Millions of Americans are facing mental and behavioral health issues.
As a matter of fact, according to the 2019 National Survey on Drug Use and Health:
- 80% of individuals with a substance use disorder do not get needed care.
- 57% of those with mental illness also do not get needed care.
- Nearly 1/3 of those living with serious mental illness do not get the care they need.
As we can see, mental, and behavioral health is something everyone should worry about because it negatively affects society – the people, jobs, safety, economy etc.
Mental and behavioral health tend to be terms that are often used interchangeably. However, they are not the same.
Mental health refers to an individual’s emotional, social, and psychological wellness. In other words, it affects how we think, feel, act, and the decisions we make. If we don’t address mental health issues early on, it can have long standing consequences that bleed into other areas of our lives.
On the other hand, behavioral health relates to the connection between your behavior and the health of your mind, body, and spirit. Think of behavioral health as the way your habits affect your mental and physical health plus your overall wellness.
Before trying to figure out how we can address our or someone else’s mental and behavioral health, first we need to understand mental and behavioral health.
So, who makes up the workforce, what do they do, the differences between mental and behavioral health, the impact COVID-19 has had on the ongoing mental health crisis, highest paying jobs and more.
As a healthcare employer, it might be good to revisit this information with your staff while gaining other insights such as top trends and staffing and recruiting best practices.
THE MENTAL AND BEHAVIORAL HEALTH WORKFORCE
Who makes up the mental and behavioral health workforce?
There are several types of professionals that make up the mental and behavioral health workforce. This includes psychologists, counselors, therapists, social workers, psychiatrist, nurses and much more.
Mental and behavioral health providers can do either of the following – 1) assess and provide therapy and 2) prescribe and monitor medication. More specifically, their primary duties may include but are not limited to:
- Diagnosing conditions.
- Providing direction, treatment, and counsel/therapy.
- Prescribing and monitoring medications.
- Educating family about mental and behavioral health disorders.
- Providing resources.
- Conducting outreach programs etc.
To further elaborate and best understand the differences and roles these mental and behavioral health clinicians play, here are more insights into what they do according to their specialty:
- Psychologists – Psychologists are trained to evaluate an individual’s mental health using clinical interviews, psychological evaluations, and other forms of testing. They can diagnose and provide individual and group therapy to help individuals overcome challenges and cope with life issues.
- Counselors and Therapists – The role of a counselor and therapist is to evaluate an individual’s mental health and use therapeutic techniques according to specific training programs.
- Social Workers – Similar to counselors and therapists, a social worker is also trained to evaluate an individual’s mental health while using therapeutic techniques according to specific training programs. Additionally, they are trained in case management and advocacy services. Social workers aim to protect the rights and well being of individuals. Their primary role is to help individuals cope and find solutions to various life and social issues that come with mental illness and help individuals transition back to family and community.
- Psychiatrists – Psychiatrists are licensed medical doctors who’ve completed psychiatric training. Their role is to diagnose mental conditions, prescribe and monitor medications and provide therapy.
- Psychiatric or Mental Health Nurse Practitioners – The role of a psychiatric or mental health nurse practitioner is to assess, diagnose and provide therapy for mental health conditions or substance use disorders. Depending on the state, they may also be qualified to prescribe and monitor medication.
- Family Nurse Practitioners – Family nurse practitioners can provide general medical services (depending on each states laws). Additionally, they can prescribe medication; however, they should work closely with mental health professionals to best determine an individual’s treatment plan.
Now that we understand the type of clinicians that make up the mental and behavioral health workforce, let’s see what the current job outlook looks like.
As of May 2020, the annual median wage for substance abuse, behavioral disorder and mental health counselors was $47,660 –with the bottom 10% earning less than $30,590 and the highest 10% earning more than $78,700.
Employment in this area is expected to grow by 25% from 2019 to 2029 due to:
- Individuals continuing to seek addiction and mental health counseling services.
- States seeking treatment and counseling services for drug offenders vs. jail time.
- The continued need for counselors to work with military veterans and more.
According to the U.S. Bureau of Labor Statistics, in 2019, substance abuse, behavioral disorder and mental health counselors held approximately 319,400 jobs with the largest employers being:
- Outpatient mental health and substance abuse centers (19%)
- Individual and family services (16%)
- State, local, and private hospitals (10%)
- Residential mental health and substance abuse facilities (10%)
- Government (8%)
If you or someone you know is looking to enter the mental and behavioral health field, here are the top 10 highest paying jobs you should consider according to Indeed and the U.S. Bureau of Labor Statistics:
- Psychiatrist (national average salary $224,103)
- Psychiatric Nurse (national average salary $110,495)
- Industrial Organizational Psychologist (national average salary $109,030)
- Clinical Psychologists (national average salary $95,837)
- Psychology Professor (national average salary $88,490)
- Registered Mental Health Nurse (national average salary $77,280)
- Mental Health Technician (national average salary $67,430)
- School Psychologists (national average salary $66,642)
- Recreational Therapist (national average salary $60,689)
- Guidance Counselor (national average salary $48,992)
MENTAL VS. BEHAVIORAL HEALTH
Now that we’re conscious of who makes up the mental and behavioral health workforce, let’s go back to basics.
How are they different?
How does each affect us as individuals?
Mental health revolves around an individual’s social, emotional, and psychological well-being. According to the World Health Organization (WHO), mental health is defined as a state of well-being where individuals realize their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and are able to contribute to society.
While on the other hand, behavioral health revolves around the impact an individual’s habits have on their physical and mental health. There are several factors that can affect your behavioral health such as diet, medication, exercise habits, alcohol and drug use, relationships, chronic health issues, trauma etc.
It’s essential to know that both mental and behavioral health have a reciprocal connection, meaning our behavior can influence our thoughts just as our thoughts can influence our behaviors.
According to the Diagnostic and Statistical Manual (DSM-5) of mental disorders, there are approximately 300 types of disorders. Some of the most common disorders include:
- Personality Disorders – People with personality disorders struggle with following thinking patterns and behaviors that deviate from the norm, causing problems in their day-to-day.
- Substance Use Disorders and Addiction – A very serious and fatal disease. People suffering from addiction often continue to use substances even when it hurts their personal relationships or even causes health issues.
- Eating Disorders – A complex and serious mental health condition causing severe health problems, even death. Common eating disorders include anorexia nervosa, bulimia nervosa, avoidant/restrictive food intake disorder and binge eating disorder.
- Psychotic Disorders – People with psychotic disorders struggle with abnormal thoughts and perceptions of others.
- Trauma-Related Disorders – The most widely known disorder. People who experience physical abuse, combat, and other types of severe illness tend to develop post-traumatic stress disorder.
- Mood Disorders – People who struggle with mood disorders often suffer from depression, bipolar disorder, seasonal affective disorder, premenstrual dysphoric disorder etc.
COVID-19’S IMPACT ON THE ONGOING MENTAL HEALTH CRISIS AND THE EVOLUTION OF PSYCHIATRIC CARE
As previously discussed, taking care of our mental health is important because it’s a vital part of our life which can impact our thoughts, emotions, and behaviors.
Being “mentally healthy” is a positive. It can make us more productive and effective in everyday activities such as work, school, parenting, etc.
It might seem like when the COVID-19 pandemic outbreak first occurred, a lot of people started reporting and seeking mental health services. However, did you know that prior to the pandemic, 19% of adults were already experiencing a mental illness?
America has been facing a mental health crisis since long before COVID-19 and things aren’t getting any better.
So how exactly did the worldwide pandemic affect the ongoing mental health crisis?
The COVID-19 pandemic had a disastrous effect on the mental health of the entire nation. We can all agree that the risk of contracting the virus alone caused a traumatizing event for everyone.
But in addition, COVID-19 led to change in our physical and social environments which led to greater rates of isolation, loneliness, financial hardship, housing and food insecurity and interpersonal violence – all affecting the mental health crisis of the nation.
To be more specific, let’s look at Mental Health America’s (MHA) 2021 State of Mental Health in America report to understand how society was affected:
- Suicidal ideation among adults increased by .15% (or over 460,000) people from last year.
- 24% of adults with a mental illness reported an unmet need for treatment (this number has not declined since 2011).
- 7% of youth in the U.S. have severe major depression; this rate was highest among youth who identify as more than one race at 12.4%.
- 60% of youth with depression do not receive any mental health treatment; even in states with the greatest access 1 in 3 are going without treatment.
- Even among youth with severe depression who receive some treatment, only 27% receive consistent care.
- 8% of Americans with a mental illness are uninsured; this increased for the first time since the passage of the affordable care act.
In 2014, MHA created an online screening program which includes a collection of ten free, anonymous, confidential and clinically validated screens that are among the most used mental health screening tools in clinical settings.
Overall, through September 2020, over 6M people have taken a screen.
But more specifically, from January to September 2020 (during the peak of COVID-19), approximately 1.5M people have taken a screen. From these 1.5M people, the data collected tells us that:
- The top 3 screens taken were for depression (35%), anxiety (20%) and bipolar (17%).
- 73% of screeners identified as female, 25% identified as male and 2% identified as another gender.
- 38% of screeners were youth ages 11-17, a 9% increase over 2019.
- Approximately 315K people took the anxiety screen, a 93% increase over 2019.
- Approximately 534K people took the depression screen, a 62% increase over 2019.
- 77,470 youth reported experiencing frequent suicidal ideation.
The pandemic not only affected society in general, but it disrupted the entire U.S. healthcare system.
Here are some key highlights from a Psychiatry Research study to understand how COVID-19 affected psychiatric care:
- In outpatient settings, the biggest changes occurred thanks to telehealth. When the pandemic outbreak first occurred, the U.S. government temporarily waived numerous regulations as well as regulatory barriers to allow for various platforms to be used nationwide.
- In inpatient settings, no visitor policies and suspension of group activities were implemented in select facilities as well as the tightening of admission criteria.
- When it came to consultation services, hybrid models were implemented to leverage all available resources. Plus, triaging, and determining whether patients were going to be seen in-person, via phone or video.
- Overall, clinicians experienced stress, anxiety, and fear plus they were affected financially and ethically. They also had specific concerns when it came to COVID-19.
Even though COVID-19 disrupted mental health services in 93% of countries worldwide, the pandemic has also allowed for psychiatric care to evolve.
Here are some highlights of what psychiatric settings have done to adapt and continue evolving:
- Outpatient psychiatric care now includes several virtual modalities (telehealth, telepsychiatry, work from home/virtual trainings etc.)
- Patients referred for inpatient psychiatric admission are immediately given a rapid COVID-19 test prior to being evaluated by a psychiatrist and being admitted to an appropriate unit.
- In emergency room cases, patients are given the choice to consult with a physician via telephone (if they don’t need to be seen in person). If they do, all personnel including patients are following social distancing guidelines plus the use of masks.
- To help mitigate the risk of infection among healthcare staff, some healthcare systems have transitioned to a shift work model.
- Leadership at many inpatient psychiatry settings are making the necessary changes to keep patients and staff safe by working together, communicating, and producing the best solutions. Some changes that occurred included:
- Screening, re-screening, PPE, use of designated clothing, cleaning of surfaces, disinfection etc. were implemented to prevent the spread of COVID-19.
- Medical student(s) visits were minimized.
- Back-up pools and job reassignments for physicians were created (as needed).
- Isolation rooms in psychiatric inpatient units were created.
- The number of visitors were restricted.
- The criteria for psychiatric admission were tightened.
- Changes to group therapy sessions (i.e., limiting the number of participants, utilizing social distancing) were implemented.
- Psychiatric care on the consultation-liaison service started using virtual methods to provide care. But, in some cases, hospitals continued to see patients in the emergency room and obstetrics floor depending on the severity of the case, with the appropriate use of PPE.
- Select state-supported community behavioral health organizations and programs of assertive community treatment developed COVID-19 response protocols for various settings such as shelters, mental health group home residences, clinics, home visits, etc.
- Several states implemented policy, regulatory and payment reforms for the provision of remote telehealth, access to residential care staff and medications, and financial support for community-based services.
- Psychiatric residencies were and to date are producing creative ways to train residents.
As the pandemic continues, and the demand for mental health services increases, we must remain positive to produce solutions that address these issues while allowing us to evolve.
TOP MENTAL AND BEHAVIORAL HEALTH TRENDS IN 2021
COVID-19 is always going to create a positive and negative impact.
However, as a nation, we must continue to face those challenges to innovate and evolve.
The evolution of psychiatric care is the perfect example of how, we came together to find solutions and revolutionize healthcare.
Because of this, new trends in the mental and behavioral health space emerged.
Here are 7 mental and behavioral health trends to look at:
- Increase Demand for Behavioral Health Services – Demand for behavioral health services jumped tremendously in 2020 due to the COVID-19 pandemic. Even though its well over a year in a half since the coronavirus outbreak, millions of Americans are still struggling with unemployment, depression, uncertainty etc. and so mental and behavioral health services are expected to continue rising past 2021.
- Employee Mental Health/Wellbeing Becoming A Budget Line Item – As we just mentioned, millions of Americans are still facing mental and behavioral health challenges, which can impact job performance, productivity and retention. With that in mind, organizations have recognized the importance of investing in mental health and wellness benefits (i.e., counseling, yoga, flexible scheduling etc.) for their employees as this can have a positive impact on productivity, retention, workplace satisfaction, job performance, employee engagement and more.
- Telehealth and Telepsychiatry – Thanks to COVID-19, telehealth and telepsychiatry emerged and is still being used today to deliver mental and behavioral health services. Telepsychiatry allows for individuals across all populations and socioeconomic status to have access to cost-effective mental health care, creating a sense of safety, security, and privacy for many patients.
- Measuring Patient Outcomes – Access to mental and behavioral health has increased – and, while providers are focused on providing care to patients, they need to know how to measure the impact of the care they are delivering. Billions of funds have been poured into the behavioral health industry; therefore, healthcare leaders should educate providers on how to measure care outcomes, define measurement-based care etc.
- Behavioral M&A Activity – As the demand for behavioral health services continues to rise, the more investor attention is it expected to gain – especially since volumes and financial performance of numerous elective and procedure-based provider sectors haven’t returned to pre-COVID-19 levels.
- Increase in Federal Funding – Trillions of dollars have been allocated to the behavioral health industry since the start of the pandemic to help address the nation’s mental health. With these funds available to mental health organizations, their role is to provide sound mental health care; otherwise, organizations lacking good quality clinical care will fade.
- Financial Failures – Even with the billions of dollars that have been allocated to the behavioral health industry, there are still some providers that will be forced to close doors. Financial failures will most likely continue this year as providers continue to deal with decreased revenues, increased costs, overworked staff among other challenges.
RECRUITING AND RETENTION BEST PRACTICES
The key to growing your practice and keeping patients happy is to have the right team.
But putting together the right team is not as easy as it sounds.
There are many items you must analyze and evaluate prior to starting your recruiting journey. Some of those items include:
- Taking a deep dive into your industry to understand current staffing challenges
- Analyzing your existing recruiting process (even if you outsource all recruiting efforts) to see what works and what doesn’t
- Determining what your staffing needs are
As you can see, point 1 and 2 are straightforward.
However, point 3 is a little more complicated as most medical practices are unsure of how to truly identify what their staffing needs are.
With that said, at MASC we’ve taken our knowledge and expertise to come up with 3 tips to help healthcare organizations identify their staffing needs. Let’s explore what they are:
- Assess Your Overall Practice: Take some time to assess how your practice is running operationally. By asking yourself key questions, you’ll be able to identify what your specific staffing needs are. Here are some questions to consider:
- Am I content with the way our practice is currently running?
- Are my staff and patients satisfied with the way our practice functions?
- Do I need to retain the same number of employees prior to the pandemic?
- How have employee roles shifted?
- Could job descriptions be more clearly defined?
- What tasks can be automated?
- Identify The Type(s) Of Candidates Your Practice Needs: Based on what you learned from your practice assessment (step 1); you might have identified that your practice needs additional staff. If that’s the case, create a list of your ideal care team (including their status – full-time, part-time, short, or temporary). Remember, your ideal care team should include a combination of primary care and behavioral health professionals.
- Define What Skill Sets and Credentials Your Practice Needs: Now that you’ve identified the type of candidate(s) your practice needs, it’s time to develop a detailed list of skill sets and credentials you are looking for. The list should show what is a must (non-negotiable) and what is nice to have but not required (negotiable). When doing this exercise, keep in mind your practices’ culture and the type of patients you serve. During this step, it’s important to be flexible, and don’t forget that not every candidate will have all the skill sets and credentials you require but that some can be trained.
Now that you’ve assessed your existing recruiting process and identified your staffing needs, the next step is to source candidates.
- Website: Leverage your website! Your website allows potential candidates to immerse themselves on who you are, your mission, vision, services, etc. Most important, it gives professionals a sense of your culture and what to expect if they take on the opportunity. Add a website link to your online job posts and make sure to leverage your careers page (if you have one).
- Hiring Sites: Hiring sites likes Indeed, Glassdoor and LinkedIn are great opportunities to source qualified candidates. But let’s be strategic as to what sites you decide to post on. Track the last couple of successful hires you’ve had and 1) identify what site(s) they applied from and 2) which sites gave you the best interviews. Once you have this information, create and post jobs on those sites.
- Email Marketing: Establish an ongoing email marketing campaign (including active and passive candidates) where you can promote your organization and connect with candidates daily while letting them know what jobs you have available.
- Internal Advertising: As an employer, it’s important to remember that internal candidates are an important source (group of people) to fill vacancies. Give them an opportunity. Many times, healthcare professionals are looking for organizations that provide room for growth – and this is one way to attract and retain them.
- Referral Program: According to LinkedIn, 48% of new hires come from employee referrals. Develop a referral program where both the referrer and referral get paid after 6+ months of being hired. Many times, referrers look after the person they’ve referred and help with onboarding and training which is a plus for the employer.
- Physician Recruiters: There are many benefits to partnering with a physician recruiter. One, they can help your practice overcome current staffing challenges. Two, they have extensive knowledge, experience, professional network and more. If you are considering going this route, first determine if it’s the right time to hire a physician recruiter. Then do your research, reach out and schedule a meeting to ask key questions to learn more about them.
Lastly, now that you’ve assessed your existing recruiting process, identified your staffing needs, and sourced candidates; let’s spotlight what types of recruitment and retention strategies leading healthcare organizations have in place to succeed.
Recruiting Strategies: When recruiting, highlight who your organization is, the type of candidates you’re looking for, why candidates should apply, and information about the region/community. Don’t forget to put a huge spotlight on the benefits that come with the opportunity (i.e., competitive compensation, sign-on bonuses, relocation stipend etc.)
Retention Strategies: Onboarding a candidate can cost anywhere between $200,000 to $300,000+. Therefore, medical organizations do everything in their power to retain candidates. Some ways medical practices retain candidates are by:
- Accommodating a flexible schedule.
- Creating a sense of belonging.
- Offering mentoring programs and career advancement opportunities.
- Addressing burnout and giving physicians autonomy to practice.
- Recognizing employees and more.
IMPROVING MENTAL AND BEHAVIORAL HEALTH –A GLOBAL CHANGE
The mental and behavioral health crisis in America has been around for years.
COVID-19 brought this crisis to light making it worst.
Now is the time to come together to create a global change.
To find solutions that improve health, reduce health care costs, and create a stronger, healthier, and more productive society/workforce.
So, what does the future of behavioral health look like?
The future looks bright thanks to the 6 disruptive factors that have the potential to drive change.
Let’s identify what those are.
- Cultural and Behavioral Change: The stigma about the behavioral health illness is starting to lessen because of the cultural and behavioral change that is occurring:
- 60% of U.S. adults ages 18-25 view seeing a behavioral health provider as a sign of strength.
- Governments are increasing investment in behavioral health; they are creating public discussions and enacting policy that integrates population-level behavioral health.
- Employers are emphasizing the importance of behavioral health.
- Scientific and Technological Advancement: Behavioral health specialists and researchers are beginning to explore the foundations of behavioral health to get greater understanding of genetics, neuroscience, endocrinology, and other relevant fields. New treatments are expected to be cost-effective, and customized while improving treatment efficacy.
- Increased Access to Care: It is believed that cultural change and cost-effective scientific breakthroughs will lead to better access to care for all. We are already seeing that with the way consumers share data as they engage in telehealth, how organizations are starting to develop behavioral health resources tailored to minority communities, how AI is playing a role by helping triage patients and delivering customized solutions based on individual needs etc.
- Data Sharing: As mentioned in point 3, consumers are more willing to share data today. It is predicted that in the future, consumers will have the capability to systematically access and control all their data within a safe data environment guaranteeing privacy and data blinding. By increasing data sharing, organizations and providers will be better informed of the current state of a person, allowing for proactive identification of potential behavioral health issues before they rise.
5. Interoperable Data: It is predicted that data sharing will be underpinned by interoperable data built on universal standards and carried on a personal, longitudinal life record. This record will collect data (i.e., holistic, lifestyle information etc.) to help identify issues and opportunities with comorbidities. Standardizing health platforms and electronic health records will help enable the aggregation of data lakes. Organizations will then apply AI to this data to predict early behavioral disorders and recommend interventions to improve outcomes.
6. Empowered Consumers: With the changes occurring, it is believed that consumers will gain more access to high-quality care while having increased control over treatment modalities. Consumers will have the opportunity to choose highly personalized health tools for self-care, gaining the opportunity to sustain their health independently. Additionally, they will have the ability to evaluate providers prior to treatment, choose services outside of the traditional services offered (i.e., telehealth), monetize data if they choose too etc. – resulting in providers and organizations becoming more consumer-centric.
Now that we are well immersed in the 6 disruptive factors, for change to happen, key players across the mental and behavioral health space must take the necessary steps to seize all possible opportunities.
So, what are some steps key players can take?
Public and private insurers should consider:
- Developing customized mental and behavioral health plans for all members –supporting proactive care and prevention built from data collected.
- Gaining greater access to consumer data to pinpoint behavioral health insights while getting a deep understanding of the drivers of health and clinical symptoms of behavioral diseases.
- Broadening the types of behavioral health care networks offered to members.
Care providers should consider:
- Leveraging emerging technology for interventions occurring in both inpatient and outpatient settings. Providers must systematically incorporate technology into care delivery at every step of their patient’s journey.
- Augmenting workforce capacity via community and in-home behavioral health care to ensure patients receive treatments as soon as possible.
- Implementing value-based financing models to compensate providers based on the overall quality of care.
Employers should consider:
- Incorporating employee assistance programs that offer high-quality, behavioral health support that allow employees to pursue their well-being holistically.
- Demonstrating to employees (by assuring them) that engaging with their behavioral health at work will not harm their career trajectory.
- Appointing an ethics and health data protection officers to manage and protect employee data.
Government policymakers should consider:
- Prioritizing new investments in behavioral health solutions (local and on a national level).
- Ways to systematically enable monitoring and care by leveraging new technology.
- Creating organizations that support and help manage the ethical and regulatory areas that exist within the behavioral health space.
Changing the way society views and understands mental and behavioral health is not something that happens overnight.
But we know if mental health goes unaddressed it can have a negative influence in society – homelessness, poverty, employment, safety, local economy and more.
From what we’ve read and uncovered, the future of mental and behavioral health looks bright, and we have the potential to drive change as public and private insurers, care providers, employers, government policymakers etc.
Millions of people worldwide suffer from a mental health condition.
It’s a global issue that has been around prior to the COVID-19 pandemic. However, thanks to the global pandemic more light has been shed on this along with other challenges.
On the positive, trends emerged, and solutions risen that not only allow the behavioral health industry to evolve but to also transform and overcome its challenges.
So, act today and help continue to stir up positive mental health.
As a result, we will generate value on various levels – better health and wellness, relationships, higher educational achievements, enhanced productivity, and overall improved quality of life among societies worldwide.