Developing a Qualified, Diverse Behavioral Health Workforce Is an Urgent Need

By Danna Mauch, MAMH President and CEO

The behavioral health workforce crisis is reflected in long waiting lists for outpatient services and an insufficient number of available psychiatric beds, especially for children. Although these workforce challenges predate the COVID-19 pandemic, the gap between the demand for behavioral health services and the availability of providers has grown.

I am encouraged by the momentum of the last two years and the Commonwealth’s commitment toward a more comprehensive, systemic approach to behavioral health workforce development in Massachusetts. This approach includes significant new loan forgiveness programs, proposals to develop a statewide behavioral health workforce development center, and - most important - efforts to increase compensation for the behavioral health workforce.

With critical funding support from the Blue Cross Blue Shield of Massachusetts Foundation, the Charles D. and Beatrice F. Adams Charitable Trust, and the MetroWest Health Foundation, MAMH and its research partner, NRI, Inc., developed a behavioral health workforce inventory to identify policies, programs, and other initiatives currently in place to help build and sustain a more robust, diverse workforce.

Key findings and recommendations from our research include the following:

• Until very recently, most efforts to recruit and retain a qualified behavioral health workforce were implemented by individual providers, rather than systemically. This has changed significantly over the last two years, with establishment of the Behavioral Health Trust Fund and a new Behavioral Health Workforce Center of Excellence; investments in a new career pipeline program to support a more culturally diverse workforce; and significant state investments in loan repayment and other workforce recruitment and retention initiatives.
• Recruitment incentives, especially hiring bonuses, are commonly provided by behavioral health agencies in the Commonwealth. Our research identified at least 362 incentives, ranging in amount from $400 for a peer specialist to $50,000 for a psychiatrist, through online searches conducted in July and August 2022. The average advertised hiring incentive was $2,964, with recipients expected to stay in their position for, on average, 7.25 months in order to receive the incentive. In general, higher value incentives were associated with longer required lengths of stay.
• Federal scholarship and loan repayment programs for a broad range of public health positions provide greater financial support than most state and individual provider incentives; they are available to but not targeted for people pursuing behavioral health careers. As a result, people interested in careers in behavioral health may not be aware of these programs or know how to access them.
• Many service systems – hospitals, schools, correctional facilities – often are competing for the same staff.

State efforts over the last few years provide a good start to addressing the challenges, but much more is needed. Most important, coordination is needed across multiple state programs and initiatives designed to expand the behavioral health workforce, recruit a more diverse workforce, and retain qualified providers. As noted above, many of these programs were established within the last two years, and there is no single website or resource that students or potential job seekers can use to identify opportunities.

In addition, we recommend that the Commonwealth direct a portion of its behavioral health workforce funding toward the development of career ladders to ensure that potential and current behavioral health providers have and understand opportunities for advancement in the field. This effort should include a review of college-level educational and training programs to determine the extent to which they are accessible for non-traditional students seeking to change fields or further their education in behavioral health. This effort also should include a review of laws, regulations, and policies that, intentionally or not, pose barriers to provider movement across service systems.

Long-term planning around workforce development should provide for early exposure to behavioral health careers, especially for young people of color. Waiting until college to introduce career opportunities in behavioral health may be too late. Successful efforts to engage students at a young age in science, technology, engineering, and math (STEM) fields may provide a model to adapt.

And finally, a qualified, committed behavioral health workforce requires adequate compensation and benefits to encourage and support their participation. The Commonwealth should build on recent steps to increase behavioral health program funding and reimbursement rates, implementing planned rate enhancements and other strategies to improve compensation for behavioral health workers across a broad range of position types.

MAMH looks forward to working with Gov. Healey and her Administration to build, strengthen, and sustain a behavioral health workforce that can meet the growing needs of residents of the Commonwealth. You can find resources to learn more about behavioral health workforce challenges below.

An Inventory of Programs & Policies to Enhance Recruitment & Retention of the Behavioral Health Workforce in Massachusetts (MAMH and NRI, Inc., Dec., 2022)

Creating a Robust, Diverse, and Resilient Behavioral Health Workforce in Massachusetts (Blue Cross Blue Shield of Massachusetts Foundation, Sept. 2022)

Outpatient Mental Health Access and Workforce Crisis Issue Brief (ABH, Feb. 2022)