Policy Statement on Behavioral Healthcare Workforce Shortage
There is a significant national shortage of professionals trained in the needs and treatment of youth with behavioral health conditions. Services have been difficult to access for the past decade, and with growing rates of behavioral health disorders among youth, coupled with increased public awareness of the issue and the pervasive impact of the COVID-19 pandemic, the gap between demand for services and the ability to meet this need is now staggering.
Prior to the pandemic, approximately half of the children with mental illness did not receive treatment from a mental health professional (Whitney & Peterson, 2019). The United States is experiencing a behavioral health workforce shortage, with less than a quarter of the workforce required to meet needs, and wide disparities between urban and rural settings. Seventy percent of counties in the U.S. have no child and adolescent psychiatrists at all (McBain et al, 2019). Overall, there are only 14 child and adolescent psychiatrists per 100,000 children in the country (AACAP, 2022). The workforce shortage has serious implications; for example, between 2015-16, suicide rates among adolescents were higher in areas with greater levels of workforce shortages, compared to areas without workforce shortages when other factors such as poverty were accounted for (Hoffman et al, 2022).
The workforce shortage can be addressed in several ways: 1) reducing barriers for students and trainees to enter the field of youth behavioral health; and 2) extending the work of specialty providers through collaborative care models, consultation, and training of other allied professionals and community resources who work with youth, such as pediatricians, clergy, peer support specialists, and teachers.
The American Academy of Child and Adolescent Psychiatry, which promotes the healthy development of children, adolescents, and families through advocacy, education, and research, is greatly concerned by the workforce shortage. The recent proclamation of an ongoing emergency in pediatric mental health by the Surgeon General’s office further reinforces the tremendous need to expand a skilled workforce in child psychiatry and children’s mental health in general.
To increase the American behavioral healthcare workforce in support of improved youth access to behavioral healthcare, the American Academy of Child and Adolescent Psychiatry recommends:
- Implementing federal and state loan forgiveness programs for child and adolescent psychiatrists and other child-serving behavioral health professionals to reduce barriers for trainees to enter these fields.
- Increasing public and private payer reimbursement for pediatric behavioral health providers, including child and adolescent psychiatrists.
- Developing mental health expertise of other child-serving pediatric healthcare providers who may be able to help youth with behavioral health needs, but who have not received sufficient training nor support.
- Changing the Health Resources and Services Administration’s (HRSA) definition of “healthcare provider shortage area” so that it includes behavioral health professionals for youth in all geographic areas, given the widespread shortage of behavioral health professionals throughout the nation.
- Promoting policies that encourage students and trainees to enter the youth mental health workforce, at every stage of the workforce pipeline. For child and adolescent psychiatrists, this training includes medical school, general residency, and child and adolescent psychiatry fellowship.
- Promoting policies that support access to quality care through increased collaboration between all professionals serving youth including increased team-based care delivery, behavioral health integration into medical networks, and increased connection to community services. Multidisciplinary collaboration and training in collaborative models must be expanded in all professional training programs.
- Training and educating community members to assist children with behavioral health conditions, including peer advocates, individuals with lived experience, caregivers, clergy, teachers, and family members.