As the need for mental health care in Washington far outstrips the state’s capacity to provide it, a group of university leaders have a new strategy: Train students earning bachelor’s degrees in evidence-based talk therapy. 

The move could quickly ramp up the number of available providers and ease the burden on those with more advanced training. It would also mark a big shift in Washington’s mindset about who can provide care for conditions like anxiety and depression.

Today, most mental health professionals in Washington are required to earn a master’s degree or doctoral degree — plus undergo thousands of hours of supervision — before they’re allowed to work with patients.

The bachelor’s training idea, which is inspired by a similar program in the United Kingdom, may soon be a reality. 

The University of Washington’s Department of Psychiatry and Behavioral Sciences received a $3.7 million grant from the philanthropy Ballmer Group in May to take the idea from a proof of concept to something that’s scalable.

Within five years, officials hope at least 50 students are licensed and practicing under the new title, “Behavioral Health Support Specialist.” (The Seattle Times Mental Health Project is funded by Ballmer Group. Our reporting operates independently and this program came to our attention through discussions with UW staff, without involvement from the funders.)

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For years, the state has struggled to recruit, train and retain a diverse behavioral health workforce. Extra degrees are costly and can translate into years of debt. Low wages for some mental health professionals might turn people off — and for those who enter the field, they might not be able to afford to stay. 

Getting students through a training pipeline faster, and more cheaply, could transform individuals’ ability to access care.


“We want to be really bold in our vision for this,” said Dr. Anna Ratzliff, director of UW’s Psychiatry Residency Training Program, who is developing the bachelor’s training program with her colleagues. “This is needed and we’re trying to build it as fast as we can.”

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The finer details still need ironing out. Creating a new category of licensed health care worker might require changes to state law — something UW Medicine officials are trying to figure out over the next year. They’ll need to work with insurance companies to nail down how these bachelor’s-level professionals can bill for services. They’re just beginning to collaborate with UW’s social work and psychology departments and other colleges and universities across the state. And they’re reaching out to providers who might offer students clinical training. 

The concept isn’t an instant fix for deep problems in the state’s behavioral health care system, said Susan Skillman, senior deputy director at UW’s Center for Health Workforce Studies. Many master’s-level mental health occupations are poorly paid. Washington mental health counselors and social workers, on average, earn less than $52,000 — while Metro bus drivers earn an average salary of $56,000, a 2017 analysis from Skillman and her colleagues suggests.

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Adding a lower-skilled and lower-paid occupation wouldn’t solve salary-related retention issues unless “comparable attention is paid to retaining the existing (more highly trained) workforce at the same time,” Skillman said. 

The training program may help diversify the largely white mental health workforce; time spent getting a degree and the cost of professional training, limits people with fewer resources from pursuing training programs. 

But the field should focus on bringing people with a broader range of life experiences and cultural backgrounds into all levels of the mental health field, Skillman said. Increasing scholarships for expensive master’s and doctoral programs, for example, might help. 

“This is one piece in a very large spider’s web of trying to find ways to solve our problems with getting people who need behavioral health services access to those services,” Skillman said. “More power to every single one of these potential solutions. But it’s going to take every one of these potential solutions.”

Sessions with a bachelor’s-level provider would be an “entry point,” for people who need care, Ratzliff said, and a means to get more people into treatment early, before their symptoms worsen and they need more intense interventions. 

But the credential would likely have limitations. Bachelor’s-level providers wouldn’t be allowed to diagnose behavioral health conditions, but could refer people with higher needs to social workers, psychologists or other professionals with more training. 

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And they couldn’t prescribe medication. They’d only provide talk therapy and would likely require some level of ongoing supervision from more highly trained professionals, Ratzliff said. 

A version of the program is already underway at Eastern Washington University. There, the School of Psychology has developed a 30-credit certificate program that allows students to learn and practice low-intensity interventions under supervision. Students learn how to practice cognitive behavioral therapy and how to teach clients coping skills, among other things. 

Five students are enrolled so far, but officials say they expect the program could grow, especially if the state formalizes a bachelor’s-level credential. 

The university forged ahead with the program since many medical offices currently rely on medical assistants and other staff to do this work now, said Kayleen Islam-Zwart, who chairs EWU’s School of Psychology. “The work is happening on some level by people who have never been trained to do it,” Islam-Zwart said; for example, a medical assistant might offer coping strategies to a patient with anxiety.

“We want to have the students ready to go as soon as the opportunity is there. And in the meantime, they can work in those jobs that exist that maybe just don’t have the title that exactly matches what we’re training them to do.”

Ratzliff and her UW Medicine colleagues are collaborating with EWU. The UW team started piloting the concept about four years ago by developing curriculum and teaching a class of undergraduates; preliminary data from a small study suggests that these students could deliver basic treatment for mild and moderate depression. The team is now creating resources that could make it easier for other colleges and universities to adopt similar training programs. 

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For now, they’re focusing their curricula on care for adults with common conditions such as anxiety, depression and substance use disorders. But they may eventually expand the training to include therapy for children. 

“We need those kinds of ideas to really make a difference for access to effective treatment in Washington,” Ratzliff said.

Mental health resources from The Seattle Times