The behavioral health care workforce, including mental health and substance use services, is facing mounting uncertainty at a critical moment. Under the recently passed, One Big Beautiful Bill Act [Congress.gov, 2025], federal loan restrictions will impose strict caps on the borrowing of future medical students and extend stricter limits to graduate degrees in fields including nursing, public health and social work. These changes have the potential to deepen long standing workforce shortages, which disproportionately affect vulnerable populations, including women and birthing people.
Perinatal mood and anxiety disorders (PMADs) remain the most common complication of childbirth. During pregnancy through the first year postpartum, PMADs impact quality of life such as adherence to medical care and loss of interpersonal and financial resources and are associated with increased medical risk for conditions like preeclampsia, gestational diabetes, and preterm birth [Weingarten, 2024]. PMADs can also contribute to substance use disorders [Weingarten, 2024]. Mental health conditions are a major driver of maternal mortality across the U.S., including New York City, where according to the Maternal Mortality Review Committee, mental health conditions are one of the leading causes of maternal mortality across all racial/ethnic groups. [Litvak, 2022] Nationally, mental health conditions while prevalent, are most often undiagnosed and undertreated [Sangtiani, 2024]. Pregnant individuals and those of childbearing potential make up a large percentage of the population [Strid] and addressing their mental health needs is critical for improving maternal health outcomes.
Given these challenges and burden, bold and sustainable solutions are needed.
Workforce Solutions
One promising approach is expanding access to education and workforce development. In New York State (NYS), residents now have access to the Excelsior Scholarship for the city and state public colleges and universities, City University of New York (CUNY) and State University of New York (SUNY). CUNY is the largest urban university system in the United States; over 75% students of color; over one-third of students are born outside of the U.S. mainland and speak a native language other than English [Office of the New York City Comptroller, 2024]. SUNY is the largest comprehensive system of higher education in the US; 56% female and non-binary; 45% students of color, multi-racial, or international [The State University of New York, 2025]. Full-time students meeting eligibility requirements are provided free tuition for Associate’s and bachelor’s programs, allowing New Yorkers to earn a degree in mental health and human services career pathways. This initiative has the potential to strengthen, expand and diversify the behavioral health workforce while improving the lives of thousands of mothers and families.
Another workforce challenge is inadequate wages or student debt related to training costs. Federal loan repayment programs (LRPs) are an incentive strategy to support the recruitment and retention of behavioral health providers in high-needs facilities or areas, or with underserved populations. This includes psychiatrists, psychologists, psychiatric nurse practitioners, clinical social workers, and primary care providers that address behavioral health. All of whom could specialize in or service the perinatal population. Though varying in their benefits, requirements, and implementation, LRPs in general have been shown to lead to an increase in behavioral health providers, increased capacity to deliver substance use treatment, greater provider presence in rural areas, and increased staffing being linked to increased patient visits [Last, 2024].
Models of Care
In our work training perinatal community health workers (CHWs), evidence shows that CHWs have a proven track record of delivering effective care and addressing the health-related social needs of mothers, including mental health support. With appropriate tools and protocols, CHWs can provide critical mental health support for mothers and serve as a bridge to specialized care when needed, ensuring that no individual falls through the cracks. This further supports the development of a culturally relevant workforce.
Emerging technologies such as artificial intelligence (AI) are being developed to support behavioral health care. Large language models and other AI-powered tools, including virtual assistants, may offer innovative ways to enhance maternal mental health care and have already shown potential in delivering personalized support [Vaidyam, 2019]. While the field should approach these innovations cautiously, the behavioral workforce should consider actively engaging with them to ensure they meet the needs of mothers and diverse communities. Inadequate information about these tools among behavioral health professionals may hinder implementation – an ongoing challenge within the field of implementation science – underscoring the need for targeted awareness and training in AI to ensure that the needs of mothers are central to these discussions.
NYS has made significant advancements in telehealth workforce development, implementing initiatives to train clinicians and providing incentives to expand their adoption of telehealth [Marks Smit]. However, challenges remain particularly in building a robust telehealth infrastructure and ensuring that providers receive sustainable, long-term support. Moreover, while recent Medicaid reimbursement rate increases have contributed to service improvements and systemic reform, further enhancements are needed to address access to care, lengthy appointment wait times, and persistent inefficiencies across the behavioral health system.
Collaborations between policymakers, community partners, and educational institutions are key to addressing maternal mental health and building a sustainable behavioral health workforce. By prioritizing investments in workforce training and technology, NYS can strengthen behavioral health outcomes for mothers, children and communities, ultimately serving as a model for other regions.
Damali Wilson, PhD, is a Maternal and Reproductive Health Fellow at the NYU McSilver Institute for Poverty Policy and Research and the Institute for Excellence in Health Equity. Rosemonde Pierre-Louis, Esq., is Executive Director of the NYU McSilver Institute for Poverty Policy and Research. Natasha J. Williams, EdD, MPH, MSW, is an Associate Professor at the NYU Grossman School of Medicine and the Institute for Excellence in Health Equity.
References
Last, B. S., Crable, E. L., Khazanov, G. K., Scheinfeld, L. P., McGinty, E. E., & Purtle, J. (2024). Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review. Psychiatric services (Washington, D.C.), 75(7), 652–666. https://doi.org/10.1176/appi.ps.20230258
Litvak J, Jiang Y, Jessup J, Grant H, Searing H. Pregnancy-Associated Mortality in New York City, 2022.
Marks Smith J, Savuto M, Augenstein J. Ensuring long term equitable access to telehealth in New York State: Opportunities and challenges. https://nyhealthfoundation.org/wp-content/uploads/2024/07/NYHealth_Manatt_Telehealth_Access.pdf
New York City Department of Health and Mental Hygiene. September 2025.
New York City Economy. NYC Comptroller. https://comptroller.nyc.gov/reports/spotlight-cuny-and-the-new-york-city-economy/
Sangtiani, A. K., Mubeen, M., & Irfan, A. (2024). Insights into perinatal mood and anxiety disorders: addressing treatment gaps, risk factors, and health outcomes. WMJ, 123(6), 497-498.
Strid, P., Simeone, R. M., Hall, R., Meeker, J. R., & Ellington, S. R. (2025). A New Tool for Estimating the Number of Pregnant People in the United States. Obstetrics and gynecology, 145(1), e11–e13.
The State University of New York. (2025, January). SUNY Fast Facts. https://www.suny.edu/about/fast-facts/
Vaidyam AN, Wisniewski H, Halamka JD, Kashavan MS, Torous JB. Chatbots and conversational agents in mental health: a review of the psychiatric landscape. Can J Psychiatry. (2019) 64:456–64. doi: 10.1177/0706743719828977
Weingarten, S. J., & Osborne, L. M. (2024). Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders. Focus (American Psychiatric Publishing), 22(1), 16–24.
