While clinical psychologist Michael T. Flaherty, PhD, believes there is a shortage of professionals in the behavioral health workforce in terms of sheer numbers, he also believes there is an emerging secondary issue. Just as concerning to him is the question of whether today’s professionals have the right training and expertise to be relevant to the needs of their communities.
“We want to be sure we have competent workers at each level of care,” he tells Behavioral Healthcare Executive.
Flaherty has studied workforce issues and is a board member of the Annapolis Coalition on Workforce Development. A clinical advisor to federal leaders, a speaker and published author, he was previously the vice president for behavioral care at the St. Francis Health System in Pittsburgh and director of its Institute for Psychiatry and Addiction Services. Additionally, he assists communities seeking to develop and implement recovery oriented system of care.
For providers, what is making matters worse is the high turnover rates, especially in public health agencies that treat behavioral health conditions, Flaherty says. About half report difficulty in retaining staff, and the turnover rates average from 18% to as high as 40%.
“Even if you get the workers, it’s hard to keep them as they seek higher wages and better working environments,” Flaherty says.
He says some solutions are already in place, but it’s a matter of implementing them more broadly and investing the right amount of funding to have impact. For example, the salaries for clinical professionals at the acute level are much greater than those working at the prevention level. With population health strategies gaining traction in the health system at large, prevention will require greater investment—including payment mechanisms.
But behavioral health is unique, he says, because it’s a profession that is driven by meaningful work, love and dedication, rather than income or advancement alone.
Flaherty recently discussed workforce issues with BHE. Here are excerpts from the conversation.
BHE: Can you give us an idea of the magnitude of the workforce shortage in behavioral health? Are we in a crisis?
Flaherty: In my own calculus, yes, we are in a crisis. We are addressing only about 10% of the population with clinical criteria for substance use and about 14% to 15% for mental health. And of course, there are co-occurring conditions. With most of the people with the issues unable to access treatment or not in treatment, we know we simply don’t have a sufficient workforce today to meet the needs of that 70% or 80% more among the population, who still need treatment.
As a result, those people end up in our public health or public safety systems—in jail or emergency rooms—and that costs our society far, far more than if they were able to access treatment.
BHE: You say there is high turnover. Do you think other industries might be pulling the workers away from behavioral health?
Flaherty: Yes indeed. We spend 20% of our gross national product on healthcare, and that’s the whole system, not just workforce, but many people feel that’s too much. And that begs an interesting question: If we stay at that level of spending, and we still can’t reach 80% of the population in need, are we really missing an opportunity for jobs and creation of new careers at a time when technology is replacing jobs? But we’d need to be willing to expand our gross national product beyond that 20% spending.
Some people working in behavioral health themselves qualify for public health or Medicaid or social security benefits. You’d think they’d have an income at least replicable of a fair job or of a peer in another industry, like a teacher or police officer. But they can’t even get salaries to that level.
Managed care companies are hiring people away at higher salaries and so are government agencies and the criminal justice system. Yes, it’s a challenging area to keep people and for them to make their careers.
BHE: In what other ways do workforce issues affect future growth?
Flaherty: The real challenge is that the science and the research has gotten way ahead of the workforce. Examples of this are integration of healthcare and parity. You should be able to go to a primary care doctor and have a mental health evaluation or a recovery check up, but we’re not there yet.
In today’s 21st century model of population health, prevention steps up as a higher priority as does early intervention, and these are all new jobs and new skills across all the specialties, not just behavioral. With parity, the mind and the body should be seen as one, and the workers should be so matched.
You can’t address workforce just as a shortage. You have to address it as a need to become modernized to a 21st century model of care.
BHE: What are some solutions with potential?
Flaherty: Conceptually, the integration of body and mind is the biggest solution. The workforce has to be modernized to match that, so the solutions of technology and precision medicine and new concepts that come along require the workforce to be more skilled.