MASSACHUSETTS HAS just launched a new Behavioral Health Help Line and 25 community-based behavioral health centers that will dramatically expand services to individuals and families dealing with mental health conditions and substance use disorders. This is an important and game-changing step forward in meeting ever-expanding public health needs.
To fulfill this promise, we will need to do more to cultivate new talent into the behavioral health workforce and retain those already working in the field. The shortage of skilled behavioral health clinicians in the midst of an ever growing crisis in mental health is taking a devastating toll. Throughout Massachusetts, an estimated 19,000 acute care hospital positions are unfilled, with vacancy rates among mental health clinicians hovering around 30 percent.
Among the provider organizations that comprise the state’s safety net for behavioral health care services, the hiring crisis is even worse: In the past year, most community-based mental health clinics have operated, on average, with 17 staff vacancies, resulting in significant delays in treatment.
We need to fill open positions, recruit for the new jobs that will come with the state’s plan to expand services, and retain workers in the field, over 20 percent of whom are thinking about leaving due to pandemic-related stress. Here are three suggestions for policymakers and employers.
Provide financial support for professional training. A significant portion of the state’s mental health clinicians are social workers who provide more one-on-one therapy than psychiatrists and psychologists. Yet the road to professional status for social workers is paved with financially onerous requirements such as unpaid clinical internships that consume up to 24 hours per week on top of classwork, paid work, and family responsibilities. The cost of a social work degree is further exacerbated by the requirement that graduates must work under clinical supervision for at least two years before being able to practice independently. These clinical jobs are almost always extremely low paying. Those requirements, coupled with the fact that most social work master’s students graduate with nearly $50,000 in student loan debt, put a social work degree out of reach for many who would otherwise enter the field.
The state can immediately mitigate the financial burden shouldered by these professionals by disbursing the $200 million set aside in the state’s $4 billion American Rescue Plan Act for wage increases for the behavioral health workforce.
Expand the pipeline for new clinicians. One of the lessons from the pandemic was that professional accreditation and training could be radically expedited without a loss in quality of care. With those lessons in mind, we need to look creatively at other ways to lower barriers to professional training to bring more people into the behavioral health field. There is much to learn from successful employer-based programs that bridge the gap between higher education and professional practice. Hebrew SeniorLife, which provides senior health care and living communities, relies on an army of nurses to deliver care. The organization offers tuition reimbursement, a scholarship program, and time for studying on the job in order to support certified nursing assistants interested in becoming licensed practical nurses. Similar models are needed at community-based behavioral health clinics where culturally and linguistically diverse peer leaders comprise a rich pool of potential recruits.
Address the mental health crisis occurring within the health care workforce. Rates of depression and burnout among clinicians—especially physicians— were at concerning levels even before the pandemic. But what we’re seeing now is unprecedented. A 2021 Kaiser Family Foundation/Washington Post survey of health care providers found that 62 percent reported that working throughout the pandemic had negatively affected their mental health. Among behavioral health providers, the toll has been more severe, with 78 percent of psychiatrists and 90 percent of clinicians working at college counseling centers reporting that they are experiencing burnout.
In 2021, the Massachusetts Health & Hospital Association convened a Caring for the Caregiver Task Force to address burnout among health care workers. Chief among the task force’s recommendations are decreasing the stigma associated with seeking mental health services and creating work environments that encourage open discussion of mental health. One way to do this is by providing easy access to mental health support in the workplace. The state is currently funding peer support programs for the medical community aimed at improving mental health. Promising models should be expanded to health care facilities across the state.
We must do more to cultivate new providers, increase resources, and talent and support those currently working in the field. The quality of our individual and public mental health rests on the availability of skilled clinicians who can help us normalize what we’re experiencing and help us move forward with confidence when the challenges of life make us feel depressed, anxious, and/or stressed.
Liz Friedman is co-founder and CEO of GPS Group Peer Support, a Northampton-based company that assists communities experiencing trauma in creating accessible and culturally responsive, evidence-based peer-led group support. GPS is partnering with the Betsy Lehman Center for Patient Safety to provide group peer support for health care workers.