As the need for mental health care in Washington far outweighs the state’s ability to provide it, a group of university leaders has a new strategy: train students with bachelor’s degrees in evidence-based talk therapy.
This move could quickly increase the number of providers available and ease the burden on those with more advanced training. It also represents a major shift in Washington’s mindset about who can provide care for conditions such as anxiety and depression.
Today, most mental health professionals in Washington are required to earn a master’s degree or doctorate — as well as undergo thousands of hours of supervision — before they are allowed to work with patients.
The idea of Bachelor’s training, inspired by a similar program in the UK, may soon become a reality.
The University of Washington’s Department of Psychiatry and Behavioral Sciences received a $3.7 million grant from the Palmer Charitable Group in May to take the idea from a proof of concept to something scalable.
Within five years, officials hope that at least 50 students will obtain a license and practice under the new title, “Behavioral Health Support Specialist.” (The Seattle Times Mental Health Project was funded by the Palmer Group. Our reporting operates independently and this program came to our attention through discussions with University of Washington staff without the involvement of funders.)
For years, the state has struggled to recruit, train, and retain a diverse behavioral health workforce. Additional degrees are expensive and can translate into years of debt. The low wages of some mental health professionals may turn people off — and for those entering the field, they may not be able to afford to stay.
Moving students through the training pipeline faster and more cheaply can transform individuals’ ability to access care.
“We want to be really bold in our vision of this,” said Dr. Anna Ratzliff, director of the psychiatry training program at the University of Washington, who is developing the undergraduate training program with colleagues. “This is required and we are trying to build it as quickly as possible.”
The finer details still need to be ironed out. Creating a new class of licensed health care workers may require changes to state law — something University of Washington medical officials are trying to figure out over the next year. They will need to work with insurance companies to determine how these bachelor-level professionals bill for services. They are just beginning to collaborate with the Departments of Social Work and Psychology at the University of Washington and other colleges and universities across the state. They liaise with providers who may offer students clinical training.
The concept is not an immediate solution to deep problems in the state’s behavioral health care system, said Susan Skelman, deputy director of the Center for Health Workforce Studies at the University of Washington. Many master’s-level mental health careers are low paying. Washington mental health counselors and social workers make, on average, less than $52,000 — while metro bus drivers make a median salary of $56,000, according to a 2017 analysis by Skillman and colleagues.
Adding a lower-skilled, lower-paid occupation will not solve salary retention problems unless “comparable attention is paid to retaining the existing (more highly trained) workforce at the same time,” Skillman said.
The training program may help diversify the white mental health workforce; The time spent earning a degree and the cost of apprenticeships limit people who have fewer resources to pursue training programs.
But Skillman said the field should focus on bringing people with a wide range of life experiences and cultural backgrounds to all levels of the mental health field. Increasing scholarships for expensive master’s and doctoral programs, for example, may help.
“This is one piece in a very large spider web to try and find ways to solve our problems with people who need behavioral health services getting access to those services,” said Skillman. “More power for each of these potential solutions. But it will require each of these potential solutions.”
Ratzliff said sessions with a bachelor-level caregiver would be an “entry point” for people who need care, and a way to get more people into treatment early, before their symptoms worsen and they need more intensive interventions.
But there are likely to be limitations on accreditation. Providers at the bachelor’s level will not be allowed to diagnose behavioral health conditions, but may refer people with higher needs to social workers, psychologists, or other professionals with further training.
They could not prescribe medication. They would only provide speech therapy and would likely need some level of ongoing supervision from more highly trained professionals, Ratzliff said.
A copy of the program is already underway at Eastern Washington University. There, the School of Psychology developed a 30-credit hour certificate program that allows students to learn and practice supervised, low-intensity interventions. Students learn how to practice cognitive behavioral therapy and how to teach clients coping skills, among other things.
Five students have registered so far, but officials say they expect the program to grow, especially if the state formalizes the undergraduate degree.
Kayleen Islam-Zwart, who chairs the EWU School of Psychology, said the university has moved ahead with the program since many medical offices currently rely on paramedics and other staff to do the work now. “The work is done on some level by people who have not been trained to do it before,” Islam Zwart said. For example, a medical assistant may offer coping strategies to a patient with anxiety.
“We want students to be ready to go as soon as the opportunity presents itself. In the meantime, they can work in those jobs that are there and that probably don’t have a title that exactly matches what we are training them to do.”
Ratzliff and colleagues UW Medicine are collaborating with EWU. The UW team began experimenting with the concept about four years ago by developing the curriculum and teaching a class of undergraduate students. Preliminary data from a small study suggests that these students can offer basic treatment for mild to moderate depression. The team is now working to create resources that could make it easier for other colleges and universities to adopt similar training programs.
Currently, they focus their curricula on the care of adults with common conditions such as anxiety, depression, and substance use disorders. But they may eventually expand the training to include treatment for children.
“We need these kinds of ideas to make a real difference to access to effective treatment in Washington,” Ratzliff said.