The mental health and addiction (behavioral health) treatment workforce is a complex and growing system made up of many professionals of varying levels of training and education. Between 2006 and 2017, Ohio added 580 behavioral health establishments, representing a more than 30 percent increase. While some behavioral health establishment types have been in decline (such as stand-alone psychiatric practices), others have experienced growth (such as mental health and substance abuse residential facilities). The increased visibility of behavioral health issues and an improved understanding of mental illness and substance use disorders as chronic diseases have led to a growth in treatment facilities, driving the need for a larger workforce to meet the demand for clinical services.
An adequate supply of a well-trained employees is the foundation for an effective service delivery system. Most of the new growth in the behavioral health workforce has been concentrated in urban
areas, which exacerbates the problem of treatment access in Ohio’s rural communities. In its most recent evaluation of the state of mental health in America, the nonprofit Mental Health America ranked Ohio 34th for mental health workforce availability with a ratio of 560 individuals to 1 health care provider. The Kaiser Family Foundation cited Ohio as only meeting 53.23 percent of the state’s behavioral health need.
The following chart shows shortage areas based on the number of health professionals relative to the population. To be considered as having a shortage of mental health providers, the population to provider ratio must be at least 30,000 to 1.
Several barriers to a satisfactory behavioral health workforce supply exist, including an aging workforce, a lack of next generation employees interested in pursuing careers in behavioral health-related fields and the difficulty in retaining workers. These challenges are further complicated by a need to ensure that the mix of professionals is appropriate to achieve the best possible behavioral health service outcome. Behavioral health care providers must be culturally competent and able to meet the needs of a wide range of people with drastically different experiences, backgrounds, and resources. Provider agencies, also referred to as establishments, report that turnover among behavioral health providers is high. This is often attributed to work-related stress, secondary trauma and low pay. In addition, primary care providers play a large role in behavioral health and are often expected to treat individuals with behavioral concerns that exceed their training and experience.
To address Ohio’s workforce gaps, the RecoveryOhio Advisory Council recommends:
8. A Workforce Needs Assessment
Commission a study to quantify the behavioral health workforce needs of Ohio and highlight disparities both geographical and cultural.
9. Creation of a Regulatory and Financing Structure That Supports Workforce Equity With Other Parts of Health Care and Between Addiction and Mental Health Specialties
Review Ohio’s regulations and reimbursement strategies to ensure that Ohio’s approach makes it attractive to employers to hire behavioral health specialists. A thorough review would include parity laws and enforcement, third- party reimbursement policies and rates, areas of conflict with federal laws and regulations, and approaches to credentialing for insurance payment that may usurp the authority of professional credentialing boards to license and determine fitness to provide care.
10. Establishment of a Career Path to the Behavioral Health Field
Develop a collaborative strategy that includes the Ohio Department of Education, the Ohio Department of Higher Education, and the Ohio Department of Job and Family Services to build on known best practices and successful innovative approaches to expand the number of credentialled professionals, to develop career exploration, and to establish pathways to jobs that support the prevention and treatment of mental illness and substance use disorders. For those health care providers and therapists who do not specialize in the treatment of mental illness or addiction, the curriculum should require exposure to standards of care for the prevention, early identification, and treatment of mental illness and substance use disorders. Institutions of higher education that train behavioral health professionals should emphasize evidence-based practice competency, so graduates enter the field prepared to provide the most modern and effective treatments upon entering the workforce at graduation.
11. Expanding the Workforce Through Financial Support for the Education and Training of Critical Specialists
Develop a student loan repayment program for those who complete their studies and agree to spend a specified time working in Ohio to address the state’s shortage of mental health and addiction specialists. Offer financial support for specialized training opportunities to retain and promote contemporary practice among the existing behavioral health workforce.
12. Supporting and Retaining the Existing Workforce
Support and retain the existing workforce through continuing education and advancing licensure. Target resources focused on trauma and burnout among first responders, child welfare specialists and health care providers working with people with mental illness and addiction.
13. Increasing the Number of Prevention Specialists
Increase the number of prevention professionals by implementing recruitment activities and making changes in reimbursement for prevention services.
14. Promoting Cultural CompetenceSupport
Support the provision of effective prevention, treatment, and recovery services for to all Ohioans while recognizing the unique beliefs, values, customs, languages, abilities, and traditions of the state’s diverse citizenry. Invest in education to support cultural competency.
15. Teaching Nonspecialists to Respond and Provide Needed Support
Invest in trainings to enhance the skills of collaborating professionals, such as health care workers and first responders, so they can respond to people with mental illness and addiction. The instruction would include Crisis Intervention Team and school resource officer training.
16. Supporting and Expanding the Role of Peer Support Specialists
Support and expand the role of peer support specialists, elevate and formalize the credentialing process, improve upon the current structure of peer support services with the Ohio Department of Medicaid and the Ohio Department of Mental Health and Addiction Services, and ensure ongoing opportunities for continuing professional development and support mechanisms.
17. Using Technology to Expand Access to Care in Underserved Areas
Advance telehealth approaches by providing clinician training and infrastructure to expand treatment opportunities to undeserved areas of the state.
18. Attracting More Child Mental Health Specialists
Provide more mental health services for children through expanded support of child psychiatry programs and new incentives for other professionals and para-professionals who specialize in meeting the needs of children and young adults in Ohio.