For several decades there has been talk of a workforce crisis in behavioral health. The evidence for the crisis comes from data assembled from diverse sources. For example, we know that only 39 percent of people in the United States who need mental health treatment receive it, while just 11 percent of those with substance use conditions receive care. Managers of behavioral health agencies report that one source of this problem is their inability to find enough qualified applicants for open positions.¹

A handful of analyses that have been conducted measure the supply of and demand for behavioral health professionals. Each of these concluded that there are worker shortages, which are severe for professionals who can prescribe medications (Hoge et al., 2013).²

The workforce lacks adequate diversity. There is also a shortage of professionals who have been trained to assess and treat children, adolescents, and young adults; older adults; individuals with severe mental illnesses; and those with co-occurring mental health and substance use conditions.

In addition to an overall shortage, the geographic distribution of workers is problematic. It has been estimated that 85 percent of the mental health professional shortage areas in the United States are in rural counties.³ Turnover, which is the rate at which individuals leave their jobs, is another dimension of the workforce crisis. Studies in the addiction field have found annual turnover rates of direct care treatment staff as high as 50 percent.⁴ Turnover is destabilizing for an organization and enormously disruptive to those in treatment or waiting for services. Among workers who stay in their jobs, we confront challenges of ensuring that they are skilled in evidence-based practices and recovery-oriented approaches to care.

There are various hypotheses about why this workforce crisis persists. Many believe that stigma and discrimination associated with mental health and addictions result in the underfunding of services and jobs in this healthcare sector. The workforce problems are numerous and complex, which can overwhelm and paralyze policymakers and agency administrators. Neither a strong evidence base nor technical assistance on workforce best practices is readily available to most organizations. Finally, so many stakeholders are involved in workforce issues (governments, colleges and universities, professional associations, accrediting organizations, and employers) that a bystander effect may occur, in which there is collective inaction.⁵ There is, however, much that can be done about this workforce crisis. At the broadest level, it is important to advocate and act. Advocate with federal, state, and local officials to improve funding for behavioral health services and to launch concerted efforts to grow and strengthen the mental health and addiction workforce. Simultaneously, take action on a day-to-day basis to strengthen your own abilities and to grow and strengthen the workforce around you.

The Annapolis Coalition on the Behavioral Health Workforce has developed the Annapolis Framework, which contains nine strategic goals to guide planning and action on workforce development.² The first three goals center on broadening the concept of “workforce” by

1. Expanding the roles of individuals in recovery and their families as part of the workforce, in self-care and peer-support roles


2. Improving the capacity of communities to identify and address their behavioral health needs


3. Increasing the ability of all health and human service providers to identify and address behavioral health needs


The next group of goals focus on strengthening core workforce practices by


4. Improving recruitment and retention efforts


5. Increasing the relevance, effectiveness, and accessibility of training


6. Fostering the development of supervisors and leaders


The final group of goals involves improving workforce infrastructure by


7. Establishing financing systems that support adequate worker compensation


8. Creating a technical assistance structure to support organizations striving to improve the workforce


9. Enhancing evaluation and research on workforce practices

Many practical tactics have been identified to accomplish these strategic goals. Easing the workforce crisis is feasible if we make it a priority within our service organizations and in the nation at large. Success will depend on continuous efforts at workforce improvement, just as we embrace continuous efforts at improving the quality of the care that we provide.

Michael A. Hoge, Ph.D., is professor of psychiatry at the Yale University School of Medicine and the senior science and policy advisor of the Annapolis Coalition on the Behavioral Health Workforce. You can contact him at michael.hoge@yale.edu.

References
¹(ATTC) Addiction Technology Transfer Center Network Coordinating Office. (2017). National Workforce Report 2017. Kansas City, Mo.: Author.

²M.A. Hoge, G. W. Stuart, J. Morris, M.T. Flaherty, M. Paris, & E. Goplerud. (2013). Mental health and addiction workforce development: Federal leadership is needed to address the growing crisis. Health Affairs, 32(11), 2005–12.

³L. Roberts, J. Smith, M. McFaul, M. Paris, N. Speer, M. Boeckmann, & M. A. Hoge. (2011). Behavioral health workforce development in rural and frontier Alaska. Journal of Rural Mental Health, 35(1), 10–16.

⁴M. A. Hoge. (2018, May 24). Workforce recruitment and retention: An overview [Webinar]. Great Lakes Addiction Technology Transfer Center. Retrieved from http://attcnetwork.org/regional-centers/content.aspx?rc=greatlakes&content=DISTCUSTOM1

⁵M. A. Hoge & M. Paris. (2018). Taking action on the workforce crisis. Psychiatric Services, 69, 619.