Addressing Barriers to Behavioral Health Professional Licensure in Massachusetts: Alden and St. Louis Co-Author Seminal Report for Blue Cross Blue Shield of Massachusetts Foundation

The behavioral health field in Massachusetts is at a pivotal moment. As demand for mental health services continues to rise, the number of professionals entering the field has stalled—or even declined in some disciplines. The widening gap between need and workforce capacity is felt most acutely in communities that have historically been underserved.

These issues raise pressing questions: What barriers do providers encounter when trying to join or remain in the behavioral health field? Why do so many trained professionals struggle to practice and meet the growing demand for mental health services? For many, the answer lies in the complex and often overwhelming process of obtaining professional licensure.

While all providers face challenges during the licensure process, these obstacles are especially significant for individuals who are underrepresented in behavioral health. Such barriers not only hinder talented professionals from entering and advancing in the field, but they also perpetuate inequities in access to care.

Recognizing this urgent need, the Blue Cross Blue Shield of Massachusetts (BCBSMA) Foundation, in partnership with William James College, sought to illuminate the licensure barriers faced by providers from historically marginalized communities and to chart a path toward a more diverse and equitable behavioral health workforce.

The report, Behavioral Health Professional Licensure in Massachusetts: Existing Barriers and Opportunities to Advance Diversity in the Workforce, co-authored by Alexandra Alden, PhD, Associate Director of Research, and Gemima St. Louis, PhD, Vice President for Workforce Initiatives in the Center for Workforce Development at William James College, set out to identify specific aspects of the behavioral health professional licensing process that are barriers to providers who identify as Black, Indigenous, or other People of Color (BIPOC); members of the LGBTQIA+ community; or native speakers of languages other than English. 

The Study

A central goal of this study was to hear directly from behavioral health professionals from marginalized groups to better understand their unique experiences—an essential first step toward building a more equitable behavioral health system.

“Even though we know the licensure burden weighs more heavily on underserved groups, their voices are not often represented in the literature,” says St. Louis, pointing to the absence of studies focused specifically on understanding the nature of the burden on these populations, and what can be done—at a policy level—to ensure the creation of accessible pathways into the field for individuals who are BIPOC, LGBTQIA+, or native speakers of a language other than English.

Commissioned by the BCBSMA Foundation, the study used a qualitative research design to capture the lived experiences of behavioral health providers facing licensure barriers in Massachusetts. Sixty-four (64) participants—including BIPOC, LGBTQIA+ individuals, and those for whom English is not a first language—were recruited through professional networks and community-based organizations. Data was collected via a combination of structured surveys and in-depth interviews, each designed to elicit detailed accounts of the challenges encountered in obtaining and maintaining professional licensure. 

To encourage candid participation and honor their contributions, all participants were compensated for their time. Interviews and structured surveys were conducted confidentially over a three-month period. The research team used thematic analysis to identify recurring patterns and unique insights related to financial barriers, lack of mentorship and supervision, difficulties navigating the licensure process, and the need for greater cultural and linguistic responsiveness in licensing exams. This approach ensured that those most impacted by systemic barriers were at the heart of the study’s findings. Their voices helped shape the report’s recommendations, guiding policy and practice changes aimed at advancing equity and inclusion in the behavioral health workforce.

The Findings

The study revealed that barriers to professional licensure are not just procedural—they are deeply personal and often discouraging, especially for providers from underrepresented communities. “We gleaned rich, qualitative data from behavioral health professionals from across the Commonwealth,” says Alden, of voices historically invisible to researchers. When asked about the specific challenges experienced in both obtaining and maintaining professional licensure, the following topics emerged:  

1. Financial Barriers—Participants spoke candidly about the financial strain of pursuing licensure.

2. Lack of Mentorship, Peer Support, and Professional Supervision—Providers frequently encountered barriers when seeking out mentorship and supervision.

3. Difficulties Navigating the Licensure Process—Participants described the licensure process as confusing and overwhelming.

4. Lack of Cultural Responsiveness, Linguistic Responsiveness, and Flexibility in the Licensing Exam and Its Administration—Participants shared that licensing exams often use language and examples that don’t reflect their cultural backgrounds, making the tests confusing and unfair for those whose experiences or first languages differ from the exam’s assumptions. 

These findings make clear that while many licensure barriers affect all providers, their impact is especially acute for those from underserved communities. The study calls for policy-level changes and targeted interventions to create more equitable pathways into the behavioral health workforce.

The Recommendations

The report goes beyond identifying problems—it offers a clear path forward, calling for both immediate action and long-term policy reforms to build a more diverse and responsive behavioral health workforce. To promote more equitable licensure practices in the field, the report outlines the following targeted strategies:

1. Expand Financial Support—Make available scholarships and stipends to help reduce financial barriers that may discourage professionals from pursuing licensure.

2. Strengthen Professional Supervision and Mentorship—Offer culturally responsive supervision and mentorship to support candidates throughout the licensure process.

3. Enhance Navigation of the Licensure Process—Provide clear, accessible guidance to help providers understand each step of the licensure journey and successfully complete all requirements.

4. Promote Cultural and Linguistic Responsiveness in Licensing Exams—Adapt licensing exams to be inclusive and accessible across languages and cultural contexts, ensuring fairness for all candidates.

“Making the licensing exam more culturally responsive and culturally attuned is a key recommendation that came out of the study,” says St. Louis. 

“Needing extra time to complete a multiple-choice test in English, when English is one’s second language, makes sense; it has nothing to do with an individual’s competency as a clinician,” adds Alden, underscoring that the “complex interplay” between state and national licensure requirements has historically made English as a Second Language (ESL) accommodations difficult to navigate and access; her hope is that this changes going forward.

Charting a New Course for Behavioral Health Licensure Equity

In keeping with the college’s commitment to workforce development, co-authoring the BCBSMA Foundation report affirmed what St. Louis and Alden already understood: that gaining insight into the challenges faced by underrepresented populations is essential to building a more diverse and equitable behavioral health workforce. 

“We strive to leverage every opportunity to amplify the voices of underrepresented groups in behavioral health and bring greater visibility to the pressing need for a workforce that reflects the rich diversity of our communities,” says St. Louis. At the Center for Workforce Development, taking practical steps toward addressing the issue remains top of mind. Seeking funding, applying for grants that support professional mentorship, and linking professionals to mentors who can help them navigate the barriers are all imperative to forward progress.

Given the lack of focused inquiry into underserved populations in behavioral health, this study offers findings that are both unique and critical to advancing the field. 

“This work reflects important research—necessary research—and sheds light on the inequities that exist in the path toward professional licensure,” says Alden, who is glad the conversation has begun to unfold. 

“To truly build a diverse behavioral health workforce in Massachusetts and beyond, we must commit to ongoing research, open dialogue, and bold action—ensuring that every provider has a fair chance to serve their communities,” says St. Louis.

Achieving meaningful progress, however, hinges on collective effort. Policymakers, educators, funders, and community leaders must work together to dismantle systemic barriers and establish fair licensure pathways for all professionals. 

Note: The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to ensure equitable access to health care for all those in the Commonwealth who are economically, racially, culturally, or socially marginalized. The Foundation was founded in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.

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