The COVID-19 pandemic and its aftermath prompted a surge in demand for mental health care, as many Americans faced increased isolation, loneliness, job loss, financial instability and grief. The demand surge exacerbated a two-part challenge that predated the pandemic: a lack of access to mental health services and a shortage of mental health providers.

Approximately 122 million Americans live in areas with mental health provider shortages. More than 6,000 practitioners are needed nationwide to meet current demand. Increased demand for mental health treatment has strained a system characterized by large caseloads and long waitlists. This has resulted in burnout, elevated stress, exhaustion and depression among providers. As these negative impacts become clearer, policymakers have begun to focus on recruiting more workers into the sector and incentivizing current providers to remain in the field.

These issues were a focus of the Mental Health Matters: National Task Force on Workforce Mental Health Policy convened by The Council of State Governments and the National Conference of State Legislatures, in collaboration with the State Exchange on Employment & Disability (SEED), which is a unique state-federal collaboration funded by the U.S. Department of Labor Office of Disability Employment Policy. The task force engaged state policymakers and subject matter experts from across the country to explore policy options and actions taken by states to address major workforce challenges and barriers to employment for people with mental health conditions. Four task force subcommittees explored specific issues. 

The Behavioral Health Workforce Shortages and State Resource Systems Subcommittee identified strategies to recruit and retain behavioral health care workers. These include:

• Improving the quality, transparency and availability of workforce data among agencies.
• Strengthening and diversifying high-quality behavioral health care education and training pathways.
• Identifying and addressing licensing challenges.
• Designing peer support models and programs.
• Alleviating provider burnout.

The first step to addressing behavioral health workforce shortages is improved data collection related to recruitment and retention of providers. This data can help states make decisions about behavioral health workforce education and training, as well as measure the impact of policy changes on access to care. Realizing this, several states have requested or completed data reports on the behavioral health workforce to identify existing gaps. For example:

• California AB 666 (2022) required the Department of Health Care Services to develop a statewide needs assessment report on the substance use disorder workforce. The report was intended to evaluate the current state of the workforce, determine barriers to entry, and assess California’s systems for regulating and supporting the workforce.
• Pennsylvania HR 193 (2019) directed the Joint State Government Commission to conduct a staff study on the shortage of mental health care professionals in the state. In 2020, the commission offered recommendations in their report, “Pennsylvania Mental Health Care Workforce Shortage: Challenges and Solutions.” The report discusses solutions and proposes recommendations to stop, reverse, or otherwise mitigate the shortage of mental health care professionals in the Commonwealth.

Individuals wishing to enter the behavioral health workforce may face a variety of barriers and challenges, including education costs and licensing and certification requirements. The cost of education and student loan debt paired with low earning potential can deter prospective behavioral health professionals, especially students with lower incomes. In response, states are enacting programs to provide students with early exposure to behavioral health careers, expanding resident training programs and providing scholarships for the promise of service. States are also promoting alternative pathways to licensure by reducing certain requirements. For example:

• New Mexico HB 178 (2021) removes a barrier for students seeking licensure as substance abuse counselors by updating the years of work experience, degrees needed and substance abuse courses required.
• Tennessee SB 298 (2021) requires state medical colleges to create resident training programs in behavioral health services for medically underserved areas and rural counties.
• Washington’s Behavioral Health Workforce Development Initiative provides scholarships to master’s level students who commit to working for certain community-based health organizations.

Incorporating peer support specialists into the behavioral health workforce can also help states address provider shortages. Specialists bring their lived experience with mental health conditions or substance use disorders to the care setting and help individuals remain in active recovery and treatment. Certification, training requirements and Medicaid reimbursement policies for peer support specialists vary by state. As of 2022, at least 37 states allow Medicaid reimbursement for peer support specialists. For example:

• Virginia HB 1525 (2023) allows the Department of Behavioral Health and Developmental Services to hire individuals as peer recovery specialists who have been convicted of certain offenses related to substance abuse or mental illness and were rehabilitated.
• Wisconsin AB 650 (2020) provides Medicaid reimbursement for peer recovery coaching under the supervision of a qualified physician or psychologist and in coordination with the Medicaid recipient’s individual treatment plan.

Approximately half of behavioral health providers experience burnout due to work-related stress, low salaries, and increased caseloads. States can advance policies and programs that support those already in the profession by creating workgroups to address trauma-informed care for frontline workers and requiring state insurance agencies to waive certain costs for mental health services for them. For example:

• Utah HB 59 (2023) requires first responder agencies to provide mental health services to all first responders, including mental health care workers, for a period of time, even if retired.
• Vermont SB 42 (2021) establishes the Emergency Service Provider Wellness Commission, which identifies where increased or alternative supports or strategic investments can improve the physical and mental health of emergency service providers, including mental health care workers.

For more information about these findings and others, visit the “Mental Health Matters: Framework on Workforce Mental Health Policy.” This resource outlines policy options to recruit and retain qualified mental health providers; increase access to workplace care and supports; address the unique needs of underserved communities; and enhance mental health parity. Such practices are vital to solve the mental health crisis — and build a stronger, more inclusive workforce and economy.