We Can’t Solve the Mental Health Crisis Without Improving Conditions for Therapists

Dr. Ashley Castro, Founding Executive Director
April 21, 2023

Part of President Biden’s strategy to fix our mental health crisis is to address our therapist shortage by growing and diversifying the mental health workforce. But as we work to bring more therapists into the system, it’s important to make sure they’re getting the support they need.

A 2018 study found that 55% of therapists experienced moderate to high levels of burnout.

Rates of therapist burnout are notoriously high in community mental health centers (CMHCs), which are critical access points to mental healthcare for low-income communities. What makes CMHCs theoretically so accessible are that they 1) offer affordable services through public insurance or financial assistance and 2) are physically embedded in communities. Unfortunately, decades of underfunding have meant that, in practice, CMHCs represent what’s not working in mental healthcare.

So what can the next generation of therapists expect when serving the underserved in CMHCs?

High caseloads. Community mental health is notorious for high caseloads, reflecting both high community demand for services and high productivity requirements to keep agencies afloat financially. Not only are caseloads typically large, they’re also complex. Patients in community mental health often face multiple stressors due to living in poverty and other forms of marginalization.

Low pay. Therapists working in community mental health generally receive lower pay compared to other settings like hospitals or private practice. The annual salary for a therapist in this setting can go as low as $39k for someone with specialized training and an advanced degree. Many therapists in CMHCs aren’t paid at all because they’re accruing hours for licensure.

The working conditions for therapists in CMHCs are most relevant to new therapists, who are broadly more susceptible to burnout. And they’re especially relevant to therapists of color and therapists from low-income backgrounds, who additionally have to contend with many of the same social stressors that bring their patients to seek therapy and the same barriers that make it difficult to access their own care. This is the perfect recipe for burnout.

And burnout isn’t just bad for therapists.

Therapists who are emotionally exhausted and less satisfied with their jobs are more likely to want to leave their job, even if they ultimately don’t. Those burned out therapists who stay in their jobs struggle to provide the quality of care that they want for their patients. They may ultimately decide to leave the profession altogether or stop working with public insurance.

If we want to improve access to care we need to make sure therapists in community mental health are adequately supported so they can provide high quality care and stay in the system.

Bringing more people into a system that doesn’t treat them well is both unethical and counterproductive. This goes for patients as well as their providers.

Part of our vision at Healwise is to ease burdens on therapists by helping patients connect to affordable, alternative sources of support. Solving the mental health crisis should not and cannot be dependent on therapists carrying this load on their own.

Thank you for being part of this journey with us.

Let’s make progress together.

This edition of Progress Notes was first published in our quarterly newsletter.