Untreated mental illness is threatening the vitality of Indiana communities. The impacts cannot be overstated, with untreated cases costing the state an estimated $4.2 billion annually. The impact extends far beyond economics, affecting Hoosiers of all ages. Alarmingly, suicide is the leading cause of death among adolescents, and thousands of children lack access to necessary care. The problem is compounded by a severe shortage of mental health professionals, with all 92 counties in Indiana federally designated as shortage areas. Addressing this crisis by strengthening the mental health workforce is crucial for improving the overall health and well-being of Hoosiers.

Every Indiana county has a federally designated shortage of mental health professionals. Federal shortage designations are based on the national population-to-provider benchmarks. Other population and systemic factors provide a context for local mental health service needs. The Playbook Workforce Assessment includes county-level resources (workforce and delivery system), community needs (population demographics and risk factors), and mental health indicators. State averages and composite scores were used to rank the counties based on their resources for meeting community mental health needs. (See here for additional details). Above-average counties have more resources (workforce and delivery systems capacity) to meet their community needs (population factors). Below-average counties have fewer resources to meet their needs. A new interactive dashboard with this information has been created to support the targeting of workforce solutions.

Mental and behavioral professionals who provide clinical services require specialized knowledge and skills developed through years of education and clinical training. The preparation of these professionals includes a mix of postsecondary degree programs (master’s and doctoral levels), postgraduate training (residencies and fellowships), and clinical experience requirements. Education and clinical experience are part of the pathway to licensure for professionals choosing to pursue clinical practice in mental and behavioral health care. Understanding the state’s workforce pipeline from postsecondary education to postgraduate training and clinical experience through licensure for independent practice is critical for identifying opportunities to strengthen Indiana’s workforce.

The Playbook focuses on identifying opportunities to strengthen Indiana’s postsecondary pipeline to practice for licensed professions dedicated to the provision of clinical mental or behavioral health services (see section on included professions above).

It is important to note that other health care, social services, and school-based professionals also make significant contributions to mental and behavioral health services in Indiana, including, but not limited to, paraprofessionals, primary care providers, school counselors, and case managers. Their contributions are an important part of the systems that support Hoosier mental health and wellbeing. Future assessments should focus on information and solutions to strengthen and support these valued professionals.

The  state’s postsecondary pipeline to practice for mental and behavioral health professionals is shaped through regulatory policies, realized in the distribution and field strength of degree programs, and experienced by students, faculty, and employers. The identification of opportunities to strengthen the workforce requires an understanding of the unique and interrelated roles each of these factors has in the pipeline to practice.

The regulatory policy defines the educational and experience requirements for licensure, including specific degree programs. A review of regulatory policy for the workforce, including statutes and administrative codes in Indiana, as well as other states, identified the complexity of the policy environment. Practice pathways vary across professions.

For some professions, the pathway from education to licensure is straightforward. In Indiana, psychiatrists and psychiatric mental health nurse practitioners are licensed as physicians and registered nurses, respectively. No additional state licenses are required for clinical practice.

The pathway from education to independent clinical licensure for psychologists is slightly different. Psychologists are first required to obtain a license and then apply for a separate endorsement as a Health Services Provider in Psychology.

The pathways from education to clinical practice are much more complex for selected Indiana professions licensed by the BHHS board and in some cases, include specific provisions related to course content and overlapping requirements related to degree programs. For example, a masters in psychology potentially qualifies an individual for licensure application as a LMHC, LCAC, and LMFT, based on specific courses as outlined in statute.