As the Illinois General Assembly continues the state’s 103rd legislative session, legislators and behavioral healthcare organizations are focused on the field’s workforce shortage.
Sonya Leathers, PhD, director of the Behavioral Health Workforce Centers at the University of Illinois Chicago, discussed the severity of the shortage in legislative committee meetings last month.
“In 2021, the American Association of Medical colleges reported that Illinois has the capacity to meet just 24 percent of the mental health needs of the state with the current workforce,” Leathers said.
She also noted that 9.8 million Illinoisans live in a designated mental health professional shortage area, and that Illinois has the eighth largest number of shortage areas in the country.
“You’re not going to solve this without a systemic strategy,” Andy Wade, executive director of the National Alliance on Mental Illness (NAMI) Illinois, told State of Reform.
Wade said NAMI has been watching the bills coming through the legislature and many positive things are happening. However, he said there needs to be a stronger focus on the front end of the pipeline.
“In terms of legislation I think that we’d like to see—we’re not seeing too much that is developing the front end of the pipeline. I understand the complexities of it. One, the provider communities are really focused on immediate things like getting enough supervisors and incentives when people are moving from one Master’s level to a PhD level. But you want to build the scale and the reach and certainly diversity that reflects the state of Illinois. The actual workforce begins much earlier, and that’s where we lose the most talent.”
— Wade
One of the issues in Illinois is that mental and behavioral health, workforce development, and higher education are all spread across multiple state agencies, he said.
“My read is one reason why the talent pool, the front-end, [and] the pre-workforce doesn’t get as much attention is because you have to navigate more space,” Wade said.
Kari Wolf, MD, chair of psychiatry at Southern Illinois University’s School of Medicine and chief executive officer of the Illinois Behavioral Health Workforce Center, made some of her own recommendations to the lawmakers at the meeting.
The recommendations included streamlining healthcare professional licensing to decrease administrative burden, expanding pathway and mentorship programs to increase early interest in the field, and developing post-grad training programs so healthcare professionals can learn more specialized skills after graduation.
She also recommended expanding clinical training programs and sites across the state, better Medicaid reimbursement rates, continued retention strategies to keep the current workforce, and improved parity laws.
Tony Ohlhausen, director of research and policy with NAMI Illinois, discussed two identical bills introduced in January that would modify parity laws: House Bill 4475, sponsored by Rep. Lindsey LaPointe (D-Chicago), and Senate Bill 2896, sponsored by Sen. Karina Villa (D-West Chicago).
“NAMI Illinois is kind of supporting this bill that would address parity issues in commercial insurance,” Ohlhausen told State of Reform. “Similar to what we see in Medicaid, there are many administrative barriers in commercial insurance plans that are regulated by the state of Illinois that make it hard for people to access behavioral healthcare in ways that we don’t see people struggling to access physical healthcare.”
Ward highlighted how these bills directly address the workforce shortage by making it easier for behavioral health providers to be in-network.
“If the providers are not in-network, they can’t get paid or the patients can’t access it,” he said. “The workforce side of it is, can providers be paid for providing services? If providers can’t be paid for providing services across the board, there are very few incentives, it lessens the incentives for people to get into the business.”
Ohlhausen said the bill would also increase access to care for the patients.
In terms of Medicaid reimbursement for behavioral healthcare workers, Wade said there has been progress on increasing these rates.
However, there are also concerns surrounding the administrative burden that providers working with Medicaid-covered clients face compared to those who are out-of-network or those who only accept commercial insurance.
One element of administrative burden is the Illinois Medicaid Comprehensive Assessment of Needs and Strengths (IM+CANS) instrument. Providers who have Medicaid-covered patients must fill out IM+CANS forms for that patient to assess things like their risk behaviors, trauma, substance abuse history, physical health, and behavioral and emotional needs before the patient can receive care.
“I know anecdotally that we have had staff leave for private practice, and they have cited the burnout associated with administrative burden,” said Kelly Epperson, chief of staff at Rosecrance Behavioral Health.
“… [Behavioral health providers’] electronic health records are actually set up differently depending on funding source. It just adds, honestly, to the cognitive burden of the clinician to be like, ‘What funding source does this person have? How am I going to document?’ And then it’s a different treatment experience for the client.”
— Epperson
Wade also said more focus needs to be put on what services Medicaid will reimburse for, because oftentimes more specialized mental health services that require more training are less likely to be covered by Medicaid.
He mentioned dialectical behavioral therapy, a form of therapy used to treat borderline personality disorder, as an example of a specialty form of therapy that is often left out of Medicaid.
NAMI has programs to bolster certain areas of the workforce. One pilot program they are working on now will begin in the fall.
“It’s a career exposure mentoring program for high school kids so that they see that mental health professionals can look like [them], and this is what [they] need to do to get ready for college, or to pursue that,” Wade said. “The fact that that doesn’t already exist in mental health is surprising, because it exists in almost every other field.”
He said pilot programs like this can be used as examples to test ideas and highlight issues or successes, but that it is not a systemic fix.