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Behavioral Health Facilities Closer to Meeting Demand, But Shortfalls Still Exist

Jun 11, 2021 1:01:13 PM

There has long been a gap between the supply and demand of specialty behavioral health establishments. The good news is the gap is finally closing. The bad news? Demand still outstrips supply, according to a study by Indiana University and University of Michigan researchers.

As Number of Establishments grows, So Do Wages and Workforce

The researchers found that between 2011 and 2019 the number of specialty behavioral health establishments increased by a cumulative 34%. Broken down by establishments, that increase translates as follows:

  • 46%: Outpatient

  • 29%: Hospitals

  • 22%: Residential

As the number of behavioral health facilities has grown, so too has the average wage for residential workers and the size of the outpatient workforce, the latter of which is reflected in the following numbers:

  • 33%: Outpatient

  • 23%: Residential

  • 5%: Hospitals

How impressive are these numbers for behavioral health practices? By comparison, the increase in the total employment in the entire healthcare sector was 20 percent.

Published in the Journal of Substance Abuse Treatment, the study is the first to examine recent changes in the specialty behavioral health workforce and the job characteristics, specifically wages, for individuals working in these settings.

"Limited availability of specialty behavioral health providers is often reported as a key barrier to filling treatment gaps," said Thuy Nguyen, research assistant professor at the University of Michigan School of Public Health and lead author of the study. "Through our study, we found increases in the number of establishments, employees and average wages in the treatment sector in recent years, which may indicate that the specialty behavioral health workforce is responding to the increased need for treatment."

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Despite Encouraging Growth, More Must be Done to Address Increasing Drug Overdose Mortality

Researchers say that while increases in specialty behavioral health establishments are important in closing the gaps in needed treatment, more work needs to be done to improve behavioral health workforce deficits, especially in areas with an elevated drug overdose mortality rate.

Concern about drug overdoses, of course, is well-founded. Over a 20-year period from 1999 to 2019, 841,000 people died of overdoses in the United States. That's a frightening number of deaths, but it doesn't explain the rising rate of overdose deaths. Consider these staggered rates and dates:

 Year 1999 2004 2009 2014 2019
 U.S. Overdose Deaths 16,849 27,424 37,004 47,055 70,630


 The majority of these deaths are attributed to the opioid epidemic that took root during the 1990s and has since spun out of control. It's an alarming trend that got even worse during a 12-month span ending in September 2020, when the CDC reported 90,000 overdose deaths. 

It's also a trend that goes a long way toward explaining a seemingly exhaustive demand for substance use disorder specialists, not just for those addicted but for their families, friends, and communities. 

At the county level, researchers found that the growth of residential treatment facilities was positively and significantly associated with the county's drug mortality rate. They did not observe a similar positive association in other settings, including outpatient clinics and hospitals.

"The good news is that this new data resource we've assembled documents a growth in the number of establishments and in the workforce, meaning an increase in treatment capacity. However, the growth in the need for treatment still outpaces available resources, as the number of overdose deaths continues to rise."

Kosali Simon, co-author of the study and a Herman B. Wells Endowed Professor in IU's O'Neill School of Public and Environmental Affairs

Using a longitudinal dataset from the U.S. Census Bureau, the study quantified national and county-level changes in specialty behavioral health workforce outcomes and assessed associations between these measures and age-adjusted drug mortality rate — rates that increased by 4% from 20.7 to 21.6 per 100,000 from 2018 to 2019. The study described specialty behavioral health workforce outcomes in 3,130 U.S. counties between 2011 and 2019.

The study stratified workforce outcomes, including the number of establishments, the likelihood of having establishments, mean number of workers and average wage of workers per county by service settings: outpatient, residential, and hospital.

InSync's Specialty EHR Software Supports Mental Health Practices Through Transitional Growth

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Journal of Substance Abuse Treatment:
Where did the specialty behavioral health workforce grow between 2011 and 2019?

Centers for Disease Control and Prevention:
Drug Overdose Deaths Remain High
Understanding the Epidemic



Andy Smith

Written by Andy Smith

Andy brings his passion for writing and editing, along with decades of experience, to research and compose stories that keep healthcare InSync. His articles take a deep dive into the trending and relevant issues of mental health, interoperability, physical therapy, speech therapy, substance abuse treatment, and CCBHC's - bringing clarity to the effects of emerging technology and Electronic Health Records on today's top healthcare stories.