The Post COVID-19 Behavioral Workforce Challenge

by Michael T. Flaherty, Ph.D.
Board Chair, Annapolis Coalition of Behavioral Health Workforce

The COVID-19 pandemic has identified and catalyzed unprecedented needs and changes that must be made in today’s behavioral health care and its workforce.

During the pandemic 4 in 10 adults in the U.S. reported symptoms of anxiety and depression, and unmet mental health care needs increased from 9.2% to 11.7% in our population. The largest were unmet needs in young adults, ages 18-29, with less than a high school education (1). Despite a loosening of supportive medication management and increased pre-pandemic focus, overdose deaths exceeded a record 90,000 in 2020 (2, 3), with increased physical vulnerability for those with SUD (4).  While largely transitioning to telehealth, treatment capacity for substance use remained at about only 10% for those in need (3). Interestingly, while traditional treatment sequestered, access to a variety of support groups (via telehealth) grew over 30% during COVID-19, offering 24/7 international contact and support (5).

The compelling questions that arise from our COVID-19 experience are how has it impacted our behavioral health services and science, and how can we become a better system and more skilled workforce?

In February of this year the King’s Fund (6), an English Charity, offered some relevant observations:

1. The people who have been most affected by COVID-19 were generally those who had the worst health care access before the pandemic, especially people from ethnic minority groups and those living in poorer areas. COVID-19 exposed deep inequalities and disparities in healthcare that exist between different populations in the U.S and around the world.
2. COVID-19 has laid bare broad weaknesses in our social fabric (e.g., nursing homes, schools, jails, tech access/use of treatment, daily routine services) and mental health systems. This lack of preparedness led to tragic consequences for families and staff, and catastrophic numbers of deaths. With renewed commitment, intentional planning, and strategic investment, the systems that provide social, medical, and behavioral care should be made better prepared for disasters.
3. A significant workforce shortagecreated a crisis across all of health care. COVID-19 took a disproportionate toll on staff from social and ethnic minority backgrounds, who already faced higher levels of systemic discrimination, poorer work conditions, and less support than wealthier or white counterparts. Of particular concern were the availability of “prepared” staff with major shortages in hospitals, nursing homes, and prisons.

Taken these early conclusions, what can we learn from COVID-19 about behavioral health care and its workforce?

First, no one discipline, psychiatry, psychology, nursing, physical medicine, social work, counseling, peer support, pharmacy, et al, can provide behavioral care alone. It takes a community of providers, working in concert, to reach, serve and address the needs of an individual, a family or a community. Population health is achieved with improved family and individual health. This understanding reinforces the need for a collaborative service/science model of care and workforce as one learning from COVID-19.

Second, telehealth, our “new” tool, should be maintained for behavioral health care.  It has proven to be cost-effective in allowing us to reach more people, including the underserved, rural, disabled. and diverse populations without the need for transportation, custodial care, increased consumer costs, etc. Thus, we must continue to design ways in which providers and clients can use this technology to scale to need. One opportunity is in rural or low populations centers, where approximately 75% of communities lack access to mental health clinicians and report consistently higher rates of mental illness compared to their non-rural counterparts (7). To reach this population we should offer sustained access, via telehealth, to skilled diagnosticians, medication support, and competent specialists with local care supports. Can telehealth expand our access to a trained workforce? Will policy makers allow this – or will we go back to the old ways that left so many without access to behavioral care? A better, broader behavioral model is now visible and achievable if we have the vision to see it and build the technology and workforce to sustain it. This is the structural change that is now possible.

Third, COVID taught us that If we are now able to reach more people, questions of reaching diverse populations and identifying inherent structural bias in worker recruitment must be an essential part of all workforce development. The old ways of recruiting and retaining workers must be put aside so that we can focus on population health factors that not only increase care but assure equitable access and better outcomes to behavioral health care. In short, our behavioral health workforce development plan needs a 21^st Century tune-up. Interdisciplinary collaboration must be the front door and include new workers such as peer supports, family supports, police MH training, pastors, and service workers. Telecommunication coordination and support for improved awareness and accountability to the community, government, and payers will also be essential. Each person must be skilled and highly valued for the part they play in insuring the health and wellness of the community, family and individual.

These are the early lessons from COVID and the opportunity for today’s new behavioral health care and workforce. If we take action now, I believe we will emerge from the pandemic with a better, broader workforce and a healthier society.

Citations:

1. Panchai, N., Kamal, R., Cox, C, Garfield, R. (2021). The Implications of COVID-19 for Mental Health Use, KFF (Kaiser Foundation), retrieved 05.17.21 from org.
2. Baumgartner, J. & Radley, D. (2021). The Spike in Drug Overdose Deaths During Deaths During the COVID-19 Pandemic and Policy Options to Move Forward. The Commonwealth Fund. orgpublished March 25, 2021.
3. National Institutes of Health, (2021). COVID-19 and Substance Use. How is the COVID-19 crisis impacting people in treatment? Frequency of drug overdose? National Institute on Drug Abuse. FAQs. Posted May 14, 2021. Retrieved from govMay 17, 2021.
4. Volkow ND, (2021). Collision of the COVID-19 and addiction epidemics . Ann Intern Med 2020; 173: 61 – 62 Crossref, Medline, Google Scholar
5. Alcoholics Anonymous (2021). Alcoholics Anonymous goes online during COVID-19. Alcoholics Anonymous, Great Britain and English-Speaking Europe, taken from alcoholics-anonymous.org.ukon 05.13.21
6. King’s Fund. (2021). Covid-19 recovery and resilience: What can healthcare learn from other disasters. The King’s Fund charity. London, UK. http;//org.uk
7. Morales, D.,Barksdale, C. & Beckel-Mitchener. A. (2020). A Call to action to address rural mental health disparities. Journal of Clinical and Translational Science, Cambridge University Press. 2020 Oct; 4(5): 463-467. Retrieved from nlm.nih.govMay 5, 2021.