Increasing Access to Behavioral Health Care: Examples of Task Shifting in Two US Government Health Care Systems

Introduction: Addressing U.S. health disparities in behavioral health care requires innovative solutions to expand access beyond the traditional specialty behavioral health (BH) service model. One evidence-based strategy to increase access is task shifting, whereby tasks usually reserved for licensed clinicians are delegated to less specialized but uniquely capable health workers. Health care systems in the United States have been slow to adopt this approach, despite the widespread success of task shifting in other countries. However, two large government health care systems have employed unique task-shifting models for decades, integrating nonclinician health workers into BH settings: the Defense Health Agency (behavioral health technicians) and the Veterans Health Administration (peer specialists). Method: This conceptual article provides overviews of these successful approaches. Challenges and opportunities, and the potential for other U.S. health care systems to adopt task shifting for behavioral health care with paraprofessionals such as community health workers (CHWs), are discussed. Results: CHWs and other paraprofessionals are ideally situated to increase access to behavioral health care, but barriers must be overcome. Recommendations are provided based on lessons from these federal system approaches to task shifting. Discussion: Expanding task-shifting paradigms as the Defense Health Agency and Veterans Health Administration have done may be vital to reaching more people who could benefit from BH intervention and prevention strategies.