February 13, 2023
Landmark UCSF Study:
California’s Ambitious Agenda to Transform Behavioral Health Care Must Be Matched by Bold Workforce Investments
Sacramento, CA – The County Behavioral Health Directors Association of California (CBHDA) today released a landmark study on the public safety net workforce serving Medi-Cal clients’ mental health and substance use disorder needs across California.
The report, Building the Future Behavioral Health Workforce: Needs Assessment, authored by two researchers from Healthforce Center at the University of California, San Francisco (UCSF), sheds light on the workforce crisis impacting California’s delivery of vital behavioral health services to safety net clients and the implementation of sweeping new behavioral health initiatives the state has launched in recent years. The clear message of the report is that California must increase investments and adopt new strategies to equip counties and their community-based organization partners to recruit and retain significantly more behavioral health professionals who reflect California’s diversity and to fuel the various new mental health and substance use disorder initiatives rolled out by the state in recent years.
Report author Dr. Janet Coffman of Healthforce Center at the University of California, San Francisco (UCSF) will discuss the findings in a webinar Monday at 1:30 PM Pacific. Register here.
“We now have a clearer picture of the behavioral health safety net workforce challenges resulting from structural and financing barriers, a narrow educational pipeline, compounded by surges in demand in the wake of the COVID-19 pandemic and fentanyl epidemic,“ said Dr. Ryan Quist, President of CBHDA and Sacramento County Behavioral Health Director.
“California’s ambitious agenda to transform behavioral health delivery must be matched by bold investments in the dedicated professionals who deliver care, with a focus on growing and retaining a workforce that reflects California’s diverse populations. We are at the precipice of a workforce catastrophe for the behavioral health safety net. What we know is that workforce challenges are solvable, but we cannot let off the gas. In fact, we need to speed up and amplify the state’s investments,” added Michelle Doty Cabrera, Executive Director of CBHDA.
Key findings include:
California is not graduating enough behavioral health professionals to replace those nearing retirement age, and in some cases the pipeline of new professionals is narrowing. For example, graduates of certificate and associate degree programs for SUD counselors decreased by 21 percent between 2015 and 2020 (pg 7).
Compounding the crisis, many current behavioral health professionals are near retirement age. Thirty-one percent of psychiatrists and 27 percent of clinical and counseling psychologists are age 65 or older (pg 26).
California’s county behavioral health departments are facing significant recruitment and retention challenges, from the inability to offer competitive pay, to lengthy hiring processes. More than 90% of counties reported difficulty recruiting Licensed Clinical Social Workers, Licensed Marriage and Family Counselors, and psychiatrists. Most counties also had difficulty recruiting substance use disorder counselors (pg 68). It is even more difficult for counties to hire professionals with specialties such as working with adolescents or people with criminal justice system involvement (pg 50).
Behavioral health professionals do not match the racial/ethnic or linguistic diversity of the clients served (pgs 28-31).
“Californians’ needs for a diverse workforce of behavioral health providers are growing far faster than the number of professionals available to deliver mental health and substance use disorder treatment,” said Dr. Janet Coffman of Healthforce Center at UCSF who authored the report with Margaret Fix. “Our state has no time to waste in scaling up our investment and training capacity if we are to keep up with our communities’ needs and go further to focus on prevention strategies.”
The report recommends a series of actions at both the state and county level to meet California’s future behavioral health needs. These include: Supporting higher education institutions to expand their educational capacity for behavioral health professions, financial assistance to support a diverse pipeline of students who commit to work in the county behavioral health safety net after graduation, increasing the rates the state pays to counties to serve the Medi-Cal population to enable counties to be more competitive on salary and compensation, and streamlining documentation requirements so professionals spend more time with clients rather than paperwork.
The needs assessment provides critical baseline information on the capacity of counties and contracted community-based organizations as California is significantly transforming mental health and substance use delivery through several sweeping state initiatives:
Substantial, additional workforce capacity will be required to meet the goals of CalAIM, the state’s Medi-Cal transformation: more quickly connecting clients to mental health and substance use disorder services, offering intensive, community-based care coordination for clients, and expanding services offered to children and families.
The Children and Youth Behavioral Health Initiative imagines school-linked and school-based behavioral health services for all students, and an expanded workforce focused on prevention, including counselors and coaches.
The state’s new mobile crisis benefit, which will scale statewide access to 24/7 mobile crisis services for the 1 out of 3 Californians with Medi-Cal insurance coverage.
Care teams implementing individualized care plans and services for clients struggling with schizophrenia and psychotic disorders central to California’s new CARE Court initiative.
As part of a multi-year Health and Human Services workforce initiative adopted in 2022, California pledged to invest over $200 million in workforce building programs for behavioral health. In his budget proposal for 2023-24, Governor Newsom has proposed delaying this workforce investment amid fiscal uncertainty.
“What is certain, is that California’s behavioral health needs will only continue to grow. As this report shows, California cannot afford to delay its workforce investments as we undertake such ambitious transformations in our mental health and substance use delivery services,” said Quist.