Behavioral Health Integration and Workforce Development

States are paying increased attention to the behavioral health needs of their residents as part of larger strategies to improve health outcomes and make the healthcare system operate more effectively and efficiently. Behavioral health integration, or BHI, requires that the health and mental health systems are organized through integrated care models that address the full spectrum of health needs. Integrated care delivery and financing requires a workforce specifically prepared to practice in these new models. However, states have found that there is not sufficient supply, distribution, and training for this workforce, and there are legal and policy barriers to facilitate practice in these settings.

The Milbank Memorial Fund and the Reforming States Group (RSG) have a track record of work in this area, including convenings and presentations for state leaders on behavioral health integration. The Fund has published several reports documenting the evidence base for BHI and its effectiveness, including within specific populations such as pediatrics and individuals with serious mental illness. In 2017, the Fund conducted a technical assistance meeting for state health policymakers in which representatives from eight states met with national experts to discuss BHI program design as well as federal policy issues, quality measurement, and value-based payment models.

Supported by the Milbank Memorial Fund since 1992, the RSG is a bipartisan group of state executive and legislative leaders who meet annually to share information,  develop professional networks, and commission joint projects. In 2017, the RSG identified BHI workforce as a topic on which it wanted more information, and the Fund convened a workgroup comprised of RSG members to guide the project.

The group heard presentations from two leading state-focused organizations about work supported by federal and state grants related to behavioral health and workforce. These presentations focused on three areas that will be described in this report: state data collection, policy barriers to integrated practice models, and coordination of resources for training and recruitment. This issue brief grew out of these presentations as well as interviews with many experts from federal and state agencies and from various national organizations devoted to improving behavioral health services and outcomes.

Key themes emerged from the Fund’s research and the RSG workgroup’s discussion—namely, that to address BHI workforce needs systematically, states need to have dedicated and coordinated resources focused on:

• Assessing BHI workforce needs (i.e., how many practitioners and what types of practitioners are needed to support BHI programs);
• Identifying legal and policy barriers to practice that state policymakers can address to make BHI programs work more effectively; and
• Aligning workforce development resources based on state priorities and effectiveness of programs to train and retain these practitioners, particularly in underserved areas.

In this issue brief, case studies are used to illustrate these themes. The brief is intended to assist state policymakers such as legislators and executive branch staff who are responsible for BHI policy in their states. It may also be helpful to academic research organizations that could apply these findings and resources in the context of their research, operations, or evaluation activities for states.