The recruitment and retention of staff, managers, and leaders are extremely critical problems for behavioral healthcare. The promise of recovery is an empty promise if a sufficient and competent workforce isn't available to effectively treat mental illnesses and addictions. On-the-job training is always necessary, but it isn't an adequate response to the recruitment crisis. Salaries must reflect the importance and complexity of the work, as well as be competitive enough to attract and keep skilled staff.
National efforts to address behavioral healthcare's workforce crisis primarily have focused on the values that drive mental health and addictions treatment and on the design and delivery of training initiatives. Far less attention has been paid to the effects on behavioral healthcare of the universal talent shortage, individual economic self-interest, the preparation of future practitioners, and the organizational systems that sustain an effective workforce. The following are four factors for consideration in planning national behavioral healthcare workforce initiatives.
The growing service economy. People increasingly are buying more goods manufactured outside the United States while spending more on services delivered in this country. Spas are opening on every street, neighborhoods are going upscale, restaurants are packed, and many people are employed in service jobs (such as selling real estate, computers, or hedge funds).
We increasingly live in a service economy that requires a consumer-centered workforce: a workforce able to reach out and engage the consumer, able to understand what the consumer wants and needs, and able to partner with the consumer to meet those needs. This new economy requires a workforce with many of the same skills required in mental health and addiction treatment workers. If finding, training, and keeping consumer-oriented staff are becoming the norms for the service economy, how can behavioral healthcare compete?
The value of money. In 1967, being financially well off was of paramount importance to 40% of graduating college students, rising to more than 80% by 2003. Given this trend, it is not a surprise that low salaries and a perceived, and at times real, lack of prestige have created a recruitment and retention crisis for behavioral healthcare.
Talk with a school of social work's faculty and you'll hear that social work is once again a woman's field which, unfortunately, is an indicator of low salaries and lack of prestige. We are demanding more skills but offering salaries that cannot attract the necessary talent. Instead of tackling the salary crisis as the nursing and teaching professions have done, we are embracing the use of paraprofessionals with abandon, creating low-paying jobs that usually offer no opportunities for advancement and exacerbating the lack of staff competent in evidence-based interventions.
The disappointment of graduate education. For the most part, graduate education does not meet the needs of public-sector behavioral healthcare. There continues to be a lack of emphasis on current evidence-based approaches and on continuous quality-improvement processes. Graduate education's failure to redesign curricula might well reflect behavioral healthcare's ambivalence about practice change.
The majority of practitioners agree in principle on the necessity of providing empiric support for their interventions. However, a survey of social workers found that the majority were not using research findings in their practice. As clinical guidelines and treatment consensus statements continue to emerge for a wide array of emotional and addictive disorders, these become, in effect, standards of care that should not be ignored for ethical and legal reasons.
Continuing education programs have the potential to promote practice change, but none of the professional groups requires these programs to focus on updated empirically based interventions. Additionally, continuing education is primarily discipline-specific and does not offer a much needed multidisciplinary approach to training.
Organizational supports. The best way to gauge if we have an effective workforce is to collect and use process and outcome data. There is a clear connection between a provider organization's capacity for quality improvement activity and the increased adherence by practitioners to effective interventions.
Provider organizations that function at the level closest to the experience of patients and families must have the tools to collect and analyze data that allow them to ask “How are we doing?” The answers should be used to continuously improve practices and client outcomes. This internal feedback loop—providers and practitioners systematically collecting and analyzing program and client outcomes—tells us where to focus workforce improvement efforts.
Members of the National Council for Community Behavioral Healthcare deliver services in communities across the country. The adults, children, and families in these communities depend on our members having an available and competent workforce. In their efforts to serve their communities, members have developed an array of recruitment, retention, and staff and leadership development strategies.