Accessibility and quality of behavioral health services is woefully inadequate in many communities. Behavioral health worker shortages are particularly prominent in rural and low-income areas, as is the need for more culturally and linguistically competent workers. For example, although research indicates that prevalence rates for mental health and substance use disorders are similar for rural and urban populations, rural communities often lack ready access to services such as crisis intervention, substance abuse treatment, family and individual therapy, group therapy, assessment, and medication management; workforce shortages are most severe in areas of children’s mental health, older adult mental health, and minority mental health. Lack of behavioral health care services in these communities points to key workforce issues: 1) there is a need to recruit culturally competent behavioral health workers into vulnerable and underserved communities; and 2) team-based care may be especially important in underserved communities, as those in need of mental health or substance abuse treatment are likely to present to a primary care physician, who in many cases becomes a de facto member of the behavioral health workforce but may lack the formal training to provide specialized services.
The purpose of this study is to survey organizations in Michigan providing behavioral health care services to rural and underserved communities to assess workforce supply and needs, barriers to recruiting and retaining care providers, and level of care integration with primary care providers serving the same population. The findings will be used to inform a larger study on team-based care in underserved communities in future years, and to develop recommendations on strategies for strengthening care delivery and workforce infrastructure in these communities of need.


In total, 16 representatives (31%) from the SWMBH organizations participated in the pilot study. Respondents represented 7 (43%) non-profit organizations, three (19%) community health centers, two (13%) private practices, one (6%) social service agency, and one (6%) hospital or health system. Fourteen (88%) organizations offered only behavioral health/substance use disorder services; two (12%) offered both behavioral health and primary care services. Responding organizations accepted patients covered by Medicaid (100%), Medicare (75%), under-insured patients (94%), and uninsured patients (93%), and provided services for mental health or substance use disorders to the following vulnerable and underserved groups listed in Table 1.
Nearly 70% of responding organizations are trying to fill vacancies for behavioral health provider positions, including clinical social workers (73%), case managers (46%), addiction counselors (36%), psychiatrists (27%), and counselors (27%). Barriers these organizations experience when trying to fill provider positions can be found in (Figure 1).

To combat these challenges, organizations noted positive factors or incentives provided to fill vacant positions: flexible work hours (75%); affordable health insurance (69%); 401k (50%); disability insurance (44%); signing bonuses (13%); extended vacation (13%); accelerated bonuses (6%); and pension (6%).
Barriers to providing behavioral health care services included: a need for more training in the treatment of behavioral health (31%); cultural and/or language differences between health care providers and patients/clients (25%); and providers’ lack of training in evidence-based behavioral health treatments (25%). Reported workforce barriers included: too few clinicians (31%), physical separation of primary and behavioral health providers (31%), information-sharing obstacles between primary care and behavioral health providers (50%), and providers’ limited time to address both physical and behavioral health concerns (38%). Organizations also identified training needs in cultural competency (44%), integrated care (50%), leadership develoment (56%), management (44%), and technical training (69%).