Report finds a 'workforce crisis' is behind long waits for mental health care in Massachusetts

A new report suggests a "workforce crisis" is affecting mental health care in Massachusetts, resulting in longer waits for outpatient treatment and fewer people getting care.

The Association for Behavioral Healthcare report released Tuesday said the average wait time in the state for an initial mental health assessment by a licensed clinician is longer than two months. It found that more licensed clinicians are leaving positions than are being hired.

The report's findings were based on surveys of 37 agencies that represent 124 outpatient clinic sites across Massachusetts. The clinic sites served almost 93,000 people in the 12 months before the surveys were conducted last October and November.

Nearly all the clinics reported increased wait times with almost 14,000 people on wait lists. The average wait for an assessment or therapy for children and youth was three weeks longer than waits for adults, according to the report. The clinics also reported serving 11% fewer people in 2021 than before the coronavirus pandemic began, despite COVID increasing demand for mental health services.

"Access to outpatient mental health services continues to diminish," the report said. "Without substantial new investment by private- and public-sectors and the implementation of bold strategies, access will further plummet and cause a system-halting workforce shortage for outpatient and acute mental health services."

The factor largely behind the long waits, according to the survey, was a diminishing workforce. The report found that for every 10 master's degree-level mental health clinicians hired, 13 similarly qualified clinicians left their positions in 2021. Nearly half of the outpatient clinics reported it took at least nine months to fill an independently licensed clinician position. The ABH members reported that each clinician served at least 40 people, and many left their jobs because of salaries.

"We are concerned that what the data is showing us is that maybe a generation of people has just done the calculus and decided that they don't want to come into this field," said Lydia Conley, president and CEO of the Association for Behavioral Healthcare. "That's what was so concerning about the study is — is this a harbinger of a really significant impact on the delivery system right now?"

Conley said many clinicians are leaving clinics to work in acute hospital settings, where salaries are often higher. The state also increased the number of acute hospital psychiatric beds in response to a dramatic uptick in mental health patients boarding in hospital emergency rooms. But Conley said this contributed to the worker shortage by creating "a potential revolving door" for workers to go to more acute settings, leaving outpatient clinics with fewer resources and staff.

"This pressure that is caused by ED boarding is driving the creation of new beds, and beds are absolutely needed, but what it is doing is it's redirecting this diminishing workforce to those settings," Conley said. "So if we don't do something to really rethink outpatient services and invest in outpatient services, we're never going to address the root cause of boarding."

Conley said the state has made efforts to improve mental health care, pointing to new legislation and Gov. Charlie Baker's "Roadmap for Behavioral Health Reform," which called for the creation of community and urgent care centers for mental health. The ABH report said the state's efforts provide "strong frameworks upon which to build."

The report made several recommendations, including rebalancing health expenditures toward behavioral health and primary care and increasing reimbursement rates and student loan repayment programs for some clinicians.

Additionally, the report asked for greater transparency from commercial insurers on reimbursement rates to clinicians and for them to help provide a more complete assessment of the state's mental health workforce.