Carrying the Weight of a Broken System

The Problem: Recognizing the scale of challenges faced by the behavioral health care industry, there is a growing call to expand the utilization of community-based health workers (CBHWs). However, neglecting to fully understand the complex realities of working in these roles risks undermining the true costs and sacrifices made by CBHWs as we strive to reshape health care policies and systems. Purpose of Article: Drawing on 21 interviews we conducted with CBHWs in Rhode Island, we describe the evolving role of CBHWs within traditional health care settings and identify policy and practice implications. Key Points: CBHWs have been taking on the burden of a broken health care system while experiencing role transformation. Conclusions: CBHW roles were designed in terms of a desired vision of the health care system—rather than the fragmented, overburdened institutional landscape that presently exists. Efforts to support CBHWs, without addressing the scale of role transformation, will continue to push much of the day-to-day labor underground

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• “’Not just a job”

  Megan Evans, Nancy Leisa et al.•Community Mental Health Journal•2026

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