Exploring the Barriers and Facilitators Mental Health Practitioners in San Diego County Face When Working with People with Severe and Persistent Mental Illness

Background and Purpose

The US is experiencing a shortage in mental health practitioners (MHPs), especially those who work with adults with severe and persistent mental illness (SPMI). California is estimated to be able to serve only a quarter of its need, and by 2027, San Diego County will need to educate, train, employ, and retain over 18,500 professionals to keep up with the behavioral health need. In past research, recent mental health graduates reported having little exposure to SPMI and feeling less comfortable working with SPMI populations compared to populations with less severe conditions. Therefore, to build the workforce needed to reduce the shortage of MHPs, it is pertinent to learn about the barriers and facilitators that current MHPs experience when working with SPMI, along with learning how to better equip students to feel confident in working with SPMI. This study aimed to explore the perceived barriers and facilitators of MHPs working with people with SPMI, paying attention to the individual, organizational, community, and policy levels.

Methods: Purposive sampling was used to recruit mental health providers (N=10) for individual interviews and master’s level social work students (N=8) for focus groups. Data was collected from October 2024-November 2024. The interviews and focus groups lasted 60 minutes. Data was analyzed using a situational analysis approach. Transcripts and researcher notes were reviewed, and situational maps were constructed as data was analyzed. After all data was analyzed through these maps, the data underwent a secondary coding to translate the elements in the maps into themes using NVivo 14 software. During the overall process, memo writing and group consultation were used to discuss the themes that came up in the data in weekly meetings.

Results: 18 participants were interviewed with 10 consisting of social workers, counselors, and supervisors who had worked with, or were currently working with people with SPMI, and 8 being students in a master’s of social work program who had experience working with SPMI in San Diego County. The barriers that were developed from the analysis included lack of educational exposure to SPMI, burnout, low pay, lack of support from an organization, and policy influencing funding. The facilitators included personal interest in the SPMI population, supervision at one’s organization, the mission of one’s workplace, community relationships, and local funding.

Conclusions and Implications: Findings from this study show that barriers and facilitators exist at all levels when working with SPMI. These include feeling unprepared in working with SPMI, lack of support, lack of pay and overall funding, and burnout. Two major facilitators in working with SPMI is interest in working with this population and supportive supervision. Overall, these findings show the need for clinical programs, like social work, to focus more on exposing students to SPMI, both through foundation learning and internship placements. Future policy should focus on funding and support that makes treatment for SPMI accessible, while also paying the workforce a living wage.