Behavioral Health Care and the Health Workforce
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What is behavioral health and who provides behavioral health care?
Behavioral health focuses on the impact of human behavior and social interaction on the well-being of an individual or society. Behavioral health covers the study of societal and public health and more individualized health fields such as psychology and psychiatry.
The behavioral health workforce specializes in the prevention and treatment of mental health and substance abuse conditions. The professional groups that are often referred to as the "core" workforce include:
Also, the direct care workers, other front-line staff and primary care providers have become more involved in the provision of mental health services. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) report, Mental Health, United States, 2008, the percentage of patients relying on their primary care providers for mental health-related treatment more than doubled in ten years. Since primary care often serves as the lone provider of health services for many individuals, it is important that all physicians be sufficiently trained in behavioral health in order to properly diagnose and treat these patients. Providing mental health services in a primary care setting can also reduce the stigma associated with treatment.
Public health professionals have also received more attention in the behavioral health field because of their importance in the aftermath of natural disasters. Public health professionals focus on societal health rather than individual mental health treatment. Their work can include disease prevention, community health education, and overall improvement in quality of life.
Additional information on specific providers in this field can be found on the Behavioral Health Occupations guide.
In what settings are behavioral health care services offered?
In the past, psychiatric hospitals and mental health facilities served as the most common settings for behavioral health services. However, the work setting has evolved in recent years from the traditional inpatient psychiatric beds to primary care and non-specialty service including:
- Community Health Centers
- Emergency Rooms
- Nursing Homes
- Correctional Institutions
The traditional inpatient care setting has now become the least likely to be used by those needing care. Instead, services are increasingly being offered through community-based treatment in outpatient settings or even directly in the patients’ home. Service provision through outpatient services has also been paired with an increased reliance on prescribing medications for treatment. Polypharmacy, or treatment with the use of multiple prescription medications, has become a major concern in the behavioral health field.
How does the supply and distribution of the behavioral health workforce impact access to care?
According to the 2012 Georgetown University’s Center on Education and the Workforce report, Healthcare, approximately 92 million individuals live in areas of the United States where there is a shortage of mental health professionals. Future retirements will likely exacerbate this shortage as a majority of mental health providers are over 50, according to a 2007 report by The Annapolis Coalition on the Behavioral Health Workforce. Retirements are only part of the problem. Recruitment and retention is also difficult due to low salaries for behavioral health occupations.
Rural communities in particular suffer from lack of adequate supply. A 2011 report by the American Psychological Association’s Center for Workforce Studies found that although only 60% of the United States population resides in metropolitan areas, at least 85% of licensed psychologists work in urban locations. This has led to rural communities making up more than 85% of mental health shortage areas in the United States.
Supply of providers is not the only concern for the behavioral health field. Demand for mental health services and substance abuse prevention is also likely to be on the rise as one of the main populations in need of behavioral health services, the geriatric population, continues to grow. According to a report by the Institute of Medicine’s Committee on the Mental Health Workforce for Geriatric Populations, there are too few providers that specialize in geriatric mental health care to meet this growing demand.
What is the role of behavioral health in interdisciplinary teams?
A study from the Milbank Memorial Fund found that behavioral health issues lead to approximately 70% of all primary care visits. Patients’ reliance on their primary care provider for behavioral health services and lack of adequate supply, especially in rural areas, has inspired the training of primary care physicians in underserved locations to provide behavioral health treatment.
Physician training has increased access and quality of behavioral health services to those in underserved locations, yet unmet need still exists, especially for complex cases. One solution has been to encourage the partnering of primary care physicians with psychiatrists to form an interdisciplinary team. Psychiatrists or other behavioral health specialists can coordinate with primary care providers and provide consultation or take over in cases requiring advanced training and knowledge.
Care coordination has improved the quality of care in all settings. Findings have suggested that cooperation between primary care providers and behavioral health specialists results in the most successful outcomes for behavioral health patients. Interdisciplinary training and coordination has also improved the ability of primary care providers to avoid polypharmacy measures by identifying behavioral health conditions in patients at an earlier stage and implementing preventive action when appropriate.
More information on interdisciplinary health care can be found on the Care Coordination guide.
Why is cultural and linguistic competence important in providing behavioral health care?
In 2001, the Surgeon General reported that racial and ethnic minority populations in the United States suffer from inadequate mental health service provision. Cultural and linguistic competence has become increasingly important as the population of those needing behavioral health services continues to become more diverse. Although the behavioral health workforce serves a racially- and culturally-diverse population, it is overwhelmingly staffed by non-Hispanic Caucasians.
An enriched understanding of diverse cultures and languages will improve providers’ ability to provide care and to reach out to underserved populations.
What innovations may help the current workforce meet our nation’s behavioral health care needs?
Telemedicine or telemental health is one of the more promising innovations for the behavioral health field. Telemedicine uses phone or video conferencing to provide mental health services to individuals in rural or other underserved areas. Individuals with behavioral health conditions may be more willing to seek care through telemental health services since they can avoid the negative stigma that is associated with mental health treatment.
Telemental health may be able to overcome some of the challenges of the behavioral health field, such as inadequate rural supply and lack of provider diversity and cultural competency. Also, telemental health may improve recruitment and retention efforts in the field, as it provides increased flexibility for mental health and substance abuse providers.
Although there are many benefits to this new method of service delivery, a recent article by Amy Novotney in the Monitor on Psychology discusses some of the challenges for telemental health. Concern for patient privacy and safety arises when using internet-based technology. Also, some practitioners have discovered issues with licensure when attempting to provide services remotely across state lines.
Page last updated December 3, 2012