HMN 2026: How Representative workforce is needed to address the US behavioral health crisis

A new paper published in Nature Mental Health argues that the U.S. cannot end its worsening behavioral health crisis without a workforce that reflects the racial, ethnic, lived-experience, linguistic, and geographic diversity of our nation. In the article, the authors highlight the central role of provider–patient concordance, the alignment in identities between providers and the communities they serve, in improving behavioral health outcomes and reducing long-standing behavioral health inequities.

The authors define behavioral health inequities as “preventable, unjust, and unfair differences in the quality and outcomes of behavioral health care.” Such inequities are long-standing among minoritized racial and ethnic groups, individuals with limited English proficiency, and residents of behavioral health shortage areas. Although evidence-based treatments and biomedical innovations continue to expand, the authors underscore that the structure of care delivery—specifically, the representativeness of the workforce remains an unaddressed driver of inequity.

“The U.S. is facing a behavioral health crisis of an unprecedented scale,” said lead author Adam Benzekri, MPH, MS Research Scientist at the Institute for Policy Solutions (IPS). “Concordance—shared identity, experience, language, or community between providers and patients—is a proven driver of trust, engagement, and improved behavioral health outcomes. Without it, we will not close treatment gaps or reverse worsening trends. A representative behavioral health care workforce is essential to any serious solution to our nation’s behavioral health crisis.”

The new paper demonstrates how concordant care improves outcomes for marginalized populations and strengthens the behavioral health system for everyone. Evidence shows that racially and ethnically concordant providers are associated with symptom reduction, improved functioning, stronger adherence, and greater trust; shared lived experience between providers and patients improves treatment engagement and care retention; language-concordant providers improve diagnostic accuracy, trauma disclosure, and continuity of care; and geographically concordant providers expand access in underserved areas.

The authors also provide actionable recommendations to recruit, train, and retain a representative behavioral health care workforce. They outline strategies to strengthen workforce pipelines, integrate lived experience into hiring and reimbursement models, integrate and enforce culturally and linguistically appropriate standards in accreditation and quality metrics, expand scope-of-practice laws, and require disaggregated reporting of provider demographics and patient outcomes to ensure accountability.

The research highlights growing threats to building and sustaining a representative workforce. Recent political and legal shifts—including the U.S. Supreme Court’s Students for Fair Admissions decision, federal pressures to roll back DEI standards in accreditation, and proposed cuts to key behavioral health care workforce training programs, jeopardize efforts to strengthen representation at the very moment it is most needed.

“Efforts to build a representative behavioral health care workforce are being undermined by flawed assumptions,” said senior author Vincent Guilamo-Ramos, Ph.D., RN, FAAN, Executive Director of IPS, and Psychiatric Nurse Practitioner. “Critics frame representativeness as a compromise to merit, and supporters frame diversity as an intrinsic good. Both are missing the point.

“A representative workforce is not only diverse, inclusive, and equitable, and does not only meet objective performance standards, it outperforms an underrepresented workforce. Efforts to undermine or reduce representation will deepen inequities and worsen the nation’s behavioral health crisis.”

The authors caution that these policy rollbacks and disinvestment in efforts to build a representative workforce may reduce progress and weaken the nation’s capacity to respond to rising mental illness, substance use, and preventable overdose and suicide-related deaths. At the same time, communities most affected by behavioral health inequities will continue to face profound barriers to accessing culturally and linguistically concordant care.

“Now more than ever, we must invest in recruiting, training, and retaining a workforce that reflects the communities it serves,” Benzekri said. “A representative workforce improves care for the populations with the greatest behavioral health needs, and strengthens behavioral health care for everyone.”

Provided by
Johns Hopkins School of Nursing

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