By the Policy Center for Maternal Mental Health Policy Team

In February 2023, the Senate Committee on Health, Education, Labor, and Pensions (HELP) requested information from stakeholders on the drivers and potential solutions to healthcare workforce shortages. The Policy Center for Maternal Mental Health (formerly 2020 Mom) submitted the following letter outlining our recommendations to increase the capacity and diversity of the healthcare workforce.

March 16th, 2023

Senate HELP Committee
428 Senate Dirksen Office Building
Washington, DC 20510

RE: Request for Information on the HealthCare Workforce Shortage

Dear Senators Sanders and Cassidy,

Thank you for allowing stakeholders to comment on the drivers and potential solutions to the healthcare workforce shortages. The Policy Center for Maternal Mental Health (formerly 2020 Mom) is an 11-year-old policy and “field catalyst” think tank whose mission is to close the gaps in maternal mental health care. We applaud the Senate HELP Committee’s dedication to removing barriers and improving access to mental health services. We are writing to propose solutions to the obstetric and mental health workforce shortages.

The following is our proposed solutions to the mental health care workforce shortage:

Prioritize ensuring enough Residency Program Placements exist to meet the growing PCP/OB-GYN need
Federal funding and guidelines could be provided to expand residency programs to meet the need.
Create a Healthcare Workforce Distribution Program/Agency that supports the distribution of the workforce
The Federal Government should develop a plan to distribute the healthcare workforce to address the HRSA workforce shortage areas. This program could tie to a medical doctor, midwife, mid-level provider, and behavioral health provider loan forgiveness program, where a provider agrees to serve a shortage area for seven or more years.
Expanding primary care provider capacity to address mental health by creating a “988 for Providers'' More specifically, creating a national consultation line for primary care providers to obtain real-time support from a psychiatrist to discuss a patient’s mental health with behavioral health professionals, including psychiatrists. Research shows PCPs are de facto mental health care providers and are treating depression but are not treating depression according to clinical guidelines, resulting in inefficient and often ineffective mental health treatment. A consultation program could address this. Such a service exists in many states for pediatricians. Still, it is a fundamental gap for PCPs who are being called on to provide mental health screening, preliminary diagnosis, and treatment plan development for depression and anxiety. This service could be modeled after the Health Resource and Services Administration (HRSA) - AIDs, National Clinical Consultation Center: https://www.hrsa.gov/grants/find-funding/HRSA-20-072
Growing the mental health workforce by providing Technical Assistance to potential employers of lay mental health professionals such as Community Health Workers (CHWs) and Certified Peer Support Specialists (CPSSs). These professionals are well-established and recognized by the Centers for Medicaid and Medicare Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA). State-sanctioned training and certification exist in all 50 states for CPSSs and are growing for CHWs, including Texas and California. However, a substantive and foundational barrier exists: potential employers like health systems and behavioral health clinics are unsure where to find these trained professionals and are unfamiliar with supervisory requirements and billing protocol. A National Technical Assistance Center for the Employment of Lay Professional Workforce, and grants to state public health departments to raise awareness of such a center, could change the trajectory and support the implementation of lay professions into the U.S. health system. Such a program could be housed under HRSA or SAMHSA, though it's important to note CHWs may provide a range of health care service support, not exclusively mental health services.
Asking health insurers/plans to develop and test robust novel new delivery systems. For example, CMS and the Department of Labor could require state Medicaid agencies and payors to use a continuous quality improvement (CQI) framework to pilot capitated behavioral health medical homes (that are connected, in a formal way, to primary care provider offices to promote behavioral health integration (BHI). Capitating behavioral health services will allow Medical Directors (aka psychiatrists) to oversee and provide comprehensive behavioral healthcare with a multi-provider team (certified peers, LCSWs/Counselors, psychologists) without the administrative burden they will continue to avoid. Provider and patient satisfaction surveys (of patients and caregivers) should be a part of required feedback loops to inform the CQI processes and to decrease provider administrative burden.

We appreciate your consideration of these recommendations, and we are grateful for this opportunity to share feedback. Please don’t hesitate to contact Sarah Johanek with questions or clarifications at Sarah.Johanek@PolicyCenterMMH.org.

Sincerely,

Joy Burkhard, MBA
Executive Director
Policy Center for Maternal Mental Health
Joy.Burkhard@PolicyCenterMMH.org

Sarah Johanek, MPH
Policy Project Manager
Policy Center for Maternal Mental Health
Sarah.Johanek@PolicyCenterMMH.org