124 mental health clinics report 640 job vacancies

As demand for care rises, clinicians treating fewer patients

LAST WEEK, a survey by the Blue Cross Blue Shield Foundation reported that Massachusetts residents are having trouble accessing mental health care when they need it. A new survey released Tuesday by the Association for Behavioral Health Care sheds some light on why.

The survey of the trade association’s members – reflecting 37 provider organizations providing outpatient mental health care at 124 locations – found 640 vacancies among clinical staff.

“It’s not that people don’t need services. We don’t have the capacity to offer them,” said Lydia Conley, executive director of the Association for Behavioral Healthcare.

CommonWealth previously reported that staffing problems have been plaguing mental health agencies, with perennial funding issues compounded by COVID-related burnout and the need for virus-related leave. The new survey, conducted in October and November of 2021, shows just how bad the problem has become.

Almost every respondent had at least one vacancy for a mental health clinician, and the clinics reported an average of 17 vacant positions each. In 2021, the organizations reported hiring 473 clinicians with master’s degrees – but 617 clinicians left during that time. The primary reason people gave for leaving was salary and benefits.

Hiring is not easy. Around one-third of respondents said it took them at least a year to hire a psychiatrist.

Unsurprisingly, the drop in staff has resulted in worse access for patients. The providers saw 92,635 patients in 2021, an 11 percent drop from the 102,823 patients seen in 2019. That is not due to lower demand, but to a lack of availability. At the time the survey was being conducted, 13,800 patients were on waiting lists for outpatient services.

Around 60 percent of providers reported having waiting lists for initial assessments and ongoing outpatient treatment, and the average wait time ranged from 10 weeks for an adult needing an initial assessment to 15.3 weeks for a child seeking ongoing outpatient treatment. Fewer providers had waiting lists for medication services (27 percent of pediatric clinics and 35 percent of those serving adults) and the average waiting time was around nine weeks.

The Association for Behavioral Healthcare represents providers who deliver services as Department of Mental Health-licensed outpatient clinics. Around two-thirds of patients have public health insurance, primarily MassHealth, and the rest have commercial insurance. These are not the private practice therapists who do not take insurance. According to Conley, their member clinics tend to be training grounds where clinicians start working before they move to more lucrative jobs in private practice, hospitals, or other settings.

Conley said in the long term, the data reflects the need to pay providers more. Rates paid by MassHealth are set by the state, while rates paid by commercial insurers are negotiated and depend on the insurance company. She also suggested a “rebalancing” of health care spending, since investments in preventative behavioral health care will reduce the number of people seeking crisis care. Bills previously proposed by Gov. Charlie Baker and a pending Senate bill would put more money toward primary care and behavioral health care.

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Shira Schoenberg

Reporter, CommonWealth

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

Conley said there is also a need to further study the workforce. It is not clear, for example, whether there are not enough providers being trained or whether there are just not enough providers in this part of the system – the safety net clinics and the insurance-based market.

The Executive Office of Health and Human Services has begun implementing a “roadmap” to increase the availability of mental health services. Baker’s fiscal 2023 budget proposal includes $115 million for new behavioral health initiatives, including improved reimbursement rates for outpatient treatment.