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The Blue Cross Blue Shield of Massachusetts Foundation today released a new report, in partnership with William James College, that finds that systemic barriers in the state’s licensure process are making it hard for aspiring clinicians of color, LGBTQIA+ individuals, and non-native English speakers to enter and remain in the behavioral health workforce.

“Massachusetts cannot meet the demand for behavioral health care without a workforce that reflects the people it serves,” said Audrey Shelto, president and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.  “This research makes clear that we must address these licensure barriers so that more clinicians from diverse backgrounds can enter and remain in the workforce.”

The study gathered input from 64 behavioral health providers and professionals in Massachusetts who identified as Black, Indigenous, and People of Color (BIPOC), LGBTQIA+, or non-native English speakers.  Participants included graduate students in their final year of training, individuals who have pursued licensure in the past seven years, individuals with leadership roles in community-based behavioral health agencies, and individuals who are involved with professional organizations or policy and advocacy efforts.

Participants in the study reported that:

• High tuition and fees, unpaid internships, limited financial aid, and added licensure costs create a substantial burden, particularly for providers from historically marginalized communities;

• Many aspiring clinicians lack access to mentors and supervisors who share their backgrounds, which can adversely affect one’s ability to move through the licensure process;

• The licensure process can be confusing and time-consuming with delays that can postpone licensure – and therefore one’s ability to work as a licensed provider – by months; and

• Licensing exams and requirements often fail to account for cultural and linguistic considerations and there is a lack of exam accommodation for those with diverse backgrounds and learning needs.

The report outlines opportunities to improve the licensure process, including reducing financial burdens, increasing access to clear and linguistically competent information about the process, expanding mentorship and supervision for providers from underrepresented populations, and enhancing licensure reciprocity and interstate compacts.

The Foundation also released a policy brief in partnership with Megan Burns Consulting that examines how low-intensity community-based mental health support programs can help meet demand for individual and community needs. These programs rely on evidence-based tools and techniques and are delivered in trusted community settings, such as schools, churches, and senior centers, by non-clinical providers who are trained in a specific program’s intervention.

While not a replacement for licensed clinicians, the models can help alleviate stress on the traditional mental health system.  These models may also address health inequities by improving access to mental health supports for historically marginalized communities and making services available that are provided by individuals who are representative of those communities and speak in their preferred languages.  These programs include interventions for depression and anxiety, such as Cognitive Behavioral Therapy, and approaches that bring specialized knowledge from experts to community providers to strengthen care locally.

“Taken together, these reports point toward a dual approach – breaking down barriers so more diverse clinicians can enter and remain in the workforce and embracing community-based models that extend the reach of behavioral health care,” Shelto added.  “The bottom line is that we need to expand behavioral health system capacity and do so in a way that is tailored to the needs of diverse communities.”

The report, titled Behavioral Health Professional Licensure in Massachusetts: Existing Barriers and Opportunities to Advance Diversity in the Workforce is available online at the following link: https://www.bluecrossmafoundation.org/publication/behavioral-health-professional-licensure-massachusetts-existing-barriers-and.

The issue brief, titled Expanding Access to Community-Based Mental Health Support: A Review of Select Programs is available online at the following link: https://www.bluecrossmafoundation.org/publication/expanding-access-community-based-mental-health-support-review-select-programs.

About the Blue Cross Blue Shield of Massachusetts Foundation

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to ensure equitable access to health care for all those in the Commonwealth who are economically, racially, culturally or socially marginalized. The Foundation was established in 2001 with an endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.  For more information, visit www.bluecrossmafoundation.org.

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