Factors that Affect Behavioral Health Provider Retention

From counseling individuals with mental health disorders to helping vulnerable children and families access critical resources, behavioral health professionals perform a wide range of important work. But while there’s no question that these professionals are an irreplaceable part of every community, far too many go without them due to the mental health workforce shortage.

As demand for behavioral health providers increases across the U.S., shortages of mental and behavioral health providers have left many individuals without access to the resources they need to lead safe, healthy lives. To help behavioral health administrators recruit and retain employees and meet the needs of the communities they serve, comprehensive strategies must be put into play.

The workforce shortage in behavioral and mental health

The U.S. is facing significant shortages within the behavioral and mental health workforce — a crisis that is escalating as demand increases and supply decreases. These problems are particularly evident in rural counties, more than half of which do not have a single psychiatrist available.

Predictions made before the COVID-19 pandemic emphasized a shortfall of tens of thousands of behavioral health professionals. Many believe this shortfall will only increase as the pandemic persists, leaving emotional and psychological trauma in its wake.

The Substance Abuse and Mental Health Services Administration predicts that, by 2025, the U.S. will have shortages of:

• 78,050 school counselors
• 57,490 psychologists
• 48,540 social workers
• 26,930 mental health counselors
• 15,400 psychiatrists
• 10,470 marriage and family therapists

These shortages will be facilitated by increasing demand for the services provided by these professionals. According to the National Council for Behavioral Health, demand for behavioral health services will increase by the following percentages by 2030:

• Addiction counselors: 21-30%
• Mental health counselors: 18-20%
• Psychiatric nurse practitioners and psychiatric physician assistants: 17%
• Social workers: 15%
• Psychiatric technicians and psychiatric aides: 13-16%
• Marriage and family therapists: 14%
• Psychologists: 7%
• Psychiatrists: 6%

At a time when nearly one in five Americans lives with a mental health condition and more people than ever are interested in seeking behavioral health support, this lack of access to qualified behavioral health professionals stands to jeopardize the wellbeing of individuals and communities across the country.

Why is there a behavioral and mental health workforce?

A variety of factors have contributed to the behavioral and mental healthcare workforce shortage, making mental health provider recruitment and retention particularly challenging.

One reason for the shortage is increasing awareness and understanding of behavioral healthcare services. According to a report published by the Centers for Disease Control and Prevention, the percent of Americans who attributed major depression to neurobiological causes increased by 13% between 1996 and 2006. Similarly, a larger percentage of people endorsed the benefits of treatment for people with major depression in 2006 (91%) than in 1996 (78%).

Other causes of the shortage are less positive. Behavioral health professionals are aging out of the profession faster than they can be replaced, leading to a retirement drain on the industry. In 2015, more than 60% of practicing psychiatrists were over the age of 55 — a percentage higher than many other healthcare specialties.

Behavioral health providers are also frequently paid less than other professionals in healthcare and beyond. This disparity is part of a larger problem in which, despite the progress made, society does not yet fully value behavioral health and stigma surrounding mental illness persists. In addition, organizations often face financial barriers (many of which, like poor funding, are outside of their control) that prevent them from offering competitive salaries or benefit packages that could entice and retain employees.

The lack of recognition and low pay are sacrifices that individuals must be willing to make before entering the behavioral health workforce. These sacrifices are significant and often deter new employees from entering the field.

Why is it important to retain behavioral health providers?

Despite the efforts of many educational institutions, there simply aren’t enough individuals entering the behavioral healthcare field to meet demand. When behavioral health administrators attain high-quality staff, they must strive to hold on to them as best as possible or risk finding themselves struggling to hire new, qualified staff from a very limited candidate pool.

Retaining staff and reducing turnover can also help healthcare organizations save money. According to a panel at a recent health summit sponsored by Crain’s Detroit Business, the statewide annual turnover rate for direct care workers in the mental health field is 37% — a metric that closely resembles those of many other states.

Turnover can cost organizations anywhere from one-half to two times an employee’s salary to replace. It also impacts the quality of care they provide, as new hires take time to adjust to the organization’s specific practices and the nuances of the community they serve.

How to retain behavioral health providers

Retaining behavioral health providers is easier said than done — especially when many facilities lack the resources to offer significant monetary incentives. Fortunately, there are several steps organizations can take to increase the chances that their providers will remain invested in their organization.

Hire the right employees

Behavioral health provider retention begins with hiring the right individuals. There is no denying that work in this field can be both physically and psychologically challenging, and not everyone is suited for that.

The hiring process is a time to determine whether candidates are prepared for the challenges of behavioral health while also presenting them with an upfront image of the organization. Being honest during the interview process helps behavioral health administrators minimize any future surprises that could contribute to an employee’s exit.

Videos, meetings with current employees, web-based presentations, and even internships can all help provide applicants with a realistic sense of the work they will be doing and the environment they will be doing it in. Hiring managers are also encouraged to ask questions that will help identify whether the applicant will be a good fit for the organization and the community they serve. For ideas on the types of questions to ask check out our blog How Better Interviews Lead to Longer Lasting Hires in Behavioral Health.

Conduct onboarding effectively

Comprehensive, individualized onboarding sets employees up for success. Personnel assessments help administrators identify a new employee’s existing knowledge base and skill level so they can create tailored, more meaningful onboarding plans that are less time consuming than standard, blanket onboarding plans. This individualization demonstrates to new employees that their time and insights are valued, leading to greater engagement during the orientation process.

Integrating new hires into the community — both the organizational community and the broader community — as soon as possible is also an important part of the onboarding process. Administrators should consider providing new hires, especially those new to the area, with recommendations on things to do and see in the community. Organizing informal team bonding activities is also encouraged.

Creating strong mentorship connections is another important layer of the onboarding process, one that can play a major role in behavioral health provider retention. Pairing new staff with more established providers ensures they have a trusted, knowledgeable person to turn to when questions or concerns arise. Oftentimes, these connections can blossom into meaningful relationships that ensure both parties feel supported during challenging times.

Invest in professional development

Some of the best ways to improve provider retention involve more structural changes, like developing opportunities for upward mobility. According to a recent survey conducted by The Harris Poll, lack of career development is one of the leading reasons why people leave their jobs. The survey also found that 70% of U.S. employees say they’re at least somewhat likely to leave their current company and accept an offer with a new company that’s known for investing in employee learning and development.

Well-defined career paths prove to providers that there are opportunities to move into leadership positions within their organization and what they must do to get there — whether it’s demonstrating excellence in their current position, gaining specific degrees or certifications, or some combination of the two. Opportunities for professional development also demonstrate an employer’s investment in their team’s continued success, boosting morale and employee engagement.

Intentionally recognize employees

Recognizing employees for their efforts as well as the value that they bring to the table is another way to combat the mental health workforce shortage and help improve retention. Employees in any field want to feel appreciated by their employers and peers alike.

Administrators must strive to find creative ways to celebrate their employees, whether through press releases, awards, announcements at staff meetings, or one-on-one conversations. By commemorating providers who pour their time and energy into helping others, organizations demonstrate their appreciation for these hardworking employees.

Recognition of employees’ dedication and hard work can also be channeled through:

• Providing extensive paid vacation
• Offering group health insurance
• Implementing and modeling healthy work/life balance strategies from the top down
• Clearly defining policies for reporting and addressing employee concerns
• Cultivating a supportive, healthy workplace culture
• Investing in technology that minimizes manual, time-consuming tasks

Increase retention to better support your community

In the face of staffing shortages and increasing demand for behavioral healthcare providers, retaining strong, productive employees is an absolute necessity for every behavioral health organization.