People have been suffering from mental health issues in larger numbers since the COVID-19 pandemic started, but there aren’t enough health care providers to meet the growing need. An October report from the Massachusetts Health and Hospitals Association found that throughout the state, 25% of emergency department beds last year were occupied by persons awaiting behavioral health treatment. Of those waiting, many were children.
The 2022 Boston Community Health Needs Assessment, compiled by community health care organizations and institutions including the Boston Public Health Commission, identified addressing the demand for behavioral health providers and community mental health deterioration as a priority for Boston. The assessment called out provider availability and “a lack of culturally appropriate and linguistically congruent care” as two of the barriers people faced accessing care.
Now, the City of Boston is using indicators like the 2022 assessment to help residents get the help they need. A recent initiative from the Boston Public Health Commission is focused on recruiting diverse new members to the behavioral health workforce to address barriers to care.
Expanding the workforce
BPHC closed submissions Monday on a request for proposals that is meant to “expand, develop and implement new and existing efforts to recruit a diverse behavioral health workforce that meets the needs of all Boston residents and creates a sustainable pathway of workers in the City.”
“It’s our task to try to seize the moment,” Dr. Kevin Simon, chief behavioral health officer for the city, told Boston.com.
Two major goals of the proposal – outside of diversifying the workforce itself – are to recruit new members through increased enrollment in behavioral health programs and widen access to certification options in the field.
“One way that we could make a contribution is trying to find individuals and making a pathway toward a career in behavioral health, particularly for persons that are from historically underserved communities,” Simon said.
Samara Grossman, director of the city’s new Center for Behavioral Health and Wellness and a licensed independent clinical social worker, said a step toward providing better, effective care, is introducing health care providers who “reflect the communities that they’re going to serve.”
The city will be using American Rescue Plan Act funding for the selected proposal, which is scheduled to be announced in April.
Diversity in care
Nhi-Ha Trinh, a psychiatrist and director of the Psychiatry Center for Diversity, Inclusion and Belonging at Massachusetts General Hospital, told Boston.com she is happy to see the city providing resources and funding toward disparities in behavioral health care.
Diversity in behavioral medicine, she said, has been a longstanding concern for providers.
“It’s always been an important issue,” Trinh said. “What we’re seeing is an increasing recognition that, ‘Wow, we need to address these issues even more urgently than before.’”
Monique Willet, co-executive director of Behavioral Health at Fenway Health, told Boston.com that it strives to hire diverse candidates.
Having a diverse provider base is important for establishing “good” connections between patients and providers, she said. But she noted that it can sometimes be difficult to find providers who have identities similar to their patients.
The challenges associated with cultivating a diverse behavioral health workforce are “entrenched in larger issues of structural racism,” Willet wrote in an email.
“Many BIPOC people are not able to afford college, never mind grad school, which leads to a very small pool of BIPOC providers graduating each year,” she said. “Fenway Health’s focus on providing behavioral health services to the LGBTQIA+ community often further shrinks the pool of diverse candidates applying for open positions.”
At MGH, Trinh said they have similar efforts to what the city is moving forward with aimed at making behavioral health roles appealing to younger generations. The hope is that programs like the MGH Youth Scholars program, which seeks to attract high school learners to health and science, and partnerships with local higher education institutions will help bring more professionals into the field.
Trinh said that “representation is important,” and she knows her patients appreciate diversity.
She said the historically white practitioner workforce does not meet the needs of the evolving demographic population requiring care.
“My patients, they really look at who’s in the waiting room, not just the other patients, but also who are the providers that they see,” she said. “They really feel like they belong and feel included when the workforce reflects them as a community.”
Services for young people
Another factor being considered in the city’s request for proposals is the youth impact. On the national level, the U.S. Surgeon General has called youth mental health a crisis and made several suggestions to address the need, including that children are ensured access to care.
A 2022 study co-authored by Simon found that children from marginalized groups, including Black children and those who identify as a sexual minority, face greater disparities in mental health.
“We see a growing body of evidence that demonstrates not only is it worse, but it’s worse for those youth that are from marginalized populations,” Grossman said.
She said that while there is a youth focus to the program, behavioral health for young people and adults alike is a problem.
“We all feel at this time that ‘after COVID-19,’ behavioral health is just a large issue and we want to be able to address it,” she said. “It’s our duty to be able to use the funds in a way that helps everyone.”
Trinh, whose focus is on adult care, said ensuring young people are getting the mental health care they need has a long-term impact.
“If we really focus on the future generations early, really focusing on their mental health early, then they can become more successful and be their fullest selves as they grow up to become adults,” she said.
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