Behavioral health: available workforce information and federal actions to support provider recruitment and retention

What the GAO found

Behavioral health conditions—mental health and substance use disorders—affect millions of people in the United States. For example, in 2020, approximately 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 depends in part on the supply of available providers. The GAO found that agencies within the Department of Health and Human Services (HHS)—SAMHSA and the Health Resources and Services Administration (HRSA)—assess and develop projections of the number of different types of providers in the behavioral health workforce. For example, a SAMHSA-supported study estimated that there were approximately 1.2 million behavioral health providers in 2020. HRSA estimated the shortage of psychiatrists in 2017 and projected a shortage of psychiatrists and addiction counselors for 2030, the last year of the forecast period. HRSA estimates that by 2030, there will be a sufficient supply of other behavioral health professions, such as marriage and family therapists and school counselors.

Based on reviews of available research and interviews with stakeholders, GAO identified three key categories of barriers that pose challenges to the recruitment and retention of behavioral health providers: financial, educational, and workplace. The GAO found that incentives such as loan repayment and scholarships for students seeking behavioral health careers help address these barriers.

Examples of barriers to recruitment and retention of behavioral health providers

GAO also found that HHS agencies have taken actions to support the recruitment and retention of 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 disbursements and grants to various types of providers, such as psychiatrists and psychologists. In return, providers agree to practice in underserved areas for at least 2 years. According to HRSA, more than 80 percent of behavioral health providers who graduated from these programs from 2012 to 2020 continued to practice in underserved areas by 2021.

Why did the GAO do this study?

Concerns about the shortage of behavioral health providers are longstanding. In addition, the health and economic consequences of the COVID-19 pandemic have heightened concerns about the growing number 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 the 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 and incentives to recruiting and retaining behavioral health providers; and (3) the actions of HHS agencies to support the recruitment and retention of behavioral health providers.

GAO reviewed federal agency workforce information, including 2020 data from SAMHSA’s Mental Health and Substance Abuse Data grant; HRSA’s Behavioral Workforce Forecast 2017-2030, released in 2020; and Bureau of Labor Statistics (BLS) labor force data released 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 barriers to recruitment and retention. 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 [email protected]

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