Behavioral health leaders are seeing a growing disconnect between how clinicians are trained and the realities they face in practice amid workforce shortages, rising patient acuity and operational pressures reshaping care delivery.
Leaders told Becker’s that many clinicians enter the field with strong academic preparation but limited exposure to crisis stabilization, integrated care models, telehealth demands and the operational complexities of modern behavioral healthcare settings.
Question: Where are you seeing the biggest gap between how the behavioral health workforce is being trained and the realities clinicians are facing today?
Dorinda Mueller. CEO of Aliso Ridge Behavioral Health (Aliso Viejo, Calif.): The biggest gap I am seeing between behavioral health workforce training and clinical reality is that the behavioral health workforce is being trained for a controlled, idealized version of clinical practice, while the realities on the ground, especially in higher acute units with high staff turnover settings are far more complex. New clinicians often enter the field with strong theoretical knowledge but limited exposure to the intensity of real‑world behavioral health work, including rapid escalation, co-occurring conditions and significant trauma histories. At the same time, persistent turnover means a large portion of the workforce is inexperienced, which forces organizations into a constant cycle of onboarding and skill‑building rather than deeper professional development. Supervisors are stretched thin, often pulled into coverage, leaving little protected time for the modeling, repetition and simulation coaching that new staff actually need. The result is a widening gap between training and day‑to‑day clinical demands, with organizations carrying the burden of providing the practical, trauma‑informed, real‑time training that academic programs do not fully prepare clinicians for.
Imad Melhem, MD. Chair of the Institute of Psychiatry and Behavioral Health at Geisinger (Danville, Pa.): The gap between behavioral health workforce training and real-world practice is multifactorial, reflecting a disconnect between structured educational environments and the complexity of clinical care settings.
Training programs are typically well-resourced and highly structured, while real-world practice often occurs in under-resourced, multidisciplinary environments. Clinicians must navigate complex patient needs shaped by social determinants of health — such as poverty, housing instability and transportation barriers — requiring strong team-based skills and collaboration across clinical and nonclinical partners.
Geographic and cultural misalignment further widens this gap. Training pipelines are often centered in urban, resource-rich settings, whereas workforce shortages are most acute in rural and underserved communities. Although cultural competence is introduced during training, real-world practice demands a more nuanced, applied approach tailored to local populations.
Operational readiness is another major challenge. Many clinicians enter practice underprepared for insurance systems, documentation requirements, team-based care models, productivity expectations and telehealth delivery — realities that shape daily clinical work.
Finally, there is a clear opportunity to strengthen leadership and management development within training programs. Behavioral health increasingly requires leaders who can adapt to rapid system changes, navigate operational complexity and drive innovation.
Micah Krempasky, MD. Chief Medical Officer of Mental Health at WakeMed (Raleigh, N.C.): For decades, health systems have relied heavily on psychiatrists to lead behavioral health care, while many other clinicians have viewed mental health as someone else’s job. Yet mental health is inseparable from physical health. Anxiety presents in GI clinics. Depression worsens chronic disease outcomes. Trauma shapes adherence, coping and recovery. Whole-person care requires all clinicians to develop comfort and competence in recognizing and addressing behavioral health needs rather than quickly deferring them elsewhere.
Additionally, we are increasingly relying on advanced practice providers to fill workforce gaps without always equipping them for the complexity of psychiatric care, particularly in the hospital setting. Managing psychiatric illness in acute care environments requires far more than medication management. It demands understanding medical comorbidity, crisis stabilization, behavioral dynamics, communication strategies and systems-based care. Many training pathways remain heavily outpatient-focused and biologically oriented, with less emphasis on psychotherapy, psychodynamic understanding and the human factors that drive behavior. This leaves newly minted advanced practice providers ill equipped for the very complex patient population that is typical in inpatient settings.
The gap is clear: We are building care models that require integrated, whole-person expertise while training clinicians in fragmented ways that do not fully prepare them for the realities of modern behavioral health care.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
