Clinicians quitting jobs at mental health centers amid rising demand, survey finds

The main reason cited by workers for leaving their jobs in clinics: low pay. Many go into private practice or take on much better paying hospital jobs.

The survey focused on a critical part of the mental health care system, state-licensed community mental health centers, most of whose patients are enrolled in the state’s Medicaid program, MassHealth.

But the clinics’ problems reveal another point of stress across the healthcare workforce as they face the extraordinary challenges of the pandemic.

“This is something that was known before the pandemic. [Patients] had a problem

lem with access to services,” said Rebekah Gewirtz, executive director of the Massachusetts chapter of the National Association of Social Workers. “Then the pandemic hits and we have a heightened crisis that is not going away.”

Diane Gould, chief executive of Advocates, a Framingham-based agency that includes five mental health clinics, described a “convergence of an already strained workforce, and a layer of COVID on top of that and a crisis mental health related to isolation, illness and loss. ”

The Association for Behavioral Healthcare, the trade group for outpatient mental health clinics, surveyed 60 of its members in November and December last year and received responses from 37 organizations with a total of 124 outpatient sites. Together, these organizations had served nearly 100,000 people the previous year.

Of the clinics that responded, almost all had vacancies – an average of 17 per clinic – for a total of 640 unfilled jobs.

Advocates has 40 vacancies among a staff of 110, resulting in a waiting list of 132 children and 22 adults, Gould said.

Over the past month, Advocates has hired 16 clinicians but 26 have left. “The money they can make elsewhere is a big draw,” Gould said. Some have large student debts to pay off and say they love the job but cannot afford to stay, she said.

A clinician making $60,000 moved to a private practice paying $90,000, she said.

According to association data, a licensed social worker can earn $52,437 at a mental health clinic and $67,600 at a hospital. A psychologist who earns $78,603 in a clinic might earn $104,125 in a hospital.

There’s a dark irony to that, noted Lydia Conley, chief executive of the Association for Behavioral Healthcare. Hospitals need mental health care providers to care for the hundreds of people waiting in emergency rooms for scarce psychiatric beds. But, she said, many of these patients would not need hospital care if they had received help earlier in their illness – and that help is becoming increasingly difficult to obtain as outpatient clinicians went to work in the hospital.

“It just never made sense,” Gould said. “Investment in the outpatient system has been so lacking. This will save money in the long run.

The issue did not escape the attention of Governor Charlie Baker’s administration, which won praise from Conley and other advocates. MassHealth recently approved a 10% salary increase for clinicians, considered an important step, although insufficient to solve the problem.

There are also high hopes for the administration’s “Roadmap for Behavioral Health Reform,” a multi-year initiative to improve access to programs such as a centralized service to connect people with night and weekend care options, placing mental health and addictions care in primary care. care offices and setting up community crisis response services to avoid emergency room visits.

Additionally, the Legislature directed federal COVID-19 relief money to a loan repayment program for mental health provider education debt.

But commercial insurers, which pay about a third of clinic patients, have so far failed to address the issue, clinic advocates said. The association recommends the state use its buying power through the Massachusetts Health Connector and the state employee insurance program to push insurers to do more.

Lora Pellegrini, chief executive of the Massachusetts Association of Health Plans, the trade group for most state health insurers, said health plans had “made significant investments, both before and during the pandemic, to increase reimbursement rates, expand access to providers, and offer telehealth services to members.

The association also supports reallocating spending to focus on primary care and mental health, Pellegrini said in a statement, but must also consider overall costs to the system.

Dr. Gregory Harris, senior medical director of behavioral health at Blue Cross Blue Shield of Massachusetts, said the root problem is multi-layered, not just financial. “Over the past two years, we’ve had a massive increase in demand, but provider networks haven’t grown at the same rate,” he said. “Just paying more for the same service is not necessarily a solution to the access problem. … Our suppliers are very busy. Everyone wants to be paid more. This does not mean that they will have room for more patients.

Blue Cross increased its payments to child psychiatrists, but required them to provide prompt access in return. So any improvements, Harris said, must involve both payments and structural changes.

In addition to seeking higher pay for its clinicians, the behavioral health association also recommended expanding loan repayment programs and reducing paperwork.

The clinics’ challenges could ripple through the rest of the mental health system, Conley said, because they are the setting where clinicians such as social workers and mental health counselors undergo the clinical training needed to become licensed. Clinics, then, are the pipeline for the mental health workforce, and Conley said the pipeline is getting thinner. “More people are leaving than arriving to be trained,” she said.

“At the end of the day, we live with this legacy of mental health care not being treated on equal footing with physical health,” Conley said.

But several defenders have expressed hope that a change in attitude could improve this problem. One of the positive results of the pandemic and the widespread mental distress it has caused is that more and more people are talking about mental health. “I hope the increased awareness of the importance of our mental health and well-being … persuades people at all levels to take action,” said Danna Mauch, executive director of the Massachusetts Association for Mental Health, an advocacy group. “It will take time and money. We must act with compassion and urgency.

Felice J. Freyer can be contacted at [email protected] Follow her on Twitter @felicejfreyer.

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