What 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 mental illness, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Access to care for behavioral health conditions depends, in part, on the provision 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 behavioral health personnel. For example, a SAMHSA-supported study estimated that there were approximately 1.2 million behavioral health workers in 2020. HRSA estimated the shortage of psychiatrists in 2017 and predicted the shortage of psychiatrists and addiction counselors by 2030, the last year of its projection period. HRSA estimates that by 2030 there will be a sufficient supply of other behavioral health occupations such as marriage and family therapists and school counselors.
Based on reviews of available research and stakeholder interviews, GAO has identified three key categories of barriers that pose challenges to the recruitment and retention of behavioral health care providers: financial, educational, and workplace. GAO found that incentives such as loan repayments and scholarships for students seeking behavioral health professions help address these barriers.
Examples of barriers to recruiting and retaining behavioral health care providers
GAO also found that HHS agencies have taken action to support the recruitment and retention of behavioral health care providers. These actions include administering various workforce development programs to help recruit and retain qualified suppliers to work in disadvantaged and mental health areas. For example, HRSA’s National Health Service Corps program provides loan repayments and scholarships to various types of providers, such as psychiatrists and psychologists. In return, the suppliers agree to practice in disadvantaged areas for at least 2 years. According to HRSA, more than 80% of behavioral health service providers who graduated from these programs from 2012 to 2020 continued to practice in disadvantaged areas starting in 2021.
Why GAO did this study
Concerns about the shortage of behavioral health workers are long-standing. Additionally, the health and economic effects of the COVID-19 pandemic have intensified concerns about the growing number of people suffering from behavioral health conditions and in need of treatment.
GAO was asked to review what is known about the behavioral health workforce and the barriers and incentives to recruiting and retaining behavioral health service providers. This report describes (1) the information available on behavioral health professionals; (2) the main barriers and incentives for hiring and retaining behavioral health service providers; and (3) the actions of HHS agencies to support the recruitment and retention of behavioral health care providers.
The GAO reviewed the federal agency’s workforce information, including 2020 data from SAMHSA’s Substance Use and Mental Health Professionals Data Grant; HRSA 2017-2030 Behavioral Healthcare Workforce Projection, published in 2020; and Bureau of Labor Statistics (BLS) workforce data released in 2021. Data from these agencies was the most recent data available at the time of the GAO review. GAO also reviewed the HHS Healthcare Workforce Strategic Plan and Implementation Plan; relevant laws and regulations; and selected research on barriers to recruitment and retention. GAO interviewed agency officials and stakeholders from 13 research organizations and behavioral health associations who are familiar with workforce data and information.
GAO has incorporated technical comments from HHS and BLS, as appropriate.
For more information, contact Alyssa M. Hundrup at (202) 512-7114 or [email protected]