Recruitment & Retention

Finding and keeping a workforce has long been identified as a challenge in the fields of mental health and addictions. But the magnitude of that challenge now seems unprecedented. Health care reform has increased access to behavioral health care, hospitals and large health systems are hiring more workers to expand their mental health and substance use services, and the strong national economy and low unemployment rates are enticing some workers to leave the behavioral health field for opportunities in other sectors. It is not uncommon for turnover rates in some organizations to exceed 100% per year for entry level direct care positions and 50% per year for licensed clinicians. High turnover disrupts established therapeutic relationships, access to care, and the delivery of evidence-based practices. It is costly for the employer and creates a burden on workers who remain with the organization.

Dimensions of the Problem

There are multiple dimensions to the recruitment and retention crisis. Efforts are needed to recruit and retain individuals to the field of behavioral, to specific professions and to specific specialties that focus on populations such as children and older adults. Within the nation’s education systems there is a demand for more faculty to train the next generation of providers. Within provider organizations, workers are needed direct care, supervisory, managerial and leadership positions. There is the need across all positions to increase the diversity of the workforce with respect to race, culture and other key individual characteristics. Focus is also needed on the maldistribution of the workforce, which impedes access to care in rural and poor urban areas.

Potential Causes

Numerous issues have been cited as casual factor of workforce shortages and turnover in this field. Compensation is lower in behavioral health compared to similar positions in other sector of healthcare. Low levels of reimbursement or funding for services can create burdens for workers and instability in behavioral health agencies. Stigma and discrimination against people with behavioral health conditions make positions in these agencies less attractive. Limited opportunities for advancement and ambiguous career paths are also likely contributors to turnover and vacancies.

The Annapolis Coalition Response

To address this issue, the Coalition has developed and launched Recruitment and Retention Learning Collaboratives. Using a model of change developed by the Institute for Healthcare Improvement, these Collaboratives have been supported by federally-funded Mental Health Technology Transfer Centers, foundations, and regional mental health boards. The process is as follows:

Interested organizations apply to participate.
Selected organizations each form a three-member Change Management Team.
An orientation webinar is provided to the teams.
The teams meet together for a one-day Launch meeting, are briefed on effective recruitment and retention methods and provided with templates to guide development of their recruitment and retention plans.
The Teams begin selecting their recruitment and retention goals and strategies during the Launch meeting and continue plan development in consultation with others in their organizations after returning “home”.
The Learning Collaborative leaders provides technical assistance to team on plans and plan implementation throughout the 9-month process.
Teams participate in three Learning Collaborative web-based virtual meetings to share with each other ideas, successes and challenges.

To inquire about sponsoring a Recruitment and Retention Learning Collaborative or obtaining technical assistance for your organization on this issue contact Dr. Michael Hoge, our Senior Science and Policy Advisor, at [email protected].

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