Challenges and complexities in quantifying the behavioral health workforce: Implications for tracking the behavioral health workforce in rural communities

Addressing the behavioral health workforce shortage, especially in rural underserved areas, has been a national priority to improve behavioral health outcomes in the United States. However, due to the lack of accurate and detailed data on the behavioral health workforce, it is difficult to identify priorities and develop policies and programs to address the shortage. The current workforce estimates rely on the licensure data which often introduce inaccuracies, and does not provide information on whether the provider is actually practicing; and if they are practicing, how much time they spend on clinical care. Also, the licensure data do not indicate what location(s) and setting(s) the provider practices. The complexities in quantifying the workforce are not widely reported in the literature, nor is the impact of these complexities on workforce planning and development well understood. In this chapter, we describe how a systematic approach to data collection through the University of Nebraska Medical Center's Health Professions Tracking Service (HPTS) can be used to actively track the behavioral health workforce practicing in a predominantly rural state. The HPTS maintains a database of Nebraska's healthcare professionals. Although, HPTS uses licensure data as its foundation, its database captures information not available through the state's licensure data and national workforce databases. Annually, HPTS provides professionals the opportunity to review and update their practice information to provide the most detailed, current, and accurate information available. We use the 2016 HPTS database to describe the geographic distribution of behavioral health professionals and discuss the complexities of workforce enumeration. Our analysis includes various types of behavioral health professionals including: psychiatrists, psychologists, advanced practice registered nurses, physician assistants, licensed independent mental health practitioners, licensed mental health practitioners, and licensed alcohol and drug counselors. We conducted a descriptive analysis to estimate the amount of time behavioral health providers spent with their patients. The time spent with patients, which is not available in most current workforce databases, may provide more accurate information for determining healthcare workforce shortages in underserved communities. The results show significant differences in the amount of time spent with patients across behavioral health providers, suggesting that some providers may have a greater impact on mental health outcomes. Additionally, our analysis highlights the geographic maldistribution in the supply of actively practicing behavioral health professionals between rural and urban areas. Finally, we discuss the policy implications by comparing enumeration methods in designating health professional shortage areas (HPSAs) in Nebraska.