Behavioral health practitioners play an increasingly important role within the U.S. health care workforce as the incidence of mental health and substance use disorders (SUD) continue to rise nationally. Recent data from the Substance Abuse and Mental Health Services Administration (SAMHSA) reveal that in 2022, almost a quarter of all US adults (23.1 percent) reported having a mental illness in the past year, while 17.3 percent of people aged 12 or older reported having a substance use disorder in the same timeframe. Despite the increase in need for behavioral health services, individuals continue to face many different barriers in accessing the care they need, such as cost, insurance coverage, and provider availability. 

It is critical that state and federal policymakers have a full, nuanced understanding of the behavioral health practitioner workforce as it seeks to meet the growing need for care. With funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) the University of North Carolina at Chapel Hill Behavioral Health Workforce Research Center (UNC-BHWRC) undertook 10 projects in 2023 that address national-level planning and policy-relevant research questions. Now, in the second year of this effort, UNC-BHWRC will focus on an additional eight projects whose findings on the behavioral health workforce will inform SAMHSA and HRSA’s strategic aims. AcademyHealth is supporting the dissemination of UNC-BHWRC’s findings to the health services research community for the following projects:

Understanding the Continuum of Behavioral Health Professionals Working in Substance Use and Addiction Services in the United States

Within the behavioral health workforce, there exists a broad range of professionals known as addiction counselors. These professionals vary widely in terms of their training, education, certification, licensure requirements, and reimbursement allowances, all of which have the potential to differ widely from state to state. To better understand the diversity within this workforce and between states, this UNC-BHWRC project aims to determine how addiction counselors are identified within each state and describe the proportion of states that permit addiction counselors and other behavioral health professionals to be reimbursed for substance use treatment and service delivery. Identifying these differences across states and programs will provide important details and context for policymakers looking to improve their states’ behavioral health services.

Inclusion of Perinatal Services at Mental Health and Substance Use Treatment Facilities in the U.S.

An estimated one in five pregnant-capable people will experience a behavioral health disorder during the perinatal period (during pregnancy and the postpartum period of up to 12 months after delivery). Furthermore, the risk of developing SUD is highest for birthing people aged 18 to 29 years old, increasing throughout the reproductive years, and co-occurring SUDs are common among those with any SUD in pregnancy. Left untreated, these behavioral health disorders worsen maternal mortality rates and increase the likelihood of poor outcomes for both baby and birth parent. 

Recent efforts at the federal and state level emphasize the importance of increasing access to behavioral health treatment for pregnant and post-partum individuals. This UNC-BHWRC project will use the National Substance Use and Mental Health Services Survey (N-SUMHSS) to understand the inclusion of perinatal service delivery at mental health and substance use treatment facilities in the U.S. The information gleaned from this project will help inform current efforts to strengthen parental health and behavioral health systems. 

Educational Pathways to Professional-level Behavioral Health Degree Programs

Many individuals in need of behavioral health services are unable to access this care, particularly those in rural areas and those from communities of color. Researchers and policymakers broadly agree that bolstering the behavioral health workforce is necessary to alleviate these disparities in care access, particularly in areas identified as mental health care professional shortage areas. There is also broad acknowledgement that increasing diversity within the behavioral health workforce can improve the delivery of culturally and linguistically appropriate services. 

In support of the goal to increase supply, geographic distribution, and diversity of the behavioral health workforce, this UNC-BHWRC’s project will identify common pathways for individuals to enter full-time behavioral health professions in the U.S. This study will leverage nationally representative data to identify distinct educational pathways into graduate-level behavioral health professions and assess associations between particular pathways and individual and employment characteristics.

Advanced Behavioral Health Training in Geriatric Fellowships

Researchers estimate that the number of Americans aged 65 years and older will reach 80 million in 2040, one in five Americans. As this population increases, so will the number of individuals in need of behavioral health services. Indeed, SAMHSA notes that 15 percent of older adults are impacted by behavioral health problems; if this statistic holds true, roughly 12 million older adults will be impacted by behavioral health problems in 2040.

There are unique factors to consider when responding to the needs of older adults with behavioral health needs, such as the loss of friends, relationships, jobs, and identity that occur with age, acute and chronic physical health conditions that are common among older adults, and the growing diversity of the older adult population. As such, geriatric fellowships may be an opportunity to advance behavioral health training for physicians who provide this care to older adults, thus increasing access to behavioral health care. In this project, UNC-BHWRC will explore the distribution of geriatric fellowships by physician specialty (family medicine, internal medicine, and psychiatry) using data from the Accreditation Council for Graduate Medical Education (ACGME) and surveying geriatric fellowship program directors. 

Together with SAMHSA and HRSA, AcademyHealth will support the researchers at UNC-BHWRC as they conduct their studies and share findings as soon as they are available. Information about the UNC-BHWRC and previous studies is available here.

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Annaliese Johnson, M.P.P.

AcademyHealth - Senior Manager

Annaliese Johnson is a Senior Manager of AcademyHealth’s Evidence-Informed State Health Policy Institute, wher... Read Bio

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