Behavioral Health Workforce Shortage – What Can We Do?

Behavioral Health Workforce Shortage – What Can We Do?

Cross-sector workforce shortages have seen a dramatic increase since the COVID-19 Pandemic began.  This shortage has hit the K-12 public school system’s mental health workforce particularly hard. 

Mental health practitioners who support students in school are not afforded a hybrid work model. Children are in school every day and therefore, so must the professionals who support them.  The Covid 19 pandemic and the stressors of working in the educational sector during quarantine, led to a dramatic departure of mental health professionals overall, but particularly in a school setting. The increase in awareness and utilization of mental health consultation is positive progress for the health and well-being of our youth and was certainly highlighted by the pandemic.  However, the supply of providers cannot keep up with the demand for services.   

A closer examination of this phenomenon reveals an equity issue related to access.  Private pay clinicians are more plentiful so, if you can pay, you can get services more easily.  If you have Medicaid, it’s unlikely you’ll get treatment quickly, unless you are in an acute crisis – in which case you may end up in an emergency room, still unable to access continuing services.    

What about the workforce shortage?  Why is it so difficult to staff K-12 public schools, particularly in areas with identified higher need, which translates to mostly black and brown students whose communities are underserved and whose families were more likely to struggle during the COVID-19 pandemic?  While physicians managed the acute impact of COVID, mental health and community-based social service organizations are managing their own version of “long covid” that is, the long-term economic and social problems following a highly stressful time.   

“A survey last year found that recruiting and retaining employees is the primary barrier substance use and mental health organizations face, with 97% saying it has been difficult to recruit employees and 78% of them calling it “very difficult.” Clinicians tell me every week they struggle to recruit and retain sufficient staff to meet the needs of communities and lose staff to employers offering more competitive salaries.”   

Less newsworthy and attention-grabbing than the thousands of deaths we saw in 2020, are the long-term mental health implications of Covid which will, over time, cost society both economically, through more expensive crisis intervention, hospitalization, and illness, and psychologically due to the increased thoughts of suicide, crime, community violence – all linked to untreated mental health conditions.   

So, what can we do? 

In the 20+ years of my social work practice, I’ve spent much of the time recruiting, hiring, training, and retaining a workforce expected to expose itself to trauma, be resilient and be effective, what I’ve come to realize is that it is a job that inadvertently takes advantage of the calling many mental health professionals to address societal injustices.  Work conditions are often unsustainable due to insufficient funds, high caseloads, and a lack of appropriate training and supervision.  Mental health providers must be mentally well and appropriately supported if they are to provide high-quality services to students. We must re-examine the value we place on this workforce and our approach to training, support, and work environment if we are to retain high-quality providers and recruit new ones.   

Clinicians in schools are often drawn to this work early in their careers when they have little experience combined with an idealistic view of working with children and the sense that they can “get experience in the trenches”.   Upon noting how complex the social and emotional issues can be, as well as the high demand and fast pace of a school setting, clinicians become overwhelmed and go into a “sink or swim” mentality.  Even with the best supervision, the learning curve is steep, and burnout sets in from a lack of feeling competent.  This often leads clinicians to leave the field early, before they have a chance to fully develop the skill set needed to be highly effective in schools.  Much of the time, it is due to insufficient training or overwhelmed guides and supervisors. 

In a survey we conducted with a new clinician workforce, the top issues that impacted retention were salary, supportive work environment, training, and supervision.  This shows us that a close 2nd to salary are all the areas that involve learning and support – showing a lack of adequate preparation for working in high-stress environments.   

Mary’s Center is leveraging its resources and expertise, along with community partners, to start a School-Based Mental Health Clinical Fellowship Training Program. The program application will launch in March of 2023 and will hire fellows to train alongside experienced mental health clinicians in DC public and public charter schools.  Paralleling their practical experience, Mary’s Center is putting together a training curriculum that includes didactic training, practical clinical experience in school settings, mentorship, resilience strategies, and direct stakeholder feedback to craft a training program that addresses key areas that impact retention and sustainability in the school mental health workforce.  A key focus of the structure and content of our program is the critical examination of racial disparities in mental health risk and outcomes and mitigation of these disparities.  Supervision will focus on self-reflection and awareness and address racism as a public health issue, including awareness of implicit bias. 

Stay tuned in March for the launch of our application for our inaugural year of this School-Based Mental Health (SBMH) Clinical Fellowship that represents one of the ways Mary’s Center is addressing workforce shortages, by bringing more experienced and supported child mental health practitioners into our schools for the long term. 

To learn more about Mary’s Center’s School-Based Mental Health program, click here.