Expanding federal programs may help to increase the behavioral health workforce

The U.S. is facing a severe shortage of behavioral health providers —those who care for people with mental health or substance use issues. In recent years, demand for behavioral health treatment has grown, and this shortage is now dire.

In a new paper published in Psychiatric Services, Stony Brook University IDEA Fellow, Briana Last, Ph.D., and co-authors provide a comprehensive review of one federal policy that has been increasingly used to address the country's behavioral health provider shortage crisis: loan repayment programs (LRPs).

The authors' review found that that while LRPs can help recruit new providers to areas in the country with severe shortages, these programs alone cannot address some of the root causes of the crisis. They point to the need for a variety of federal policy strategies to address it.

Professional behavioral health associations and policymakers agree that the U.S. is in a behavioral health crisis and policy solutions are needed to address it. In 2023, the Health Resources and Services Administration (HRSA) estimated that 165 million Americans live in behavioral health provider shortage areas. By 2036, the HRSA projects the country will be short over 85,000 behavioral health providers.

"Supply is far outpaced by demand for behavioral health services, and we need big policy solutions to support the development of this workforce in the coming years," says Last, lead author of the paper and a researcher in the Department of Psychology at Stony Brook University.

The authors write that "major factors preventing the recruitment and retention of providers include the prohibitive costs of post-secondary education and inadequate wages, which do not fully return the investment costs of pursuing professional behavioral health training or incentivize individuals to enter the field."

The authors explain that federal policy makers have deployed a variety of financial strategies to recruit and retain behavioral health providers, including the use of LRPs. These federal programs vary in benefits but can offer as much as $250,000 in loan repayment in exchange for several years of clinical service in high-need geographic areas and facilities. Policy makers have increased funding for LRPs as the behavioral health provider shortage crisis has worsened.

The researchers found 17 publications in their scoping review, and less than half of the papers included in their article were peer-reviewed empirical articles, which suggests that these programs are understudied. The work that has been published paints a complex picture of LRPs.

On the one hand, these programs help recruit behavioral health providers to serve in provider shortage areas in the short-term. Providers and facilities in shortage areas seem to be satisfied with many aspects of LRPs. These programs are also effective at diversifying the workforce.

On the other hand, behavioral health providers tend to be dissatisfied with their wages and workloads during their years of service. One study the team examined revealed that over half of behavioral health providers complete their LRP service contracts with debt remaining. This suggests that these programs are insufficient to relieve the debt that most behavioral health care providers take on during the early part of their careers.

"Our search of the literature reveals that although loan repayment programs are helpful, ultimately we need additional solutions to build this workforce. The review suggests that more federal scholarship programs may be the most effective solution to the behavioral health provider shortage," says Last, summarizing the team's conclusions.

Separate from the paper's findings, Dr. Last adds that public universities like Stony Brook, which offer affordable tuition, are an important part of the solution to developing the behavioral health workforce. A public university education enables people to receive affordable graduate training in an era where tuition costs are skyrocketing among private universities nationwide.