Who's Qualified to Fix Your Mind?

Nearly half of Americans who need treatment for mental health issues can’t get it – that’s millions of people.

Dr. Amanda West, Chair of Social Work at the University of the Pacific, puts it plainly:

"There is an incredible shortage of mental health workers in behavioral health. We are talking about rural areas. We are talking about communities at risk. Communities that are underserved that have even higher needs."

Why is the shortage so severe? The pipeline for master's level therapists is broken – we’re talking licensed clinical social workers and licensed marriage and family therapists, among others.

First, there aren't enough training spots for these master's-level therapists. Then, once they complete two years of classroom work, graduates must complete 2,000 hours of supervised clinical training — a process that takes two to three years. And finding a supervisor isn't easy.

"There just are not enough clinical supervisors," says West, “because it's out of the generosity of your heart to supervise. The task of taking on a student is not something that a lot of people want to do, and it's voluntary."

Once training is done, candidates face national and state licensing exams. Licensure matters — it protects the public by ensuring therapists are genuinely qualified. But some argue the exams are too difficult, or culturally biased, blocking capable people from ever practicing.

And underneath all of it is a system that chronically undervalues this work. As Dr. West points out:

"We have a system that has neglected behavioral health for decades, specifically regarding work conditions. So, we're talking about pay. We're talking about the level of burnout, the level of trauma that people see on an hourly basis. This has been a crisis all along."

The demand is so acute that some people now argue therapists don't need master's-level training. They propose "mental health extenders" — people with as little as a 40-hour course — to fill the gap. The appeal is real: these are often people who want to serve.

"People that have a passion because they may have their own lived experience,” says West. They're from the community they want to serve, which is what we want. You know, representation matters. However, what is that going to look like long-term? Because are you going to create a two-tiered system?"

A 40-hour certificate is inadequate. And those providers would be most likely to end up serving people who have no other choice. Yes, talking to a peer or member of the clergy can help — but that's not therapy. Master's-level training teaches diagnosis, clinical theory, and evidence-based treatment. These are skills that take years to develop, for good reason.

We need more mental health providers, but the answer is to build a better pipeline — not abandon the one we have. That means government-funded training programs in underserved communities, paying supervisors so clinical training doesn't depend on someone's goodwill, and loan forgiveness for clinicians who commit to working in shortage areas. The shortage is a policy failure. It deserves a policy fix.

— Dr. Michael Wilkes with a Second Opinion