Breaking Down the Mental Health Worker Shortage: Root Causes and How to Address Them

Published on May 5, 2023
Written by Rachel McCrickard, LMFT

According to a CNN poll, 90% of Americans believe there is a mental health worker shortage.

Either they’ve seen the floods of articles on the topic, or they’ve tried to get an appointment. 

 

The Mental Health Worker Shortage Crisis: How Bad Is It?

In 2016, the Health Resources and Services Administration looked at two different scenarios to predict a profound mental health worker shortage. 

They estimated upcoming retirements and the rate of new clinicians entering the field. 

In Scenario 1, they were assuming the demand for mental health services would be equal to the number of therapists available. According to this scenario, while there would be a deficit of marriage and family therapists (-2,440) and clinical social workers (-16,940), there would be more than enough mental health counselors (+7530)

But in Scenario 2, they were taking into account SAMHSA’s 2013 National Survey on Drug Use and Health which indicated that 40-45 million adults who had needed services did not receive mental health or substance abuse care and that would alter future demand. 

This changed the picture drastically.

 

HSRA Estimated Mental Health Worker Deficit for 2025

And let’s keep in mind—at this point, there was no pandemic on the horizon.

 

Factors contributing to the therapist shortage

We know that the pandemic made things worse than we could have ever predicted.

It turns out when you change every aspect of the way people live their lives, what they can expect, and how they relate to each other, it causes a lot of stress. 

Here are some factors that explain the mental health worker shortage and provide a direction for helping your colleagues and those on your clinical teams. 

 

Huge increase in demand for mental health and substance use care

People lost loved ones to COVID and they weren’t even allowed to sit by their bedsides.

People lost their jobs.

They couldn’t pay their rent, and only emergency measures kept them from being evicted.  

They found that their strategies for staying focused at work didn’t work at home, so they decided it was time to get ADHD meds.

They were stuck in their houses and apartments alone in conditions similar to solitary confinement or with their entire families absorbing each others’ stress.

They were scared of getting sick. They were scared of dying.

Substance use escalated. Suicides and attempts increased.

People sought out help and they still are. Every day more people are realizing how hard they were hit and they’re seeking out therapy. 

 

A mass mental health professional exit

Even before the pandemic, there was growing concern about the number of mental health professionals who were approaching retirement age.

We also knew low pay, long hours, piles of paperwork, and compassion fatigue were contributors to therapist burnout.

The pandemic moved up the retirement timetable for many therapists. 

And for others, their own stress, including going through the same things their clients were struggling to process, was too much to take. 

Fewer therapists are handling more cases that are more severe means even longer hours and more burnout.

Therapists have Masters’ degrees and a boatload of soft skills. They have options in other fields that offer lower stress and more time with family.

 

Shortage of specialists who treat specific conditions or work with specific populations. 

We need therapists who specialize in the conditions that are more difficult to treat like bipolar, obsessive-compulsive disorder, schizophrenia, and autism spectrum disorder. 

There’s a severe shortage of therapists who work with children, adolescents, or the elderly. 

We also need therapists with unique backgrounds—BIPOC, different cultural backgrounds, faiths, or experience with lower incomes. These groups historically have hesitated from seeking therapy because of implicit bias.

People like working with therapists who understand them and their experiences. 

 

Therapists who don’t take insurance

This gets overlooked when we look at therapist/demand disparity.

An estimated 42% of therapists in California don’t take insurance or take part in federal or state programs, including those with the most in-demand skills. Numbers are similar across the nation.

That changes the ratio of available therapists to those who need counseling.

Therapists choose not to bill insurance because of:

  • Low reimbursement rates
  • Insurance companies’ policies and management
  • Supply and demand imbalance—there are enough clients who can afford to pay out-of-pocket that they can earn enough without dealing with insurance companies.

But this also means there are fewer therapists available to those who need to use insurance so they can afford therapy. 

It also means mental health is a class issue.

 

Therapists not reaching licensure

57% of professional counseling Master’s graduates (social work, professional counseling, marriage and family counseling) don’t attain licensure. For details, you’ll want to read our white paper.

Debt, inability to secure supervision, confusing regulations, and the need to earn a living wage mean that a majority of professional mental health workers aren’t even staying in the field long enough to take the licensing exam.

 

How Do We Improve the Situation for Mental Health Professionals?

1. Increase pay rates and benefits

Mental health clinicians have devoted years of their lives to helping others. But they do a better job of that when they can provide for their families, improve their skills, and have enough PTO to take care of their needs. 

The director of behavioral health in San Diego County discovered  mental health professionals working at Panda Express instead of substance disorder clinics “because they simply cannot make as much

 

 2. Reduce hours and paperwork 

This crisis is long-term, so we need to develop strategies to help our clinical teams run marathons, not sprints—that means manageable caseloads and less complicated case management processes.

 

3. Make regulations easier to navigate

State regulations are beyond confusing. Clinical supervision, qualifying coursework, clinical hours… it’s hard for associate therapists to figure out if they’re on track. 

And despite most states using the same exams for licensure, reciprocity is rare. When half the nation is in a mental health shortage area, we need to make it easier for cynical professionals to move in and provide services.

 

4. Explore integrative care frameworks

There aren’t enough therapists. We know that. But health systems and nonprofits have explored using integrative care teams to provide expanded support and have had great success.

Teams that include mental health coaches and peer counselors working with clients mean that a therapist can see clients less often, but cost-saving mental health coaches and peer counselors can provide more frequent support and create a larger support system for the client. 

 

5. Recruit future therapists

Promote professional counseling degrees in high schools and colleges. Talk about how important it is to help people. 

Colleges, grad schools, organizations, and state and federal governments can offer graduate school scholarships for first and second-career students to ease the financial burden.

 

6. Loan forgiveness and reciprocity

The National Health Service Loan Repayment Program allows medical, dental, and mental health professionals to earn up to $50,000 in loan repayment for two years of service in a health professional shortage area. 

However, that option is not yet available to pre-licensed clinicians. The program needed to be expanded.

Federal student loan forgiveness programs exist for teaching, public service, and nonprofit work. Programs that are available to medical professionals should be opened up to mental health professionals. 

Financial aid reciprocity is also an option school districts and health systems have used as a recruiting benefit. Companies have agreed to pay financial aid payments while the employee is working with them, sometimes with an agreed contract for a specific length of time. 

Nonprofit counseling services are also considering options that ease the cost of living burdens, depending on their resources,  like providing housing. 

 

Commit to Reducing the Mental Health Worker Shortage by Supporting Your Clinical Team

When you commit to supporting the therapists on your staff with training, clinical supervision, and a healthy workplace, you’re taking a big step toward making your therapists feel like they are in a good place, and that helps you retain your therapists. Motivo can help you support your team.

We provide continuing education, professional resources, and most of all, we provide affordable, quality clinical supervision services to organizations like yours. Go here to find out how we can help you affordably support your team. 

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