The mental health needs of youth have increased significantly as a result of trauma, social isolation, and other factors experienced during the COVID-19 pandemic. Financial and health challenges for families and strains on the health care system have also restricted access to care and exacerbated longstanding provider shortages in children’s mental health. States have responded by expanding children’s mental health services and supports, including initiatives to enhance school-based services, crisis intervention services, and recruitment and support of pediatric mental health providers. In the first six months of 2022, 30 states enacted laws to address workforce shortages in children’s mental health services.
Background
Key national groups have declared a “National Emergency in Child and Adolescent Mental Health”. One analysis reported that the percentages of youth experiencing depressive and anxious symptoms are nearly double pre-pandemic estimates, at 25 percent and 20 percent respectively. According to the Centers for Disease Control and Prevention (CDC), the proportion of children’s emergency department visits related to mental health and the number of adolescent visits for suspected suicide attempts also rose significantly from pre-pandemic rates.
Challenges in accessing pediatric providers, including child and adolescent psychiatrists, clinical and school psychologists, counselors, and therapists, were persistent prior to COVID-19. Shortages and turnover have been amplified during the pandemic, in large part due to provider burnout and trauma. Currently, 155 million Americans live in mental health professional shortage areas. Staffing of school psychologists is well below recommended levels, and less than four percent of clinical psychologists specialize in youth according to the American Psychological Association.
Alleviating high turnover and shortages in the workforce is a key priority of recent federal laws, strategies, and advisories to address children’s mental health. The Bipartisan Safer Communities Act, passed on June 26, 2022, sets aside nearly $1 billion in mental health supports for children. The Biden Administration announced their goal to use this funding to double the amount of mental health professionals, such as school counselors and social workers. Additionally, the American Rescue Plan of Act of 2021 provided enhanced funding for Medicaid home and community-based services. Many states are using these federal funds to support the children’s mental health workforce by recruiting pediatric behavioral health providers and building the capacity of existing professionals to deliver mental health services.
State Laws to Support the Children’s Mental Health Workforce
Over half of states (30 states) enacted laws in their recent legislative sessions (from January through June 2022) to address mental health provider workforce shortages for youth. Approaches include assessing workforce gaps and vacancies, enhancing recruitment and support of providers, establishing trainings and resources for behavioral health professionals, and modifying policies around the provision of mental health services (see table below).
Data and Assessment of Provider Availability and Capacity
Eight states enacted laws supporting efforts to monitor the capacity of the pediatric mental health workforce and identify and assess potential policy recommendations through the convening of work groups or task forces. Examples include:
- Georgia’s HB 1013 (Act 587) established the Behavioral Healthcare Workforce Database to collect and analyze data on the availability and capacity of behavioral health providers in the state. The measure also created the Multi-Agency Treatment for Children (MATCH) work group to facilitate collaboration between state agencies and providers in identifying resources for children’s unmet mental health needs. (Enacted April 4, 2022)
- Illinois’ HB 4306 (Public Act 102-0898) created the Holistic Mental Health Care for Youth in Care Task Force to assess the capacity for mental health professionals to treat foster youth, review payment rates for mental health providers serving this population, and evaluate the recruitment and retention of providers of color who work with foster youth. (Enacted May 25, 2022)
Investments in Provider Recruitment, Retention, and Support
Nearly half of states (21 states) enacted laws to invest in expansions and improvements of the pediatric mental health workforce. Investments in the behavioral health workforce have historically lagged far behind those for physical health care providers, and schools have reported inadequate funding as the most common limitation to employing mental health professionals. These measures include support for schools in hiring and retaining providers and for primary care providers, such as pediatricians, in delivering mental health care. Examples include:
- Colorado’s SB 22-147 allocated $4.6 million to the establishment of the Colorado pediatric psychiatry consultation and access program (CoPPCAP), which supports primary care providers in identifying and treating children’s behavioral health needs. The measure also supports grant programs for pediatric behavioral health providers and school-based health centers. (Enacted May 17, 2022)
- Kentucky’s HB 1 (Chapter 99) appropriated $7.4125 million to fund positions for school-based mental health providers on a reimbursement basis. (Enacted April 13, 2022)
Provider Training and Resources on Mental Health Supports
Eight states enacted laws to enhance education, training, and staff resources for providers and ancillary staff (e.g., school staff) in delivering mental health supports. Examples include:
- Maine’s HP 1380 (Chapter 542) established the Maine School Safety Center to provide training and resources for schools on behavioral health supports and assessments. (Enacted March 31, 2022)
- Nebraska’s LB 852 requires that the State Department of Education provide school districts with mental health first aid training for staff and a registry of local behavioral health resources. (Enacted April 20, 2022)
- New Hampshire’s SB 444 (Chapter 243) established a resource center that provides technical assistance to pediatric behavioral health professionals on trauma-informed care and treatment of adverse childhood experiences (ACEs). (Enacted June 22, 2022)
Provider and Service Provision Policies
State policies often determine who provides health care services (e.g., which professionals deliver care, required education and training, etc.) and how services are provided (e.g., in-person vs. remote, reimbursement across state lines, etc.). Eleven states enacted laws updating policies around the provision of services. These measures include creating new positions of professionals working with youth, modifying workforce standards and licensure requirements, and allowing for telemental health services. Examples include:
- Connecticut’s SB 2 (Public Act 22-81) requires that school districts employ a family care coordinator to collaborate with school-based mental health professionals and facilitate referrals to care. The measure also implements interstate agreements on the licensure of counselors and psychologists, including those serving youth, to align standards across states. (Enacted May 24, 2022)
- Indiana’s SB 284 (Public Law 109) enables school psychologists, developmental therapists, and other children’s mental health providers to practice telehealth. (Enacted March 14, 2022)
Conclusion
The mental health care workforce and youth access to mental health services will remain a high priority as states move toward recovery from the COVID-19 pandemic. While this blog analyzes state actions in the first six months of 2022, states continue to consider and adopt new policies and laws to support children’s mental health, with more to come in their 2023 legislative sessions.
State Laws to Support the Children’s Mental Health Workforce (January 1 – June 31, 2022)
| Approach | States |
| Data and Assessment of Provider Availability and Capacity | |
| Collecting and monitoring data | CT, GA, IL, KY, NJ |
| Convening work groups to assess needs | CO, GA, IL, NJ, NM, TN |
| Investments in Provider Recruitment, Retention, and Support | |
| For providers generally* | AK, CA, CO, CT, ID, IN, MD, ME, NE, NH, NM, OR, RI, WA, WY |
| For school-based providers | AL, CA, CO, CT, KY, MD, NE, NJ, NY, UT, VT |
| Provider Training and Resources on Mental Health Supports | |
| For providers generally** | CO, GA, NH |
| For school-based providers and staff | ME, NE, NY, OK, WV |
| Provider and Service Provision Policies | |
| Establishing or requiring new positions | AL, AZ, CT, FL, NE |
| Modifying standards and licensure | AZ, CT, DE, GA, KY, NY, OH |
| Permitting telehealth services | IN, OH |
Note: The states listed here have enacted laws to support these mental health workforce approaches. These laws distinctly and specifically reference children and youth. Other states may have enacted laws that support the broader mental health workforce, but they have not been included without specific reference to children. Additionally, other states may have implemented these approaches through other policy mechanisms.
*This category does not include state laws that specifically fund school-based mental health providers (these laws are included separately in the row below).
**This category does not include state laws that provide training and resources for school-based mental health providers (these laws are included separately in the row below).
Acknowledgements
This blog was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number U2MOA39467 the National Organizations of State and Local Officials co-operative agreement. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. government.
