States are making significant investments to expand access to behavioral health services and address workforce shortages and maldistribution. While strategies to retain the current workforce and cultivate future talent are critical, state policymakers recognize that increasing the number of clinicians, while vital, is part of a multipronged approach to meet the growing mental health and substance use treatment needs of most – especially underserved and at-risk populations. Successfully advancing workforce development strategies to improve supply, distribution and allocation requires collaboration among key partners in the behavioral health ecosystem. To capture this expertise, the National Academy for State Health Policy (NASHP) convened a multi-sector roundtable comprised of policymakers, payors, providers, employers, and individuals with lived experience to explore innovative solutions and identify actionable strategies for strengthening the behavioral health workforce.
Key Strategies from the Roundtable
The roundtable yielded several key strategies for states to consider as they work to strengthen the behavioral health workforce:
- Data-Driven Workforce Planning: By mapping workforce data to care models, states can identify gaps and prioritize investments. Predictive analytics can also support better patient matching and workforce distribution.
- Mapping Roles and Functions: States can proactively map roles and responsibilities across the licensed and unlicensed workforce to optimize team-based care models. By identifying opportunities for clinically appropriate task delegation and defining clear responsibilities, states can build a framework that strengthens care coordination and leverages the full potential of the behavioral health workforce.
- Enhancing Regulatory Flexibility: States can explore opportunities to update regulations to allow licensed professionals to practice at the top of their licenses and enable task shifting where appropriate. This flexibility supports the implementation of team-based care models, fosters collaboration across the workforce, and improves access to high-quality care.
- Training and Incentives: States can designate funding for training programs, continuing education, and partnerships with academic institutions. Financial incentives, such as stipends for advanced practicums in integrated care settings, can help build the workforce pipeline.
- Technology Investment: Continued access to telehealth and teleconsultation services with ongoing assessment of quality and patient choice and exploring digital solutions can bridge gaps in care access, especially in rural areas. States can consider regulatory and financial support for these technologies to maximize their impact.
A Collaborative Approach to Addressing the Workforce Shortage
The roundtable, supported by Kaiser Permanente’s Institute for Health Policy and the Health Resources and Services Administration (HRSA), included a diverse group of stakeholders—including state and federal officials, healthcare providers, payors, and employers – focused on addressing the behavioral health workforce challenge. Participants exchanged best practices and explored ways to optimize existing and potential workforce through data-informed policymaking, promoting team-based care models, technological innovations, and delivery and payment and other funding strategies. The discussion also focused on opportunities and challenges for state policymaking and public-private partnerships to invest in the behavioral health workforce and build evidence-informed, flexible approaches that leverage the unique contributions of both licensed and unlicensed workers.
Key Themes from the Roundtable
1. Understanding the Workforce You Are Building
Data-driven insights are critical for informing policy decisions and investments in the behavioral health workforce. States must rely on clear projections of service demand and a comprehensive understanding of a workforce supply, including its composition and distribution. During the roundtable, Utah’s approach to addressing workforce development gaps was highlighted. Like some states that require periodic reviews of regulated occupations, Utah mandates its Office of Professional Licensure Review (OPLR) to systematically evaluate all regulated occupations at least once every 10 years. Using a systematic, inclusive approach, OPLR combined national and state data with a survey of all licensees to produce a comprehensive behavioral health field-level report. The report informed legislative action and supported workforce strategies tailored to meet both current and future needs.
Additionally, over 13 states have established workforce centers at academic institutions to enhance their understanding of and capacity to develop the behavioral health workforce. Nebraska’s Behavioral Health Education Center of Nebraska (BHECN), created by the Legislature in 2009 (LB603) and updated in 2021 (LB1068), was an early example of state-funded workforce development. Housed at the University of Nebraska Medical Center (UNMC), BHECN focuses on workforce research, career preparedness, and interprofessional training for students statewide, with a strong emphasis on building collaboration among programs and behavioral health professionals. These efforts exemplify how states can align resources and policy to build a sustainable workforce.
2. Scaling Effective Treatment Teams for Greater Impact
At the roundtable, participants discussed the promise of evidence- and team-based care models in expanding access to care through new models like Certified Community Behavioral Health Centers (CCBHCs), mapping roles and functions and maximizing scope of practice, strategic incorporation of peer support specialists and other unlicensed direct service providers, and unique considerations for rural and frontier areas. These models facilitate collaboration among multidisciplinary teams to provide comprehensive, coordinated, and individualized care that focuses on recovery and whole-person health.
Mapping provider types across the service array, including both licensed and unlicensed workforce, helps identify opportunities and gaps for targeted workforce investments. For example, Table A – Practitioner Detail in Georgia’s Medicaid provider manual provides a clear framework by outlining the behavioral health professionals eligible to work in various settings and detailing their reimbursement rates.
States can engage their early adopters of integrated care. Cherokee Health Systems in Tennessee, uses a dynamic process for mapping staff roles and functions intersecting with scope of practice to underpin team-based care to meet diverse patient needs effectively. This approach has helped them to optimize workforce deployment and enhance care delivery.
Participants also emphasized that workforce policies promoting team-based care should be carefully designed to ensure quality is maintained. Elements discussed included:
- Incorporate regulatory flexibility in a wide range of areas including staffing composition wherestates adjust requirements around who can perform certain tasks or how teams are structured to align with best practices in delivering evidence-based practices, enabling a more effective and efficient workforce.
- Align with ongoing initiatives like Certified Community Behavioral Health Centers (CCBHCs).The CCBHC model can support the scaling of effective treatment teams by providing enhanced, flexible funding that can enable comprehensive, team-based care. This approach expands access to services, including integrated medical services.
- Supporting Collaborative Care through Rate Increases: By raising reimbursement rates for Collaborative Care Model (CoCM) codes, states can incentivize providers to adopt the model and support the sustainability of hiring behavioral health care managers. These managers play a critical role in the care team, coordinating services and ensuring the effective integration of behavioral health into primary care settings.
- Advance strategic workforce planning solutions. Ohio’s Workforce Roadmap includes a focus on supporting contemporary practices. This involves examining flexible work best practices, caseload guidelines, and behavioral health job reclarifications.
- Designate training funds and financial incentives to team-based training programs, continuing education (CEUs), and partnerships with academic institutions. States can collaborate with higher education partners to obtain HRSA funding for stipends, providing students with advanced placement practicums in integrated behavioral health and collaborative team settings. For example, Missouri’s training program prepares trainees for professional clinical practice in integrated behavioral health (IBH) and collaborative team setting.
- Promote the adoption of CMS-approved team-based reimbursement for Coordinated Specialty Care for Early Psychosis (CSC-EP). CMS has authorized two HCPCS team-based billing codes simplifying payment for team-based care through private and public insurance and enabling community-based mental health programs to offer these critical services.
3. Better Patient Matching to Need
During the roundtable, participants highlighted the role of effective mental health triage, which prioritizes assessing psychological and emotional stability, identifying and mitigating the risk of self-harm, and providing immediate treatment tailored to the individual’s specific needs. They discussed how effectively matching therapists to patients can improve psychotherapy outcomes, as demonstrated in a study published in JAMA Psychiatry. This approach is currently being explored in various settings, including:
- Health plans and private providers, such as Blue Cross Blue Shield (BCBS) and One Medical, are implementing triage models to maximize workforce efficiency and connect individuals to appropriate levels of care based on patient needs. A notable example is their CoCM in primary care clinics, which integrates behavioral health components through telehealth. This approach can help individuals receive timely care while reducing pressure on the broader workforce.
- As part of the evolution of the crisis continuum, Medicaid Managed Care for mobile crisis services emphasizes the importance of appropriate patient matching and the role of mobile crisis or call centers in directing individuals to the right level of care. States like Arizona are enhancing crisis stabilization facilities to connect people to the right services and reduce emergency department
- Court systems are exploring how to create a triage system to identify individuals with behavioral health conditions at the earlies point of court involvement and connecting them to treatment and supports that align with their needs.
Policy strategies can promote innovative approaches that support individual choice, use financial incentives and support tools such as advanced decision-making systems and predictive analytics. States are exploring ways to streamline administrative processes aimed at reducing the burden on the existing workforce. By simplifying paperwork, automating routine tasks, and enhancing communication channels, providers can focus more on delivering quality care rather than navigating complex administrative hurdles, ultimately improving patient outcomes and workforce efficiency.
4. Technological Workforce Extenders
There was consensus that telehealth, teleconsultation, and other digital workforce extenders are valuable tools for increasing the capacity of the current behavioral health workforce. During the pandemic, telehealth provided continuous access to behavioral health care and has become a standard component of care.
Looking ahead, participants emphasized the importance of prioritizing quality and patient choice. Key considerations include developing the right regulatory infrastructure, leveraging data science tools, and incorporating clinical supervision to ensure patient safety and maintain high clinical standards.
Additionally, a variety of technological tools can support healthcare delivery and planning at all levels, including within state government. These tools enable the workforce to operate more efficiently by streamlining tasks and optimizing resource allocation.
Roundtable participants also stressed that the use of technology in clinical care must complement, not replace, clinician oversight. Ensuring that technology is integrated with clinical supervision is essential to maintaining patient care as the primary focus while safeguarding safety and quality.
5. Optimizing the Unlicensed Skilled Workforce
Optimizing the Unlicensed Skilled Workforce by clearly defining their roles and expanding their scope of practice ensures they can effectively contribute to various care settings, aligning with newly created provider types and supported by robust quality assurance measures.
As states have continued to expand mental health crisis systems following the launch of 988 and the enhanced Medicaid match opportunity for mobile crisis services, states have implemented strategies to further integrate peers into crisis response systems.
The Camden Coalition, a regional hub in New Jersey, used its health information exchange and coordinated efforts with local providers and agencies to address challenges in determining which provider is responsible for managing a Medicaid beneficiary’s care, reducing overlap and improving service coordination through streamlined data sharing.
States are also integrating Community Health Workers (CHWs) into the behavioral health field and can explore value-based models to fund CHWs and other team members as part of interdisciplinary care teams.
6. Payment and Financing Strategies
With input from providers and consumers (especially in underserved, rural/frontier areas) the roundtable participants discussed ways states can update payment models to encourage flexible workforce models that deliver evidence-based interventions with strong lived-experience components. Value-based payment arrangements, increasing uptake of existing billing codes for Psychiatric Collaborative Care Model (CoCM), and financial incentives for adopting team-based care can drive improvements. In addition,
- States can implement and support provider uptake of the 2023 CMS policy change that enables state Medicaid programs to cover interprofessional consultation services.
- States can leverage payment strategies to improve the delivery of integrated SUD services
- States can integrate workforce initiatives targeting shortage professions, such as psychiatry, into their 1115 waivers, similar to New York’s 1115 waiver.
Addressing the behavioral health workforce shortage requires a multi-faceted approach that goes beyond increasing the number of clinicians. By reimagining treatment teams, leveraging technology, and adopting innovative payment models, states can build a more robust and resilient behavioral health workforce. These insights provide ideas for states to modernize workforce strategies and enhance access to high-quality behavioral health care.
