Texas is struggling to diversify its mental health workforce as the state becomes less white

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Lynette Carrillo felt alone. Looking around at her small doctoral psychology class at Texas Woman’s University in 2021, she realized she was the only Spanish speaker.

At that point, Carillo had almost grown used to it. After nearly a decade pursuing degrees at Angelo State University in San Angelo and TWU in Denton, she could count on one hand how many professors and classmates came from diverse backgrounds. It’s just how the mental health field is, she thought.

“For a long time, I didn’t know that there were clinicians who spoke Spanish or who came from diverse backgrounds like me,” she said. “In the Latin culture, community is important, so I had to put in that extra effort to find common ground with my classmates. I had to have that mindset with myself in order not to feel like I was so alone.”

As the daughter of Mexican immigrants, Carillo knew it would be challenging to become one of the rare Spanish-speaking psychologists in Texas. Her parents didn’t go to college, and she never had any mentors to tell her which fellowships to pursue or which conferences to attend.

Even the mental health curriculum was a challenge for Carrillo, because the medical terms are catered to English speakers, and most don’t have a direct translation into other languages. For example, she said explaining the symptoms of anxiety can be tricky since the best Spanish translation is “butterflies in your stomach,” but it doesn’t precisely describe the diagnosis.

This leaves many Spanish-speaking psychologists feeling unprepared to serve clients in their native language.

“A lot of us have to make this pathway on our own,” Carillo said.

Despite the nation’s growing diversity, the mental health workforce is still predominantly white and English-speaking.

As of 2021, the American Psychological Association reported that approximately 80% of the psychology workforce in the United States was white, compared to 85% in 2011. At the same time, the U.S. Census Bureau reported the white population nationally decreased from roughly 64% in 2010 to just under 58% in 2020.

In Texas, more than 40% of the state’s more than 30 million residents are Hispanic, but its mental health provider population is more than 80% white, according to 2023 data. Also, less than 20% of the state’s 10,440 mental health providers who responded to the 2023 workforce survey said they offer mental health services in a language other than English.

People of color and white people have similar rates of mental health disorders; however, people of color are less likely to receive treatment for their mental health issues. According to the National Institute of Mental Health, in 2020, 52% of white people with a mental illness received treatment, but only 37.1% of Black, 35% of Hispanic, and 25.4% of Asian people received treatment.

Carillo said the concept of mental health among diverse populations has become a talking point since the COVID-19 pandemic, but addressing these issues requires more than just recognizing their existence. She said it calls for culturally competent mental health providers who can relate to their patient's needs.

“There are diverse needs within this mental health umbrella, and that also lends itself to culturally and linguistically diverse issues,” she said. “We all experience the world differently. We all see it differently. And so, in that same respect, we need people who can understand those differences.”

Today, 251 of Texas’ 254 counties are wholly or partially designated by the federal government as “mental health professional shortage areas” in a state where roughly 5 million people do not have health insurance. That means finding a mental health provider whose client list isn’t miles long can be challenging, much less one that speaks any language other than English.

As a result, more Texans are opting to bypass waiting lists and head straight to emergency rooms with loved ones who need mental health treatment.

As the need for more mental health workers grows, Texas lawmakers and regulatory agencies are looking more closely at job requirements and ways to get more people licensed quickly to help bolster the mental health workforce.

The Texas Behavioral Health Executive Council, which oversees mental health licensing for marriage and family therapists, professional counselors, psychologists, and social workers, has seen a slight increase in the total number of licensed professionals over the years. But the industry has been unable to keep up with the growing demand for mental health providers.

Darrel Spinks, the council’s executive director, said this has forced the state to review its rules to determine the best way to maximize the use of existing providers to meet the demand. He said the council recently expanded the types of degrees that can be used to apply for psychology licenses to work in K-12 schools in an effort to expand the state’s numbers.

“We know we can’t provide enough providers through training programs within the state or import enough providers outside the state,” Spinks said.

However, the high cost of getting a degree and being licensed as a psychologist has become one of the main hurdles to diversifying the field. Years of education can quickly put a student into debt.

Currently, Texas licensed psychologists must have a doctoral degree and pass three exams: the $800 knowledge exam by the national testing board, a $210 jurisprudence test, and a $320 oral exam. This is in addition to the $340 a prospective psychologist must pay to do their required 3,500 hours of supervised work.

“During my training experience, I also worked three different jobs to maintain some financial stability while maintaining the number of hours and training needed for my program,” said Carillo, who is now a psychology post-doctoral fellow at the Momentus Institute in Dallas.

The national testing agency now plans to add a $450 skills test on top of the other tests. Last week, the Texas State Board of Examiners of Psychologists moved to research the possibility of adopting a less expensive state exam instead of requiring applicants to take the national test. This would allow the state agency to approve psychologists to work in Texas, but they would not be able to work in other states without passing the national skills test.

“This additional exam will undoubtedly affect the future of the psychology workforce and, to a lesser degree, the diversity of that workforce,” Spinks said.

Jessica Gomez, executive director of the Momentus Institute and a bilingual licensed psychologist, has made it her mission to recruit more Spanish speakers into the field. However, she said reform is needed for that to happen in Texas.

“We must address the high cost of education, licensing, and training. Providing more funding, scholarships, loan forgiveness, or salary subsidies could help open these doors,” she said.

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