Behavioral health conditions—including mental health and substance use disorders—affect millions of Americans. The COVID-19 pandemic may have also increased the number of people affected. A well-trained and diverse behavioral health care workforce is critical to providing the services people need.
We reviewed Department of Health and Human Services information on the number of behavioral health care providers nationwide and found barriers to recruiting and retaining them. For example, there is a shortage of internships and qualified workers in rural areas.
We also looked at steps HHS has taken to address these barriers.
What GAO Found
Behavioral health conditions—mental health and substance use disorders—affect millions of people in the United States. For example, in 2020, an estimated 53 million adults had a mental illness, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Access to treatment for behavioral health conditions relies, in part, on the supply of available providers. GAO found that agencies within the Department of Health and Human Services (HHS)—SAMHSA and the Health Resources and Services Administration (HRSA)—estimate and develop projections of the number of various types of providers in the behavioral health workforce. For example, a SAMHSA-supported study estimated there were about 1.2 million behavioral health providers in 2020. HRSA estimated shortages of psychiatrists in 2017 and has projected shortages of psychiatrists and addiction counselors for 2030, the last year of its projection period. HRSA estimates there will be a sufficient supply of other behavioral health occupations such as marriage and family therapists and school counselors by 2030.
Based on reviews of available research and stakeholder interviews, GAO identified three key categories of barriers that pose challenges to recruiting and retaining behavioral health providers: financial, educational, and workplace. GAO found that incentives such as loan repayment and scholarships for students seeking behavioral health professions help to address these barriers.
Examples of Barriers to Recruiting and Retaining Behavioral Health Providers
GAO also found that HHS agencies have taken actions to support recruiting and retaining behavioral health providers. These actions include administering various workforce development programs to help recruit and retain qualified providers to work in underserved and mental health shortage areas. For example, HRSA's National Health Service Corps program provides loan repayment and scholarships to various types of providers, such as psychiatrists and psychologists. In return, the providers agree to practice in underserved areas for at least 2 years. According to HRSA, over 80 percent of behavioral health providers that graduated from these programs from 2012 through 2020 remained practicing in underserved areas as of 2021.
Why GAO Did This Study
Concerns about shortages of behavioral health providers are longstanding. In addition, the health and economic effects of the COVID-19 pandemic have intensified concerns about the increasing numbers of people affected by behavioral health conditions and in need of treatment.
GAO was asked to review what is known about the behavioral health workforce, and barriers to and incentives for recruiting and retaining behavioral health providers. This report describes (1) available information on the behavioral health workforce; (2) key barriers to and incentives for recruiting and retaining behavioral health providers; and (3) HHS agencies' actions to support recruiting and retaining behavioral health providers.
GAO reviewed federal agency workforce information, including 2020 data from SAMHSA's Mental Health and Substance Use Disorder Practitioner Data grant; HRSA's 2017-2030 Behavioral Health Workforce Projection, published in 2020; and the Bureau of Labor Statistics' (BLS) workforce data published in 2021. These agencies' data were the most recent data available at the time of GAO's review. GAO also reviewed the HHS Health Workforce Strategic Plan and implementation plan; relevant laws and regulations; and selected research on recruitment and retention barriers. GAO interviewed relevant agency officials and stakeholders from 13 research organizations and behavioral health associations familiar with workforce-related data and information.
GAO incorporated technical comments from HHS and BLS, as appropriate.
For more information, contact Alyssa M. Hundrup at (202) 512-7114 or firstname.lastname@example.org.