We are a nation in crisis. Drug overdoses claimed 72,000 lives in 2017. Suicide rates continue to climb. Life expectancy is on target to drop for a third straight year — something that hasn’t happened in this country since the Spanish flu pandemic a century ago. Now, more than ever, we need an educated and trained workforce to address the mental health and substance use challenges facing Americans, but we are coming up short.
Consider these facts:
- The behavioral health workforce (comprised of mental health and addiction professionals) is not sufficient to meet current demands. Perhaps nowhere is this clearer than in the shortage of psychiatrists. From 2003 to 2013, there was a 10 percent decline in the number of practicing psychiatrists, and 55 percent of U.S. counties have no psychiatrists at all.
- In 2017, substance use and mental health counselors earned a mean hourly wage of just $22.38 (less than some occupations that require no advanced degrees or specialized training).
- As of 2017, only 10 states mandated any kind of suicide prevention trainingfor mental health or health care professionals.
We heard some of these facts at the Kaiser Permanente Institute for Health Policy Forum on Strengthening America’s Mental Health Workforce, held September 27 at Kaiser Permanente’s Center for Total Health in Washington, D.C. But speakers from a broad range of disciplines, from health care and academia to public policy and faith communities, made clear that this about more than numbers — this is about people. This is about our ability to access, treat, and support the community college student experiencing his first episode of psychosis … to connect the divorced, single mom addicted to pain pills with treatment … to serve the elderly widower who is lonely and isolated.
While the challenges we face are great, there is much we can and have already begun to do. We must begin by educating and training a behavioral health workforce that can practice 21st-century medicine. We know that mental illnesses and addictions can be chronic, relapsing conditions, but individuals can and do recover. We have evidence-based treatments that work that are not reaching the people who need them.
At the National Council for Behavioral Health, we offer a full slate of training intended to bolster the knowledge, skills and attitudes of everyone from peer specialists who take our Whole Health Action Management training to new managers who enroll in our Middle Management Academy, from emerging leaders participating in our Addressing Health Disparities Program to senior leaders who take part in our Executive Leadership Program.
We also know that colleagues, friends and family can help each other. We know that with information and support, faith leaders, business owners and community members can be powerful health care extenders. And Mental Health First Aid does just that — it teaches anyone who takes a course the signs of mental illnesses and addictions, the skills to initiate a conversation and the knowledge of community resources should they be needed.
People frequently have co-occurring medical and mental health needs and ignoring treatment for either complicates recovery from both. Integrated physical and behavioral health care demands that we pay attention to trauma in the lives of patients. The National Council is leading a three-year initiative to educate health care providers on the importance of trauma-informed approaches in the primary care setting. We also help primary care providers incorporate SBIRT (screening for substance use using screening, brief intervention and referral to treatment).
But teaching isn’t enough. We need policies that support quality care and expand the number and type of practitioners who can treat people with mental illnesses and addictions.
Recent legislation included in Congress’s sweeping opioids package would bolster the behavioral health workforce by making loan forgiveness available to substance use disorder treatment professionals and by allowing behavioral health National Health Service Corps participants to work in schools and other community-based settings, thereby lowering barriers to access, especially in rural and frontier communities.
Most importantly, we must transform community services from a patchwork of underfunded and overburdened organizations to a thriving array of clinics that meet standards for comprehensive, high-quality treatment. CCBHCs (Certified Community Behavioral Health Clinics) authorized by the Excellence in Mental Health and Addiction Treatment Act are doing just that.
CCBHCs provide expert mental health and substance use services integrated with primary care. In return, they receive cost-based reimbursement that supports the infrastructure, staff and skilled supervision to deliver care that works.
Just six months into a two-year demonstration, CCBHCs had hired 1,160 new staff. They are hiring psychiatrists and addiction specialists, ensuring patients can get care when and how they need it. CCBHC status has bolstered organizations’ ability to recruit, hire, retain and supervise qualified staff.
At the National Council, we are a proud supporter of CCBHCs and of the Excellence in Mental Health and Addiction Treatment Expansion Act. This bill would expand the program to an additional 11 states that participated in the planning period and fund all current CCBHCs beyond the initial two-year demonstration period.
The need is great and doing nothing is not an option. We must educate, train and support a 21st-century workforce. The time to start is now.