Mental Health Matters: A Conversation with Keita Franklin

At Deloitte, we are deeply committed to well-being, not just for ourselves, but for our clients, our communities, and society.

As we mark Mental Health Month, we sat down for a candid conversation with Keita Franklin, who joined Deloitte as an executive focused on supporting our clients in the mental health field. Keita has more than 25 years of experience in direct mental health clinical practice and public health programming. She is a former Senior Executive Director for the Office of Mental Health and Suicide Prevention at the U.S. Department of Veteran Affairs and Senior Executive for Defense Suicide Prevention Program for the U.S. Department of Defense.  

What are some of the most prominent issues impacting the field of mental health at the moment?

Keita Franklin: The issue concerning me the most is the pervasive and perennial shortage of qualified health care providers.  

In light of the social and mental health challenges we face across the country, we simply do not have enough people entering the helping professions at the rate and pace that we need to keep up with the demand for services. Some states report needing upwards of 700 providers to meet the demand for services.

So, how have we found ourselves in this position? Some answers can be found in the workforce itself. First, many in the “helping professions” are retiring or rapidly approaching retirement. Then, for those just entering the field, navigating the various career paths for mental health professionals can be complicated. For example, someone just entering the field faces the real or perceived pressure to choose a career path. Should they become a Licensed Professional Counselor (LPC) or a Licensed Mental Health Counselor (LMHC)? A Licensed Clinical Social Worker (LCSW)? Or a psychologist or psychiatrist? In short, those entering the field may not know which to pursue or how to pursue it.

What do you think is the heart of this issue? Why aren't more people coming to the field?

I have often wondered if mental health is not perceived to be a desirable career choice because of the stigma attached to mental health and the stress on the current workforce which is often rightly characterized as overworked and underpaid. The good news is we have the power to address these challenges in the helping profession.

To this end, we need a national strategy to close this gap so that the next generation of mental health care providers is excited about this work and the ability to make a difference in the lives of those who are most vulnerable.

Yet, addressing this gap in motivated and capable mental health providers is not our only challenge. Connected to the shortage of providers is the problem of accessing mental health care. As anyone who has tried to access mental health care can attest, getting an appointment when and where you need it is not easy. As a result, some people often are not seen as part of an early intervention and may end up entering the mental health system when they are at a state of crisis. This creates a perpetual cycle of crisis-driven care which places extreme stress on the mental health system.

What do you think could be done about this issue?

In the short term, designing a continuum of care that includes an assortment of professionals, like prevention specialists, peer support, care coordinators and case managers, can help people get to the right level of care at the right time. Long-term system redesign that includes a focus on capacity building and designing full scale programming targeted across prevention, intervention, treatment, and aftercare is critically important.

Mental health issues rarely occur in a silo. They typically emerge from a set of complex issues and struggles. Helping clients who are grappling with mental health issues using evidence-based therapies is necessary. At the same time, we must address co-occurring issues such as homelessness, domestic violence, employment, substance use and a host of other social determinants of health care is necessary. 

How would you propose getting this work done?

Integrated models are needed. Cross-disciplinary staff working hand-in-hand on shared risk factors and in collaborative ways enables holistic care that is less fragmented and more targeted toward building resilience. This requires increased teaming across sectors — state, non-profit and others — to ensure a coordinated approach. It’s hard work, but necessary for our clients. 

It’s also incredibly important to address racial disparities in mental health care. On average, racial and ethnic minorities report that they experience mental health issues at the same rate as their white counterparts, yet they have less access to high quality care when they can even get it, and often receive care that is not culturally responsive. Racial and ethnic minorities with mental health issues are also more likely than whites to be incarcerated. We can’t fully address these racial disparities without considering the role of trauma on certain at-risk demographic groups. 

What should we do about these disparities?

As a field, we can’t have these issues going under-treated. People from Black, Hispanic and Native American communities should be able to find a culturally responsive provider who is properly trained and available to offer them the best available care. As a nation, we need to work on a strategy to address this; it begins by owning what we see in the data and developing a set of goals to address these disparities. If it means recruiting new providers from certain demographic groups, we need to do that. If it means training providers and ensuring cultural readiness and measuring their ability to engage on cultural issues, let’s do that, too. We also need to bring more racially diverse people to the table when we are designing these service delivery models. Truly listening to our patients will provide a unique opportunity to make the changes necessary both they and the field need.

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