As this legislative season draws to a close for many states, about a third of the 160 successful bills dealing with health workforce issues in 2025 have focused on the behavioral health workforce shortage.

Given the mental health and substance abuse crisis in the US, this year’s enacted bills seek to deal with a wide variety of long-standing behavioral health workforce issues, with dire consequences and potential solutions described in the June 8, 2025 “Our American States” podcast from the National Conference of State Legislatures.

As producer and host Edward Smith described the situation in the podcast introduction, “For more than two decades half the people who needed behavioral health services in the US, did not receive them.” Digging further into the problem, Smith noted that “about 35 percent of the US population lives in areas with shortages of psychologists, counselors and social workers.”  

While about two-thirds of shortage areas are rural, serious problems of access to care also affect areas of high social disadvantage. “We found areas of high social need have half as many behavioral health clinicians as do areas with low social need,” said Brianna Lombardi, director of the Behavioral Health Workforce Research Center at the University of North Carolina, Chapel Hill, and one of three guest speakers on the podcast. “It’s not just rural areas that have a maldistribution of behavioral health workers, but also some of higher need communities don’t have the supply.”

The other two podcast guests were Jeff Shumway, director of Utah’s Office of Professional Licensure Review, who discussed the effect of shortages in that state and Karmen Hanson, senior fellow at NCSL, who discussed the wide variety of 2025 legislative approaches.

All three guests on the podcast emphasized the complex nature of the issues that states are trying to solve. While increasing the supply of behavioral health workers is critical, it is only one problem that besets the field. There are plentiful other issues including the poor distribution of individuals with high level degrees; the increasing number of clinicians who don’t take insurance; patient level barriers, which may include limited transportation or other difficulties in accessing specialized mental health centers, and the need for greater practitioner diversity with an emphasis on cultural and linguistic competence.

A critical point made by Lombardi was that legislators need to understand the specific problems in their own state – a point that was also emphasized by Hanson, who spoke about a variation in issues. “Some have a shortage in a certain type of provider like psychiatry or licensed professional counselor. Or they may have shortages in certain areas of the state” – such as urban core shortages or ones in rural areas.

One example of this year’s legislation came from Shumway, who described how the focus in Utah was in extending the behavioral workforce with legislation that helps to fill the “massive gap” between the half a million individuals in the state who do receive services and as many as another half million who don’t. As he described Utah’s 2025 legislation it built in two new types of licenses, with one offered to behavioral health technicians through a one-year certification program, and the other creating a behavioral health coach, with bachelor level preparation. 

The idea is to fill the gap between peer support specialists and the highly educated individuals who have advanced degrees and currently dominate the field.

This year’s legislation, as described by Hanson included many other approaches, such as statewide assessments and plans for better measurement of the issue; the creation of career pathways; counseling or social work compacts, and financial incentives to encourage better professional geographic distribution, such as loan forgiveness, tax credit or sign on bonuses. Other enacted bills focused on the issue of retaining professional workers with a focus on professional burnout or workplace safety, including enhanced penalties for violence against health care workers.

To delve further into this issue, NCSL has a Health Workforce Legislation database that enables users to search for 2025 behavioral health workforce legislation either in specific states or all the states. 

More legislation will be coming in calendar 2025 in states with continuing legislative sessions and in 2026. 

Beyond any new policies, it will be critical for researchers, evaluators and state and local government managers to carefully evaluate the policy approaches from 2025 and previous years that work best and share the lessons learned during implementation.

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