We Already Know How to Eliminate Barriers to Access

A crippling workforce shortage represents one of the biggest barriers we face in efforts to help those with mental health and substance use challenges.

Too many people face barriers to accessing care. They live in deserts of care. They face extensive wait times when they do have access to care.

We’ve made some progress. The Bipartisan Safer Communities Act provides the most significant investment in mental health programs since the Kennedy administration. Because of new federal investments, crisis care began to improve when the National Suicide Prevention Lifeline transition to 988 on July 16.

And we are more willing to talk about mental health and substance use challenges. Overcoming stigma by acknowledging the need for treatment provides hope that mental wellbeing — thriving regardless of a mental health or substance use challenge — helps everyone.

But we have so much work left to do.

Recruiting more mental health and substance use professionals represents one of the most urgent needs we face in efforts to improve access to care.

A survey last year found that recruiting and retaining employees is the primary barrier substance use and mental health organizations face, with 97% saying it has been difficult to recruit employees and 78% of them calling it “very difficult.” Clinicians tell me every week they struggle to recruit and retain sufficient staff to meet the needs of communities and lose staff to employers offering more competitive salaries.

We must find ways to make the mental health and substance use treatment field more attractive so organizations can increase the number of peer specialists, social workers, case managers, psychiatrists, nurse practitioners and administrative staff.

Increasing the size of the workforce will make crisis care systems more resilient. With 988 now operational, communities need to ensure they have support from organizations providing mental health and substance use treatment because they work effectively with hospitals and law enforcement to ensure people receive appropriate care and don’t end up in jails or emergency departments.

Bolstering the workforce provides more resources for communities to address a youth mental health crisis that could remain with that generation for years to come if we don’t respond.

The National Council for Mental Wellbeing, Health Management Associates and the College for Behavioral Health Leadership have focused on a series of changes to address the workforce crisis. We also have developed a framework to address the workforce shortage through changes in regulations, policy, payment, clinical model innovation, workforce expansion and quality and accountability.

At an Oct. 18 press conference, Department of Health and Human Services Secretary Xavier Becerra highlighted another strategy. He applauded Certified Community Behavioral Health Clinics (CCBHCs) for eliminating barriers to access.

“Behavioral health is health. Period. There should be no distinction,” Becerra said. “This investment [in CCBHCs through the Bipartisan Safer Communities Act] will bring us closer to that reality.”

That’s because CCBHCs ensure people get the care they need, when they need treatment. They help communities in their fight against the overdose crisis because substance use treatment organizations offer medication-assisted treatment, an evidence-based approach that saves lives. They make barriers to access less onerous. They shrink wait times by providing care more quickly. Almost nine in 10 (87%) CCBHCs report seeing patients for routine needs within 10 days of the initial call or referral, 71% offer access within one week or less, and one-third (32%) offer same-day access to services.

This is in contrast to the national average of 48 days between a client’s first outreach or referral and their first appointment, as cited in an MTM Services analysis of 10,000 care access protocol flowcharts collected from 1,000 community mental health centers engaged in initiatives to measure and reduce wait times for care in 47 states.

CCBHCs do one more thing to improve care. They hire.

A new survey by The Harris Poll found that CCBHCs are able to leverage either Medicaid funding structures or grant funding to add staff, despite the workforce shortage that afflicts other organizations. The 249 CCBHCs responding to the survey said they hired 6,220 new staff positions, an average of 27 workers per clinic, after becoming a CCBHC. An estimated 11,240 new staff positions were added across all 450 of the nation’s CCBHCs as of August 2022, in part because they were able to offer competitive salaries and provide bonuses.

Clinics that hired workers also increased the number of clients they served. On average, CCBHCs served about 900 people more than before becoming a CCBHC.

As our nation copes with an increase in mental health and substance use challenges, the new federal investment in CCBHCs represents an opportunity to expand comprehensive care and improve health outcomes. The Bipartisan Safer Communities Act will expand the CCBHC program to all states beginning in 2024 and every two years thereafter and further increase access to services.

The pandemic worsened our mental wellbeing. We cannot be mentally well and actively thriving if we can’t access substance use and mental health services. Hiring more workers will help chip away at barriers to access. So, let’s invest in our substance use and mental health workforce before it’s too late. Our wellbeing depends on it.