Given the limited availability of evidence-based, in-person mental health care, digital mental health (DMH) is a rapidly growing field that is uniquely poised to address mental health needs in children and adolescents. The youth DMH field operates across multiple sectors (e.g., academic and industry) and bridges multiple disciplines (e.g., child development, clinical psychology, user design/experience, pediatrics), but little is known about the training needs and existing opportunities to prepare students to effectively contribute to the youth DMH workforce. To address this gap, the current study conducted a needs assessment, using a mixed-methods survey design, with an academic (N = 107) sample asked about training needs, strengths, and barriers in an academic research environment, and an industry (N = 60) sample asked to identify training needs, strengths, and barriers for graduates to effectively contribute to youth DMH industry roles. Quantitative findings suggest different training needs are endorsed at different frequencies by academic and industry sectors. The academic sample emphasized training needs in DMH-relevant research design and methodology, whereas the industry sample prioritized training in the fundamentals of healthcare administration. Qualitative findings highlighted the key priorities across academic and industry fields, including the logistics of conducting academic research (e.g., funding resources and research design) and translating academic research training into an industry space (e.g., demonstrating value for business and understanding industry research standards). These findings indicate a need for academic programs to provide tailored training and support to ready trainees to advance effective youth DMH.
Psychiatric advance directives (PADs) are designed to preserve patient preferences during psychiatric crises and reduce reliance on coercive interventions. Although PADs are supported by randomized and observational evidence, they remain infrequently used in US behavioral health systems. This Policy Perspective argues that PAD underuse reflects failures in system design rather than lack of effectiveness or patient interest. We describe the magnitude and consequences of PAD under-implementation, including its implications for crisis-based care, racial and ethnic inequities, and system inefficiency. We then examine how existing policies and health system structures limit PAD accessibility and use during psychiatric emergencies, despite evidence that facilitated PADs can improve outcomes. Finally, we outline policy and system-level reforms to support PAD implementation, including investment in infrastructure, reimbursement for facilitation, integration into crisis response workflows, and equity-focused community partnerships. Advancing PAD implementation represents a practical opportunity to reduce coercive crisis responses and strengthen equity in behavioral health care.
Rural communities face persistent shortages in behavioral health providers and lower access to behavioral health services, contributing to poorer population behavioral health outcomes. Although prior research has documented lower provider availability in rural areas, less research has examined how rurality shapes provider acquisition and growth over time. This study analyzes 25 years of Florida behavioral health licensure data to examine associations between workforce acquisition and growth and population mental health outcomes. A multilevel hurdle negative binomial model estimated provider acquisition (presence versus absence of providers in a county) and provider growth conditional on presence (number of providers among counties with at least one provider). The model was applied to licensed mental health counselors, clinical social workers, marriage and family therapists, and psychologists. County-level estimates of provider availability and growth were extracted and used to examine associations with county-level mental distress and suicide rates. Urban and rural provider gaps remained stable over time. However, rural counties exhibited lower probabilities of provider presence and lower per capita provider rates across all provider types. Provider availability and growth were not associated with self-reported mental distress, yet higher provider availability and growth were associated with lower suicide rates in non-rural counties, with these associations attenuated in rural counties. These findings suggest workforce expansion alone may be insufficient to reduce mental distress in rural settings where structural barriers may limit the impact of provider supply on population-level outcomes. Policy efforts addressing workforce expansion and rural service delivery constraints may improve behavioral health outcomes in underserved counties.
Mental health provider shortages and associated mental health service treatment gaps have led to recent initiatives to broaden the types of providers delivering mental health services in the USA. A key example is the Behavioral Health Support Specialist (BHSS), a supervised bachelor's-level mental health provider, introduced in Washington State in 2023. Yet there is limited understanding of how behavioral health organizations who may employ these new providers perceive the acceptability and feasibility of these new roles, though such perceptions have critical implications for successful rollout and uptake. The research team conducted semi-structured individual interviews with n = 18 staff at organizations delivering behavioral health services throughout Washington to understand staff perspectives on these roles as the first cohort approached graduation and prepared to enter the workforce. The research team identified four main themes related to anticipated acceptability and feasibility: (1) the introduction of a bachelor’s-level mental health provider role alongside existing behavioral health credentials was viewed as acceptable; (2) a lack of clear information on billing codes and financing could present an organizational barrier to uptake; (3) limited supervisor availability could present a barrier to feasibility at some organizations; and (4): high levels of burnout that exist among mental health providers could also present feasibility challenges for bachelor’s-level providers. Although findings suggest promise for ongoing bachelor’s-level mental health provider initiatives in Washington and other states, they also highlight several areas in which proactive implementation support may be needed to support successful introduction and sustainment of these roles.
Suicide is a leading cause of preventable death among youth worldwide. Improving the knowledge and skills of professionals who care for youth is imperative to lowering the suicide rate. The Assessing and Managing Suicide Risk (AMSR) training aims to enhance professionals’ therapeutic skills and increase the use of best practices for those working with individuals at elevated suicide risk. Changes in suicide prevention–specific therapeutic skills and the utilization of recommended brief interventions were evaluated in the 3 months following participation in AMSR training. Participants were youth-serving professionals (N = 115) across varied practice settings (e.g., mental health, education, emergency services) who attended an AMSR training and completed a pre-training and a 3-month post-training evaluation. Wilcoxon signed-rank tests were used to examine changes across time. Professionals reported a significant increase in use of recommended therapeutic skills overall, specifically in validating youth’s experience of suicidal thinking and conveying that suicidal ideation is taken seriously. Moreover, professionals reported a significant increase in the use of specific brief interventions, namely safety planning and referring youth to additional care. Brief interventions that did not demonstrate significant change post-training included lethal means safety counseling and collaboration with caregivers. This is one of the first studies to evaluate the impact of AMSR training, a widely disseminated suicide prevention training, on self-reported clinical practices. Findings have important implications for efforts aimed at training a competent and confident professional workforce.
The Veterans Community Care Program (VCCP) has become essential to how the Veterans Health Administration (VHA) delivers care. Although VCCP expands Veterans' access to community providers, ongoing process inefficiencies create barriers to timely care. Veterans affected by military sexual trauma (MST) are at heightened risk for behavioral health challenges, especially when care is delayed or fragmented. These delays may be particularly harmful for Veterans with MST living in rural communities where structural barriers exacerbate health risks. In this study, the primary author interviewed 38 Veterans with MST (29
Military-affiliated adults including veterans, active-duty service members, and their families experience elevated rates of mental health conditions such as PTSD, depression, and anxiety. Addressing these needs requires accessible, high-quality, and evidence-based care delivered at scale. Cohen Veterans Network (CVN), a national network of community-based military family clinics, was established in 2015 to provide rapid access to mental healthcare, emphasizing evidence-based psychotherapies, measurement-based care, and standardized clinical and operational practices. This retrospective study examined ten years of outpatient mental health care (2016–2025) across CVN clinics (N = 45,947 clients). Analyses focused on symptom change, clinically significant improvement, and trends over time, with stratification by client type and gender. Results indicate that across more than a decade of care, clients demonstrated consistent, meaningful symptom reductions. Among clients who screened positive at intake, mean PHQ-9 improvements ranged from 6.05 to 7.10 points, GAD-7 improvements from 5.67 to 6.24 points, and PCL-5 improvements from 16.50 to 18.37 points, with 55–68
This cross-sectional study explored patients with suicidal ideation history's preferences regarding health system collection and utilization of social needs data. Surveys asked about willingness to report and request assistance for social needs, comfort reporting across methods, and inclusion of needs in health outcome prediction. Differences by demographics and suicidal ideation severity were examined. Willingness to report needs differed by domain (legal concerns 66
Mental health professionals frequently work with individuals who have addiction concerns; however, limited training is occurring in their educational programs. The purpose of this study was to evaluate counselors, psychologists, and social workers and investigate aspects of their addiction training and perceived addiction-related competency. The majority of the 1596 mental health professionals who participated in the study identified as White, non-Hispanic/Latino, heterosexual, women with a master's degree in social work. Over one-third had an addiction credential (35.81%) and worked in the addiction field (35.48%); 60.82% were counselors, 45.44% worked in an outpatient setting, and 24.51% worked in private practice. Half of the workforce felt unprepared in the area of addiction upon graduation, and over two-thirds wished they had taken more addiction coursework. Over nine out of 10 mental health professionals reported that addiction training is necessary in degree preparation programs, and almost three-fourths recommended that students complete one or more addiction-specific courses. The highest perceived competence among the participants was in the areas of motivational interviewing and diagnosis, and the lowest was in diversity aspects and drug policy. Despite being the largest group of mental health professionals within the USA, the social workers in the study reported the lowest overall perceived confidence. Results support the need for more addiction training in mental health professional preparation programs.
Health systems increasingly deploy telehealth suicide prevention in emergency departments (EDs), yet little is known about required organizational investments. Transparent resource estimates are needed to plan and scale behavioral health services in acute care. This micro-costing study examined implementation of a centralized Suicide Prevention Consultation Center (SPCC) delivering telehealth Safety Planning Intervention with follow-up (SPI +) to suicidal ED patients across eight hospitals. Using Time-Driven Activity-Based Costing (TDABC) from a health system perspective, implementation strategies were mapped to actions, personnel roles, and time drivers. Standardized wages were applied to calculate total and per-ED costs, distinguishing centralized from site-specific activities and classifying costs by implementation strategies and Exploration, Preparation, Implementation, and Sustainment (EPIS) framework phases. Over 14 months, implementation required 1824 staff hours costing 163,329 (20,416 per ED). Clinician consultation, workflow development, and training accounted for three-quarters of costs. Most resources (84
Burnout has received ongoing attention in the psychotherapist literature, with much of the emphasis placed on examining risks for its development and consequences of its occurrence. However, there is a paucity of research comparing burnout between psychotherapist training levels. The current study examined a sample of licensed psychotherapists (n = 108) from different training levels and educational backgrounds. Differences in emotional exhaustion, depersonalization and personal accomplishment were examined between psychotherapists trained at the master’s-level and those trained at the doctoral-level. Findings indicated that master’s-level psychotherapists experienced more depersonalization on average compared to doctoral-level psychotherapists. Moreover, exploratory regression analyses found that training-level moderated the relationship between treatment hours provided per week and depersonalization scores, which was additionally moderated by control over client caseload. Specifically, master’s level-psychotherapists with less control over their caseload experienced greater depersonalization scores the more time they spent treating clients per week. Whereas no conditional relationships were found for doctoral-level psychotherapists or master’s-level psychotherapists who reported greater control over their caseload in relation to treatment hours per week and depersonalization scores. Allowing master’s-level psychotherapists to have more control over the topography of their client caseload when feasible may help to reduce burnout-related depersonalization.
Integrated treatment services for co-occurring mental health and substance use disorders are recommended best practice, yet their relationship with facility-level provision of detoxification and medications for opioid use disorder (MOUDs) is not well understood. The researchers analyzed 2021–2023 National Substance Use and Mental Health Services Survey (N-SUMHSS) data from 49,623 facilities offering any substance use services. Multivariable logistic regression models examined associations between integrated services and availability of detoxification and MOUD, adjusting for facility characteristics and Chronic Care Model elements. Primary treatment focus (substance use, mental health, mixed) was evaluated as an effect modifier. Overall, 61.2
Evidence suggests that 10-30% of youth have co-occurring physical and mental or neurodevelopmental disorders (multimorbidity) and that up to 40% of youth with multimorbidity that require mental health services report unmet mental health care needs. This study examined mental health service use (i.e., perceived need or utilization) and access barriers among youth with multimorbidity (n = 3307) in comparison to youth with mental or neurodevelopmental disorders only (n = 2391). Data come from the 2019 Canadian Health Survey on Children and Youth (youth aged 5-17 years). Physical health conditions and mental and neurodevelopmental disorders were measured using a standard checklist. Participants were asked about the reasons for youth mental health services, professional consults, and among those who endorsed need/use of services if they had experienced barriers to access. Overall, 66.1% of youth in the sample perceived a need for or used services related to focusing/controlling behaviors, mental health, or learning difficulties; of these, 39.5% experienced barriers to accessing services. Compared to youth with mental or neurodevelopmental disorders only, those with multimorbidity were more likely to perceive need for services for mental health (AOR = 1.29 [1.10, 1.48]), and to consult psychiatrists (AOR = 1.32 [1.14, 1.62]). There was no significant difference in the overall difficulty in accessing services (AOR = 1.11 [0.92, 1.28]); however, youth with multimorbidity were more likely to experience barriers due to service unavailability (AOR = 1.48 [1.09, 2.13]). Findings underscore the importance for health systems to adopt models of care that integrate physical and mental health services, and for policies that eliminate mental health service barriers for youth with multimorbidity.
Depression remains a common and debilitating condition, and measurement-based care is widely recommended to guide treatment decisions. The study examined whether regular versus irregular completion of standardized symptom monitoring predicted differential improvement in depression outcomes within psychiatric specialty care. The research team analyzed electronic health record data from 502 adult outpatients between October 2023 and September 2024. The study categorized patients as regular (> 50
As initiatives to address mental health crises are expanding throughout the United States, many efforts are focused on police, who often respond first to these emergencies. Co-response models have grown substantially over the past several decades. However, there is a limited evidence base for hybrid models that pair in-person police officers with virtual, on-demand behavioral health professionals (BHPs). This hybrid modality is important to assess given the increased use of telehealth for behavioral health services more generally to improve accessibility. Drawing from semi-structured interviews with 21 co-responders (police officers, n = 15; BHPs, n = 6) involved in a hybrid co-response program in Central Florida, this study provides insights into co-responders’ experiences with the partnership and perceptions of the model’s benefits and challenges. Findings revealed that co-responders valued the partnership for providing on-scene mental health support and assessment, real-world training during live emergencies, safety for both partners, and promoting trust with individuals in crisis. The hybrid model expanded service connections beyond mental health crises for substance use, grief counseling, and housing support. However, differing views on averting involuntary mental health examinations highlighted role conflicts rooted in liability concerns, alongside challenges such as securing consent for virtual consultations and limited partnership interactions. These data can guide agencies in refining hybrid models to align with frontline perspectives, especially in the absence of standardized interprofessional policies. Overall, this study has implications for broader behavioral health co-response teams that may involve other partners, such as paramedics in substance use crises.
Parents play a central role in youth mental health service utilization, including by seeking care, selecting treatment providers, and supporting treatment engagement. This help-seeking process often depends on parents having sufficient mental health literacy, including knowledge of treatment options. However, limited research has examined how parents-particularly those from racially and ethnically minoritized backgrounds-learn about youth mental health treatments and the degree to which they are familiar with evidence-based treatment options. Using a cross-sectional design, this study explored parents' use, preferences, and trust in information sources and their familiarity with treatment modalities, across White, African American, Hispanic/Latino, and Asian parents. Participants were 281 parents who completed an online survey battery. Results from descriptive analyses suggest that parents most commonly use pediatricians, health websites, and family members to gather information, though healthcare providers (i.e., pediatricians, mental health professionals, psychiatrists) were rated as the most trusted sources. Discrepancies emerged between information sources used and those preferred, including an unmet desire for information from mental health professionals. On average, parents recognized 40% of treatment modalities, with highest familiarity for family therapy, medication, and cognitive behavioral therapy. Results from chi-square tests of independence and ANOVAs showed both commonalities and differences in parental information-seeking and knowledge of youth treatment across racial and ethnic groups. Together, findings have implications for the design and delivery of programs designed to improve mental health literacy and ultimately increase mental health service utilization among youth, including those from racially and ethnically minoritized backgrounds.
This study evaluated the factor structure of a measure of mental health literacy (MHL) tailored to the role of helping professionals and assessed its association with help-seeking intentions among a sample of 946 child-serving professionals. Confirmatory factor analysis was used to model different factor structures of MHL for supporting youth, item response theory examined item discrimination, and structural equation modeling tested the relationship between MHL for supporting youth and help-seeking intentions. Results provided support for a higher order factor of MHL for supporting youth, with four first-order factors (i.e., mental health knowledge, attitudes/beliefs, perceived behavior control, subjective peer norms). Item discrimination varied across observed items and first-order factors. The second-order, multidimensional MHL factor was positively correlated with help-seeking intentions. These findings provide an initial step in validating a measure of MHL that accounts for the specific work roles and population characteristics unique to at-risk youth and aligns with prior definitions of MHL and the Theory of Planned Behavior. Future research should seek to replicate these findings across diverse service settings.
This paper describes conclusions from an expert report prepared for litigation against the Office of Refugee Resettlement (ORR) with relevance for all children at risk for placement in restrictive settings. The claims that ORR refused to release unaccompanied immigrant children to appropriate custodians, improperly retained children in restrictive placements, and placed children with behavioral, mental health, or intellectual and/or developmental disabilities in restrictive facilities because of their disabilities rather than their needs have universal relevance to systems of care for children. These conclusions could be used by regulators, funders, advocates, family members, and others to improve decision-making about the management of children at risk for placement in restrictive settings.
