Taking on our workforce crisis

I am delighted to announce that the American Journal of Preventive Medicine has released a Special Supplement on workforce developments in behavioral healthcare. You can access this entire document gratis.

Articles in this special issue cover a broad range of topics. Specifically, they address research on workforce planning, service delivery and practice, and workforce preparation. They also advocate for intelligent allocation of resources to ensure all clients have access to behavioral healthcare.

No more important topic surrounds our field than the current and growing crisis in the availability of well-trained providers. Our baby boomers are retiring, and too few millennials are joining us. Thus, this Special Supplement could not come at a more opportune time. It focuses a spotlight on our human resource issues and provides an important glimpse into new developments that can allay this problem.

On several prior occasions, I have argued that our human resource crisis is far, far too important to be ignored or left to chance. Here is one simple example of the growing magnitude of this crisis: By 2060, almost100 million Americans will be age 65 and older. Of this total, it is reasonable to estimate that about 20 million persons will require behavioral healthcare services. This latter group would represent an approximate doubling of the number who currently receive behavioral healthcare services today. Clearly, such growth simply will not be achievable unless we have a dramatic change in direction.

What are some of our options?

Almost everyone’s first thought is to train a larger number of behavioral healthcare providers of all kinds. Federal financial incentives will be required to effect this solution. Yes, absolutely true, but this strategy will be a long-term solution at best. Universities have quite limited capacities that are inelastic to change, and the full training cycles are very long.

Thus, we also will need to devise short-term solutions.  These can include expansion of peer support services, task shifting, better alignment with primary care, and retention of Baby Boomers as part-time volunteers and employees. Let’s talk briefly about each.

Peer Support Services: Peers represent an expert, willing, and available workforce to support behavioral healthcare services. Currently, 43 states are approved to pay for mental health peer support services under Medicaid; 13 are approved to do so for substance use services. We need to expand this to 50 for both types of services. We also need to introduce peer support services into other private and not-for profit behavioral healthcare and integrated care settings.

Task Shifting: Beyond peer support, we need to ask what other types of task shifting are possible. Some tasks can be done by volunteers from the community; some can be done by job sharing; and some can be done by modern information technology. Organizational analysis will be required to plan for these changes in a systematic and effective way.

Alignment with Primary Care: Currently, primary care accounts for more than 70% of all behavioral healthcare delivered in the United States. Our efforts to integrate behavioral health services with primary care are essential going forward, but they are complex and long-term endeavors. We need to identify the steps that can be taken today to increase the capacity of primary care practitioners to provide services to a larger number of persons with behavioral health conditions, especially those with less complex and severe conditions. For example, what roles could physician assistants fulfill in supporting this expansion?  Nurse assistants? Peer support specialists? Information technology links?

Retention of Baby Boomers: For the most part, our former providers who are of baby boomer age are an unrecognized resource to address our work force shortages. They may not wish to manage large programs or to work full-time any longer, but many will want to participate on a part-time basis as a volunteer or paid clinician or clinician supervisor. In fact, this group is the largest potential pool of providers currently available.

I hope that these comments will generate conversations and actions. The clock continues to click on this crisis.