A Call for a National Strategy to Strengthen the Youth Behavioral Health Workforce

Since the COVID-19 pandemic began, many sectors have been hit with high staff vacancy rates. This includes behavioral health professionals who serve young people, and includes school behavioral health staff, child psychologists, and therapists. In Massachusetts a recent survey reported that for every 10 clinicians that are hired, 13 leave. At the same time, the number of young people diagnosed with anxiety, depression, and behavioral problems has increased significantly. This past fall, more than a hundred state and national organizations focused on improving young people’s mental health and well-being sent a letter to President Biden, calling for a national emergency and specifically for a “robust and comprehensive mental health workforce strategy.”

This increased demand comes at a time when people are leaving the behavioral health workforce for a variety of reasons, including administrative burden, low wages, high caseloads, lack of quality supervision, and poor organizational culture. More than 111 million people live in areas with mental health professional shortages, with an even greater need in sparsely populated states and territories. The U.S. Department of Health and Human Services issued a health workforce strategic plan that outlines goals and partially addresses the gap, but does not focus enough on the growing need for mental health workers, particularly those who specialize in treating young people. Slowing the workforce exodus and meeting growing demand will require action from behavioral health leaders and federal and state policymakers.

The Biden administration has committed funds to address the U.S. workforce crisis but hasn’t committed to a national strategy to address the youth mental health worker shortage specifically. In the absence of such a coordinating force, individual states and organizations are making recommendations and creating individual plans. The National Association of State Mental Health Program Directors issued a draft workforce resource guide in October 2022, outlining several innovative state initiatives addressing workforce challenges. The United States needs a 10-year national youth mental health workforce strategy that considers the challenges of all states and territories and provides standardized strategies and measurable outcomes.

A national strategy should focus on:

• Equitable pay for behavioral health providers. Medicaid should pay fair and equitable rates across all provider types and ensure there are enough in-network providers, including youth behavioral health workers. Payment inequality — that is, the gap in payment rates between behavioral health and primary care providers — leaves behavioral health providers inadequately compensated. This limits access to quality services, particularly in communities of color and in rural areas. According to the Bureau of Labor Statistics, the median annual salary for master’s-level therapists was $49,880 a year in 2021, compared to $123,780 for master’s-level nurse practitioners.

• Loan forgiveness and stipends. We should consider simplifying the Public Service Loan Forgiveness (PSLF) program. An estimated 98 percent of PSLF applicants, of the more than 9 million public service workers with eligible federal student loans, were denied loan forgiveness from 2020 to 2022. Forgiving student loans for individuals working in nonprofit organizations encourages behavioral health professionals to work in organizations serving the nation’s at-risk youth and families.
• Professional capacity-building. Provide funding to centers such as Nebraska’s Behavioral Health Education Center (BHECN), which established behavioral health career pathways and mentoring programs to engage rural high school students in behavioral health careers and provide funding for graduate school and residency. The BHECN projects include funding clinical supervision, licensure application reimbursement, workforce recruitment and retention projects for students and behavioral health professionals, telehealth support in rural areas (including funding for equipment), and training opportunities.
• Interstate licensure simplification. The process to become licensed in multiple states can be labor-intensive, as each state sets its own criteria. As telehealth expands and there is a need for increased access to behavioral health services, interstate licensure is important. Currently, 17 states have signed the interstate counseling compact into law. This allows licensed counselors to easily practice across state lines, in person or remotely.
• Diversity and equity. A diverse workforce is essential for addressing the behavioral health needs of youth. Licensure boards must look at exam pass rates by race and ethnicity and address disparities.

• Integrated behavioral health care. A qualified and sustainable youth behavioral workforce should operate in different settings (e.g., primary care, schools, rural settings) and include diverse providers to reflect the population served. This strategy also should consider the use of peers and family partners.

Now is the time for our nation to adopt a systematic approach to meeting the needs of young people. Coordination across federal, state, and local levels is imperative to address the need for more youth behavioral health workers. We must also strive to address the barriers to recruiting and retaining professionals, and advancing diversity and equity.