Prioritizing public policies to recruit and train mental health professionals and expand access to care
BY COSETTE TAILLAC
There is an urgent need to provide universal access to effective, equitable mental health and addiction care services in this country. The mental health care access challenges facing healthcare organizations are layered and complex, and at Kaiser Permanente we believe it’s time to prioritize expanding the available mental health workforce as part of the solution. We’ve made great strides in the areas of parity of care and stigma reduction.
However, access to a racially and culturally diverse, geographically balanced corps of clinicians who accept insurance and provide evidence-based treatment has remained inequitable. These barriers predate the COVID-19 pandemic and cause the greatest harm to people of color, rural and low-income residents, and people without adequate broadband or transportation.
When you add in the stress and social isolation brought on by the COVID-19 pandemic, especially among youth and older adults, we find ourselves in a mental health pandemic.
In 2022, healthcare stakeholders need to come together to build on emerging efforts to reshape the system that healthcare organizations rely on to attract, educate, license and deploy their mental health workforces.
Expanding the workforce is essential
According to the Bureau of Health Workforce, (https://bhw.hrsa.gov/)
the majority of states will experience shortages of licensed mental health counselors by 2030. Rural and low-income areas and communities of color are expected to suffer the most from these shortages. With growing numbers of clinicians approaching retirement age, both state and federal governments should engage stakeholders and begin to act. Kaiser Permanente supports prioritizing key policy actions including:
- Exposing young people to mental health career paths in high school
- Easing the time-consuming and financially burdensome clinical hours requirements future clinicians face as they pursue their licenses
- Focusing on filling the workforce pipeline with compassionate, ethnically diverse, multilingual clinicians prepared to work for clinics and health care organizations
- Reducing financial barriers to entering the mental health workforce by providing scholarships and supporting loan forgiveness and stipend programs
Kaiser Permanente is committed to doing our part. In 2021 we hired nearly 1,000 new therapists nationally and are actively recruiting to fill additional openings. We are working to build the pipeline through a $30 million investment in the Mental Health Scholars Academy that supports members of our own workforce who want to become mental health clinicians. In addition, we train hundreds of masters- and doctorate-level clinicians every year at Kaiser Permanente sites. We’re doing this with a strategic emphasis on graduating bilingual and diverse students who reflect the people within the communities they serve.
This work complements an historic $3 billion investment from the American Rescue Plan to the Substance Abuse and Mental Health Services Administration for block grants to address addiction and mental health, including a wide variety of mental health workforce expansion and support efforts.
Aligning the workforce to demand
As the pipeline grows, stakeholders’ focus should include incentives for hiring and retaining therapists to work for organizations providing care to patients with Medicare, Medicaid, and commercial health care coverage. Health care organizations and advocates will not be able to improve access if too many clinicians opt for private practice serving clients with the means to pay out of pocket.
We also need to consider removing some of the burdens emerging clinicians face between the time of receiving their degrees and securing employment as a licensed provider. Many of these individuals struggle to meet their supervised hours requirements because of low or no pay and sparse access to supervisors. Some states are providing licenses after people graduate and pass an exam so that newly graduated social workers can work for an agency providing services to patients within a defined scope of practice while reporting to more experienced licensed clinical social workers. We encourage other states to explore this model.
Improving access through telehealth
The increased use of telehealth during the COVID-19 pandemic offers a significant opportunity to improve access to care. Kaiser Permanente patients and clinicians alike are reporting greater convenience and comfort with telehealth sessions. A review of the literature released this year by SAMHSA (https://store.samhsa.gov/) acknowledges that “telehealth is effective across the continuum of care for serious mental illness and substance use disorders.” Telehealth is here to stay and should be enhanced and expanded for those who can benefit from it. Critical to this is digital equity: continuing efforts to extend broadband availability to underserved populations.
The increased demand for mental health care predated COVID-19. The pandemic’s soul-shaking impact on our sense of security, combined with the stresses of our modern world have cemented mental health and wellness as an essential health care need for all Americans. Let’s come together to creatively meet the challenge through policies that truly build the mental health workforce that is needed today and into the future.
Reprinted with permission: Kaiser Permanente Public Policy Perspective
COSETTE TAILLAC, LCSW, is the VP for Mental Health and Wellness at Kaiser Permanente. In this role, she leads the transformation of Kaiser Permanente’s delivery of evidence-based, outcomes-driven mental health and addiction care therapy and counseling services. Taillac is known for her work with the Early Start Perinatal Substance Abuse Prevention Program, which won an award from the American College of Obstetricians & Gynecologists in 2008. She has published research on Early Start Perinatal Substance Use Prevention Program and presented about it at conferences across the nation.
Taillac has worked for Kaiser for more than 20 years. A licensed, board-certified psychiatric social worker, she received her master’s degree in child and adolescent mental health, from UC Berkeley.