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By Jennifer L.W. Fink

January 2025

The math isn’t mathing: There are not enough mental health providers to meet the current demand for care. In 2024, 121 million people in the U.S. lived in federally designated mental health professional shortage areas, according to the U.S. Health Resources and Services Administration (HRSA), which estimates that more than 6,000 additional mental health workers are needed to fill the gap.

The gap is expected to become a yawning chasm over the next decade. HRSA projects a 49% increase in the demand for mental health and substance use disorder care by 2033 — and only an 11% gain in the supply of available mental health and substance use disorder professionals, according to a September 2024 report by The Kennedy Forum.

This imbalance is expected to have profound consequences for individual and community well-being. If action is not taken, countless people will face prolonged struggles with mental health and substance use disorders, often without access to the support they need. This unmet need may lead to increased rates of chronic health conditions, strained relationships, and diminished quality of life, affecting not only those directly in need but also their loved ones and the professionals who serve them.

However, that future is not predestined. “The future is not a thing that just happens to us. We create it with the choices we make today,” says futurist Yasemin Arikan, director of futures research at NEXT Generation Consulting Inc., a firm that uses strategic foresight to help organizations and companies prepare for future trends and challenges. Futurists like Arikan study current trends to make predictions about the future.

There is still time for counselors — and the counseling profession as a whole — to shape a better tomorrow, one that not only meets the growing and diverse needs of individuals seeking mental health care but also supports the well-being of the professionals who provide it.

Collectively, we get to choose: Which future do we prefer? Which will we work toward?

Based on current trends, Arikan sees four possible futures:

#1: The Status Quo

In this “expectable future,” mental health services struggle to keep up with demand and health disparities persist. If steps aren’t taken to expand and diversify the counseling workforce, we’re likely to experience the future predicted by The Kennedy Forum. Those who seek mental health care will face long wait times. Anxiety and depression will likely increase, as will mental health crises. Counselors may feel undervalued; work-life balance may be difficult to obtain. Individuals who want to work in mental health will continue to face barriers, including the cost of getting a degree and becoming certified.

According to ACA’s 2024 Counseling Workforce Report, counselors reported an average student loan debt of $79,500 — an amount 113% higher than the national average and that outpaces the average salary of professional counselors ($71,000). And because unlicensed providers do not qualify for reimbursement from most payers, individuals’ income is limited while they are under supervision and working toward licensure. This limits the pool of people who can afford to pursue a counseling career.

“Best-case scenario, it takes two years after graduation until you can get licensed. But many licensing boards are so backed up that, on average, it’s taking about three years. That’s three years of being really underpaid for your work, and yet your loans are due,” says Erin Parks, PhD, co-founder and chief clinical officer at Equip, an eating disorder treatment program.

The use of telehealth to extend the reach of mental health providers “is one way to address workforce challenges, especially in rural and other underserved areas,” says Anita Everett, MD, director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration (SAMHSA). “The continuing developing of apps and artificial intelligence (AI) solutions could also augment the work of professional counselors.”

#2: The Roller Coaster

In this “especially challenging future,” unpredictable factors — such as economic downturns, environmental crises or other catastrophes — further strain the mental health care system.

Already, we have seen human migration due to climate change and increased costs of living, which may result in “disproportionate needs for care in certain areas,” says Lindsay Angelo, a futurist and strategist dedicated to advancing wellness. “I think there’s going to be a lot of shifting happening, which can absolutely impact areas of demand for mental health, as well as how it will be delivered.”

Political rancor could stifle efforts to alter the policies that currently limit the pipeline of counselors. And, the combination of increased demand and dwindling supply could lead to an uptick in the use of technology to manage mental health.

“Maybe in desperation, more people will turn to things like AI or video games that have a mental health component,” Arikan says. “In a particularly challenging future, you can see how there may be an over-reliance on tools like that. They could delay professional help or even exacerbate existing problems.”

#3: The Alignment

In this “surprisingly successful future,” governments and organizations work to reform mental health care, increase access and decrease disparities. If state and federal governments band together, the supply of mental health providers could increase dramatically.

“Antiquated” state licensing laws currently inhibit counselors who move from one state to the next, Parks says, because they must apply (and pay for) a new license. Adopting interstate licenses or interstate licensure compacts would allow counselors to work wherever they may move, without significant delays or costs. �ֲ���ýis leading this charge: Currently, 37 states and Washington, DC, have signed on to the Counseling Compact. �ֲ���ýis continuing to advance the compact and fund its commission, which will grant privileges to practice in other compact states.

Altering reimbursement guidelines to allow reimbursement of pre-licensed counselors and those licensed in other states could release “tens of thousands of providers into the market,” Parks says. Loan forgiveness programs for those who earn mental health degrees and work in the field could also dramatically increase the supply of providers — and would likely increase the diversity of the profession in terms of race, socioeconomic background, gender and sexual orientation.

Expansion of programs such as SAMHSA’s Minority Fellowship Program, which provides stipends to increase the number of culturally competent behavioral health professionals, can also help. (Currently, about 400 fellows receive scholarships and training annually.)

Thoughtful use of technology and available counselors may further increase access to care without creating undue stress on mental health professionals. One innovative example of this is ENGAGE, a collaborative initiative between Columbia University Irving Medical Center’s Department of Psychiatry and the New York State Office of Mental Health, which is leveraging technology for “both training and to ensure the rigor of care,” says program director Milton Wainberg, MD, professor of clinical psychiatry at Columbia University/New York State Psychiatric Institute.

ENGAGE hires people who have bachelor’s degrees in social sciences and live in areas that need care. These “community wellness specialists,” as  they are called, are then trained to triage and provide short-term evidence-based counseling for mild-to-moderate mental health problems such as depression, anxiety, post-traumatic stress disorder, substance use and suicide risk.

The counseling is provided via a digital decision and treatment support platform. The tool uses 13 simple questions. The first three questions screen for any mental disorder (with 95% specificity), Wainberg explains. The next 10 questions screen for depression, anxiety, substance use, suicide risk and severe mental health problems, also with high sensitivity.

Individuals with severe mental health symptoms get immediately triaged to mental health specialists, Wainberg says. Those with mild-to-moderate depression, anxiety, substance use or suicide risks receive evidence-based treatment from the community wellness specialists, who receive rigorous training in interpersonal counseling, motivational interviewing and safety planning for suicide. Specially trained counselors supervise the community workers.

“We use technology as a way of verifying and making sure that the science is used properly,” Wainberg says, noting that deviations in interventions have been shown in research to affect outcomes. “With the digitization, I can tell proactively if you are doing the right job.” The system flags supervisors if there’s a problem, so they can intervene as needed.

ENGAGE increases access to care by tapping into a previously untapped resource: community members who are willing and able to provide mental health support but do not have advanced degrees. Such creative thinking will likely be necessary to solve the current workforce and mental health crises.

“We have to ask, ‘why do we require so much from providers to be able to work in this space?’” says Brie Reimann, vice president of practice improvement and consulting at the National Council for Mental Wellbeing. “Are there different, innovative ways we can build the peer workforce?”

Evidence to date from ENGAGE suggests the answer is yes, Wainberg says, noting that similar culturally appropriate versions of the program are in use in Mozambique, South Africa, Thailand and Israel. Sustaining ENGAGE, however, “will require changes in policy so that reimbursement can be done properly,” Wainberg says.

#4: The Community-Supported Way

In a “resourcefully resilient future” local communities and grassroots efforts support mental wellness through creative, resourceful, bottom-up approaches. In the absence of government cooperation and large-scale transformation of the mental health system, local communities and individuals may find ways to support mental well-being.

“We may see the formation of local peer support networks and significant changes on how we design and strengthen communities,” says Arikan, the futurist. “There are some strategies and tactics for urban design, public spaces, and cultural and recreational opportunities we can use to reduce isolation and make places that facilitate connections.”

Some places are already using design/build interventions to bring mental health services to areas that need service. People who live in rural communities, for instance, often have limited access to treatment due to a lack of providers. One organization in Southwest Colorado is building tiny houses to provide affordable housing for mental health care providers, according to Reimann. And increasingly, organizations are exploring ways to extend — and improve — mental health services by thoughtfully integrating peer support.

Parks’ program, Equip, provides virtual eating disorder treatment. All patients are matched with a peer mentor, an individual who is in recovery from an eating disorder. Their family members are also paired with a family mentor, someone who has already helped a loved one with an eating disorder. These peer mentors train alongside clinicians and are an important part of the treatment team, Parks says.

“The mental health workforce needs to start thinking about behavioral health treatment as more than an hour in a session with someone with a bunch of licenses,” Parks says. “We also need to start thinking of trained but unlicensed, lived experience professionals as not just ‘less expensive’ but also as more effective in some situations.”

A resourcefully resilient future may also embrace a more holistic view of health and well-being. “Our physical health and mental well-being are connected,” Reimann says, “and we must work toward making that a reality for everyone.”

Writing the Future

The future, of course, is not yet written. It’s imperative that each of us takes steps to build the future we would like to see.

“It’s very easy to look at the whole big picture and say, ‘I don’t know what to do,’” Arikan says. “So, start with this: What is one thing you could stop doing — or start doing — to make a preferable future more likely?”

Upskilling and advocacy are likely necessary. So is hope and optimism. Despite the challenges, Reimann says, “there’s no better time to enter the field, as you have the opportunity to be change agents, be innovative and to contribute to a new vision of the future of the workforce.”