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This report analyzes and projects future needs related to California’s behavioral health workforce. This workforce is critical to meeting California’s health care needs. One in six adults suffers from mental illness and one in fourteen children has a serious emotional disturbance. While access to public and private insurance coverage for behavioral health services has improved substantially over the past two decades, many Californians with mental illness or substance use disorders do not receive treatment. To increase the likelihood that better coverage for behavioral health services will yield better access to treatment, California needs an adequate supply of behavioral health workers who are distributed equitably across the state and who reflect the demographic characteristics of the state’s population. These workers must also possess the skills and credentials necessary to deliver the type of behavioral health care (e.g., prescribing/medication management, counseling) that people need and participate in public and private health insurance plans. This report summarizes findings from analyses of data from multiple sources including licensing boards, the American Community Survey, the Occupational Employment Statistics program, and the Integrated Post-secondary Education Data System. Funding for this project was provided by the California Health Care Foundation.

Key Report Findings

• Ratios of behavioral health professionals to population vary substantially across California’s regions—the lowest ratios persist in the Inland Empire and San Joaquin Valley.
• African-Americans and Latinos are underrepresented among psychiatrists and psychologists relative to California’s population; and Latinos are also underrepresented among counselors and clinical social workers.
• Forty-five percent of psychiatrists and 37% of psychologists are over age 60 years and are likely to retire or reduce their work hours within the next decade.
• Wages vary widely across behavioral health occupations, as do the settings in which people are employed. Psychiatrists have the highest mean annual earnings and substance abuse and addiction counselors have the lowest mean annual earnings.
• California’s behavioral health trainees are not distributed evenly across the state. There are no residency programs for psychiatrists and no educational programs for psychiatric mental health nurse practitioners (PMHNPs) or psychologists north of Sacramento. There are no doctoral programs in psychology in the Central Coast and San Joaquin Valley regions.
• If current trends continue, California will have 41 percent fewer psychiatrists than needed and 11 percent fewer psychologists, licensed marriage and family therapists, licensed professional clinical counselors and licensed clinical social workers than needed by 2028. Additional behavioral health professionals will be needed to care for Californians with unmet needs for behavioral health services.

Top Recommendations and Action Areas

• Increase supply. California’s policy-makers need to simultaneously consider ways to increase the number of psychiatrists and expand models of care that rely less heavily on psychiatrists. Example strategies include utilizing psychiatric mental health nurse practitioners more extensively; transitioning to team-based models of care in which primary care physicians, physician assistants and nurse practitioners prescribe medications under the guidance of psychiatrists either in person or via telehealth technologies.
• Reduce geographic maldistribution. California needs to expand access to education in behavioral health professions in the Far North, Central Coast, and San Joaquin Valley regions. Possible models for expanding access to behavioral health training in underserved regions of California include providing clinical training in these regions or expanding access to didactic education via distance learning.
• Increase racial/ethnic diversity. California needs to increase racial/ethnic diversity in the behavioral health professions, particularly in psychiatry and psychology, to improve access to professionals with the same racial/ethnic and cultural backgrounds as the people they serve. Strategies for addressing this challenge include providing comprehensive academic, social, emotional, and financial support to underrepresented minority students at the undergraduate level in preparation for admission to professional school.
• Increase collection, analysis, and dissemination of workforce data. California needs to improve and expand the collection, analysis, and dissemination of data that can be used to describe California’s behavioral health workforce. Expanding data collection about persons who treat substance use disorders is especially important because existing sources of data provide little information about this workforce.