For the past two decades there have been significant programmatic efforts to intervene intensively with individuals who are experiencing the early onset of psychotic symptoms. Coordinated Specialty Care (CSC), which is a multi-component team-based service, has been shown in randomized clinical trials to produce greater reduction in symptoms, less time in psychiatric hospitalization, improved vocational outcomes, and enhanced quality of life when compared to usual care.
Much of the behavioral health care delivered to people with serious mental health and/or chronic addictive disorders is provided by front-line or direct support workers. Issues related to the qualifications, training, and ongoing evaluation of the competencies of this important provider group have received scant attention in the behavioral health field.
The case for focusing on diversity, equity, and inclusion in the workforce is threefold. It is, first and most important, a moral and ethical issue. Each person has value and should have equal access to training, employment and career opportunities in the behavioral health professions, and assistance addressing any barriers to those opportunities. The service case is that organizations with a diverse workforce will be better able to care for the diverse populations they serve.
People with mental health and substance abuse conditions can recover – improve their health and wellness, live a self-directed life, and strive to achieve their full potential. Evidence suggests that while medication and counseling may be helpful and necessary, personal commitment to and action towards health and wellness are essential for recovery from behavioral health conditions.
Systems, regions of the country often lament about workforce shortages in particular sectors of healthcare. Primary care, nurse practitioners, behavioral health (psychiatrists, psychologists, social workers, counselors, nurses) are considered under-resourced, and under-integrated. But that suggests that if we only had “enough,” everything would be okay.
Finding and keeping a workforce has long been identified as a challenge in the fields of mental health and addictions. But the magnitude of that challenge now seems unprecedented. Health care reform has increased access to behavioral health care, hospitals and large health systems are hiring more workers to expand their mental health and substance use services, and the strong national economy and low unemployment rates are enticing some workers to leave the behavioral health field for opportunities in other sectors.
One fifth of America’s population lives in rural areas. Rural America includes more than 2,000 counties and 49 million people. While research indicates that the prevalence of mental health and substance use disorders are generally similar to urban populations, the services and workforce present are not.
Aside from major a pandemic such as COVID-19, substance use has been recognized as America’s number one “preventable” health problem for nearly two decades. In 2017, when overdose deaths in America reached 70,200 individuals, the total life expectancy rate of American’s dropped by 0.1% due largely to substance use. This was the first lowering of life expectancy in America since the early 1900s. Today, substance use disorders are believed to be impacting 10%-12% of Americans or about 25 million individuals and one in five families.
Historically, there has been a strong emphasis in behavioral health on the supervision of the workforce. However recent changes in the field have created an even more compelling argument for enhancing that supervision: Care is increasingly provided in the community where workers receive less observation and have more autonomy; the clinical and social complexity of individuals and families has increased; and services and service systems have become much more complicated.