses and paraprofessionals tend to pay less than those in medical and surgical care, Covall said, making them less desirable and harder to fill. Plus, most counselors prefer to work at outpatient facilities, he said, creating an even worse shortage of inpatient psychiatrists.

On top of that, the unemployment rate is the lowest it’s been in 50 years, the Department of Labor announced in October, making the competition for employees especially fierce across all sectors.

“In a good economy, there’s much more competition – even outside of the health care industry – for workers,” Covall said, particularly referring to paraprofessionals. “Overall, it leads to the challenge not only of bringing them in, but retaining them.”

The effects of employee turnover are patently obvious for a provider’s bottom line, Covall said.

“It increases costs of training and retraining [employees], affects continuity of care with new caregivers coming and going, and increases the need to recruit when the marketplace has an overall shortage of personnel,” he said.

Potential solutions

As a new year and decade approach, a number of potential strategies for tackling behavioral health’s workforce shortage bear watching.

For example, industry insiders are keeping their eyes on the performance of federally-designated certified community behavioral health clinics (CCBHCs ), which currently operate in more than 20 states. The goal of CCBHCs is to expand services to consumers by way of increased Medicaid funding for clinics.

“The best solution to this problem is the expansion and extension of the Excellence In Mental Health Act, which created certified community behavioral health centers,” Parks said of the 2014 legislation passed by Congress establishing CCBHCs. “In their first years, they are recording much lower rates of vacancy in their workforce.”

Meanwhile, a number of academic studies have advocated for the hiring of more peer navigators, who are individuals that have undergone mental health or addiction recovery and are qualified to provide non-counseling support services to others.

Also worth paying attention to is the continued relaxation of rules around telemedicine, which can lessen the effects of the workforce shortage by making better use of current employees, particularly for those in remote locations.

“Advances in technology, such as telepsychiatry and self-care apps, and changes in how different types of mental health professionals are utilized may enable providers to deliver services more efficiently,” Janet Coffman, professor of health policy and family and community medicine at the University of California-San Francisco, told BHB.

However, she cautioned that technological advances won’t be enough to eliminate the behavioral health care workforce shortage altogether. Brittany Ramenani, a community mental health worker in Chicago, echoed those sentiments.

“The job itself requires an individual to show up to work ready to support another individual,” Ramenani told BHB. “This, in itself, can be draining if support throughout the job is not provided. A plan to address staff turnover, to ensure that employment gaps are being filled so that clients receive access to care, is needed.”

Written by Kyle Coward

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