Experiences of Diverse Youth Mental Health Providers in King County
By: Isis Garcia
Diversity of Providers Needed to Address Youth Mental Health Concerns
The COVID-19 pandemic exacerbated mental health issues, particularly for youth of color and gender diverse youth. Over one-third (36.4%) of King County school-aged youth reported experiencing depression symptoms in 2021. Students who identified as transgender (67.3%), something else (67%), questioning (62.9%), lesbian, gay and bisexual (60%) were almost twice as likely as the King County average (34.6%) to experience depressive symptoms. Hispanic/Latino (41.0%) and Multiple Race (40.9%) students also had higher than average depression rates.
In 2022, the US Bureau of Labor Statistics reported that 82.4% of mental health counselors and 65.4% of social workers are White, revealing a scarcity of BIPOC mental health professionals. This shortage hampers the access and quality of culturally competent and affirming care that BIPOC and LGBTQ+ youth can receive. By attaining a more representative mental health workforce, people of color and gender diverse individuals gain the power of choice in practitioners who deeply understand their unique needs. It can also bridge gaps in access to mental health services, as people are more likely to seek services when they feel understood and represented by their provider. To enhance diversity and culturally sensitive care for youth, King County embarked on understanding the behavioral health workforce landscape.
Project Overview
In response to this concern, the King County Youth Mental Health Collaboration Team gathered representatives from key organizations like Best Start for Kids, Community Well-Being Initiative, Zero Youth Detention, Care and Closure Program, and School Based Health Centers to design and implement a qualitative study to learn more. This study thoroughly investigated challenges confronted by BIPOC and LGBTQ+ behavioral health providers and healers serving youth aged 5 to 24 through a literature review to establish a foundational understanding of behavioral health workforce issues, combined with qualitative analysis of insights from 19 participants in five focus groups and seven individual interviews. The goals were to:
Identify strengths and challenges impacting recruitment and retention in the education-to-work pipeline; and
Develop programmatic and policy recommendations to enhance BIPOC and LGBTQ+ students' and providers' experiences in the behavioral health field, boosting recruitment and retention and fostering diversity.
You can find a one-pager project overview here.
Key Findings
Participating providers described challenges getting into and affording an advanced behavioral health degree, encountering discrimination in school and fieldwork settings, as well as difficulties in obtaining continuing education.
“I would say that one of the most significant that I had coming from a BIPOC background was financial access to pay for a program. Due to those financial barriers, I had to rely either on student loans or applying for scholarships, and so I was very mindful of the programs that I was limited to.”
Getting Into Higher Education
Participants highlighted the prohibitive cost of higher education, a significant obstacle for individuals from lower-income BIPOC and LGBTQ+ backgrounds who are more likely to experience systemic discrimination and a lack of generational wealth. The high financial burden can deter potential mental health professionals from pursuing advanced degrees.
Numerous participants voiced additional concerns regarding limited access to information and knowledge concerning the matriculation process and diverse career pathways accessible to behavioral health professionals.
“Concerns with the content itself or interactions with peers… cultural differences based on identity distracted from the work that I wanted to do in the program and felt like a barrier to being successful. It took a lot of extra attention and energy individually versus feeling supported by the institution or the program itself.”
Higher Education Experiences
Identified barriers to retention in higher education included a lack of representation and instances of racism and discrimination.
Participating providers would like to see programming and access to safe spaces, building community and mentorship opportunities, and wrap around services for students in graduate programs as a way to address the barriers mentioned above.
Fieldwork Experiences
Participants identified racism and discrimination in the workplace as a barrier to retention among BIPOC and LGBTQ+ providers.
“Microaggressions, not being appreciated due to an ideology of what professionalism is. Some supervisors have an idea of what therapy should look like and will try to change how a person of color will conduct sessions, talk and discuss issues with clients. I struggled with finding my voice early on because of supervisors wanting me to speak and act a certain way.”
Participants noted that navigating the licensure process is challenging, with specific reference to complex documentation requirements, varied supervision hours, out-of-pocket supervision costs, and difficulties in licensure submission and approval.
“What hinders [the licensure process] is just so much bureaucracy that makes it really hard. If you don’t count your hours quite right, there’s all these things that can happen… There’s just like 20 pages of these finite details that are just so absolutely ridiculous and unhelpful. Reducing that is important.”
Participants mentioned that the inadequate pay and benefits hinder workforce retention, causing high turnover in community settings. Consequently, providers often opt for better-paying positions in Managed Care Organizations (MCOs) or government roles.
“The pay is astronomically terrible, especially in King County – they need to completely change the way that Medicaid pays for community behavioral health. General retention is terrible. There’s a lot of turnover - folks on average leave after 8 months. If you have no one in your clinic, everything falls to you – identity aside it’s going to suck… It has to be fixed on the county level, because clinics are closing due to insufficient Medicaid reimbursement.”
Professional Development
Continuing education (CEUs) is essential for licensure and is mandated for specific behavioral health professions annually or biannually. Participants noted challenges in accessing CEUs due to costs and time constraints.
Participants emphasized workplace-based or institution-provided programs focused on cultural competence and integrated service approaches. They stressed the importance of comprehensive support, including financial assistance for CEU’s.
“I think finding time to attend those courses, or to do the self-paced courses to get that credit [is a barrier]. For my job as a therapist, I see clients throughout the week, and that’s how I make my income to pay for the courses and everything else. However, courses often coincide with my client schedule, forcing me to choose between attending and earning income, or paying for the course itself.”
Next Steps to Support Diversity in the Behavioral Health Workforce
This qualitative study underscores the need for diversity in the behavioral health workforce to achieve an inclusive and effective mental health care system. Implementing the recommendations below will enhance recruitment and retention, expand access to care, and empower the next generation of BIPOC and LGBTQ+ mental health professionals.
A summary of the key action steps highlighted by participants include:
Increased pay for providers,
Creation of community spaces for BIPOC and LGBTQ+ students and providers,
Offering support for licensure requirements and applications, and
Providing funding for professional development
For additional recommendations and details, refer to the report or presentation.
For more information about this project, please contact:
Isis Garcia MPH - imgd@uw.edu
Sarah Wilhelm - sarah.wilhelm@kingcounty.gov