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Perceptions with Impact
A Public Prospectus of Research, Findings, and Innovation
Updated Edition — October 2026
Voice Up Publishing, Inc.
Note: The interviews for this study were completed in 2024 and 2025. The dissertation is in its final stage, with the defense set for December 2, 2026. This page shares the study as the final manuscript presents it.
"This document is written for the general public. No prior knowledge of research, health policy, or academia required."
University of Indianapolis
Where the study was done
IRB Study 02135
Approved September 28, 2024
11 students
Interviewed one on one
10 states · 10 universities
Five U.S. regions
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The Origin of Voice Up and the Make the Difference Network
Across the United States, millions of people struggle to find mental health support. For years, the solution seemed obvious: train more professionals. But one question had rarely been asked:
"What if the problem isn't just a shortage of professionals — but a failure to recognize the people who are already doing the work?"
The Career Perceptions Gap
Students already held the experience. What was missing was the connection, named out loud.
A Definition, Shared Out Loud
Partway through each interview, students heard the field's own definition of behavioral health. Their language began to widen.
The Hidden Workforce
The shortage ends not only by training new people, but by recognizing the people already ready.
"What if the people we're looking for… are already here?"
This page tells the story of one study. It covers what was asked, what was done, what was found, and why it matters. It is written for anyone: a student, a parent, a neighbor, a policymaker, a funder, or anyone who cares about mental health in America.
The study is the doctoral dissertation of our founder. Its title is Perceptions With Impact. It asked how African American college students think about careers in behavioral health. That is the broad field of mental health care, substance use care, counseling, peer support, and related work. Eleven students, at ten universities in ten states, sat for one-on-one interviews. The study read those interviews with care, using a method called thematic analysis. Four themes came out of them.
Across the four themes, one pattern kept returning. Students held lived experience that fit this field. Most had never linked that experience to a career in it. The study names that pattern the Career Perceptions Gap. In the words of the dissertation itself, this gap "concerns the entryway to considering possibilities, not a demonstrated change in career choice or a causal effect of definitions."
One study. Eleven students. One pattern, seen again and again.
And a clear set of next questions, which the last part of this page lays out with care.
Section 1 · The Crisis: A Hidden Cause
America Is Running Out of Mental Health Workers
As of December 2025, 137 million Americans, 40% of the country, lived in areas the federal government names Mental Health Professional Shortage Areas. The shortage is not ending soon. Federal projections through 2038 show supply meeting only part of the need:
30%
Of the need for addiction counselors met by 2038
48%
Of the need for psychologists met
55%
Of the need for mental health counselors met
40%
Of Americans live in a shortage area
These figures come from the federal Health Resources and Services Administration. They are the ones the dissertation itself uses. Behind each one is a person who needs care and cannot find it close to home.
The Disproportionate Burden on Black Communities
This crisis does not affect everyone equally. African American communities carry a significantly heavier burden — both in terms of mental health need and in terms of access to care.
Rise in African American suicide rates from 2018–2021 across all age groups
Increase for youth ages 10–24 — the highest of any demographic group
Increase in suicide rates among Black youth ages 10–17 between 2007 and 2020
More likely to seek mental health care in an ER due to lack of other options
African Americans among U.S. psychologists (2021)
African Americans among counselors, social workers, and other behavioral health clinicians — while African Americans are 13.6% of the U.S. population
The Question Nobody Was Asking
Billions of federal dollars have been invested to address this workforce shortage — scholarships, loan forgiveness programs, new clinic models, new legislation. These investments focus on training more people already interested in behavioral health.
But our founder asked a different question. One that had barely been studied in over twenty years of research:
"What do African American college students actually think about careers in behavioral health — and why aren't more of them pursuing those careers in the first place?"
The study also asked what shapes those views: family, culture, and the schools themselves. And it asked what students would change if they could. Their answers fill the rest of this page.
Section 2 · The Study: How It Was Done
Eleven Students, In Their Own Words
This is a qualitative study. It listens closely to a small number of people, instead of counting a large number from far away. Its strength is depth: what students said, in full, and what their words show when read with care.
👥 Who Took Part
Eleven African American college students: eight women and three men, most of them seniors. They studied at ten universities in ten states, across five regions of the country. They were chosen on purpose, for the range of schools and fields they came from. Each gave verbal consent at the start of the interview. Each received a $25 gift card.
🎙️ How It Worked
Each student sat for one interview on Zoom, between late 2024 and early spring 2025. The talk began with their own life, and their own words for this field. Only later did they hear the field's formal definition. That order was the point. It let the study see what students already understood, before anyone handed them new words.
🔍 How the Words Were Read
Each interview was recorded and typed out word for word. Then the words were read through a six-step method called thematic analysis. The first read produced 156 codes, small labels for small ideas. By the tenth interview, the same themes kept returning, and no new ones were appearing. Four themes held. One honest note: one researcher ran the interviews and did the coding. There was no second coder. The dissertation says so in plain words. So does this page.
One more honest detail: in nine of the eleven interviews, students also heard the formal definition of mental health. In two, the talk moved on before it came up.
The dissertation reports that difference openly, instead of smoothing it over. So does this page.
Section 3 · The Dissertation: What the Research Discovered
The Central Discovery: The Career Perceptions Gap
"The Career Perceptions Gap is the space between what students recognize and name in their lived experiences and what directly connects to tangible career pathways, in this case behavioral health."
The students in this study already had the experience, the skills, the empathy, and the values this field needs. What they lacked was not ability. The link between what they had lived and the careers it pointed to had simply never been named for them.
The gap is not inside the students.
It sits in what the world around them never said out loud.
A Definition, Shared Out Loud
No student began the interview with a working definition of behavioral health. Yet they knew mental health well. Their own words for mental health already matched the formal one. Behavioral health was the new term. Partway through, each student heard the definition the field itself uses:
The definition shared in the interviews (Centers for Medicare & Medicaid Services, 2023):
"Behavioral health includes the emotions and behaviors that affect a person's overall well-being. It is an umbrella term for how behaviors affect overall mental and physical health (i.e., eating, sleeping, diet, exercise)."After it was shared, students named a wider range of careers than before. Their lists included psychology, counseling, social work, and health education. The lists centered on clinical and health-adjacent work. One kind of role still did not appear at all:
0
Students who began with a definition of behavioral health
9 of 11
Also heard the formal definition of mental health
0
Entry-level roles, like peer support, named in any career list
"I feel like that's what I would have wanted to say if I could find the words." One student, after hearing the formal definition of mental health
One definition. Shared out loud. A wider field came into view.
The study is careful here, and so are we. This was one moment inside an interview. It was not a program or a treatment. On its own, it does not prove lasting change.
Students Were Already Doing Behavioral Health Work
Student after student described the same kind of work. Sitting with friends in crisis. Checking in on people who were struggling. Carrying family members through hard seasons. Being the person others call. That is the daily work of peer support, the field's own entry-level role. They were already doing it. They held the core skill of the profession in their hands.
What they did not have was anyone telling them it counted. No school had ever said: what you already do has a name, and it is a profession. Students do not need to be built from scratch. They need the connection named.
The Gap Starts in Childhood, Not College
The students' earliest memories were already full of this work. They watched parents manage hard seasons, without ever hearing the words for them. Many became the anchor of their families while they were still young, with no frame at all for what they were doing.
The pattern ran through families, across generations.
Parents carried it without words. Their children grew up doing the same work, also without words, because no one ever provided them. By the time a student reaches college, the gap has been years in the making.
Faculty Were Not Making the Connection
Across all 11 students, at 10 universities in 10 states, one pattern repeated. In most accounts, students described little or no guidance from faculty about behavioral health careers. At some schools, contact with faculty ran through teaching assistants. At others, the topic never came up outside class content.
This was not because faculty were careless. No shared norm said: this is part of your job. Engineering professors link class work to industry careers. Business professors link it to corporate paths. The same habit does not exist yet for behavioral health.
Students Knew Exactly What Would Fix It
When asked what their schools could do, students in different states, with no contact with each other, asked for the same kinds of changes:
Reach out on purpose. Write directly to students in fields close to this work, instead of waiting for them to find it.
Bring in speakers from across the whole field. Not only therapists and psychiatrists, but peer support specialists, community health workers, case managers, and more.
Give behavioral health a clear place at career fairs, next to business and engineering.
Train faculty on these career paths, so the connection gets made in class, where students already are.
Build behavioral health career content into regular coursework. Spell out the path step by step: courses, credentials, and how to get from here to there.
None of these require new funding, new buildings, or new programs.
They require one thing: changing how institutions communicate.
Section 4 · The Four Themes
What Eleven Interviews, Read Closely, Organized Into
The findings of the dissertation stand on four themes. Each one came from the words of the students. Read in order, they tell one story: who these students were, what they understood, how they chose, and what they asked their schools to change.
Social Identity and Cultural Influences
Family, culture, and community shaped what students wanted, long before college. They arrived with deep experience of care, and a strong sense of duty to the people who raised them.
Perceptions of Behavioral Health
Students knew mental health well. Behavioral health, as a named field with many kinds of careers inside it, was new to them. Then the definition was shared, and their language began to widen.
Career Exploration and Decision-Making
Career interests grew out of personal experience and one-off chances: a class here, a person there. They did not grow from clear, visible paths laid out by their schools.
Career Opportunities and Institutional Practices
Students could name what their schools could do in a new way: make the field visible, train the faculty, and show the path step by step.
Across all four themes, one pattern kept returning: the Career Perceptions Gap.
It is not a fifth theme. It is the thread that runs through the other four. It is the distance between a life already lived and a career never linked to it.
Section 5 · The Evidence: What the Study Found, and What It Does Not Claim
A study earns trust in two ways. It shows what it found. And it states its own limits in plain words. The dissertation does both. This page follows it in both.
📄 What the Study Found
11 students. 10 universities. 10 states. 5 regions. No contact between them.
No student began the interview with a definition of behavioral health.
The own words of students for mental health already matched the formal one. Behavioral health was the new term. That contrast is the finding.
After the definition was shared, students named a wider range of careers. Entry-level roles still did not appear.
Students in different states, with no contact, asked for the same kinds of changes.
📏 What This Study Does Not Claim
The definition was not a treatment or a program. It was one step inside an interview, part of the approved study plan.
The study does not show that the definition caused lasting change, or that the gap closed. It shows a shift in words, inside one talk.
Eleven students were chosen on purpose. The findings do not describe all students. They are not offered as proof for any larger group.
One researcher ran and coded the interviews, with no second coder. Counts drawn from the coding are one careful read, open to audit.
Why This Still Matters
Workforce policy spends its money late in the pipeline. It trains people who already chose this field. This study names an earlier stage that policy skips: the moment before a student ever weighs the field at all. That moment can be reached with clearer words, at almost no cost. Do clearer words change choices over time? That is a real question. It is the next question. The dissertation says so itself.
Section 6 · What This Study Adds
Naming the Stage Policy Skips
Before this work, the standard account of the shortage began with training capacity. This study names an earlier stage: the moment a student sees a field as a possible future, or never sees it at all. The Career Perceptions Gap gives that stage a name. It gives it a place, inside the perception of the student. And it gives it a shape that future research can test.
One Field, Many Names
The dissertation also maps how the field itself is named. Federal agencies define behavioral health in varied ways, and count it in varied ways. The national clinic model for this work names 13 kinds of professionals. Five of them do not rest on a clinical license. Some roles, like peer support, have no standard job code of their own. A field that cannot name itself clearly cannot expect students to find it.
The Definition Moment, Documented
Inside these interviews, something small and worth study took place. After a plain definition was shared, the language of students about the field grew wider. The manuscript treats this as something observed, not a proven effect. One of its eight future research directions is a controlled test of this exact point: does a short, clear module change what students weigh?
Students Wrote the Blueprint
The fixes in this study do not come from the researcher. They come from the students: reach out on purpose, bring in speakers from the whole field, give the field a place at career fairs, train the faculty, teach the path in class. Five kinds of change, named the same way in state after state.
Low-Cost Moves for Colleges
The practice steps the study points to are plain ones. A short module in new-student orientation. Guides that compare career paths role by role, side by side. Working agreements between clinics and universities, so students can see these jobs up close. None of them needs a new building.
A Research Agenda, Not a Victory Lap
The dissertation ends with eight directions for the work still to come: a survey tool that can measure the gap, a controlled test of a short awareness module, a study comparing HBCUs and other universities, the same questions asked of other student groups, a study of what faculty themselves know, a look at families and faith communities, a look at K-12 schools, and a look at how AI is changing these careers. The construct is offered as a start, not a settled theory.
Section 7 · What This Means for You
For Students
If you have helped people through hard times — friends, family, your community — you already hold experience this field values. Ask what it is called. Ask what careers use it. The gap this study found is not a lack in you. It is a lack of naming, and naming can be fixed.
For The University System
Students asked for five simple things: direct outreach, speakers from the whole field, a place at career fairs, trained faculty, and the path taught in class. Start with two: state the field's definition plainly in orientation and advising, and show the full range of careers it holds — not only the ones with a license.
For K–12 Education
Career ideas form early. By college, the frame is already set. Health careers can be shown in full — not only doctor and nurse, but also counselor, peer support specialist, community health worker, and case manager. The dissertation names K-12 as one of its eight future research directions.
For Policymakers
Workforce money now flows late in the pipeline. This study points to an earlier, cheaper stage: whether students ever consider the field. A shared national definition of the field would help — the study offers that as a baseline to build on. Recent law also matters here: the national clinic model for this work is now a permanent, optional Medicaid benefit states can choose.
For Funders
The honest ask here is not to fund a proven fix. It is to fund the questions this study opens: a tool that can measure the gap, a follow-up study that tracks students over time, and a controlled test of whether a short, clear module changes what students consider. Small studies, careful answers.
For The Research Community
The Career Perceptions Gap is offered as a developing idea, not a finished theory. It needs what good constructs need: measures, tests, and honest challenge. The dissertation lays out eight directions, from HBCU comparison studies to the role of AI in career recognition. The invitation is open.
Why Voice Up Exists Because of This Research
Voice Up Publishing, Inc. — the organization that published this research — exists because of what the dissertation asked and what eleven students answered. Our founder, Arthur L. Fuller, Jr., built Voice Up at the same time he was doing this work: first as a teacher and administrator in Virginia, then as a researcher in Indianapolis.
— Arthur L. Fuller, Jr., Founder
Voice Up is where this research is practiced. Our programs carry the study's plain lesson into daily work: name the field clearly, show its full range of careers, and walk with students while they connect their own lived experience to a path forward.
Section 8 · Everything in One Place
🔴 The Crisis
- •137M Americans (40%) in shortage areas as of December 2025
- •Supply by 2038 meets only 30% to 55% of the need in key roles
- •4% and 9% African Americans among psychologists and other behavioral health clinicians, vs. 13.6% of the U.S. population
- •+144% Black youth suicide increase, 2007–2020
🔬 The Dissertation
- •Career Perceptions Gap: the space between lived experience and a named career path
- •Entryway, not choice: the gap concerns considering the field, not choosing it
- •Students already working: doing peer-support work, uncredited
- •Faculty silent: few connections made, in most accounts
- •Students' fixes: five kinds of change, named in their own words
📋 The Study at a Glance
- •Where: University of Indianapolis
- •Approved by: IRB Study 02135, September 28, 2024
- •Who: 11 African American college students
- •Where from: 10 universities, 10 states, 5 regions
- •How: one-on-one Zoom interviews, late 2024 to early spring 2025
- •Read by: thematic analysis, six steps, 156 first codes
- •Came out as: four themes, one pattern across them
America faces a mental health workforce crisis. This study found that part of the shortage begins earlier than anyone assumed — not in training capacity, but in recognition. Eleven students held the experience this field needs. The connection between their lives and its careers had never been named for them. That is the Career Perceptions Gap, and naming it is the first step toward closing it.
— Voice Up Publishing, Inc. · October 2026
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