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Biden’s Plan to Confront Behavioral Health Workforce Shortage: 3 Questions We Must Answer
Almost a month ago, President Joe Biden announced that he intends to confront our current US behavioral health crisis. Both mental health and opioid use will be major administration budget priorities for fiscal year 2023. The president’s plan has 3 primary components:
- Address the current behavioral health workforce shortage
- Expand parity to all health insurance including a minimum of 3 behavioral health visits each year
- Extend behavioral health care into non-traditional settings
In a recent commentary, I addressed the extension of behavioral healthcare into new settings—the third element in the president’s plan. Here, I would like to discuss Biden’s proposal to expand the behavioral healthcare workforce. In a future commentary, I will review his plan to extend parity protection to most Americans.
For longer than 2 decades, we have known that our behavioral healthcare workforce was not large enough to serve the number of Americans with behavioral health conditions. Already by 2006-07, this concern had grown serious enough to prompt the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a national behavioral healthcare workforce strategy. However, this strategy was not funded by Congress.
By, 2012-13, and more recently, Congress requested status reports from SAMHSA on the behavioral healthcare workforce. By 2016, SAMHSA co-funded with HRSA a Behavioral Healthcare Workforce Research Center, which continues to produce essential analyses on the functioning of the current workforce. In 2020, the American Rescue Plan included funding for HRSA to increase training of behavioral healthcare providers.
During this long period, our label for the workforce issue has changed gradually from a “problem” to a “crisis,” fueled most recently by the effects of the COVID-19 pandemic. We are very grateful to the president for elevating this issue to the national agenda for FY23, when he proposes to invest $700 million in behavioral healthcare workforce training.
As we go forward to advocate for this plan, we will need to develop consensus on our approach to 3 questions:
- What are the key elements of the future behavioral healthcare workforce?
- What are some related regulatory requirements that require change?
- What are the steps that we now can take to help our communities and counties begin to move in this direction?
The following paragraphs offer some thoughts to help us develop a consensus around these key questions.
In the future, the behavioral healthcare workforce likely will be much broader than it has been in the past. First, it will include the same professional disciplines (psychiatrists, psychologists, social workers, psychiatric nurses, marriage and family therapists, clinical mental health and substance use counselors, rehabilitation counselors) as in the past, as well as related disciplines (primary care physicians, physician assistants, and nurse assistants) who also have delivered behavioral healthcare for many years. Second, peer support workers will continue to grow both in number and in range of services that they offer. Third, other groups, such as community health workers, social service workers, paraprofessionals with short-term behavioral health training, community members with leadership roles, such as teachers, community center workers, and city and county workers not currently in behavioral healthcare roles, also will be added. And finally, volunteers will be solicited from the community to mentor children and adolescents in socio-emotional learning, provide support for community members with behavioral health conditions, lead weekly chat and social gatherings, and generally serve as behavioral health resources in the community. Thus, the training program currently being devised by the administration should consider this breadth of personnel.
The administration also will need to address regulatory reform. Specific issues likely will include expansion of the actual disciplines and levels of training eligible for service reimbursement; increases in reimbursement rates; expansion of scopes of practice; interstate and intercounty compacts to permit sharing of services across borders; permanent use of all virtual tools, such as video and cell phone, to deliver care; rapid expansion in the use of apps and artificial intelligence for care delivery and self-direction; changes in current legal practices for persons with behavioral health conditions who experience crises; and much greater focus on self-directed care, recovery, and population-based prevention. Perhaps the best way to address these issues would be for the administration to create a taskforce to operationalize each issue and to recommend priorities.
In the meantime, we can take many actions to begin to enhance our workforce capacity. I will cite a few illustrative examples here. Please add to this list in your own communities.
An obvious action is to re-engage providers who have left the field or who have retired. These are trained professionals who could work 1 or 2 days a week, either on a paid or volunteer basis. Another action is to expand peer support services so that all states offer these services for both mental health and substance use clients under the Medicaid program. Similarly, we can involve physician assistants, who have prescription authority, and community health workers, who engage community members in needed care. Finally, we can identify community members who would like to serve as volunteers. These volunteers could support school socio-emotional learning programs as mentors, serve as companions to neighbors with behavioral health conditions, and promote socially engaged neighborhoods to reduce crises. The list of possibilities is quite long.
President Biden’s workforce training program will require our very strong support and advocacy. As a field, we must develop a laser focus on the human resource deficits that must be addressed. Time will be short to develop our consensus on these issues. We must start today.
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.
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