Behavioral health conditions are common, chronic, and treatable. While insurance coverage for behavioral health care has improved over the past two decades, many Californians with behavioral health needs still do not receive treatment. One of the most significant barriers to care is scarcity of licensed mental health clinicians. California had 80,000 licensed behavioral health professionals according to a 2018 analysis, but they were not distributed evenly across the state and, for most communities, the workforce does not reflect the racial, ethnic, or linguistic diversity of the state’s population.

Yet expanding the number of licensed providers takes time and money. One innovative approach gaining traction is training “lay counselors” — people in community settings with interest and relationship-based skills who can offer mental health counseling even if they are not formally licensed to practice therapy.

Lay Counseling in Other Countries

Lay counseling is widespread in low- and middle-income countries, where it has been used to fill a severe resource gap — much like the one we are experiencing in the US. Research has shown lay counseling in these countries has been effective for multiple mental health conditions and populations.

Nonlicensed helpers exist in the US in many areas, including on suicide prevention lines and in health education and coaching programs. The addiction field has long relied on helping professionals who do not have master’s degrees, licenses, or traditional mental health educations. These examples indicate a diversification of the workforce beyond licensed professionals, and a broadening of the criteria used to decide who can be helpful.

Evaluation of California Program

In California, The Lay Counselor Academy was created in response to the experience in other countries showing that lay counselors who enter the mental health counseling field directly through experience and practice can effectively provide high-quality mental health counseling to those in need. The academy provides relationship-based training that builds on the skills, experience, and knowledge participants already possess.

CHCF is supporting an evaluation of the Lay Counselor Academy, including the scope of practice and quality of care of lay counselors. The evaluation will also explore the impacts of lay counselors trained in the academy on their home organizations, including how they are deployed after training and how counselors use mental health counseling skills learned in the academy. Last, it will explore how lay counselors could be integrated into the mental health system of care in California.