Rural areas disproportionately experience mental health professional shortages. Maldistribution of behavioral health practitioners, especially in sparsely populated frontier counties, creates an additional burden. As rural health providers move toward integrated and managed care, workforce development programs are promoting and incentivizing primary care practitioners to receive training to become competent in behavioral health provision.

This project builds upon a pilot study previously conducted by the BHWRC with behavioral health organizations in Michigan. The purpose of this study was to survey a national population of organizations providing behavioral health care services to rural and underserved communities in order 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.  This study compares results of different geographic regions around the following themes:

  • Behavioral health needs of the population; services provided and accessibility to population
  • Service provider demand in behavioral health and primary care
  • Cultural/linguistic competence of the existing workforce
  • Workforce development initiatives: current and needed
  • Factors impacting worker recruitment and retention
  • Integrated care: current status, future plans, barriers and facilitators to adoption

The findings of this research were used to develop recommendations for strengthening care delivery and workforce infrastructure nationwide, particularly in rural communities.


Researchers at the Behavioral Health Workforce Research Center (BHWRC) sent an online survey to 454 rural behavioral health provider organizations. Of the 35 organizations (7.7%) of the organizations that finished the survey, most were community mental health organizations (n=21, 60.0%) or non-profit organizations (n=10, 28.6%). The average organization had about 115 employees of which support staff, behavioral health specialists, case managers, and mental health counselors made up the largest employee categories. The three highest priorities for new hires were occupational therapists, pharmacists, and nurse practitioners, while the lowest were administrators, managers, and non-masters addiction counselors. These organizations showed signs of not fully integrating behavioral health and primary care services. Policy recommendations include funding more integrated care sites, empowering physician assistants and nurse practitioners to work to their full education/training, and developing rural America’s telehealth infrastructure.


Characteristics of the Rural Behavioral Health Workforce: A Survey of Medicaid/Medicare Reimbursed Providers

Policy Brief
Full Report

Key Partners

National Council for Behavioral Health
Charlie Smith, PhD
SAMHSA Region 8
Shinobu Wanatabe-Galloway, PhD
Behavioral Health Education Center of Nebraska