Addressing our mental health crisis will require a multipronged approach. A centerpiece of these efforts must be workforce incentives to build a strong pipeline of mental health treatment professionals and to adequately compensate these positions, particularly community-based mental health professionals. Without workforce development initiatives, access to treatment will remain elusive for thousands because there are simply not enough workers.   

HIRE additional Community-based mental health professionals who treat and support individuals living with serious mental illnesses such as bipolar disorder or schizophrenia are a key segment of the mental health workforce. These professionals provide treatment and support at home or in the community rather than in a traditional clinic setting, which is essential for a population that is often reluctant to seek treatment due to a combination of mental health symptoms, frequent homelessness, unstable housing, and extreme poverty. Since 2011, the mental health professional workforce serving this population has decreased by 23%.    
 
There are a number of effective community-based treatment models for serving these individuals, including assertive community treatment (ACT) and coordinated specialty care (CSC). ACT was developed decades ago to facilitate community reintegration from psychiatric hospitals. Most of the services are delivered in the individual’s home or where the person is most comfortable receiving services, by a multidisciplinary team of mental health professionals. ACT continues to be very effective for managing symptoms and reducing housing instability and psychiatric hospital admissions. CSC, a community-based model for treating early psychosis, has been a major step forward for the early treatment of serious mental illnesses, with the potential to change the trajectory of illness. 

EQUIPING the mental health professionals necessary to do this kind of work, however, has been difficult. In home- or community-based, work has a different set of challenges than clinic-based treatment. For instance, community-based work has a wider scope of care than traditional therapy in a clinic, ranging from engaging people who may not want treatment, teaching daily living skills, addressing social determinants, and teaching illness self-management strategies. Community-based mental health professionals must also negotiate nontypical challenges more directly than their clinic-based counterparts, such as providing care in high-crime neighborhoods (because of lack of affordable housing in lower-crime areas) and working toward the care goals of stable housing or jail diversion. 

This work is often stymied by the multiple fragmented systems within which these professionals work. Not surprisingly, studies document higher rates of burnout for community-based mental health professionals compared to those who are clinic-based. This is compounded by extremely low Medicaid reimbursement levels, causing this important work to go significantly underpaid.  

MISSION

Grow the community-based mental health workforce:

MAINTAIN essential workers by Improving reimbursement rates for specific treatment models aimed at treating those with serious mental illnesses. Low reimbursement means providers that treat this population do not have the resources to hire enough professionals to treat those with the most significant conditions, thus limiting access to treatment. As a result, it can take someone with a serious mental illness years to get the right treatment, and treatment lags result in accumulating disability that can mean a lifetime of debilitating symptoms. Enhanced reimbursement would enable providers to hire more clinicians, thus growing access to care.

Modernizing these rules in ways that harness the community-based workforce, allowing for innovation, staffing flexibility, and the integration of mental health and substance use treatment with other medical care, combined with paying for positive health outcomes, would not only improve the quality of care delivered but also would reduce workforce burnout and turnover. 
We hope policy makers will take action to support and implement these recommendations to grow the community-based mental health treatment workforce, and thereby improve access to treatment.

AWARENESS: Raising awareness of trauma about the individuals we currently serve.  

TRAIN: Train staff in the basics of trauma to become familiar with the values and terminology of trauma-informed care. Leadership recognizes that understanding and responding to trauma is essential to fulfilling the organization’s mission and institutes a change process

The Ultimate goal is to Moving the organization toward a trauma-informed organization, providing trauma informed care.