Colorado's demand for people working in the mental health and addiction fields more than doubled during the pandemic, but the supply of actual workers hasn't kept up — a situation that state agencies, higher education and health systems are trying to fix.
The number of openings for behavioral health jobs in the state increased 152% from 2019 to 2022, and projections show that figure could rise another 30% from 2023 to 2030, said Lisa Weinberg, the Colorado Behavioral Health Administration's workforce development director.
In Colorado, as in the rest of the country, mental health worsened during the pandemic, with some public officials calling the situation a "crisis."
As of February 2023, about 30% of Colorado adults reported symptoms of possible anxiety disorders or depression, which was slightly lower than the national average. The most recent data for youth was from 2021, when 40% of high school students reported symptoms that might indicate depression. Not everyone who reported some symptoms needs treatment.
Hiring people to work in those mental health roles is a challenge for all providers, said Laura Patke, executive director of behavioral health at Kaiser Permanente Colorado. The Colorado Health Access Survey found that the top reason people reported they didn't get needed mental health care in 2023 was that appointments weren't available.
"We're seeing that the current supply of providers, therapists… is not keeping up," she said.
To close the access gap, the state needs to not only train more professionals, but keep them from burning out and leaving the field, and encourage them to serve where people need them, Weinberg said.
"Increasing the number of professionals doesn't always correlate to accessibility," she said.
State agencies and other organizations are trying different approaches aimed at bringing more people into the pipeline, and patching the spots where they tend to leak out, including a Youth Mental Health Corps and financial aid to help new counselors and social workers get their licenses.
Some Front Range high schools are offering an elective that teaches mental health first aid and could be a first step on the path to a career in that field, Weinberg said. The agency hopes that more rural schools will agree to offer the elective, which could encourage young people to consider working in behavioral health in their hometowns, she said.
Colorado's community colleges also worked with the state to create a credential so adult students can start working in behavioral health as soon as possible, while continuing to study for more advanced roles, Weinberg said. These "microcredentials," which students can earn within a year, allow them to get frontline experience and determine whether the mental health field is right for them as quickly as possible, she said.
"We want to try to get them into that next level," she said.
Youth helping youth, starting careers
The young people in Colorado's first Youth Mental Health Corps, which is part of the AmeriCorps volunteer program, start by earning one of the microcredentials, becoming "qualified behavioral health assistants."
The first corps members are scheduled to start working in Colorado in September. The plan was for the first cohort to include 50 people, but the group may be larger because more people applied than organizers expected.
Once they've completed their training, the youth corps members will work in high schools, talking through problems with students who have routine mental health needs and suggesting resources for those who need professional help.
The only qualifications are that corps members have to be adults under 25 with permission to work in the United States and either a high school diploma or GED. Typically, people join AmeriCorps during gap years before or after college.
The corps will help students now, by giving them someone of a similar age to talk to, said Lt. Gov. Dianne Primavera, whose office oversees the AmeriCorps program in Colorado. But it also will help young people interested in the mental health field by giving them experience and a credential they can use, she said.
"We've understood for a while in Colorado there is a crisis with mental health, especially with youth," she said. "Peer-to-peer (counseling) can be very powerful."
Corps members aren't required to be Colorado residents, but the hope is that both local and out-of-state members will decide to stay.
The program not only allows young people to get hands-on experience in behavioral health, but gives them a pathway to pursue clinical roles, said John Kelly, executive director of the lieutenant governor's office. If they decide to continue in the mental health field, they could use their AmeriCorps scholarships to pursue other microcredentials or a degree, he said.
"This is a great entry-level credential," Kelly said.
Help with the licensing "paywall"
Sometimes, aspiring mental health workers make it through school, only to be derailed before they can get licensed.
The number of new licenses that states grant to work in behavioral health fields each year is less than half the number of students who completed master's degrees that would allow them to get a license in those fields, said Emily Matuszewicz, director of Metropolitan State University of Denver's Health Institute.
Some students probably didn't intend to pursue a clinical license, but others are deterred by financial barriers and the time it takes to complete supervision and pass the exam, she said.
"It's financial, it's time, it's having access to resources," Matuszewicz said.
Last week, MSU Denver and Kaiser Permanente Colorado announced a partnership to help new graduates get the 100 hours of professional supervision they need to be eligible for a Colorado license in fields like counseling. MSU Denver is helping place licensure candidates in jobs where they can get clinical experience and run peer support activities, while Kaiser Permanente is supplying about $4.2 million for stipends and to cover supervisors' costs.
MSU Denver estimated it costs about $10,000 to supervise a candidate in licensed professional counseling, licensed marriage and family therapy, or licensed clinical social work. If a licensure candidate's employer doesn't provide that supervision, the candidate has to pay an outside provider to oversee their work, Matuszewicz said. For many, that kind of expense isn't feasible, particularly since jobs open to people with a master's degree but no license don't pay especially well, she said.
The collaborative set a goal of getting 87 candidates who'd completed their master's and 36 who had a bachelor's degree through the licensing process, which takes about two years.
Anyone who has completed the necessary education can apply, though they particularly encourage people of color and other groups underrepresented in the mental health workforce, Matuszewicz said.
"If we don't have enough providers out in the field, and providers who reflect the communities that have the most needs, we're not going to solve the problem," she said.
The members of the collaborative are working together to find where people are falling out of the pipeline to behavioral health jobs, said Patke, the head of behavioral health at Kaiser Permanente Colorado. Usually, when people don't complete their licenses, they leave the mental health field altogether, she said.
"We want to support emerging professionals," Patke said.
C Blanck, who is working toward becoming a licensed clinical social worker specializing in complex and religious trauma, said that the collaborative's program eased some of the financial anxiety they had about the licensing process.
A scholarship made it possible for them to get a master's degree at the University of Denver, but didn't cover the cost of supervision, materials to study for the licensing exam and the license itself, they said.
Blanck, who is nonbinary, said they would like to see more support for people going into mental health fields at all levels. Candidates who are less affluent or from marginalized backgrounds are less likely to make it through, which makes it harder for patients to find a provider who understands their perspective, they said.
"It's almost like a paywall just to get licensed," Blanck said.
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