Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and the Assistant Secretary for Planning and Evaluation, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-73121-8
International Standard Book Number-10: 0-309-73121-6
Digital Object Identifier: https://doi.org/10.17226/28583

This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2025 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Addressing workforce challenges across the behavioral health continuum of care: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/28583.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

WORKSHOP PLANNING COMMITTEE

W. PERRY DICKINSON (co-chair), Director, Practice Innovation Program

PATRICIA AREÁN (co-chair), Director, Division of Services and Intervention Research, National Institute of Mental Health

DANIEL DAWES, Senior Vice President, Global Health, Meharry Medical College

KATHLEEN DELANEY, Professor Emeritus, Department of Community, Systems, and Mental Health, Rush College of Nursing

JUDITH DAY, Economist, U.S. Department of Health and Human Services

ANITA EVERETT, Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration

JOHN GONZALEZ, Department Chair and Professor of Psychology, Bemidji State University

THERESA NGUYEN, Chief Research Officer, Mental Health America

PATRICIA PITTMAN, Professor, Department of Health Policy and Management, George Washington University

Staff

ALEXANDRA ANDRADA SILVER, Forum Director/Program Officer

VIOLET BISHOP, Research Associate

SHARYL NASS, Senior Board Director, Board on Health Care Services

Consultant

M. SUSAN RIDGELY

This page intentionally left blank.

Reviewers

This Proceedings was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by JACK EBELER, former member of the Health and Medicine Division Committee. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

This page intentionally left blank.

Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Forum on Mental Health and Substance Use Disorders wishes to express its sincere gratitude to the planning committee cochairs Patricia Areán and W. Perry Dickinson for their valuable contributions to the development and organization of this workshop, in addition to the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. The forum wants to thank the speakers who shared a lived experience perspective: Eduardo Vega, Nev Jones, and Wendy Dean. Finally, the forum thanks all the speakers and moderators who generously shared their expertise and time with workshop attendees. Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to its work, including the National Institutes of Health (National Institute Common Fund, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health), American College of Clinical Pharmacy, American Psychiatric Association, American Psychiatric Nurses Association, American Psychological Association, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Council on Social Work Education, Office of the Assistant Secretary for Planning and Evaluation, Hogg Foundation for Mental Health, and Substance Abuse and Mental Health Services Administration.

This page intentionally left blank.

Contents

OVERVIEW

Welcome

KEYNOTE PANEL: PERSPECTIVES ON THE BEHAVIORAL HEALTH WORKFORCE

Discussion

SESSION 1: PATIENT-LEVEL CONTEXT

Projected Cost and Economic Impact of Mental Health Inequities in the United States

Behavioral Health Integration and Depression Care Equity

Telepsychiatry Collaborative Care to Improve Rural Access and Capacity

Cross-Sectorial Partnerships to Address Growing Behavioral Health Workforce Challenges

SMI and the Behavioral Workforce Crisis

Discussion

SESSION 2: HEALTH CARE PROFESSIONALS

Systemic Integrated Care: Responding to Biopsychosocial Health Care Needs

Reframing Distress: Why Moral Injury Matters

Re-Envisioning the Behavioral Health Workforce with a Focus on Underserved Communities

Challenges Across the Behavioral Health Continuum

The Pharmacy Department’s Role in Mental Health Management: An FQHC Case Study

Discussion

SESSION 3: FINANCING AND PAYMENT CHALLENGES

Addressing Behavioral Health Workforce Challenges

Addressing Workforce Challenges: An Implementation Perspective

Addressing Workforce Challenges Across the Continuum of Care: Financing and Payment Challenges

CMS Innovation Center: Behavioral Health Transformation

Discussion

SESSION 4: STRUCTURAL AND POLICY CHALLENGES

Improving Accountability for Behavioral Health Access: Evaluating the Evidence for Network Adequacy Standards

State Legislative Trends in Behavioral Health Workforce

Identifying and Filling Gaps to Promote Value-Based Care Through Quality Measures and Client-Centered Supervision

Discussion

SESSION 5: CHALLENGES ACROSS DIFFERENT SETTINGS

Recruiting and Retaining Native American Care Providers in Behavioral Health Settings

Psychiatric Advanced Practice Nurses for School-Based Mental Health Services

Addressing Workforce Challenges: Perspective of the Bipartisan Policy Center

Workforce Development Strategies: State Mental Health Authorities

Discussion

SESSION 6: INNOVATIONS, TECHNOLOGY, AND MEASUREMENT

Innovation, Technology, and Measurement in the Behavioral Health Workforce

Using AI to Improve Care Quality for Mental Health and Substance Use Disorders

Integrating Digital Mental Health Tools in the Behavioral Health Continuum of Care

Discussion

CLOSING REMARKS

REFERENCES

APPENDIXES

A Statement of Task

B Workshop Agenda

C Readings and Resources Shared by Workshop Speakers

Boxes, Figures, and Table

BOXES

1 Highlights from Individual Workshop Participants: Keynote Panel

2 Highlights from Individual Workshop Participants in Session 1

3 Highlights from Individual Workshop Participants in Session 2

4 Highlights from Individual Workshop Participants in Session 3

5 Highlights from Individual Workshop Participants in Session 4

6 Highlights from Individual Workshop Participants in Session 5

7 Highlights from Individual Workshop Participants in Session 6

FIGURES

1 Telepsychiatry collaborative care

2 Projected supply and demand of all health care occupations

3 Health Professional Shortage Areas: Mental health

4 Network adequacy standards

5 Service use among adults with mental illness

TABLE

1 Excess Costs Arising from Mental Health Inequities

Acronyms and Abbreviations