Survey Highlights Behavioral Health Workforce Gaps in Massachusetts | Healthcare Innovation

The Association for Behavioral Healthcare (ABH), a nonprofit organization representing 80 community-based behavioral healthcare providers in Massachusetts, says a recent survey it conducted provides insights into a growing workforce crisis.

The ABH surveyed 37 Massachusetts outpatient provider agencies, representing 124 outpatient mental health clinic sites. Recruitment and retention concerns and hundreds of vacancies are contributing to months-long waitlists and an 11 percent decrease in the number of individuals served compared to 2019.

“Clinicians are leaving community-based outpatient clinics faster than they are being hired, and this is causing an unprecedented number of vacancies in key positions and creating long waitlists for people seeking care,” said Lydia Conley, ABH president and CEO, in a statement. “We must act now – through enhanced reimbursement, rate parity and other measures – to better support our clinicians and address the mental health crises being experienced in classrooms, living rooms and workplaces across Massachusetts.”

Survey responses point to significant recruitment and retention problems. In 2021, for every 10 master’s level clinicians hired, approximately 13 master’s level clinicians left their positions, contributing to the nearly 640 staffing vacancies across respondents – an average of 17 per clinic.

Other survey findings include:
• Two-thirds (67 percent) of respondents report it taking nine months or more to fill a psychiatrist position.
• 92 percent reported at least one vacancy for a mental health clinician.
• Nearly 14,000 individuals are on waitlists to receive outpatient services.
• 62 percent of respondents reported waitlists for initial assessment for children and adolescents.
• Children and adolescents spend an average of 15 weeks on a waitlist before starting ongoing therapy.

According to ABH, many vacancies can be attributed to the pay gap – which widened to nearly 38 percent in 2020 – between salaries in the behavioral healthcare system and acute care hospitals for equivalent positions. On average, a licensed clinician earns $20,000 more annually in a hospital setting than in the community-based behavioral health treatment system.

ABH offered a number of recommendations to address the crisis, including a collaboration among policymakers and private insurers to ensure rate parity between hospitals and community-based providers. Other recommendations include:
• Supporting Gov. Charlie Baker’s past proposal and a pending Senate bill that would require health plans to shift 30 percent of healthcare expenditure to behavioral health and primary care;
• Calling on commercial and public payers to invest in short- and long-term access through immediate outpatient clinic rate increases;
• Implementation of a behavioral health workforce data collection and planning strategy;
• Adoption of MassHealth’s allowable providers by health plans to include license-eligible clinicians;
• Expansion of student loan repayment programs for recruitment and retention; and
• Private and public health plans taking immediate steps to reduce redundant or outdated administrative and documentation requirements.