Access to behavioral health care is a major challenge in Massachusetts and nationally. Behavioral health needs have risen in recent years due to the effects of the opioid crisis, the COVID-19 pandemic, economic pressures, and other stressors. In 2024, nearly 1 in 4 adults experienced a mental illness in the past year, and in Massachusetts, behavioral health needs are disproportionately high among historically underserved and marginalized populations. The current behavioral health care system does not have the capacity to meet community needs – recent reports have highlighted an alarming shortage of behavioral health workers, and the shortage is expected to worsen in the coming years. Currently, about 40% of the U.S. population lives in a Mental Health Professional Shortage Area (a designation from the Health Resources and Services Administration (HRSA) for areas or populations with insufficient providers). HRSA’s workforce projections for 2038 show significant shortages across many behavioral health roles, with the greatest projected shortages for mental health counselors and psychologists. Even in places with sufficient providers, community members can face access barriers related to cost, transportation, stigma, language, or culture. 

One strategy to improve access to care is to build the capacity of non-clinical staff in community-based settings to provide evidence-based interventions to people with mild to moderate behavioral health needs. In addition to supporting improved outcomes for participants, this can also relieve some of the stress on the clinical care system, opening more space for people with more severe needs who require higher levels of care. ICH recently completed a 3-year evaluation that showed how effective this approach can be. Through the Advancing Community-Driven Mental Health (ACDMH) program, the Blue Cross Blue Shield of Massachusetts Foundation funded five community-based organizations (CBOs) to adapt and implement the evidence-based Problem Management Plus (PM+) intervention. PM+ is a brief low-intensity mental health intervention developed by the World Health Organization that is oriented around participants’ self-identified problems, providing specific strategies over a series of five sessions. With ACDMH, Partners In Health and The Family Van provided training and technical assistance (TA) to the CBOs to build their staff capacity and support them with implementation. 

While PM+ is an evidence-based program, the established evidence primarily comes from international settings with different populations and contexts than the ACDMH CBOs. For our evaluation, we wanted to understand how CBOs adapted the program to fit their unique settings, who they were able to reach, and how effective their adaptations were. The ACDMH CBOs included housing providers, a disability services organization, and multi-service agencies specializing in working with low-income and immigrant communities. Many of the CBO PM+ providers had similar cultural backgrounds and/or lived experiences to the client populations, and four of the five CBOs were able to deliver the intervention in non-English languages, including Spanish, Amharic, Cantonese, Bangla, and more. While CBOs retained the core components of the evidence-based intervention, they made adaptations to elements such as the session cadence, the setting and modality of visits, the staff supervision structure, and the way they described the program to potential participants. For example, because of stigma around mental health topics, CBO staff tended to avoid clinical terminology (e.g., “depression”, “anxiety”) and instead used words like  “wellness” or “life balance” to talk about PM+.

Our evaluation showed positive outcomes for staff and for clients. Through training and experience, CBO PM+ providers strengthened their skills around building rapport with participants, assessing needs, setting appropriate boundaries, and supporting participants with PM+ strategies. Providers shared that they have become more comfortable working in the mental health space and supporting people with different challenges, and some said PM+ had improved their job satisfaction.  

At the client level, CBOs reached a linguistically diverse population, with almost half of PM+ participants preferring a language other than English. Those who completed PM+ had significant improvements (both statistically and practically!) in their mental health, measured with two different assessment tools. In interviews, participants said that PM+ helped them feel more empowered, strengthened their ability to cope with stress, and improved their day-to-day functioning. Some shared examples of loved ones noticing changes in them, such as a participant who said, “My grandkids are always saying, ‘Nan, you’re so happy now.’ They used to say, ‘Nan, put a smile on your face. Why are you so sad?’”

However, ACDMH was not without challenges. Most CBOs experienced staff turnover that disrupted their ability to deliver the intervention, and they had to invest time in training new providers. Participant recruitment was more challenging than expected for most CBOs, requiring them to come up with new strategies over time as well as devote ongoing effort to combatting stigma. CBOs also found that running a successful PM+ program takes significant staff time beyond the sessions themselves, and some struggled with fitting PM+ into staff schedules and balancing the program against other responsibilities. With the support of TA providers, most CBOs were able to work through these challenges, and from my perspective as an evaluator, I know that the lessons learned will be very valuable for other organizations that want to do something similar. 

I have really enjoyed working on the ACDMH evaluation over the last three years. Obviously, it is satisfying to have strong data showing positive outcomes! But more than that, it is heartening to see CBOs rise to the challenge of meeting their communities’ mental health needs, with the support of a strong training and TA structure. We have learned so much from this work about how to integrate evidence-based approaches into community-based settings and improve access to care, and I can see many opportunities to translate this work to other settings and health topics. ICH’s tagline is “Building sustainable community health, together” and this project brings those words to life—great things can happen when community-based expertise and research knowledge are brought together, and I feel so lucky that I get to be a part of that.