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Oklahoma behavioral health experts say ‘bold steps’ needed to invest in future workforce

Priscilla Du Preez

A bicameral, bipartisan study was held Tuesday to examine challenges and opportunities in Oklahoma’s behavioral mental health workforce.

The state's 77 counties are all considered mental health professional shortage areas. Experts and providers recommend the legislature consider further supporting in-state training opportunities, enhancing education programs and providing additional financial support.

Retaining psychiatrists and psychologists

Oklahoma Healthy Minds Policy Initiative, a nonpartisan team of policy and behavioral health experts, presented a year-long study to lawmakers exploring the state’s workforce shortage and identifying ways to improve employee recruitment and retention. It recommends the legislature spend roughly $30 million to strengthen workforce pipelines and meet the state’s growing needs.

Tequia Sier, Healthy Minds’ project director for behavioral workforce, said it’s important to understand the challenges facing Oklahomans, who live in a state with the seventh highest suicide mortality rate in the nation. Sier also said over 56% of Oklahomans who needed mental health treatment didn’t get it in 2022.

Oklahoma's supply of behavioral health professionals is well below national levels, with the state having 10.8 psychiatrists per 100,000 people and 2.3 psychiatric mental health nurse practitioners per 100,000. This compares to 13.8 and 6 nationwide, respectively, and the Department of Health and Human Services recommends 27.7 and 8.

The initiative found Oklahoma’s psychiatrists are only meeting 39% of the state’s estimated need, and psychologists are meeting 37%. But that doesn’t mean people aren’t applying to study and become these professionals.

Dr. Sara Coffey, OSU’s interim chair for the Department of Psychiatry and Behavioral Sciences, reported that 400 people applied to its psychiatry residency program this year. OSU only has six spots, and Oklahoma has 23 over four programs.

“That means that graduates are not really able to complete their residency in Oklahoma, and where you start your residency and where you work at this end of your training, providers are typically going to stay,” Sier said. “And so, they complete their residency, they say where you train, you retain. And so, we're really losing our workforce due to a lack of residency positions here.”

Sier said if Oklahoma added 28 psychiatry residencies over the next 10 years, it would meet the national average but still fall short of the federal estimated need. This would require a ten-year investment of $9.52 million.

She also recommended increasing the number of psychology internships by about 20 in Oklahoma over the next five years to meet state needs. Currently, Oklahoma has 13 psychologists per 100,000 Oklahomans, and its estimated need is 35.4 per 100,000. Around $4 million would fully fund these internships for three years and partially fund them in years four and five.

Coffey said there is also a major shortage of child adolescent psychiatrists in Oklahoma, with seven per 100,000 children.

Students must complete two additional years of training to become one of these professionals. They also mainly practice in Oklahoma, Tulsa and Cleveland County, leaving rural counties with few nearby options.

Healthy Minds’ report recommends exposing medical students to specialization earlier in school because many medical students don’t become familiar with options like child adolescent psychiatry until their third year. This can be too late to plan and apply for a residency.

In 2021, Oklahoma also received a five-year grant from the Department of Health and Human Services to start the Oklahoma Child and Adolescent Psychiatry and Mental Health Access Program. The initiative supports medical providers' provision of pediatric mental health care by giving medical providers child and adolescent psychiatry and mental health consultations.

Coffey serves as the Friday afternoon psychiatrist on call for providers. She urged the state to continue funding the grant once it ends in a few years to help more Oklahomans access this care.

“It is super complicated, the mental health disorders that are occurring in our children, and to be able to have a child psychiatrist right there available is just amazing,” Coffey said. “To be that child psychiatrist is also wonderful because you feel like you're providing such good support.”

Improving programs and their accreditation

Oklahoma has 27 master’s programs at 17 institutions to prepare licensed professional counselors, marriage and family counselors, and alcohol and drug counselors. Healthy Minds found that 75% of these programs are unaccredited, and 66% of licensed professional counselor graduates come from unaccredited programs.

Attending these programs can result in challenges in completing licensure and employment. An example is the Department of Veteran Affairs, which doesn’t hire mental health professionals from unaccredited programs.

“Currently, the licensure boards don't have requirements around them being accredited,” Sier said. “In the state regents, there's not a requirement, so programs are not necessarily incentivized to be accredited. … Smaller universities and programs sometimes don't have the staff to meet some of the accreditation requirements. The costs can be prohibitive.”

Healthy Minds recommended the legislature help programs seek accreditation with competitive grants to help master's programs. Sier said faculty support is also important, and funding could be used to help institutions meet supervision requirements.

An investment of $2.25 million over five years would support up to six institutions in achieving accreditation for their degree program, according to Healthy Minds.

Sier also said Healthy Minds recommends the state fund scholarships for bachelor’s-level graduates to pursue social work degrees.

There has been a significant increase in licensed clinical social workers in Oklahoma, with 58.3 per 100,000 Oklahomans. The national supply is 87.5 per 100,000, and the Department of Health and Human Services estimated need is 86.5 per 100,000.

An investment of $750,000 could fund 20 master’s of social work degrees, Sier said. Healthy Minds recommends Oklahoma fund nine cohorts, which could produce 180 social workers.

Julie Miller-Cribbs, a professor at OU-Tulsa’s social work program, said social workers provide the most mental health services in the U.S. They also work in a diverse set of fields, ranging from mental health agencies to schools.

She said, after spending time analyzing data on Oklahoma social workers, she’s found that providing support in bachelors programs could help them be more successful in the workforce.

“Getting a master's degree definitely helps, because in our survey, interestingly, those people with just undergraduate debt were actually faring more poorly than even those people with both undergrad and grad debt,” Miller-Cribbs said. “My guess is because getting that master's degree upped their salary, and the resources and support from that help enabled [them] to be more successful.”

Loan repayment

Across the board, Healthy Minds recommended additional loan repayment programs to support Oklahoma’s upcoming behavioral health professionals.

Healthy Minds lobbied for House Bill 2175, which recently went into effect. This created the Behavioral Health Workforce Development Fund, which would allow the Oklahoma Department of Mental Health and Substance Abuse Services to operate a loan repayment program for anyone wanting to get a degree as a therapist or another mental health professional.

It will also permit funding to go toward increasing the number of psychiatric residencies in Oklahoma. Sier said an initial commitment of $1.25 million could fund $25,000 in loan repayments for 50 people.

Sier also said Healthy Minds recommends Oklahoma replicate and expand statewide its Oklahoma State University Medical Authority grant program. This currently funds initiatives to recruit health professionals to Tulsa.

A $9 million investment would help the program provide financial incentives for students to move to Oklahoma, like signing bonuses, tuition assistance and loan repayment.

Sier said she hopes all of these recommendations inspire bold steps in policy.

“What’s next?” Sier said. “I think I’d say just to continue to build on the momentum that we’ve started.”

Editor's note: This story was updated at 9:41 a.m. to reflect the correct last name of Tequia Sier.

StateImpact Oklahoma is a partnership of Oklahoma’s public radio stations which relies on contributions from readers and listeners to fulfill its mission of public service to Oklahoma and beyond. Donate online.

Jillian Taylor reports on health and related topics for StateImpact Oklahoma.
StateImpact Oklahoma reports on education, health, environment, and the intersection of government and everyday Oklahomans. It's a reporting project and collaboration of KGOU, KOSU, KWGS and KCCU, with broadcasts heard on NPR Member stations.
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