Adding Specificity to Biden Administration's Healthcare Workforce Proposal

Earlier this year, President Joe Biden announced and then incorporated a major behavioral healthcare initiative into the administration’s fiscal year 2023 federal budget request. Over the past 3 months, I have presented an overview of his plan, followed by summaries of its 3 principal components:

• Growing the behavioral healthcare workforce
• Extending parity protections to all health insurance
• Expanding behavioral healthcare services into new community settings

I also compared each of these components to several core values of the behavioral healthcare field. The results suggest that the president’s initiative aligns closely with our core values.

Here, I would like to explore how we can amplify and add specificity to the president’s efforts to grow the behavioral healthcare workforce.

As you already know, the behavioral healthcare workforce is in crisis today. It is far too small to address the expansion in the number of people with behavioral health problems that occurred during the COVID-19 pandemic. It also is aging quickly and rapidly losing senior expertise, while at the same time having great difficulty in recruiting and retaining younger persons all the way from millennials to Generation Z. Burnout and inadequate salaries are serious issues.

Biden’s proposal would fund $750 million per year in training of professionals, paraprofessionals, and peers. This would be accomplished largely through the National Health Service Corps and the Behavioral Workforce Training Program operated by the Health Resources and Services Administration (HRSA), and the Minority Fellowship Program operated by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The administration’s proposal can become a wonderful opportunity to modernize the training of behavioral healthcare professionals, add a much-needed cadre of peers, paraprofessionals, and community members, reinstitute a management and technical training program that has been absent for the past 40 years, and develop a pipeline of youth and others who wish to commit to work in our field. Finally, a new federal infrastructure will be required to manage these training programs in a coordinated way, provide essential technical assistance, and serve as a center of excellence for best practices. Let me describe each briefly.

Modernize professional training. Clearly, we need to adapt professional training to today’s developments in the field. Some key examples include:

• Training in integrated care and team-delivered services
• Culturally relevant services and care delivery in nontraditional community settings
• Training in evidence-based practices
• Deconstruction of the social and physical life determinants, population health management and new financing models, such as value-based purchasing
• Community development and empowerment

Similarly, we must explore how to accelerate these professional training programs so that students can complete them in shorter periods of time. We also need to expand the programs so that they can train additional students in each training cycle. Both changes have implications for accreditation of our training programs and for state licensure of those they train.

Add paraprofessionals, peers, and community members. Only recently have we fully realized the critical role that peers, paraprofessionals, and other community members can play in outreach, support, and care of those we serve. Hence, the president’s training proposal must include specific courses and programs for each of these groups.

For peers, we must assure that training is appropriate for the settings in which they will work, e.g., traditional and nontraditional community facilities, jails and diversion centers, emergency rooms, and the community itself. Peers also must be trained to protect their own mental health, and to avail themselves of support from other peers.

For paraprofessionals, such as community health workers, physician assistants, and nurse assistants, training needs will be different because most have not worked previously in behavioral healthcare. Hence, they will require training on how behavioral healthcare actually is organized, as well as training on how to work with clients who have behavioral health conditions. Much of this training can be accomplished in operating community programs with appropriate mentoring. An important proviso is that such training reflects modern developments in behavioral healthcare.

For community members who wish to volunteer or work on a part-time basis, the necessary training can be much like that for paraprofessionals, with specific adaptation to the setting in which the work will occur, e.g., a school—to mentor a student in social-emotional learning; a community center—to mentor a client in work skills, etc.

Reinstitute management and technical training. The absence of management and technical training for the behavioral healthcare field has extracted an untold toll over the past 40 years. We have numerous examples of managers and directors who have been promoted from the clinician ranks without any management training in topics as important as leadership style and modern Medicaid.

With the president’s proposal, we can change that. We can develop a curriculum that spans the major functions conducted by managers at various levels. Ideally, each state would have at least one center to offer such training in a university context via a certificate program.

Similarly, we need to develop technical training in key topics. These could include understanding and evaluation of apps, artificial intelligence, program evaluation procedures, application of outcome and performance measures, online record keeping and reporting, and predictive analytics, among others. Such training could greatly strengthen how our field actually operates.

Develop a pipeline. Each of the training areas identified above is contingent upon the availability of a pipeline of bright and enthusiastic youth and others who wish to join the behavioral healthcare field. Hence, some portion of the resources proposed by the president should be spent on developing and testing procedures to enhance our pipeline.

These efforts should start at the middle and high school levels, and extend into community colleges, and other undergraduate and graduate programs. A number of large county school systems are just beginning this important work.

Federal infrastructure. Currently, a federal infrastructure does not exist to lead, coordinate, and manage these training initiatives. One will need to be developed and then staffed by specialists with appropriate managerial and technical expertise. One potential model would be a new center with joint oversight by SAMHSA, HRSA, and the Centers for Disease Control and Prevention (CDC). The success of the entire training endeavor will depend upon the nature and operation of this federal infrastructure.

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None of the developments I just described will happen without broad-based and intensive advocacy to Congress by all elements of the behavioral healthcare community. Organizing steps now are underway for this endeavor. Please step forward and join this once-in-a-lifetime landmark effort.

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.