The need for improved access to behavioral and mental health care seems to be a well-accepted truth in the eyes of a society that has journeyed through the COVID-19 pandemic and its related fallout. Part of this realization is that improved access to care cannot be accomplished by merely improving insurance coverage without a commensurate effort to both grow and support the mental health workforce and to reduce disparities by ensuring that mental health services are available to all those who need them.

Psychiatric Nurse Practitioner Andrew Penn suggests that everyone have a primary mental health provider in this recent video as part of Psycom Pro’s special report on depression screening gaps in the US. However, to accomplish this laudable goal, the US will need to take significant steps to increase the number of mental health providers. Here’s what others are recommending to fill in the cracks in the system.

Mental Health Care: The Urgent Call for Access

Policymakers across the nation are striving to heed the call for increased access to mental health care at both the federal and state levels. Health systems, school systems, private employers, and even digital health apps are also trying to bend the curve. These widespread efforts aim to improve access to care at all levels and are slowly opening new ways for people to find and use mental health services. At the same time, their work is creating new professional opportunities and incentives for psychiatrists, clinical psychologists, therapists, social workers, counselors, addiction treatment specialists, and other mental health professionals.

Whether the quality of care offered through these new and growing programs is adequate remains to be seen. Not all programs and providers are able to prescribe (if applicable to the patient) or manage serious mental illness.

The Mental Health Professional Shortage: Ways to Grow the Workforce and Reduce Disparities

It starts with medical training and the growth of the professional workforce. As stated in May 2021 by Surgeon General Vivek Murthy, the US is “not doing enough” to address the growing mental health crisis and must prioritize training more behavioral and mental health care providers amid a shortage.1

The Senate Finance Committee met in June 2021 to explore potential solutions to the nation’s mental health concerns as part of a hearing entitled “Mental Health Care in America: Addressing Root Causes and Identifying Policy Solutions.” In his opening statement, Senator and Chairman Ron Wyden listed a number of challenges to expanding access to mental health services, with the very first being the need for a larger mental health workforce.

According to Sen. Wyden, who outlined the issue for the Committee, “There simply are not enough providers, whether it’s psychiatrists or therapists or staff in inpatient facilities. For example, due to a major staffing shortage, the psychiatric hospital in Salem is currently being staffed in part by members of the Oregon National Guard.”

(See our Psycom consumer report on America’s Psychiatrist Shortage)

Sen. Wyden went on to state that the situation was even worse for minority and marginalized communities, including Black, Indigenous, and People of Color (BIPOC). Black and Latino Americans are half as likely as white Americans to receive treatment for a mental illness, and there “are not enough Black, Latino, and Native American mental health providers,” he said.2

Psychiatrists Danielle Hairston and Racquel Reid get at this issue in their curated collection on the depths of racism in psychiatry, while Dr. Steven Starks discusses the importance in treatment outcomes of having access to a provider of a similar background.

In her testimony, Dr. Michelle P. Durham of Boston Medical Center urged the Committee to address the mental health workforce shortage by increasing funding for loan forgiveness programs, particularly for those who work in underserved areas, pointing out that the average medical student has accumulated $250,000 in debt by the time their residency is complete.3 She further explained that this debt ultimately drives practitioners to pursue practice in affluent areas, which negatively impacts access to care for lower-income populations. While there are currently some loan forgiveness programs available to healthcare providers, they often only cover a fraction of the debt carried by new providers and only apply in limited practice settings.4,5

The Office of Behavioral Health Equity, a division of the Substance Abuse and Mental Health Services Administration (SAMHSA), recently shared its own strategies for growing a more diverse and culturally competent behavioral health workforce.6 A number of approaches are encouraged, with a strong focus on nurturing interest in behavioral health careers from the early teenage years, through increased career shadowing opportunities, diverse mentorship programs, and dual-enrollment and technical training programs. Youth, along with their parents and caregivers, could be exposed to behavioral health career possibilities through social media campaigns targeted at racial and ethnic minorities and career fairs held in communities of color.

See also, a look at mental health care biases and disparities in Asian American populations.

Behavioral and Mental Health Care: Private Companies Introduce Programs to Increase Access

With public demand for mental health care accessibility at a historic high, private sector companies are stepping up to try and fill existing gaps. Amazon and CVS Health have both recently made major announcements that will dramatically increase access to mental health care, as well as concurrently increase demand for providers. It is worth noting that these are not just any companies but the #2 and #4 companies, respectively, on the Fortune 500, and thus have the power to greatly influence the national landscape with their programs and policies.7

Amazon Implements Mental Health Benefits for Employees

Amazon recently announced that it will be providing mental health benefits to every full-time employee, as well as to all members of their household. 8 The benefits will include three one-on-one counseling sessions per topic a covered person wishes to discuss, and the sessions can be held in-person or on the phone via audio call, video call, or text message. Further, the company will provide interactive self-care programs, a stress resource center, crisis and suicide prevention support, 24/7 access to a licensed mental health clinician, and an app that offers computerized Cognitive Behavioral Therapy and mindfulness resources.

Drugstores Expand Counseling and Therapy Services within Drugstores

Taking a different approach, CVS has announced its intention to expand a pilot program that offers mental health counseling and therapy services inside its retail stores.9 The program provides counseling services with licensed therapists, including behavioral assessments, referrals, on-the-spot counseling, and personalized care plans. Simplifying matters for patients, programs are integrated with the on-site pharmacy. A key feature to the program’s success is that CVS negotiates with insurance companies to reduce the cost of visits, enabling the company to offer sessions at rates far lower than national averages. The pilot program initially launched in January, operating in 12 locations across Houston, Texas; Philadelphia, Pennsylvania; and Tampa, Florida. Within the year, CVS plans to expand the program to another 17 stores, targeting communities where mental health care isn’t readily available.10

Walmart Health, Walgreens, Rite Aid, and Albertsons have also recently introduced mental health programs.11 (More on drugstore therapy trends and on employer contracts.)

Mental Health Services in Schools: Districts Adopt New Mental Health Policies Before Fall Reopening

American Rescue Plan

While exact strategies differ, children and youth advocates across the nation seem to be in agreement that the prolonged isolation and fear experienced by children during the pandemic now requires increased social and emotional support, as evidenced by the significant year-over-year increase in pediatric emergency room visits due to a mental health crisis.12 In response, schools across the nation, armed with new funding for mental health services and supports courtesy of the American Rescue Plan, are racing to institute mental health policies for their students, including trauma care.

Hopeful Futures Campaign

Numerous coalitions have emerged to urge schools to prioritize their students’ mental health, armed with specific strategies for schools to consider implementing. The Hopeful Futures Campaign, which includes members such as the National Alliance on Mental Illness (NAMI) and The Kennedy Forum, is taking a national focus, urging Congress to pass The Mental Health Services for Students Act (H.R. 721) and the Pursuing Equity in Mental Health Act (H.R. 1475).13 They are also urging schools to offer multitiered mental health supports and services, including specialized support teams that include counselors, psychologists, and other trained professionals to provide support from assessment to treatment.

Birmingham Coalition for Student Mental Health: Student Mental Health Policy Playbook

In a more localized effort, the Birmingham Coalition for Student Mental Health is a grassroots coalition representing a diverse group of 27 local organizations that includes students, parents, and community advocates. The Coalition surveyed local community members and ultimately created the Student Mental Health Policy Playbook, which offers a comprehensive, community-driven game plan for expanding support for student and teacher well-being in the classroom. Their stakeholders’ first priority is to increase the number of on-campus mental health professionals.14

See also, how learning specialists can help students with decreased executive functioning and working memory as a result of the pandemic.

Arizona

A number of schools have already started to update their mental health policies in preparation for the upcoming school year. In Arizona, the Tempe Union High School District adopted a comprehensive mental health and social and emotional policy for students and staff that includes suicide prevention and postvention. Among the goals is to educate students and staff on mental health and if tragedy does strike, the policy calls for a crisis team to come on campus to support classmates.15

North Carolina

In North Carolina, the Carteret County Board of Education recently adopted a state-mandated mental health policy that addresses both student and staff mental health needs. Among other things, the plan calls for a six-hour professional development session for staff, administrators, and teaching assistants on topics such as suicide prevention, substance abuse, sexual abuse prevention identification and intervention, teenage dating violence, and sex trafficking prevention and awareness.16

More on how schools aim to tackle trauma in light of the pandemic’s impact on adolescents.

 

Professional Takeaways

Expanding access to mental health care for persons of all ages and all racial and socioeconomic backgrounds is a societal imperative. As policymakers at all levels have turned their attention toward addressing the mental health crisis, a steady drumbeat has emerged: we must harness our collective resources to grow and support a diverse, culturally competent, and accessible mental health workforce.

While this goal is not simple and will take time, it does bring with it exciting opportunities for mental health care professionals (as well as emerging and early career psychiatrists and psychologists) to consider practicing in previously unexplored treatment settings.

References
Last Updated: Aug 2, 2021