certain advanced practice nurses, and physician assistants are generally licensed to diagnose and treat general health conditions. By contrast, clinicians licensed to diagnose and treat M/SU conditions include psychologists, psychiatrists, other specialty or primary care physicians, social workers, psychiatric nurses, marriage and family therapists, addiction therapists, and a variety of counselors (such as school counselors, pastoral counselors, guidance counselors, and drug and alcohol counselors). These various types of clinicians are likely to have differing education, training, and therapeutic approaches. As a result, the M/SU workforce is not uniformly equipped with respect to the knowledge and skills needed to provide high-quality services. This situation is compounded by other deficiencies in education that exist across all types of clinicians, as well as long-standing problems in achieving cultural diversity in the workforce and an adequate supply of clinicians for all geographic areas. These problems have persisted despite recurring, short-lived initiatives to address them. The committee recommends a long-term, sustained commitment to developing the M/SU workforce by following a model that provides sustained attention to the nation’s physician and nursing workforce.

Recommendation 7-1. To ensure sustained attention to the development of a stronger M/SU health care workforce, Congress should authorize and appropriate funds to create and maintain a Council on the Mental and Substance-Use Health Care Workforce as a public–private partnership. Recognizing that the quality of M/SU services is dependent upon a highly competent professional workforce, the council should develop and implement a comprehensive plan for strengthening the quality and capacity of the workforce to improve the quality of M/SU services substantially by:

  • Identifying the specific clinical competencies that all M/SU professionals must possess to be licensed or certified and the competencies that must be maintained over time.

  • Developing national standards for the credentialing and licensure of M/SU providers to eliminate differences in the standards now used by the states. Such standards should be based on core competencies and should be included in curriculums and education programs across all the M/SU disciplines.

  • Proposing programs to be funded by government and the private sector to address and resolve such long-standing M/SU workforce issues as diversity, cultural relevance, faculty development, and continuing shortages of the well-trained clinicians and consumer providers needed to work with children and the elderly; and programs for training competent clinician administrators.



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