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Background A shortage of behavioral health clinicians impedes access to mental health services nationwide in the U.S., with shortages most acute in federally designated Mental Health Professional Shortage Areas (mHPSAs). Retaining behavioral health clinicians currently working in mHPSAs is thus critical. This study sought to identify behavioral health clinicians’ assessments of various aspects of their work and jobs that are associated with their anticipated retention within mHPSA practices. Methods Data for this cross-sectional study were drawn from an annual feedback survey of clinicians when they complete federal education loan repayment support contracts for their work within mHPSAs, from 2016 to 2023. Clinicians’ assessments of various aspects of their work and jobs were measured with validated survey items with Likert-scaled response options, with most combined into scales for analyses. Bivariate and then adjusted associations with 5-year anticipated retention were assessed for clinicians’ assessments of various aspects of their work and jobs controlling for demographic, professional, and community characteristics. Results The 2,587 respondent behavioral health clinicians (67.5% response rate) included 42% licensed clinical social workers, 39% licensed professional counselors, 12% psychologists, and 7% licensed marriage and family therapists. Two-thirds of these clinicians worked in either community mental health centers or federally qualified health centers. 42% anticipated they would remain in their practices at least another five years. Five-year anticipated retention rates were nearly three times higher for clinicians who indicated satisfaction on global work and practice assessment measures than for clinicians neutral or dissatisfied on these measures. Five-year anticipated retention rates were also higher for clinicians who reported they had an effective and supportive administration, felt well and fairly compensated, had jobs that permitted a good work-life balance, and had jobs that allowed them to practice the full range of services they desired. Conclusions How behavioral health clinicians view their jobs within U.S. mHPSAs is important to their anticipated retention. Based on study findings, to promote their retention practice administrators should provide fair and adequate compensation, foster work-life balance, permit them to deliver the services they wish to provide, and value them and their input and maintain good relationships with them.

The supply of mental health workers in low-income countries is estimated to be as low as 2 per 100 000 population, compared with more than 70 per 100 000 in high-income nations. This shortage in health-care providers results in major gaps in services, contributing to unmet health-care needs and greater disease burden in underserved regions.1 Furthermore, in times of humanitarian crisis, such as natural disasters, infectious disease outbreaks or war, the necessity for health-related services arises rapidly and unexpectedly, potentially leaving many thousands of people in need of assistance.One emerging technology with the potential to help address some shortages and unmet needs not only in mental health, but also for health-care services generally are conversational agents. Conversational agents are software programs that emulate conversation with humans through natural language. Chatbots are the most basic form of a conversational agent and typically communicate with the user through a simple text interface. Embodied conversational agents, or intelligent virtual agents, use computer-simulated virtual characters with the visual appearance of humans or other forms, ranging from simple cartoon-like characters to highly detailed three-dimensional forms.2 Speech recognition and natural language processing technologies can allow conversational agents to converse with humans. Affective computing techniques can then provide the conversational agent with the capability to recognize and express emotions, giving them the ability to adapt to the changing states and needs of people while establishing empathetic relationships with them.

There are widespread shortages of mental health professionals in the United States, especially for the care of adults with serious mental illnesses. Such shortages are aggravated by maldistribution of mental health professionals and attractive practice opportunities treating adults with less severe conditions. The Affordable Care Act (ACA) and legislation extending mental health parity coverage are contributing to an increasing demand for mental health services. I consider four policy recommendations to reinvigorate the mental health workforce to meet the rising mental health care demand by adults with serious mental illnesses: expanding loan repayment programs for mental health professionals to practice in underserved areas; raising Medicaid reimbursement for treating serious mental illness; increasing training opportunities for social workers in relevant evidence-based psychosocial services; and disseminating service models that integrate mental health specialists as consultants in general medical care. Achieving progress in attracting mental health professionals to care for adults with serious mental illnesses will require vigorous policy interventions.

In the 1980s US mortality rates in rural areas surpassed those in urban areas, and the gap has steadily widened since. However, this growing mortality differential has not been uniform with respect to cause: The widening of the rural-urban mortality gap over the past decade is due disproportionately to differential death rates from suicide, overdoses, and alcohol-related liver disease. Together with the well-documented scarcity of mental health professionals in rural areas (exhibit 1), this makes it important to better understand rural-urban differences in access to mental health services. This study extends previous research on rural-urban differences in mental health care access, which is typically based on the supply of providers and overall utilization rates, by describing rural-urban differences in unmet need for mental health services. Specifically, based on a nationally representative sample of adults likely to need mental health care, we present findings on rural-urban differences in ambulatory mental health visits, controlling for mental and physical health status and a variety of sociodemographic characteristics.

The mental health and addiction workforce has long been plagued by shortages, high turnover, a lack of diversity, and concerns about its effectiveness. This article presents a framework to guide workforce policy and practice, emphasizing the need to train other health care providers as well as individuals in recovery to address behavioral health needs; strengthen recruitment, retention, and training of specialist behavioral health providers; and improve the financial and technical assistance infrastructure to better support and sustain the workforce. The pressing challenge is to scale up existing plans and strategies and to implement them in ways that have a meaningful impact on the size and effectiveness of the workforce. The aging and increasing diversity of the US population, combined with the expanded access to services that will be created by health reform, make it imperative to take immediate action. [PUBLICATION ABSTRACT]

Background Occupational therapists are health professionals with knowledge and capacity to address mental health (MH) needs and reduce MH workforce shortages worldwide. However, occupational therapists working in MH are often underrepresented within the MH and occupational therapy workforce. Aim Using the perspective of occupational therapists with MH practice, the study aimed to: identify barriers and facilitators for occupational therapy practice in MH, and analyze differences in respondent or country level characteristics. Methods The study involved secondary ecological analysis of survey responses. The survey was developed and disseminated by the World Federation of Occupational Therapists. Ordinal logistic regressions were used to determine whether individual- and country-level variables (e.g., demographic, socio-economic factors) significantly affected the survey responses. Results Survey responses ( n  = 1102) were obtained from 67 countries or territories. Of the nine surveyed factors, six (66%) were rated more often as barriers for practice, including “waiting times”, “services funding”, “intervention costs”, and “therapists availability”. “Screening & referral” and having “education /preparation for MH” were practice facilitators. Responses did not substantially vary by respondent or country-related factors, except for the Socio-Demographic Index which substantially and significantly affected the response pattern for “safety concerns” (estimate: 11.08; 95% CI:7.09-15.07; p <.0001). Conclusion The results of this large worldwide survey of occupational therapists on the facilitators and barriers for practice in MH can help inform strategies to strengthen practice in this field. While referral and screening mechanisms should be reinforced to facilitate access to occupational therapy, such actions need to be complemented with adequate service funding, career attractiveness, and therapist availability; otherwise, increased service demands may result in unmet needs and service constraints. Further research is needed to investigate why “safety concerns” was a reported barrier particularly for countries with a lower Socio Demographic Index.

Village health volunteers (VHVs) are the backbone of primary healthcare in many low-and-middle-income countries, including Thailand, where healthcare professionals are scarce. Previous studies looking at their role have been broader and lacked a specific mental health focus. In 2019, Thailand introduced a policy endorsing a recovery orientation in mental health care, however, the potential for VHVs to implement the approach remains underexplored. This study aims to: [1] describe VHVs' mental health practices, [2] explore stakeholders' perspectives on these practices, and [3] understand stakeholders' views on their potential to deliver recovery-oriented community care. This exploratory qualitative study involved nineteen semi-structured interviews conducted between August 2023 and March 2024 in a rural subdistrict of Northern Thailand. Participants included ten VHVs, four nurses, four caregivers, and one individual with mental health conditions. Purposeful and snowball sampling techniques were used. Reflexive thematic analysis was used to analyse interview data. Official documents related to VHVs' job descriptions, training, and recruitment policies were also examined to understand the scope of the role. The analysis identified three main themes: [1] Mental health practices and roles perceptions, highlighting variability among VHVs; [2] Organisational constraints on mental health practice in the community, demonstrating limited policy support and training for VHVs; and [3] Factors influencing the implementation of recovery-oriented approaches by VHVs, including barriers such as stigma and workload, and enabling factors such as specialist training and professional support. This study reveals that VHVs in Thai rural communities prioritise physical health due to policy adopting a biomedical approach and limited training on providing mental health care. A range of culturally adapted approaches are needed to expand and enhance the contribution that VHVs can make to improving the quality of life of individuals experiencing mental health conditions in rural communities in Thailand.

The global mental health workforce is facing a severe crisis marked by burnout, secondary trauma, compassion fatigue, and workforce shortages, with disproportionate effects on marginalized communities. This paper introduces the Integrated Workforce Trauma and Resilience (IWTR) Model, a comprehensive framework to understand and address these interconnected challenges. This study employs a conceptual, documentary analysis approach to examine the challenges faced by mental health workers, particularly trauma, burnout, and workforce shortages. By synthesizing existing qualitative and quantitative studies, the research identifies recurring themes and provides recommendations for policy reform to improve workforce sustainability and equity. Using a thematic synthesis of 75 peer-reviewed articles, conceptual papers, and policy reports published between 2020 and 2025, alongside foundational theoretical works, the IWTR Model integrates five theoretical perspectives: trauma-informed care, Conservation of Resources Theory, Intersectionality Theory, the Job Demands–Resources Model, and Organizational Justice Theory. The analysis identifies three dimensions: the impact of trauma on mental health professionals, organizational and systemic factors influencing workforce retention, and strategies to build resilience through policy and education. The findings reveal how secondary trauma, burnout, and systemic inequities interact to undermine workforce stability and access to care. The IWTR Model emphasizes that individual-level interventions will be insufficient without addressing structural issues, such as workload inequities, lack of leadership diversity, and underfunding. This model offers a roadmap for systemic reforms to strengthen workforce resilience, improve retention, and advance global equity in mental health care systems.

Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.

This manuscript reviews the unique challenges, barriers, and ethical implications of providing mental health services in rural and underserved areas. Community mental health centers in rural areas are often underserved due to shortages of mental health providers and limited resources. Individuals living in rural areas are at increased risk of developing mental health condition with limited access to mental health clinicians and healthcare facilities. These access to care issues are often exacerbated by geographical barriers as well as social, cultural, and economic challenges. A rural mental health professional may encounter several barriers to providing adequate care to individuals living in rural areas. For example, limited services and resources, geographic barriers, conflict between professional guidelines and community values, managing dual relationships, and challenges pertaining to confidentiality and privacy are several barriers to providing adequate care in rural areas. We will briefly summarize the primary ethical domains that are especially influenced by rural culture and the complex responsibilities of mental health providers in rural areas including barriers to care, crisis intervention, confidentiality, multiple relationships/dual roles, limits of competency, and rural mental healthcare practice implications.