Do We Need More Clinicians or a Better Care Model?

The behavioral health workforce shortage isn’t something we’re going to recruit our way out of.

The numbers tell us why. The Health Resources and Services Administration projects that by 2038, the U.S. could face shortages of nearly 100,000 mental health counselors, 100,000 psychologists, and 44,000 psychiatrists. And those projections are based on current levels of service use, not the full level of care people need but aren’t receiving.

For behavioral health leaders, that creates a difficult tension. We need to expand access, but not at the expense of quality. We need to support our clinicians, not simply ask them to carry heavier caseloads. And we can’t solve the problem by lowering the bar for who provides care.

So what can we do?

We can start by looking differently at how care is organized.

That means asking whether every task currently assigned to a clinician actually requires a clinician. It means building stronger interdisciplinary teams, expanding the roles of other members of the care team, using technology where it genuinely adds value, and creating care pathways that match patients with the right level of support at the right time.

We're already seeing organizations move in this direction, from integrated care models and team-based approaches to virtual care and new ways of extending behavioral health capacity. The opportunity now is to be more intentional about what works, where it works, and how we measure whether these approaches actually improve access while maintaining clinical quality.

That last part is critical.

Workforce innovation should never be code for doing more with less. It should mean designing care so that every member of the team can work at the top of their expertise.

The organizations that navigate this labor market successfully won't necessarily be the ones with the biggest recruiting budgets. They will be the ones willing to rethink the model itself—how teams are built, how work gets distributed, and how clinical capacity is used.

The question is no longer simply how to fill open positions.It’s how to build a sustainable system of care around the workforce we have.

Building a Sustainable System of Care 

For years, the behavioral health workforce conversation has largely focused on one question: How do we find more clinicians?

That question still matters. But in today’s labor market, it can’t be the only question.

Even organizations with strong recruiting strategies are finding that hiring alone cannot keep pace with demand. At the same time, clinicians are navigating growing caseloads, administrative demands, and the emotional demands of the work itself. Simply asking the existing workforce to absorb more patients is not a sustainable answer.

A more sustainable approach starts with a different premise:

We need to design the system around the workforce we have, while continuing to build the workforce we need.

That means taking a closer look at how care is organized, how clinical expertise is used, and where we can create capacity without asking clinicians to stretch beyond reasonable limits.

Start with clinical capacity, not headcount

Headcount is an easy metric to understand, but it doesn't necessarily tell us how much care an organization can actually provide.

Two organizations with the same number of clinicians may have very different levels of capacity depending on their care model, administrative burden, patient mix, scheduling practices, use of technology, and distribution of work across the team.

That is why workforce planning needs to move beyond questions like How many therapists do we need?

A better question is: What clinical capacity do we need, and what is preventing our current workforce from providing it?

Sometimes the answer really is more clinicians. But sometimes the constraint is a process, an administrative task, a scheduling model, or a role that has evolved without anyone reconsidering whether it is still the best use of a clinician's time.

Before adding another position to the recruiting plan, organizations should map where clinical time is actually going.

How much time is spent in direct patient care? How much is spent documenting? Coordinating care? Managing referrals? Completing administrative tasks? Waiting for information or approvals? Performing work that could safely be handled by another member of the team?

Those answers can reveal capacity that already exists but is currently tied up in the wrong places.

Build teams around patient needs

A sustainable system of care doesn't mean every patient needs the same type or intensity of clinical intervention.

It means having the right people involved at the right point in the care journey.

That could include therapists, psychiatrists, psychiatric nurse practitioners, social workers, care managers, peer specialists, community health workers, primary care providers, and other members of an interdisciplinary team. The exact configuration will vary by organization and patient population.

The important part is that roles are intentional.

A psychiatrist should be able to focus on the patients and decisions that require that level of expertise. A therapist should be able to spend more time providing therapy and less time navigating administrative processes. A care coordinator can help close gaps between providers and services. Technology can reduce repetitive work.

This isn't about replacing one professional with another.

It's about making sure every member of the team is working at the top of their training and within clearly defined clinical guardrails.

When done well, team-based care can extend clinical capacity without diluting clinical responsibility.

Protect the workforce as part of the care model

There is another reason this matters: a sustainable system has to be sustainable for the people delivering the care.

Recruitment and retention are often treated as separate from care delivery. They shouldn't be.

If the care model routinely creates excessive administrative work, inefficient handoffs, unpredictable schedules, or caseloads that aren't manageable over time, no recruiting strategy will completely solve the problem.

Compensation matters. Career development matters. Leadership matters. But so does the daily experience of doing the job.

That means organizations should examine workforce sustainability with the same rigor they apply to patient access and financial performance.

Are clinicians spending enough of their time in meaningful clinical work? Do they have access to appropriate supervision and support? Are workloads distributed fairly? Are there clear pathways for escalation when patient needs exceed the resources available?

These aren't simply employee-experience questions.

They are quality-of-care questions.

Use technology to create capacity

Technology will be an increasingly important part of the behavioral health workforce strategy, but the goal shouldn't be technology for technology's sake.

The most useful applications are often the ones that remove friction from the clinician's day.

Better scheduling. More efficient documentation. Automated reminders. Streamlined intake. Easier access to patient information. Tools that support measurement-based care. Virtual services that make it possible to reach patients who otherwise might struggle to access treatment.

The standard should be simple: Does this technology make care better or make the clinician's job more manageable?

If it does neither, it may be adding complexity rather than solving it.

And where technology touches clinical decision-making, organizations need clear standards for oversight, privacy, safety, and human review. Technology should extend clinical expertise, not replace it.

The Workforce We Have Is the Starting Point

There is a temptation, when talent is scarce, to think of the current workforce as a constraint.

But it can also be the starting point for redesign.

The clinicians already in our organizations have expertise, experience, relationships with patients, and a deep understanding of what good care looks like. The opportunity is to build a system that uses that expertise more effectively and protects it for the long term.

That doesn't mean giving up on recruiting. Organizations will continue to need talented clinicians, and workforce pipelines still need significant investment.

But recruiting should be one part of the strategy, not the strategy itself.

The sustainable system of care is the one that can continue to deliver high-quality care even when the labor market doesn't give us everything we want.

That requires better team design. Smarter allocation of work. Thoughtful use of technology. Strong clinical guardrails. 

The state of the current behavioral health workforce provides an opportunity to design the system around the professionals that already exist.