Behavioral healthcare workforce shortage

There has been a long-standing mismatch between the demand for behavioral health services and available supply of behavioral health professionals. Even before the Covid-19 pandemic dramatically increased behavioral health needs, the Department of Health and Human Services estimated that by 2025, the supply of psychiatrists would fall short of demand by 25%.

The behavioral health workforce includes a wide array of roles that provide support to patients. Below is a non-exhaustive list of the most common behavioral health professionals. Licensure and certification for these jobs vary by specialty and state. Compared to the national job market’s overall projected growth rate of 7.7% from 2020 to 2030, the demand for nearly every type of behavioral health professional is significant.

To meet growing demand, the behavioral health workforce must include not only enough professionals by sheer numbers but also professionals who:

• Match patients’ geographic area
• Have training to provide culturally humble care
• Have capacity to treat new patients
• Offer affordable rates and accept patients’ insurance
• Have the expertise required to treat patients’ specific behavioral health conditions

A shortage of behavioral health professionals worsens access challenges for patients seeking care. It can take patients up to several months to find a provider—without the guarantee that they are the right fit.

When patients are unable to access preventative or low acuity care, their conditions often become more complex and severe. They may ultimately receive behavioral health care treatment in high acuity, high-cost sites of care like emergency rooms that often lack the resources and infrastructure needed to provide effective care. Furthermore, insufficient treatment of behavioral health conditions can worsen a patient’s other comorbidities, increasing total cost of care.

A shortage in the behavioral health workforce also impacts equity. Some patients can access the limited professionals available more easily than others, which widens the gap in patient outcomes. For example, white middle-class women are more likely to receive a call back from therapists compared to Black working-class men (20% vs 1% of the time). ¹ Geographic disparities in access persist too, as 45% of the U.S. population (151 million Americans) live in a designated mental health professional shortage area. ² Telehealth can help support patients in areas without a sufficient supply of locally practicing professionals, but many rural or low-income patients do not have broadband internet access. And some severe mental illnesses can’t be treated exclusively via telehealth.

¹ Data from the Journal of Health and Social Behavior.
² Data from Health and Human Services data in June 2022.

There are several factors influencing the number and type of behavioral health professionals in the workforce:

Insufficient pipeline of professionals entering the field

The current rate of growth in the behavioral health workforce isn’t enough to meet demand. Merritt Hawkins estimates that with nearly 60% of all practicing psychiatrists at least 55 years old, the industry could soon see a disproportionately high retirement rate compared to the number of psychiatrists entering the field. For many, behavioral health has become an unappealing sector of health care to join, especially considering increased acuity and demand of behavioral health needs as a result of Covid-19.

There is also a significant lack of representation of professionals with marginalized identities entering the workforce, making it difficult for some patients who wish to see a provider of a similar background. Being a professional with a particular identity doesn’t guarantee the ability to deliver culturally humble or sensitive care—all behavioral health professionals must be able to provide culturally sensitive care for all patients. However, a diverse workforce provides more choice for patients who prefer to see a similarly identifying provider or need care in certain languages.

Inadequate and cumbersome reimbursement

Reimbursement structures for behavioral health care professionals are highly variable across states, professions, and payers. Participating in multiple health plans involves considerable paperwork for clinicians in return for reimbursement levels that may not feel worth the administrative burden. According to data from MACPAC, ¹ only 62% of psychiatrists accept commercial or Medicare insurance, just 35% accept Medicaid, while other clinicians don’t accept insurance at all.

Emotional labor and burnout

Behavioral health work is challenging and requires a significant amount of emotional labor from professionals. Along with other factors, emotional exhaustion from this field of work has contributed to 78% of psychiatrists reporting symptoms of high levels of burnout. ¹ Without adequate support, the workforce is primed for rapid burnout and higher levels of turnover.

Policy and credentialing limitations

Federal and state policies regulate which behavioral health professionals can be reimbursed for certain types of care, along with where and how they may deliver that care. For example, policies may prevent a clinician in one state from delivering tele-behavioral care to a patient in a different state. The pandemic loosened these restrictions, for some temporarily and others permanently.

¹ Medicaid and CHIP Payment and Access Commission (MACPAC).
¹ Data from The American Journal of Psychiatry.

These conversations will help craft your approach to addressing the growing demand of behavioral health services with a limited supply of professionals.