Like other segments of the human services field, the public mental health system is experiencing significant difficulty in attracting and retaining qualified personnel to provide appropriate services and to effectively manage the myriad agencies on which it relies at the community level. Constrained state budgets and tightly capped reimbursement rates result in salaries for line staff and other professionals that are barely competitive with fields requiring far less professional commitment and responsibility. Mental health officials in many states report difficulty in filling positions at the service provision level. Some positions remain vacant for long periods of time. Officials also report high rates of turnover in sensitive line positions in both hospitals and community agencies. In many agencies, ironically, the pathways for career advancement lead only to management positions where clinical skills and experience may take a back seat to other attributes. As a result, mental health agencies can find themselves with few experienced clinicians meeting clients and poorly prepared managers dealing with increasingly complex reimbursement, staffing, and planning issues.

Case managers are, arguably, the most important link in an individualized, community-based system. Theoretically, they should be the most constant face of the system to consumers and their immediate families.  However, most consumers who have received services in community mental health centers for any length of time report that they have seen their case managers turn over steadily. Moreover, many complain that their case managers are almost universally young, inexperienced, minimally trained, and paid on a par with people working at McDonald's. Many consumers report that they - the consumers - know far more about the mental health system and how it works than do the case managers they are meant to rely on.

At the same time, mental health workers with the ability to provide services with particular sensitivity to cultural, language, or age-related needs are in especially short supply in many areas. At a time when awareness of the need for culturally sensitive services has grown, it is a sad truth that providers in many communities simply cannot attract the workers needed to implement those services. 

It is evident that there are any number of reasons for high vacancy and turnover rates. The jobs entail stressful workloads and conditions, while commanding little public respect or compensation. Reality may not jibe with expectations or training, and paperwork and other bureaucratic imperatives place an additional set of burdens on workers who may have a genuine desire to serve people in need. Moreover, staff currently entering the field may find themselves in agencies oriented only toward survival and not toward achieving the high expectations that should be the hallmark of the community mental health system. Services researchers must thoroughly examine the factors involved in workforce recruitment and retention, and steps must be taken to address the gaps evident in the field. Without significant improvement in this area, many of the important recommendations in this report will not be implemented, simply because competent staff will not be available to do the necessary work.

Recommendations:

a.

Plan to increase the supply of skilled and experienced mental health providers.

b.

Promote the employment of current and former clients in the provision of mental health services.

c.

Provide training that specifically addresses the consumer and family experience of mental illness.

d.

Plan to increase the supply of skilled and experienced mental health providers in rural areas.