Study finds specialty behavioral health establishments increased, but more needs to be done

The number of specialty behavioral health establishments, their workforce and their wages have increased steadily between 2011 and 2019, according to a new study by Indiana University and University of Michigan researchers.

The largest increases were found in the number of outpatient establishments and the size of their workforce, as well as an increase in the average wage at residential health establishments.

Researchers say while these increases are important in closing the gaps in needed treatment, more work needs to be done to increase behavioral health workforce deficits, especially in areas with an elevated drug overdose mortality rate.

At the county-level, they found that the growth of residential specialty behavioral health establishments was positively and significantly associated with the county's drug mortality rate. They did not observe a similar positive association in other settings, including outpatient clinics and hospitals.

"The good news is that this new data resource we've assembled documents a growth in the number of establishments and in the workforce, meaning an increase in treatment capacity," said Kosali Simon, co-author of the study and a Herman B. Wells Endowed Professor in IU's O'Neill School of Public and Environmental Affairs. "However, the growth in the need for treatment still outpaces available resources, as the number of overdose deaths continues to rise."

The study was published in the Journal of Substance Abuse Treatment. It is the first study to examine recent changes in the specialty behavioral health workforce and the job characteristics, specifically wages, for individuals working in these settings.

"Limited availability of specialty behavioral health providers is often reported as a key barrier to filling treatment gaps," said Thuy Nguyen, research assistant professor at the University of Michigan School of Public Health and lead author of the study. "Through our study, we found increases in the number of establishments, employees and average wages in the treatment sector in recent years, which may indicate that the specialty behavioral health workforce is responding to the increased need for treatment."

According to the study, the number of specialty behavioral health establishments has increased 34 percent from 2011, with the largest increase in outpatient establishments (46 percent) compared to 29 percent for hospitals and 22 percent for residential establishments.

Within each type of specialty behavioral health establishment setting, the study found the number of employees also increased considerably: 33 percent in outpatient establishments, 23 percent in residential and 5 percent in hospitals. By comparison, the increase in the total employment in the health care sector was 20 percent.

Using a longitudinal dataset from the U.S. Census Bureau, the study quantified national and county-level changes in specialty behavioral health workforce outcomes and assessed associations between these measures and age-adjusted drug mortality rate. The study described specialty behavioral health workforce outcomes in 3,130 U.S. counties between 2011 and 2019.

The study stratified workforce outcomes, including the number of establishments, likelihood of having establishments, mean number of workers and average wage of workers per county by service settings: outpatient, residential, and hospital.