What the GAO found
Behavioral health issues – mental health and substance abuse disorders – affect millions of people in the United States. For example, in 2020, approximately 53 million adults suffered from a mental illness, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Access to treatment for behavioral health problems depends, in part, on the supply of available providers. GAO found that Department of Health and Human Services (HHS) agencies—SAMHSA and Health Resources and Services Administration (HRSA)—estimate and develop projections of the number of different types of providers in the workforce. behavioral health. For example, a study supported by SAMHSA estimated that there were approximately 1.2 million behavioral health care providers in 2020. HRSA estimated shortages of psychiatrists in 2017 and projected shortages of psychiatrists and addiction counselors for 2030, the last year of its projection period. HRSA estimates that there will be an adequate supply of other behavioral health professions such as marriage and family therapists and school counselors by 2030.
Based on reviews of available research and interviews with stakeholders, GAO has identified three main categories of barriers that pose challenges to recruiting and retaining behavioral health providers: financial, educational, and professional. The GAO has found that incentives such as loan repayment and scholarships for students pursuing behavioral health professions help overcome these barriers.
Examples of Barriers to Recruitment and Retention of Behavioral Health Service Providers
The GAO also found that HHS agencies have taken steps 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, the HRSA’s National Health Service Corps program offers loan repayments and scholarships to various types of providers, such as psychiatrists and psychologists. In return, service providers agree to practice in underserved areas for at least 2 years. According to the HRSA, more than 80% of behavioral healthcare providers who graduated from these programs from 2012 to 2020 went on to practice in underserved areas in 2021.
Why GAO Did This Study
Concerns about the shortage of behavioral health care providers are longstanding. Additionally, the health and economic effects of the COVID-19 pandemic have heightened concerns about the growing number of people affected by behavioral health issues and requiring treatment.
The GAO was asked to examine what is known about behavioral health personnel, as well as barriers and incentives to recruitment and retention of behavioral health providers. This report describes (1) the information available on the behavioral health workforce; (2) key barriers and incentives to recruitment and retention of behavioral health providers; and (3) the actions of HHS agencies to support the recruitment and retention of behavioral health providers.
GAO reviewed workforce information from federal agencies, including 2020 data from SAMHSA’s Mental Health and Substance Use Disorders Practitioner Data Grant; HRSA Behavioral Health Workforce Projection 2017-2030, 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. The GAO also reviewed the HHS Health Workforce Strategic Plan and Implementation Plan; relevant laws and regulations; and some research on barriers to recruitment and retention. GAO interviewed agency officials and stakeholders from 13 research organizations and behavioral health associations 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 hundrupa@gao.gov.
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