They have done so primarily by holding hearings and introducing legislation addressing the interrelated topics of quality of mental health care, access to mental health care, and the cost of mental health care. The quality of mental health care, for example, is influenced by the skills of the people providing the care. Access to mental health care depends on the number of appropriately skilled providers available to provide care, among other things. Thus, an understanding of the mental health workforce may be helpful in crafting legislation and conducting oversight for overall mental health care policy. It is important to note that, while the federal government has an interest in the mental health workforce, and federal initiatives may affect the training of mental health care providers, for instance, most of the regulation of the mental health workforce occurs at the state level. It then describes three dimensions of the mental health workforce that may influence quality of care, access to care, and costs of care: (1) licensure requirements and scope of practice for each provider type in the mental health workforce, (2) estimated numbers of each provider type in the mental health workforce, and (3) average annual wages for each provider type in the mental health workforce. Mental Health Workforce Definition: No Consensus

No consensus exists on which provider types make up the mental health workforce. The Substance Abuse and Mental Health Services Administration (SAMHSA)—the public health agency within the Department of Health and Human Services (HHS) that leads efforts to improve the nation's mental health—has defined the mental health workforce to include psychiatry, clinical psychology, clinical social work, advanced practice psychiatric nursing, marriage and family therapy, substance abuse counseling, and counseling. Notably, this definition is limited to highly trained mental health professionals. Mental Health Workforce Overview

In conceptualizing and outlining the mental health workforce, this report relies on the HRSA definition of mental health providers, including clinical social workers, clinical psychologists, marriage and family therapists, psychiatrists, and advanced practice psychiatric nurses. Although the licensure requirements vary widely across provider types, the scopes of practice converge into provider types that generally can prescribe medication (psychiatrists and advanced practice psychiatric nurses) and provider types that generally cannot prescribe medication (clinical psychologists, clinical social workers, and marriage and family therapists). All provider types in this report can provide psychosocial interventions (e.g., talk therapy). Administration and interpretation of psychological tests is generally the province of clinical psychologists. Mental Health Workforce Annual Wages

Just as access to mental health care providers depends partly on the size of the mental health workforce, the cost of mental health care depends partly on the wages paid to mental health providers. Psychiatrists are the relative highest earners, followed by advanced practice psychiatric nurses and clinical psychologists. Marriage and family therapists generally earn more than clinical social workers. An understanding of typical licensure requirements and scopes of practice may help policymakers determine how to direct federal policy initiatives focused on enhancing the quality of mental health care such as those related to training mental health providers. Policymakers may also wish to consider the relative wages of different provider types, particularly when addressing domains within which the federal government employs mental health providers. As such, the cost of employing different provider types—as well as their scopes of practice—may be a consideration in determining staffing priorities.
Congress has held hearings and some Members have introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy.
No consensus exists on which provider types make up the mental health workforce. This report focuses on the five provider types identified by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) as mental health providers: clinical social workers, clinical psychologists, marriage and family therapists, psychiatrists, and advanced practice psychiatric nurses. The HRSA definition of the mental health workforce is limited to highly trained (e.g., graduate degree) professionals; however, this workforce may be defined more broadly elsewhere. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) definition of the mental health workforce includes mental health counselors and paraprofessionals (e.g., case managers).
An understanding of typical licensure requirements and scopes of practice may help policymakers determine how to focus policy initiatives aimed at increasing the quality of the mental health workforce. Most of the regulation of the mental health workforce occurs at the state level because states are responsible for licensing providers and defining their scope of practice. Although state licensure requirements vary widely across provider types, the scopes of practice converge into provider types that generally can prescribe medication (psychiatrists and advanced practice psychiatric nurses) and provider types that generally cannot prescribe medication (clinical psychologists, clinical social workers, and marriage and family therapists). The mental health provider types can all provide psychosocial interventions (e.g., talk therapy). Administration and interpretation of psychological tests is generally the province of clinical psychologists.
Access to mental health care depends in part on the number of mental health providers overall and the number of specific types of providers. Clinical social workers are generally the most plentiful mental health provider type, followed by clinical psychologists, who substantially outnumber marriage and family therapists. While less abundant than the three aforementioned provider types, psychiatrists outnumber advanced practice psychiatric nurses. Policymakers may influence the size of the mental health workforce through a number of health workforce training programs.
Policymakers may assess the relative wages of different provider types, particularly when addressing policy areas where the federal government employs mental health providers or pays for their services through government programs such as Medicare. Psychiatrists are typically the highest earners, followed by advanced practice psychiatric nurses and clinical psychologists. Marriage and family therapists earn more than clinical social workers. The relative costs of employing different provider types may be a consideration for federal agencies that employ mental health providers.