New research from the USC-Brookings Schaeffer Initiative for Health Policy questions the reality of a behavioral health workforce shortage in the U.S.

It casts a skeptical view of the methodology used in crucial analyses of the behavioral health workforce shortage. It also questions the efficacy of many attempted solutions to addressing the perceived workforce shortage.

In the short term, it suggests a better approach to dealing with workforce shortages is to address distribution inequities.

“Across all provider groups and geographies … it is not clear that there is an aggregate shortage of mental health practitioners,” the report states. “The key strategy for workforce policy in the immediate term is how to address serious problems of misallocation rather than focusing on aggregate supply.”

The U.S. lacks clarity on the behavioral health workforce’s true scale and reach. While several studies show substantial regional variances in provider distribution, the report questions the effectiveness of the common definition behind regional shortages.

Specifically, the report says that the calculation used to define mental health provider shortage areas (MHPSAs) lacks the specificity and clarity to be a “meaningful concept.” The MHPSAs are defined by the Health Resources and Services Administration (HRSA), a part of the federal government. It defines 88% of all U.S. counties as being MHPSAs.

The report also points out that there are several types of behavioral health providers. Each has expansive or limited roles in providing care; many providers’ responsibilities and services overlap.

“Given the diverse pool of mental health provider types, estimating demand for services based on past patterns of usage fails to consider the overlap or malleability of provider capacities,” the report states. “Improving access in the short run will require taking steps to utilize the entire range of provider types more effectively.”

It points to additional “substitution” of providers in addressing behavioral health.

It is also skeptical of using what it calls “modest incentives.” The report states that these approaches have been “largely ineffective.”

Most of the approaches to addressing behavioral health shortages focus on increasing the supply of providers. Even if fully realized, growing the behavioral health workforce to meet demand that way would take a long time.

The report lists a handful of policy recommendations.

It calls for greater ease in using telehealth, pointing to the federal flexibilities extended by state and federal governments during the acute phases of the coronavirus pandemic. This helps address regional maldistribution.

It also calls for better use of the full spectrum of potential behavioral health providers in future policies, including peers, community health workers and other paraprofessionals.

A handful of efforts are underway to incrementally bring peer services, especially for addiction treatment, into greater use with the workforce.

“Improving access in the short run will require taking steps to utilize the entire range of provider types more effectively, through team-based models and consultation arrangements, and by matching patients with the most appropriate providers for their conditions,” the report states.

A better understanding of the behavioral health workforce, the adequacy of care access and the challenges of specific populations also stand as a barrier to long-term solutions. The report goes so far as to say that redefining the behavioral health workforce shortage and adequacy measures is the “most critical element of an improved mental health workforce policy.”

“Our current measures are imprecise, difficult to measure, and challenging to enforce,” the report states.