State Policies Can Help Address the Mental Health Care Workforce Shortages
Needs assessments, financial incentives, and career pathways can help close the gaps
Hospitals and health systems are a critical point of intervention for individuals experiencing suicidal thoughts and behaviors. In just five years, the share of emergency department visits because of suicide attempts or intentional self-harm more than tripled—climbing from 0.6% in 2015 to over 2% in 2020.
The effective delivery of evidence-based suicide screening and care in hospital settings relies heavily on a sufficiently staffed, knowledgeable, and supported workforce. However, workforce shortages continue to strain health system staff and affect consistent, quality health services for people in crisis. In fact, according to a nationally representative survey conducted by The Pew Charitable Trusts and the Joint Commission—an independent nonprofit organization that accredits 70% of hospitals in the U.S.—examining the implementation of universal suicide screening in accredited hospitals, about half of hospitals reported challenges stemming from insufficient staffing that affected their ability to provide suicide care interventions.
Recent data estimates that about 40% of the U.S. population—approximately 137 million people—live in areas designated by the federal government as having a shortage of mental health providers, with rural and low-income areas experiencing the greatest gaps. For example, the Health Resources and Services Administration report explains that 22% of rural counties throughout the U.S. lack social workers, compared with only 5% of urban counties. Similarly, rural counties are nearly three times more likely to lack psychologists.
State legislatures and workforce agencies have responded by using data collection and analysis to assess the problem and make it easier for people to afford to train and work in the mental health field.
State efforts to support and expand the mental health workforce fall into three broad categories:
State needs assessment
Mental health workforces are often unevenly distributed in a state. Some policymakers have used state needs assessments to understand how these gaps are affecting access to and delivery of care, and how best to allocate resources.
For example, the Florida Center for Behavioral Health Workforce, created by S.B. 330 in the state Legislature, conducts comprehensive data analyses to identify needs and priorities throughout the state. In California, the Department of Health Care Access and Information was established through the state’s Health Care Quality and Affordability Act as the primary source for all health care workforce data. It produces annual reports to the Legislature along with other analyses, including a tool modeling the supply and demand of the state’s behavioral health workforce.
Financial incentive programs
Programs that support mental health workers’ financial well-being can be used to incentivize providers to work in rural, low-income, and other high-need areas. For example, loan repayment programs help to pay down existing student loans in exchange for a commitment to work in a high-need area for a period. Research indicates that such programs are effective in recruiting and retaining providers.
North Carolina recently launched the Licensed Workforce Loan Repayment Program, a $20 million initiative that offers licensed clinical mental health professionals up to $50,000 in educational loan repayments. The program requires providers to serve high-need communities, including rural areas where the youth suicide rate is twice as high as in urban areas. And in Virginia, a scholarship program for nurse practitioners pursuing a post-master’s psychiatric mental health nurse practitioner certificate was designed to increase the number of licensed nurse practitioners with advanced behavioral health training in the state. The initiative is funded through a public-private partnership and provides full scholarships for a two-year commitment to practice in a medically underserved area.
Career pathways
States have also created pipeline programs that strengthen the mental health workforce through supportive pathways that guide students and current health care professionals to begin or advance their careers. These initiatives have meaningfully addressed workforce shortages and helped to increase the number of underrepresented providers. Pipeline programs can offer a range of resources, including education funding, mentoring programs, and professional development opportunities.
Texas established the Texas Mental Health Professional Pipeline Program in 2025 to encourage academic institutions to develop pathways for public junior college students to pursue degrees and licensures in the mental health field. And in the Nevada state Senate, S.B. 379 charged the Health Care Workforce and Pipeline Development Workgroup with advancing educational and workforce pipelines to improve the recruitment, training, and retention of behavioral health professionals throughout the state.
States are well positioned to leverage policy strategies to mitigate workforce shortages that harm health systems’ ability to care for individuals at risk for suicide. Through comprehensive data assessments, financial incentives, and pipeline programs, states can measure and prioritize their needs while supporting and expanding the behavioral health workforce.
Stacey Baxter works on Pew’s suicide risk reduction project.
If you or someone you know needs help, please call or text the Suicide and Crisis Lifeline at 988 or visit 988lifeline.org and click on the chat button.
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