Brief Psychiatric Specialists, Technicians and Aides

State legislators are looking for ways to alleviate the health care worker shortage and increase access to behavioral health services. States may leverage a variety of behavioral health professionals-including those with bachelor's degrees or high school diplomas (or equivalent) and professionals in training-to ensure access to care. These professionals may expand access to services in underserved areas and establish a career pipeline to behavioral health occupations that require postgraduate education.

The Bureau of Health Workforce identified provider-level barriers, "such as limited scope of practice, reimbursement challenges and clinician burnout" as limiting the availability of high-quality behavioral health care across the United States. Nationally, there are substantial shortages of addiction counselors, marriage and family therapists, mental health counselors, psychologists and psychiatrists projected by 2036. Rural counties are more likely than their urban counterparts to lack behavioral health providers, and rural residents are more likely to receive behavioral health services from primary care providers.

Training and Education

Historically, the behavioral health workforce has included professionals that must complete a master's degree or higher, in addition to supervised clinical training requirements. These include mental health counselors, clinical social workers, marriage and family therapists and psychiatric advanced practice registered nurses. State-level education requirements for psychiatric technicians and aides vary. Psychiatric technicians typically require a postsecondary certificate, and aides require at least a high school diploma or equivalent.

States consider various education and training initiatives to support these professions. Utah established its Office of Professional Licensure Review through legislation in 2022, which was charged with reviewing the occupational licensure regulation of every occupation licensed within the state. The office began with a review of behavioral health occupations, and identified a gap in the career pipeline among bachelors-level behavioral health occupations. The office recommended the state provide additional opportunities for individuals to enter the behavioral health workforce through extender roles, including a one-year Behavioral Health Technician voluntary certification and bachelor's-level generalist license. Utah established a certification process for behavioral health technicians in 2024.

Several higher education institutions have developed new educational pathways into behavioral health professions (including child behavioral health specialist training by the Ballmer Institute at the University of Oregon and mental health assistant training the Northeastern Ohio Medical University). Washington codified behavioral health support specialists in statute in 2023, and appropriated $70,000 in fiscal year 2023 for University of Washington to develop a licensure and regulatory program. Behavioral health support specialists must be 18 years or older, complete background check requirements and complete a clinical training program developed by the University of Washington. These professionals are not allowed to make diagnoses but may track and monitor treatment response and outcomes.

Licensure and Scope of Practice

States are responsible for setting the licensure requirements for health care occupations and the scope of practice for licensed professions with the aim of protecting the health and safety of residents. Behavioral health occupation licensure requirements vary greatly, and services each profession is allowed to provide reflect the education and clinical training requirements.

Several states have established licensure programs for trainees or graduates who have not yet completed the required number of supervised clinical hours for full licensure. Arkansas licenses associate counselors and requires them to practice under the direct supervision of a licensed professional counselor. Applicants for associate counselor licensure must meet all requirements for professional counselor licensure, except for 3,000 supervised client contact hours. Once they complete the necessary supervised client contact hours, they may petition the board for licensure as a professional counselor.

Delaware offers limited licensure for a Licensed Associate Counselor of Mental Health for applicants that meet all requirements, except for the requirement of two years of supervised professional mental health counseling experience. Rhode Island established an entry-level licensing program for mental health counselor and marriage and family therapist associates to practice under supervision prior to becoming a licensed mental health counselor or a licensed marriage and family therapist.

In addition to creating licensure and certification paths for students or graduates of masters programs, states may also establish licensure pathways for entirely new occupations, which includes defining the scope of practice-or the activities professionals are allowed to perform under their licensure or certification-within the state.

Virginia established a licensure process for behavioral health technicians, behavioral health technician assistants and qualified mental health professional trainees in 2024. Each occupation is limited to delivering collaborative behavioral health services. Those are services that are provided under the direction and in collaboration with a licensed mental health professional or another professional licensed under the Boards of Counseling, Psychology or Social Work.

Recruitment and Retention

In addition to establishing a career pipeline into traditional mental health occupations, states may also bolster the health workforce through other recruitment and retention strategies. These may include scholarships, loan repayment or forgiveness and workforce development initiatives.

Colorado established a scholarship and loan repayment program for behavioral health professionals in 2022, and established a feasibility study in 2023 to determine career pathways into behavioral health occupations for individuals with serious mental illness. Iowa also established a loan repayment program in 2022 for master's level mental health professionals in psychology, counseling and guidance, social work, marriage and family therapy or mental health counseling.

Georgia tasked its Office of Health Strategy and Coordination (OHSC) with developing solutions to barriers impeding the delivery of behavioral health services in 2022. Following OHSC recommendations, the legislature appropriated more than $400,000 in 2023 to implement several recruitment and retention initiatives, including College Completion grants, the HOPE Highschool Equivalence program, HOPE Career grants and the Behavioral Health Service Cancelable Loan program.

Oregon and Vermont authorized agencies to conduct studies on licensure processes for behavioral health professions, including mitigating barriers to practicing in underserved communities. Nevada established a Behavioral Health Workforce Development Center to build relationships with K-12 school districts, postsecondary institutions, occupational licensing boards and other public and private entities to establish pipelines into behavioral health careers.