State and Federal Efforts to Bolster the Behavioral Health Workforce

August 26, 2024 | Beth Giambrone, Takiyah Thomas

Since the onset of the COVID-19 pandemic, the U.S. behavioral health workforce has faced increasing and significant challenges. There has been an increase in the percentage of U.S. adults receiving mental health treatment between 2019 and 2021, and more than 50 million people in the United States over the age of 12 required treatment for alcohol or drug use in 2022—including three million adolescents between ages 12 and 17. The demand for behavioral health providers is evident and in stark contrast to the limited supply, with approximately one provider available for every 340 individuals and long waitlists.  

State Efforts

To address the demand for behavioral health services and bolster the workforce, states are deploying several policy strategies. Much like federal agencies, states provide educational opportunities for students in the behavioral health field. These state-level policies enable additional specialty training with the goal of increasing the number of behavioral health providers.

• Florida enacted a comprehensive behavioral health bill (SB 330) during its 2024 legislative session, allowing hospitals that partner with a university school of medicine to be designated as a behavioral health teaching hospital if they meet certain criteria (e.g., developing and maintaining workforce development programs such as internships and practicums for clinical and nonclinical behavioral health professions). It also established a scholarship and grants program for students enrolled in educational programs at behavioral health teaching hospitals.
• Washington enacted HB 1823, amending the qualifications for the state’s student loan program to include graduate students in specialized fields of study facing a workforce shortage or high demand, including healthcare and behavioral and mental health.
• Oklahoma enacted HB 3449, which expanded the Oklahoma State University Medical Authority pilot program to include psychiatric and psychological residencies, internships, and post-doctoral training programs, and provides scholarships for social workers and mental health nurses, one-time private-sector workforce innovation grants, and licensure preparation assistance. It also created a revolving fund for pilot programs at behavioral health facilities, aimed at supporting workforce development and facilitating access to behavioral health professionals.

Pipeline programs provide pathways for students and current healthcare professionals to begin or advance their careers. These programs have demonstrated success in addressing workforce shortages in rural areas and increasing the number of underrepresented healthcare providers and leaders, resulting in a more diverse healthcare workforce—a key factor in reducing health disparities.

Current programs, such as Oregon’s Behavioral Health Workforce Initiative, outline models and resources for creating career pathways for secondary school students and young adults, focusing on mentorship and career exposure in behavioral health fields. Other state programs developed plans to enhance the behavioral health workforce through educational and cross-sector collaboration strategies, such as the Nevada Health Care Workforce and Pipeline Development Workgroup plan. And, in 2023, Connecticut passed HB 5001, aimed at creating a career pipeline to increase the number of trained providers for vulnerable populations (e.g., the elderly, people with disabilities, and those with mental illness).

In 2024, several states enacted legislation to assess the needs of the current behavioral health workforce and develop plans to recruit and retain more practitioners.

• Florida’s SB 330 establishes the Center for Behavioral Health Workforce at the University of South Florida to assess the current behavioral health workforce as well as expand and promote pathways to the profession by researching factors affecting recruitment, retention, and advancement. The center will develop a statewide strategic plan to achieve these goals by 2025.
• Oregon enacted HB 2235, requiring the Oregon Health Authority to convene a work group to study and offer recommendations to improve recruitment and retention barriers in the state’s behavioral health system, reduce administrative burden, increase pay and reimbursement, reduce workload and burnout, and diversify the workforce. It also enacted HB 4151, establishing a subcommittee within the System of Care Advisory Council, responsible for determining the structures and supports needed to sustain the youth behavioral health workforce.
• Utah enacted SB 27, establishing a behavioral health commission to oversee creating and implementing behavioral health workforce initiatives in cooperation with other state agencies and councils such as the System of Higher Education, Health Workforce Advisory Council, and the Department of Health and Human Services.

Federal Efforts

HHS is focused on building a robust, sustainable health workforce through by educating, recruiting, and retaining behavioral health professionals through its Roadmap for Behavioral Health Integration:

• The Minority Fellowship Program funds eight professional medical organizations to offer behavioral health training and resources and better serve racial and ethnic minorities.
• The Teaching Health Center Graduate Medical Education program provides grant funding to teaching health centers operating primary care medical residency programs (including psychiatry residencies) to better meet the needs of rural and underserved communities.
• The Certified Community Behavioral Health Clinics model ensures access to comprehensive behavioral health care.

HHS also directly supports the behavioral health workforce with loan repayment programs such as the National Health Service Corps and the Behavioral Health Workforce Education and Training Program.

As the number of Americans seeking behavioral health treatment continues to climb, state governments and federal agencies are finding new ways to bridge the gap between this growing demand and the current capacity of the workforce. ASTHO will continue to monitor this important issue and provide updates.