As the need for mental health care in Washington far exceeds the state’s capacity to provide it, a group of university leaders have devised a new strategy: educate bachelor’s degree students in evidence-based conversation.
This move can quickly increase the number of vendors available and ease the burden on those with higher skill levels. It would also mean a big shift in Washington’s thinking about who can care for conditions such as anxiety and depression.
Today, most mental health professionals in Washington must complete a master’s or doctoral degree and go through thousands of hours of supervision before being allowed to work with patients.
The idea of training bachelors, inspired by a similar program in the UK, may soon become a reality.
In May, the University of Washington’s Department of Psychiatry and Behavioral Sciences received a $ 3.7 million grant from the charity Ballmer Group to transform an idea from a proof-of-concept to something scalable.
Officials hope that within five years, at least 50 students will be licensed and practice under the new name Mental Health Support Specialist. (The Seattle Times Mental Health Project is funded by the Ballmer Group. Our reporting is independent, and this program came to our attention in discussions with UW staff, without sponsorship.)
Over the years, the state has struggled to recruit, train, and retain a diverse range of mental health personnel. Additional degrees are expensive and can lead to multi-year debt. Low salaries of some mental health professionals can scare people away, and for those who start work, they may not be able to stay.
Teaching students faster and cheaper through the learning pipeline could change people’s ability to access health care.
“We want to be really bold in our vision for this,” said Dr. Anna Ratzliffe, director of the UW Psychiatric Residency Training Program, which is developing a bachelor’s degree program with her colleagues. “This is necessary and we are trying to create it as quickly as possible.”
Smaller details still need some work. The creation of a new category of licensed healthcare professionals may require changes to state law – something UW Medicine officials are trying to find out over the next year. They will need to work with insurance companies to figure out how these bachelor-level professionals can bill for services. They are just starting to partner with UW’s Social Work and Psychology departments, as well as other colleges and universities across the state. And they look to providers who can offer clinical training to students.
“This concept is not an overnight solution to major problems in the state’s mental health system,” said Susan Skillman, senior associate director of the Center for Health Workforce Research at the University of Washington. Many mental health professions at master’s level are poorly paid. Washington-based mental health consultants and social workers earn less than $ 52,000 on average, while Metro bus drivers earn an average of $ 56,000, according to a 2017 analysis by Skillman and colleagues.
Adding a lower-skilled and lower-paid profession will not solve the problem of wage retention unless “comparable attention is paid to maintaining the existing (higher-skilled) workforce at the same time,” Skillman said.
The training program can help diversify the predominantly white mental health workforce; the time spent earning a degree and the cost of vocational training limit people with limited resources from pursuing training programs.
But this area should focus on reaching people with broader backgrounds and cultural backgrounds at all levels of mental health, Skillman said. For example, increasing scholarships for expensive master’s and doctoral programs may help.
“This is one piece of a very large web of efforts to find ways to solve our problems in providing access to these services to people who need mental health services,” Skillman said. “More power for each of these potential solutions. But that will require each of these potential solutions. ”
According to Ratzliffe, sessions with a bachelor-level therapist will be a “starting point” for people in need of care and a means of early treatment for more people before their symptoms worsen and require more intensive intervention.
But credentials are likely to have limitations. Bachelor-level providers are not allowed to diagnose behavioral health disorders, but they can refer people with higher needs to social workers, psychologists, or other professionals with a higher level of training.
And they couldn’t prescribe medication. They will only provide talk therapy, Ratzliffe said, and will likely require some level of ongoing supervision by more highly trained professionals.
A variant of the program is already being implemented at Eastern Washington University. There, the School of Psychology has developed a 20-credit certificate program that allows students to study and practice supervised low-intensity interventions. Students will learn how to practice cognitive behavioral therapy and, among other things, teach clients coping skills.
Five students are currently enrolled, but officials say they expect the program to expand, especially if the state formalizes the bachelor’s degree.
According to Kailin Islam-Zwart, who heads the EWU School of Psychology, the university has moved ahead with the program as many medical offices now rely on physician assistants and other staff to do the job. “Work at some level is done by people who have never been trained to do this,” Islam-Zwart said; for example, a paramedic may suggest coping strategies to a patient with anxiety.
“We want students to be ready to work as soon as the opportunity arises. In the meantime, they can work in those positions that exist, which, perhaps, simply do not have a name that exactly matches what we teach them. “
Ratzliffe and her UW Medicine colleagues are collaborating with the EWU. The UW team began testing this concept about four years ago by developing a curriculum and teaching a class of students; Preliminary evidence from a small study suggests that these students can provide basic treatment for mild to moderate depression. The team is currently building resources that can make it easier for other colleges and universities to implement similar curricula.
They are currently focusing their curricula on caring for adults with common medical conditions such as anxiety, depression and substance use disorders. But over time, they can expand the training to include therapy for children.
“We need these kinds of ideas to really impact access to effective treatment in Washington,” Ratzliffe said.