Overview

The U.S. behavioral health¹ care workforce contends with several significant challenges that undermine its efficacy and capacity to address mental health needs and at-risk substance use. Foremost among these is an uneven distribution of qualified professionals across urban and rural areas, leading to acute service gaps (Morales et al., 2020). It also faces systemic issues related to funding, reimbursement rates, and regulations that can affect service provision, innovation, and provider willingness to accept public and private insurance. Furthermore, ongoing stigmatization of mental health and substance use related issues and the lack of integrated care models complicate the delivery of effective and comprehensive care. A recent consensus report from the National Academies of Sciences, Engineering, and Medicine (the National Academies) provided recommendations for expanding participation of the behavioral health care workforce participation in Medicare, Medicaid, and marketplace plans (NASEM, 2024a).

To explore the workforce needs and challenges in different settings across the continuum of behavioral health care and to examine strategies to improve the infrastructure needed to increase service access and quality to advance health equity, the National Academies Forum on Mental Health and Sub-

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¹ According to the American Medical Association, behavioral health refers to mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms. Behavioral health care refers to the prevention, diagnosis, and treatment of those conditions. See https://www.ama-assn.org/delivering-care/public-health/what-behavioral-health (accessed November 5, 2024).

stance Use Disorders hosted a public workshop on July 10–11, 2024. The workshop featured a keynote panel and six sessions that brought together subject-matter experts on workforce challenges across the behavioral health continuum. Participants included individuals with lived experience, representatives from interest groups, government officials, academics, practitioners, industry executives, and others who shared diverse perspectives on the barriers and opportunities within the field. The discussions provided insights into structural and policy challenges, the integration of care, and the role of technology and innovation in addressing workforce shortages.

This Proceedings of a Workshop summarizes the presentations and discussions. It reflects the observations made by individual workshop participants and should not be seen as representing a consensus of the workshop participants, the forum, or the National Academies. Appendixes A and B include the statement of task and agenda, respectively. The presentations (as PDF and video) and speaker bios have been archived online. Appendix C includes readings and resources shared by workshop speakers.

WELCOME

W. Perry Dickinson, professor in the department of family medicine at the University of Colorado, opened the event by outlining several key goals for the workshop, highlighting the importance of “breaking down silos” in health care delivery and redesigning systems to better use the full spectrum of the behavioral health workforce. He emphasized the need to address pressing challenges, particularly in the context of increasing demand for services and persistent shortages of qualified professionals.

In describing the pressing need for action, Dickinson mentioned the impact of recent shocks, such as the COVID-19 pandemic, rising civil unrest and gun violence, and the consequences of climate change, on increasing rates of anxiety, depression, and substance use disorders in the United States, which have led to increased demand for behavioral health care services over the last 5 years. This is especially true for underserved groups, such as those living in rural areas, youth, and communities of color. He said that workforce shortages are contributing to other existing barriers to accessing mental health care services and noted that the workshop would consider challenges from a variety of perspectives, including that of patients, health care providers, and payers.