INDIANAPOLIS - A collaborative project aims to combat untreated mental illness in Indiana by identifying opportunities and recommendations to strengthen the state's pipeline of licensed mental and behavioral health professionals.
Led by the Indiana University School of Medicine's Bowen Center and made possible with a $515,005 grant from Lilly Endowment Inc., "The Playbook for Enhancing Indiana's Mental and Behavioral Health Workforce" presents an overview of Indiana's post-secondary education pipeline environment, while also setting forth recommendations to strengthen the pipeline to independent practice for the mental and behavioral health workforce moving forward.
"The Playbook for Enhancing Indiana's Mental and Behavioral Health Workforce," led by the IU School of Medicine's Bowen Center, is made possible by a $515,005 grant from Lilly Endowment Inc.
As of 2024, 90 out of 92 counties in Indiana were federally designated as mental health care workforce shortage areas, just one of the complex factors contributing to the burden of untreated mental illness. An IU study released at the end of 2023 showed that untreated mental illness costs Indiana more than $4 billion each year.
"This is a crisis, and while there is no silver bullet to address mental illness, improving access to high-quality mental health care is critical for the thousands of Hoosiers currently suffering," said Hannah Maxey, director of the Bowen Center and leader of the project. "Access to care hinges on the availability of mental and behavioral health professionals who are ready and willing to provide care. Identifying the root causes of these shortages and formulating strategies to strengthen the workforce across the state must be a top priority."
"Through Lilly Endowment's statewide GIFT initiative for Indiana community foundations, our Comprehensive Counseling Initiative for Indiana K-12 schools and many other sources, we frequently hear about the scarcity of mental health providers in Indiana communities," said N. Clay Robbins, Lilly Endowment's chairman and CEO. "We are pleased to help the IU School of Medicine's Bowen Center conduct this vital research required for the development of effective strategies to address the state's critical mental health challenges."
To guide the development of the playbook, the Bowen Center convened a team of expert advisors, which included representatives from health care organizations, universities and colleges, and state agency leadership. The Bowen Center also conducted research to understand the regulatory environment, education landscape and perspectives on the workforce, including those of licensed professionals, those who educate them and those who employ them.
Hannah Maxey. Photo by Eric B. Schoch, IU School of Medicine
"Licensed professionals specializing in mental and behavioral health care who are authorized to provide clinical services as independent practitioners are particularly important because of the services they provide, the workforce they supervise and the referrals they accept," Maxey said. "These professionals require graduate education and clinical experience to be licensed as independent practitioners in Indiana. Their workforce roles include mental health counselors, marriage and family therapists, licensed clinical social workers, clinical addiction counselors, psychiatrists, psychologists and psychiatric- mental health advanced practice registered nurses.
"In developing the playbook, we worked with the Indiana Commission for Higher Education and Indiana Professional Licensing Agency to create the first-ever inventory of degree programs across the state to map the licenses available to behavioral and mental health professionals. The inventory reveals gaps in education opportunity," Maxey said. "We also found that Indiana doesn't have a formalized approach to training or credentialing/designation for clinical supervisors of Behavioral Health and Human Services licensees. Most states have a formal process in place."
The playbook includes four categories of recommendations:
Secure the pipeline
Recommendations in this category include ensuring that data are continually available to support assessment, planning and evaluation for Indiana's mental and behavioral health workforce, as students work to get from schooling to licensure to practicing independently. The playbook also recommends increasing awareness among Hoosier youth about these careers and training pathways, while addressing training deserts across the state.
It also recommends that the state expand the number of accelerated degree programs to help students earn their degree sooner, stabilize psychiatry residency funding, expand doctoral psychology internships and establish pipeline incentives, such as funds to support strategic recruitment and retention of faculty and students.
Strengthen clinical training to practice
The playbook recommends expanding currently offered clinical experiences in Indiana, explaining that new opportunities are desperately needed to ensure Indiana can develop the workforce it needs to support the population. It also recommends elevating and supporting professional supervisors who are mentoring Indiana graduates looking to go into this profession through a formal credential, training and incentives.
Align education, policy and practice
The playbook recommends establishing a new education and reciprocity coordinator position to support streamlined licensing and serve as a liaison through the state Behavioral Health and Human Services Licensing Board and academic programs. It also recommends a curriculum review to evaluate the extent of evidence-based practice training and continuing education to promote the adoption of and increase workforce understanding of evidence-based practice. The final recommendation in this category focuses on increasing psychotherapy skills in psychiatric advanced practice registered nurses.
School-based behavioral health workforce
This recommendation suggests collecting information on Indiana's school-based behavioral health workforce to support policy and planning focused on expanding critical services for Indiana youth.
The Bowen Center hosted a gathering in April that brought together more than 150 individuals from across the state representing academic institutions, professional associations, state agencies and employer groups to review a draft of the recommendations and give feedback before they finalized the playbook.
Some organizations have already committed to implementing some of the recommendations, including 4C Health, which offers mental health inpatient and outpatient services across 14 counties in north-central Indiana.
"Moving forward, we now need Indiana organizations and individuals to champion and carry the ball forward on these recommendations," Maxey said. "This is a playbook for Indiana, for all of us. It's up to everyone to consider the recommendations and how they can be appropriately implemented across the state to help to solve this critical part of the workforce shortage puzzle."
