7 State Policy Strategies For The Workforce Emergency In Behavioral Health

After decades of minimal attention by most states to the challenges of recruiting and retaining a mental health and substance use disorder workforce, the last several years have seen a substantial increase in state activity. Senior Science and Policy Advisor of the Annapolis Coalition, Dr. Michael Hoge, and his colleagues have recently identified seven state policy strategies now in use by many states to strengthen this workforce. Their article has been released online by the journal Psychiatric Services in advance of publication. The analysis builds on long standing efforts by the Coalition and the Child Health and Development Institute (www.chdi.org) to identify and disseminate best practices on workforce development. In an online supplement to the article, authors Hoge, Manuel Paris, Aleece Kelly, and Jason Lang provide links to over 140 examples of implementation of these strategies by states. This work is intended to help states learn from each other about the range of possible workforce interventions and their implementation.

To learn more:

• Access the article at https://psychiatryonline.org/doi/full/10.1176/appi.ps.20230617
• Read the detailed CHDI blog post on this work at https://www.chdi.org/news/blog/lang-kelly-co-author-paper-reviewing-state-policies-address-behavioral-health-workforce-shortage/.
• Contact the lead author at Michael.hoge@yale.edu.

THE 7 STATE POLICY STRATEGIES

The state policy strategies are described below. States have infused most of these strategies with efforts to achieve a more diverse and bilingual workforce.

1. CREATE A PERMANENT WORKFORCE DEVELOPMENT STRUCTURE.

An increasing number of states are creating organizations to strengthen the behavioral health workforce. Typical responsibilities include workforce assessment and planning, and the funding, implementation, and outcome evaluation of workforce interventions.

2. DEVELOP A COMPREHENSIVE BEHAVIORAL HEALTH WORKFORCE PLAN.

A relatively large number of states have developed detailed plans that focus on cross-agency and multi-stakeholder workforce interventions. Areas of focus often include onboarding, training and education, licensing, recruitment, retention, and professional development.

3. INCREASE STATE FUNDING OF BEHAVIORAL HEALTH SERVICES.  

States are increasing Medicaid funding and grants to service providers under the assumption that this will lead to improvements in worker compensation, recruitment, and retention.

4. FUND RECRUITMENT AND RETENTION GRANTS AND INITIATIVES.

This strategy involves the provision of targeted funding to service agencies to directly address worker recruitment and retention. Such funds are generally time-limited with a requirement that most of the funding be spent on worker compensation.

5. INCREASE FUNDING FOR TRAINING AND EDUCATION.

This approach increases financial support for behavioral health education programs, internships and residencies, continuing education, and training in evidence-based practices. It is designed to grow the pipeline of new workers and support worker licensure, certification, retention, advancement, and effectiveness.

6. PROVIDE TUITION REIMBURSEMENT AND STUDENT LOAN REPAYMENT.

Significant expansion has occurred in the use of tuition reimbursement and loan repayment linked to service commitments in underserved areas. This strategy supports student completion of their behavioral health education and promotes retention by easing the financial burden of student loans on graduates.

7. EXPAND THE DIRECT SUPPORT, PEER SUPPORT, AND FAMILY ADVOCACY WORKFORCES.

States are strengthening their efforts to recruit, train, and certify direct support staff to expand the pipeline of workers. They are also financially supporting the training, certification, and service reimbursement of peer support workers and family advocates, both to increase the workforce pipeline and to build on the unique contributions that those with lived experience can make within the workforce.