Op-ed: We can’t address our substance use crisis without addressing our workforce shortage

Marjorie Page, Behavioral Health Manager at Community Health Care, and Claudia D’Allegri, Senior Vice President and Chief Behavioral Health Officer at Sea Mar Community Health Centers, wrote the following op-ed on a solution to improve Washington’s behavioral health system. 

There is widespread agreement among policymakers in Olympia and communities across the state that we must invest in our behavioral health system. As we deal with such crises as homelessness and substance use dependency, the growing need for improved behavioral health care is clear. While the legislature and Governor Inslee have proposed significant dollar investments to fix these problems, there is a no-cost solution that shouldn’t be overlooked this session.

That solution lies with the people who are already on the front lines of our primary care system and have the potential to identify and treat mental health and substance use issues early on. Currently, Washington state has about 16,000 behavioral health clinicians, licensed as either psychologists, clinical social workers, marriage and family therapists, or mental health counselors, but fewer than four percent of them have a dual credential that lets them treat both mental health and substance use disorders. With a state population of 7.5 million people, we have only about 2,900 credentialed chemical dependency professionals. That’s an incredible shortage of professionals who are able to help people with substance use challenges.


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At community health centers, it is estimated that roughly 70 percent of patients have some type of behavioral health condition. And a substantial number of our patients are dealing with both mental health and substance use issues at the same time. Often people use alcohol or drugs to cope with untreated trauma, anxiety, depression, or other mental illness. It makes no sense to have our providers in separate silos when these issues are so often intertwined.

Because stigma still persists around seeking out behavioral health care, we often don’t identify these issues until a patient comes in to take care of a medical condition. Which is why the concept of integrated care is so powerful and is the future of effective health care. This means that behavioral health professionals must be in primary care settings, like our community health clinics, and these professionals should be trained to understand and provide both mental health and substance use care to better serve their patients.

There is a pathway for our mental health clinicians to also screen, develop treatment plans, and provide care to address substance use. But in practice it is nearly impossible for a professional working in the field to achieve a dual credential. It’s a burdensome and time-consuming process that prevents most clinicians from pursuing it. We need to streamline the credentialing process to support a more versatile workforce, utilizing the mental health clinicians we have to more effectively serve their patients when substance use is a factor.

With funding for our state hospitals and community psychiatric beds dominating the conversation, we can’t forget about improving our primary care efforts of prevention, early intervention, and ongoing treatment. We can increase our capacity to provide that care with new and expanded space at community health centers, which the legislature has taken a first step toward recognizing this session. We can also increase our capacity by supporting our workforce to better care for the full range of behavioral health conditions their patients have. The legislature can make that happen by creating a streamlined credentialing process that adds no cost to the state budget and enables mental health professionals to get the training and supervised experience they need to provide substance use disorder treatment. It’s not often that effective solutions are so straight-forward and inexpensive.


Marjorie Page is a Licensed Marriage and Family Therapist (LMFT) with an interest in integrated behavioral health. She began working as a Behavioral Health Consultant and the Behavioral Health Manager at Community Health Care (CHC) in 2016, and has worked both within CHC as well as with other Pierce County agencies to help move the integration of behavioral and physical health forward.

Claudia D’Allegri is a Senior Vice President and Chief Behavioral Health Officer at Sea Mar Community Health Centers. Claudia is responsible for Sea Mar’s outpatient and inpatient behavioral health programs, including four inpatient treatment centers and 39 outpatient clinics that provide a combination of mental health and/or substance use disorder outpatient treatment. Claudia is a minority mental health consultant for many organizations in Washington State, providing cultural diversity training and consultation on outreach to communities of color.  Claudia is also the co-chair for the King County Mental Illness and Drug Dependency (MIDD) committee – funded by the 1% sales tax in King County –, a board member for the Latino Civic Alliance, and a commissioner for the Seattle Police Department.