Patients and providers want to see representation when they engage with the behavioral health care industry.

Historically, that has been a challenge as the behavioral health workforce continues to under represent minority communities. That makes hiring and retaining a diverse clinical workforce a daunting but vital task for organizations seeking to improve the health of their respective communities.

“Diversity can’t be an afterthought,” Alice Zhang, co-founder and CEO of Anise Health, told Behavioral Health Business. “If you think you can hire one or two clinicians to represent that small group that you’re serving and call yourself a culturally responsive provider — it doesn’t quite work out that way.”

Most behavioral health providers focus on populations based on geography and diagnoses. For many communities, various minority populations represent a smaller percentage of their customer base, Zhang said. Organizations will focus on the larger portion of their business without specific intent.

Anise Health offers culturally responsive therapy, coaching and digital tools tailored to the specific stressors of the Asian American community. This population focus is imbued throughout the organization, Zhang said. The company operates in California, New York, Washington, Massachusetts and Florida. It raised a $1.2 million pre-seed round about a year ago.

Several sources in the behavioral health industry, which tend to be brick-and-mortar organizations, have privately expressed challenges with hiring and retaining a diverse workforce. Anise Health has not had that problem; Neither has the LGBT-focused digital holistic health platform FOLX Health. Leaders at both organizations say clinicians from these communities have sought out their respective businesses to empower them to address the challenges they see in their communities.

“We frankly have more (talent) than we’re able to hire right now as far as people who are interested in working here and are very qualified and capable,” Greg Sottolano, chief people officer for FOLX Health, told BHB. “With them, they bring along a really strong network of individuals that they work with.”

FOLX Health offers gender-affirming, mental health, primary care and sexual health services. Sottolano said that mental health-related services make up a “significant” portion of the company’s patient visits.

The success of these two organizations is despite the overall shortage of providers in the space. Other behavioral health providers with a more general population focus face a more stark outlook. Despite the challenge, the wider picture of American behavioral health shows a crying need for more providers to similarly address the needs of specific minority communities.

Articulating the challenge

Several data points show acute needs within specific minority populations compared with the aggregate or with their majority-population peers.

Survey data show that “sexual minority” females, or females with a sexual orientation other than straight, report substance use disorders at a rate higher than their straight peers. For sexual minority males, the rate is about one-and-a-half times as high as that of those who identify as straight. Rates of any mental illness (AMI) and serious mental illness (SMI) are similarly two- to three-times higher among sexual minority populations when compared with straight populations. 

While rates of AMI are lower among racial and ethnic minorities, researchers point to underdiagnosis due to a general lack of cultural competency in the health care system, muddying population figures. However, Black, Hispanic and Asian adults with AMI are less likely to report receiving mental health services, according to data from the Kaiser Family Foundation. 

Further, research suggests a severe shortage of behavioral health services that dedicate programming to meeting the specific needs of minority populations. One study finds that only about 13% of mental health and about 18% of addiction treatment facilities offer LGBT-specific programs. 

Generally, minority populations tend to be underrepresented in the behavioral health workforce. The American populace identifies as about 59% White, 19% Hispanic/Latino, 13% Black, 6% Asian and 2% two or more races, according to Census data.

American Psychological Association data show that 81% of psychologists identify as White, while about 8% identify as Hispanic/Latino, 5% as Black and 3% as Asian. Cumulatively, about 10% of practicing psychiatrists were Black, Latino or Native American, according to a study by Johns Hopkins University School of Medicine.

The behavioral health clinician workforce has diversified over the years. Sources tell BHB that they expect the diversification to continue as generational shifts about behavioral health take root. Other Census research finds that the count of racial diverse practitioners increased by 166% between 2000 and 2019. 

Sustained strategies enable recruitment and retention

Making and maintaining dedicated corporate actions demonstrate that diversity is a priority within an organization. This can include internal and external strategies.

For example, taking a hyper-local approach to recruitment helps ensure providers employ clinicians who are from that community, Thriveworks’ Chief Clinical Officer Heidi Faust told BHB. The company operates about 350 locations, making it one of the largest outpatient mental health providers in the U.S.

The local hiring focus is a manifestation of ensuring diversity is a company-wide effort, which includes the creation of Thriveworks’ diversity and inclusion council. Faust started and was the corporate sponsor of the effort starting in March 2022 until recently, she said.

“Let’s make this a big focus,” Faust said of the thinking behind the development of the council. “Let’s get a bunch of people that work for the company — clinicians and administrators — that are interested in being thought leaders and get a lay of the land.”

The council’s first effort was to compile the optional demographic data the company accumulates through hiring and human resources efforts and internal surveys. That was the basis for several focus groups that delivered a strategic action plan for diversity for the company to follow. One of the outgrowths of the plan was the creation of employee resource groups centered on racial identity, sexual identity, disability and accessibility and religiosity/spirituality.

“These organizations might just be for mutual support,” Faust said. “But we think they are important because it shows employees we care enough about diversity to find these groups and give them a voice. And if they are ever concerned, they have allies to talk to if they don’t feel ready to come to HR.”

Faust said that Thriveworks has not experienced difficulty finding clinicians who come from the shared backgrounds of its patients. As of the writing of this article, Thriveworks HR tech was being updated, and specific company data was not available.

These internal advocacy efforts over time build a reputation for prospective clinicians and retain them, Faust said, adding that fostering curiosity and openness in the company bleeds over into clinical work.

Strategic investments in clinical care

FOLX Health got its start in 2020, providing gender-affirming care. Its strategic focus on a specific population and clinical experience enabled it to build a specific brand that attracted the talent it needed to diversify its offerings and establish its employment brand.

“You are only as powerful as the mission and brand that you put out there and the talent that it attracts,” Sottolano said. “We very clearly have leaned in strongly to a mission-driven purpose and the focus around sharing lived experiences with patients and community members that we serve.”

More than 75% of FOLX Health clinicians identify as LGBT. More than a third identify as transgendered, nonbinary or two-spirit people.

An organization whose employment brand is too generic or doesn’t reflect the diversity of the populations it serves will fail to catch the eye of the clinicians it seeks to hire, Sottolano said.

Some traditional retention strategies apply. Each source spoke to continually investing in the education and training of clinicians as well as addressing their specific needs within the structure of an organization. Training and investment are likely to require a special focus to include insights on specific minority populations. Zhang notes that minorities are severely underrepresented as research subjects in academic literature.

Organizations that continue to struggle to find or retain a diverse clinician workforce today have an opportunity to partner with organizations such as FOLX Health or Anise Health. These digital- and population-specific-focused companies were much rarer in previous years.

Zhang was also optimistic about organizations being able to meet the needs of a diverse population despite hiring challenges.

“An analogy I like to use is that you don’t have to be French to cook French food,” Zhan said. “While it is helpful to have a baseline understanding of one’s cultural and historical context, that in and of itself is insufficient to drive outcomes. So at the end of the day, it is really about training and understanding how to adapt the current Eurocentric model to meet the needs of these diverse individuals.”