As demand for behavioral health services continues to grow, providers nationwide are still contemplating the best way to recruit and retain workers amid industry-wide labor shortages. A related and pressing issue is the lack of diversity in the workforce.
While there is a significant shortage of behavioral health workers in general, clinicians of color are even harder to come by, prompting many non-white patients to distrust the system and forgo care. The disparity is a decades-long problem that does not have an easy solution.
To fix the problem and better serve patients of color, behavioral health providers first have to understand why these shortages exist.
One of the biggest reasons is education, according to David Acosta, the chief diversity and inclusion officer with the Association of American Medical Colleges (AAMC). Acosta has worked with the AAMC since 2005 and has over 30 years of experience bringing to light issues of equity and inclusion in medical education.
“We have a system that essentially is built by not making it easy for people of color and people that come from disadvantaged backgrounds — including socioeconomic backgrounds — [to] actually access … higher education,” Acosta said.
Plus, there are a lack of role models of color in the behavioral health industry for students to look up to.
“If it’s not visible to students, then they don’t think it’s possible,” Acosta said. “They’re looking for mentors and role models. Another adage is, ‘I can’t be what I can’t see,’ and that’s very true.”
In certain Black and Latino communities — the latter of which Acosta is proudly a part of — treating mental illnesses as “invisible” problems also contributes to the disconnect between behavioral health practices and people of color, Acosta said.
“Mental health … is a stigma in my community,” Acosta said. “We don’t talk about it, we’re embarrassed to talk about it, and it’s invisible. We make it invisible for a reason. … There are not … a lot of people of color that are mental health providers, psychiatrists [or] psychologists.”
Why is it important?
Having diversity in the behavioral health workforce is important because of the lack of trust that currently exists between providers and patients of color. As such, many people forgo care, causing their conditions to become more acute and costing the overall health care system more money in the long run.
According to the American Psychological Association, in 2015 around 86% of U.S. psychologists were white. Meanwhile, a similar 2017 study from the University of Michigan’s Behavioral Health Workforce Research Center found that minority providers are more likely to meet the needs of underserved populations and that a diverse workforce leads to greater patient satisfaction.
Caroline Karanja knows this firsthand. Originally from Kenya, Karanja is a behavioral health nurse who works directly with patients and clients from five different providers in the Lowell, Massachusetts, area. The Lowell Community Health Center serves a very diverse population, including the second largest Cambodian community in the United States.
Karanja has worked in the U.S. since 2011. She said she has witnessed that lack of trust between patients of color and white behavioral health workers.
“There’s a cultural component there,” Karanja said. “I’m not saying it’s a must for certain patients to be seen by certain people, but cultural competence and understanding people on a cultural level is important.”
Meanwhile, Acosta agreed.
“We need more health care providers out there, including behavioral health workers, who ultimately look like the communities they’re going to be taken care of, because that’s where the trust is gonna come,” he said.
Fixing the problem
The behavioral health workforce won’t become more diverse overnight.
Still, providers can — and should — make incremental changes to fix the problem, experts say. For example, they should examine their recruiting channels and pursue avenues to reach more diverse pools of applicants. Plus, they can rewrite job descriptions to eliminate bias, with officials at DATIS recommending providers work with historically black colleges and universities (HCBUs) to help with that.
Acosta said providers must be intentional when trying to solve the issue. Major associations and nonprofits also have to work together and figure out different ways to recruit, whether that be through partnering with community colleges, which generally have a more diverse student base, or providing road maps for students and young professionals interested in behavioral health but uninterested in becoming doctors or nurses.
“From a group standpoint, associations, behavioral health scientists and psychologists really need to come together and not be in separate camps,” Acosta said. “Mental health is not going away. It’s growing. It’s getting worse, and we have a society that doesn’t want to pay attention to mental health.”
Written by Patrick Filbin