Filling the Mental Health Worker Pipeline Amid a Growing Crisis

By Van Ton-Quinlivan, CEO Futuro Health

You don’t have to look further than the daily news headlines to be reminded that we are facing an unprecedented mental health crisis in our nation. The unfortunate aftermath of COVID-19 has resulted in a subsequent pandemic impacting the mental and behavioral health of those in communities across the country, and the numbers are alarming.

According to new data from the National Alliance on Mental Illness (NAMI), one in five adults in America experience a mental illness and nearly one in 25 adults live with a serious mental illness. And, perhaps even more startling, one-half of all chronic mental illness begins by the age of 14. In some instances, this equates to a 25 percent increase in those being diagnosed with behavioral health disorders when compared to pre-pandemic levels.

There have been numerous studies on the pandemic’s impact on the state of mental health in America, many citing isolation, disruptions to schools and businesses, and limitations placed on in-person health care services as contributing factors to the current mental health crisis. While the pandemic was undoubtedly a tipping point in the escalation of mental health diagnoses, behavioral health experts have been warning of looming disruptions for mental health providers for years prior to the repercussions of COVID-19, including job burnout, availability of training, lack of opportunity for minorities, an aging workforce and retirement drain.

These factors become compounded when considering that mental health services have historically been difficult to access in rural communities, where healthcare choices are more limited than they are for residents of cities and suburbia. And for those hoping to find a Black or Spanish-speaking therapist, their options are even less, resulting in significant disparities in care for those who need it most, all of which has only been exacerbated by the aftermath effects of the pandemic.

A Skilled Workforce: Building Blocks to a Solution

It’s difficult to solve the big issues when there are missing pieces to construct the solution.  A key piece is always the workforce necessary to do the work.  A skilled workforce is one of those building blocks that enables and, when not available, certainly hinders progress.

The lack of mental health workers isn’t confined to rural America. In California this week, the San Diego Workforce Partnership issued its own call to action by highlighting the importance of adding more skilled workers as a solution to the mental and behavioral health issues within its own densely populated county lines.

The Workforce’s new report: Addressing San Diego’s Behavioral Health Worker Shortage, emphasizes the need to fill the mental health worker pipeline by educating, training, attracting, employing, and retaining 18,500 additional professionals between 2022 and 2027 to meet the anticipated behavioral health and addiction treatment needs for residents of San Diego County. According to the report, the worker shortage in San Diego County spans a range of titles, some trained through certificates that can be attained under one year, while others require advanced degrees.

Barriers to Mental Health for Racial and Ethnic Minority Groups

Research has shown that racial and ethnic minorities have significantly less access to mental health services than others, and thus are less likely to receive proper care and treatment. Many of these same studies show that one of the best ways to improve health outcomes in underserved communities and among minority populations is to ensure that the medical professionals not only serve their communities but are representative of their communities they serve.

At Futuro Health, we place critical importance in helping students get a tuition-free education in healthcare roles that are in-demand and impactful, filling the gaps caused by differences in income, education, race, ethnicity, and location. Since our launch in 2020, Futuro Health has successfully brought over 8,000 adults back into higher education, with 80% diversity, to train at our partner colleges.

We make education journeys into allied health careers possible by growing the talent that employers need and creating a path to opportunity that workers want.

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Investing in Growing the Mental Health Workforce

It is encouraging to see new funding initiatives and legislative actions that many states have taken in response to the need for growing their behavioral health workforce. In California, Gov. Gavin Newsom recently announced a new plan to invest $4.7 billion to overhaul California’s mental health system for children, laying out strategies to improve access to mental health and substance abuse services, including adding 40,000 new skilled workers in mental health fields. This investment comes at a critical time for parents of adolescents experiencing mental health concerns. Since the pandemic the wait time to see a professional has increased to nearly four months according to data from the Association for Behavioral Healthcare.

“Mental and behavioral health is one of the greatest challenges of our time. California is doubling down with the most significant overhaul of our mental health system in state history.”

- California Governor Gavin Newsom​

The Governor’s announcement adds to California’s mental health assistance coffers, which includes more than $260 million already earmarked in the state’s 2022-23 budget  for initiatives and programs to address the state’s behavioral health crisis. As the Council Vice-Chair of the Health Workforce Education and Training Council – the state’s entity responsible for helping coordinate California’s health workforce education – I foresee these funds creating new and innovative approaches to increase the capacity and diversity of the behavioral health workforce in California over the next one to three years.

The allocation of additional mental health funding comes on the heels of the passage of Senate Bill 803 (SB 803), positioning California on the list of other states that allow certification of Peer Support Specialists, to fill the needed gap in the behavioral healthcare workforce, and improve access, recovery, and outcomes for patients. Peer Support Specialists have lived experience with the process of recovery from mental health or substance use challenges and provide peer support for others experiencing similar issues.

As mental healthcare providers in California prepare for this new benefit, data from other states where Peer Support Specialists have existed for years has proven that professionalizing these roles has bolstered the ranks of mental health workers by providing new pipelines into behavioral health careers for many more individuals seeking jobs in the mental health field. Futuro Health is proud to have been selected as a  state approved Medi-Cal Peer Support Specialist Training Program provider, and will begin student enrollment in the program beginning in the fall of 2022.

This is a pivotal time for mental health care providers, educators, workers, and residents of communities everywhere, both large and small. Like other crisis situations, it is vitally important that we approach the mental health workforce shortage crisis in a comprehensive, strategic manner – creating a systems solution, understanding the causes and factors that contributed to the shortage, while keeping focused on actions needed now to recruit and train behavioral workers and get more individuals into the education and training pipeline to fill the vacancies that currently exist.

Futuro Health CEO Van Ton-Quinlivan is a nationally recognized expert in workforce development. Her distinguished career spans the private, public and nonprofit sectors. She is a White House Champion of Change and California Steward Leader, and formerly served as Executive Vice Chancellor of the California Community Colleges.

Solving Workforce Shortages is Not an Individual Sport: What Healthcare Needs to Do Differently

by Van Ton-Quinlivan, CEO of Futuro Health and Jeff Weiss, Founder and Managing Director of Center for Corporate Innovation (CCI) 

We all know how deep and severe the demand for nurses and allied health workers grew over the course of the pandemic. We still live it. From the skyrocketing cost of traveling nurses to retaining those who are burnt out and frustrated, from sourcing diverse hires for better health outcomes to reskilling current employees for technology changes, to addressing how telework impacts culture and employment tenure, these challenges facing the healthcare workforce keep CEOs up at night. Many of you share in their struggle and seek to find solutions.  

How do we fill vital allied health roles in a reliable and inclusive way? Allied health roles comprise an estimated 60% of the care workforce. They run the gamut of occupations including medical assistants, phlebotomists, vocational/practical nurses, sterile processing techs, surgical techs, health IT and data analysts, peer support specialists, community health workers, and so on.   

According to pre-pandemic numbers, the United States will need an additional 2.3 million allied healthcare workers by 2025, and California alone will need 500,000 of them by 2024. Numbers this large mean the challenge is structural, and no one organization can realistically take on the challenge alone.  

One proven solution is through industry collaboration: working together to source, support, and train a diverse talent pool so they have the right skills at the right time. It’s often tempting for healthcare employers to try and build their own workforce solution. Forming a consortia can feel like an anathema for healthcare systems that normally compete. However, reaching out to partners and forging a path of collaboration can make a stronger workforce pool and one infused with more diverse talent. 

Employer consortia is a best practice in workforce development.

Grouping employers into a consortia is a workforce best practice. Bringing together peers, suppliers, adjacent industries, and even competitors in order to bring forth solutions at a level of scale to mirror the size of the issue can have outstanding results. Once employers form into a consortia within a region, education and public sector resources can more efficiently liaison and braid to meet the labor market needs.

This playbook comes road tested. The nation’s electric, gas, and nuclear sectors (for short, we’ll call it the energy sector) went through a similar metamorphosis in the early 2000s when it foresaw 25-50% of workers on the verge of retirement. Like the aging of seasoned nurses in healthcare, energy employers foresaw the exodus and ushered in a whole set of strategies based on collaboration. State-by-state, employers within the industry coalesced to form consortia to take on workforce challenges they had in common.  

These consortia infused vibrancy into outdated curriculum, retrained faculty at participating colleges in the latest skill sets, added seat capacity to previously atrophied programs, and stood alongside certificate and degree offerings to signal their intent to hire students. They exchanged tools and practices for their regionalized and localized needs.

Healthcare can rally in a similar way. Solving workforce shortages is better done as a team, not as an individual sport. Additionally, the Governor’s proposed 2023 California state budget offers $1.7B in new healthcare workforce incentive funds that can be more readily tapped when employers collaborate. 

No one size fits all when it comes to the intervention.

No one size fits all when it comes to the intervention.

Top of mind for all healthcare executives are nurses. Paying 2-3 times more for traveling nurses is financially unsustainable and bad for employee morale. To determine the fix, remember to evaluate where the workforce pipeline is broken.  

Are colleges graduating enough nurses? According to a University of California, San Francisco presentation of data hosted by the California Department of Labor, the anticipated shortage of RNs in the state will dissipate as new graduates enter the labor market over the next five years. Total enrollments were down from 2018-2019 to 2020-2021, but projected enrollments for 2022-2023 trend higher than the two previous academic years. However, attrition remains high for both new and seasoned RNs, and not all new graduates are getting hired – and those that do are not staying on the job.  Base in point, the same UCSF presentation noted that between 2018 and 2020 nearly 1,000 new, younger RN graduates did not persist.  

While employers prefer to hire seasoned workers, there’s not enough of them, and they’re commanding high wages as traveling nurses.  To grow and retain the talent pool, new graduates need to get hired, and industry should invest in a first-year nursing retention and preceptor program to prepare them to persist. Common Spirit just announced an innovative nurse residency program for their 45,000-person nursing workforce across 21 states.   

Meanwhile, specific nursing specialties in California are in limited supply. More nurses are required in the emergency department, operating room, and psychiatric settings. Rather than starting from scratch, the prescription here is to develop more advanced skills in the existing workforce through upskilling existing RNs and BSNs to these specialty areas.  

Employers need to go a step further and adopt best practices in tuition support programs – shifting from tuition reimbursement to disbursement in order to help workers address cashflow. If you want to know how employers are changing their thinking about educating workers in the wake of COVID, Jaime Fall is in a great position to tell you. As director of the Aspen Institute’s workforce development initiative Upskill America, Jaime is constantly in touch with some of the 5,000 businesses in the program’s network. He shared ideas and best practices with me on a recent episode of the WorkforceRx podcast.  

Another significant challenge at hand are “bottlenecks” in the workforce pipeline, wherein more students are trying to fulfill their required clinical hours—which are as high as 1,850 hours, depending on the program—than there are clinical hours available. Last year, California Competes, in partnership with Futuro Health, conducted a study to measure the extent of the allied healthcare worker shortage, forecast the increased demand of clinical placements, and identify policy solutions to address the bottleneck caused by the lack of availability of and access to clinical training hours.  We offered three categories of solutions to address the bottleneck issue: 

  1. Changes in collective stakeholder efforts: Strengthening regional consortia composed of educational institutions, employers, and community organizations who are committed to addressing the bottleneck problem.

  2. Changes in education programs: Increasing the use of various simulation modalities, implementing credit for prior learning and competency-based education, and incorporating the use of telehealth are all ways to help students achieve minimum competencies.

  3. Changes in employers: Incentivizing clinical training sites to increase clinical training opportunities, identifying currently untapped physical facilities, and expanding the use of Federally Qualified Health Centers can help with not having enough clinical placements for students. 

Download the study for a more complete examination of each category. 

You don’t have to do this work alone. Futuro Health is here to help.

Kaiser Permanente invested to create Futuro Health (as a nonprofit) to bring forth innovative solutions for the whole healthcare industry. In just two years since launch, over 5,000 diverse adults have gone on to pursue healthcare credentials thanks to the education and support ecosystem developed by Futuro Health. Futuro Health’s design of the student journey and generous scholarship opportunities create a diverse talent pool employers can draw from. Eighty percent of our adult students are ethnically diverse, 51% are bilingual (an essential skill in any healthcare setting), 73% are female, and the average age of our participants is 30.  With the right employer and consortia of healthcare partners, we can bring our best practices to share. 

About Van Ton-Quinlivan:  Ton-Quinlivan is CEO of Futuro Health and the Vice Chair of  the California Healthcare Workforce Education and Training Council, established to coordinate the State’s healthcare workforce needs. She served previously as Executive Vice Chancellor of the California Community Colleges and was named a White House Champion of Change. 

About Jeff Weiss: Jeff Weiss founded CCI, Inc. in 1986.  He is also an Adjunct Assistant Professor of Medicine at UCLA, where he co-leads the Leadership Program for UCLA/Rand National Clinician Scholars Program (Formerly Robert Wood Johnson Clinical Scholars) and is a Trustee and was a Founding Director of Thrive Scholars, which provides mentoring and scholarships to gifted minorities nationally.  Jeff is also on the Board of AltaMed Foundation and RAND Health. 

About the Center for Corporation Innovation: CCI runs exclusive ongoing forums where CEOs and senior executives from Global 1000 firms and large healthcare systems can explore strategies and growth.  CCI is partnered with major global consulting firms.   

About Futuro Health:
Futuro Health’s nonprofit mission is to improve the health and wealth of communities by growing the largest network of allied health workers in the nation. We make education journeys into allied health careers possible by growing the talent that employers need and creating a path to opportunity that workers want.

Intrigued by what you read? For more best practices in workforce development read Ton-Quinlivan’s best-selling book WorkforceRx: Agile and Inclusive Strategies for Employers, Educators and Workers in Unsettled Times (proceeds benefit Futuro Health’s nonprofit mission). You can also stay up to date by learning from experts on WorkforceRx, wherever you listen to podcasts.

Invest in a Culture of Learning

The old way of managing a workplace was relentless, and the message was clear: Work comes above all else.

That approach has been slowly changing over the years, and was drastically rewritten during the COVID-19 pandemic. As companies were forced to allow employees to work from home and to take personal time when they and their families were impacted by sickness, it became clear that there was no turning back to the era of unrealistic demands.

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