The behavioral healthcare workforce is under considerable duress and ill equipped to meet a moment marked by unprecedented rates of mental illness, substance dependence, and other indices of human distress. By some measures, approximately half of mental health professionals report burnout because of the emotional demands of their profession and systemic factors that undermine their efficacy (Ballout, 2025). Workforce pressures are intensified by a global shortage of professionals and structural impediments to the recruitment and retention of qualified personnel (World Health Organization, 2022). Service professionals also experience widespread moral injury due to their actual or perceived failure to meet needs beyond their conventional scope of practice (Rabin et al., 2023). For instance, service recipients’ widespread exposure to such socioeconomic stressors as food insecurity and housing instability requires providers to pursue interventions largely beyond their control to alleviate the suffering of those entrusted to their care. For most professionals this has proven a Sisyphean task that compounds other stressors and exacerbates burnout. Moreover, these challenges are not evenly distributed across the behavioral health workforce. Members of historically marginalized populations including Black, Indigenous, and people of color (BIPOC) experience additional challenges in navigating bias and racism embedded in the structures of our healthcare and social welfare systems (Kyere & Fukui, 2023). Designated Peer Specialists enlisted to utilize their lived experience in recovery in service of others also encounter systemic bias and related obstacles to workforce integration.
Nearly half of the U.S. population resides in federally designated Mental Health Professional Shortage Areas (MHPAs), regions with moderate or severe shortages of mental health professionals available to meet their populations’ needs (Ballout, 2025). This is tragic but unsurprising in consideration of innumerable impediments to the recruitment and retention of qualified personnel. Employment in behavioral healthcare and social welfare entails a specific type of labor that is unique among the professions and predisposes many to burnout and secondary trauma. Theoreticians have defined “Emotional Labor” as a process in which employees calibrate their emotional expressions in accordance with the needs of their clients and, in doing so, experience a dissonance that arises from discrepancies between their authentic emotional experiences and expressions of them (Zhao et al., 2025). Emotional Labor has been repeatedly linked to burnout, and its impact is presumed to be greater among employees who must manage large client caseloads due to the workforce shortage. Emotional Labor may be further compounded by the acuity of service recipients’ needs amid widespread economic distress and related impediments to health and stability. Providers heretofore tasked to treat clients’ behavioral health symptoms must now address their myriad Health Related Social Needs (HRSNs) without the resources needed for this task. Other factors implicated in this shortage include but are not limited to systemic dysfunction in the training, education, and professional development of behavioral healthcare professionals; regulatory and administrative barriers; and inadequate financial support for the behavioral health sector in general.
Aspiring behavioral healthcare practitioners incur exorbitant expenses in pursuit of their careers. Tuition for undergraduate and graduate education, supervisory fees, and other expenditures are prohibitive for most, and those who finance their education with loans often emerge with debts that eclipse their annual salaries. This is both a deterrent to entrance to this field and an additional source of stress for professionals who elected to enter it despite its inherent financial disadvantages (Georgetown University Center on Health Insurance Reforms, 2024). In addition, emerging professionals often encounter difficulties in locating eligible mentors or preceptors to ensure they fulfill licensure requirements. Senior professionals with the requisite experience to fulfill preceptor roles may command greater compensation in other settings. A consequent shortage of preceptors forestalls the development of aspiring professionals and exacerbates an existing workforce shortage. Opportunities for professional advancement are also notoriously scarce in the behavioral health and social welfare sectors, as advancement is highly dependent on education, credentialing, and licensure requirements. Providers with bachelor’s or comparable (i.e., sub-graduate) degrees frequently attain the maximum, albeit meager, compensation available to them within their organizations and must assume additional responsibilities without commensurate opportunities for wage increases or professional growth. This trend may produce professional dissatisfaction and contribute to organizational turnover and attrition (Georgetown University Center on Health Insurance Reforms, 2024).
Regulatory schemes and administrative workloads characteristic of the behavioral health and social welfare sectors often undermine employee satisfaction and compound the foregoing challenges. Inasmuch as the sector is entrusted with the care of vulnerable individuals and depends largely on public funding for its operations, an extensive body of regulation has been enacted to ensure recipients’ welfare and the appropriate use of available funding. These regulations, though necessary and justified, have had the unintended consequence of alienating professionals beholden to them. Professionals whose time is spent on adherence to complex (and ever changing) regulations and the preparation of clinical and administrative documentation have less time with which to meet recipients’ needs (Frier Levitt, 2025). This trend is particularly acute within organizations that rely on private insurers, and Managed Care Organizations (MCOs) in particular, for reimbursement. MCOs are private (and frequently for-profit) organizations incentivized to maximize financial returns for their investors at the expense of their members (i.e., service recipients) and the behavioral healthcare providers on whom they depend. MCOs are notorious for their failures to process provider claims in a timely manner and their frequent rejection of claims on dubious grounds. These practices are particularly prevalent within the behavioral healthcare sector. MCOs have repeatedly engaged in disparate or outright discriminatory practices that favor primary care (i.e., medical and surgical care) over behavioral healthcare. These practices persist despite the passage of the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and similar legislation in New York State (NYS). As recently as 2022, NYS began to recoup monies MCOs improperly withheld and to reinvest them into the behavioral healthcare provider community. Such egregious payor practices are both injurious to service recipients and demoralizing to provider organizations, behavioral healthcare professionals, and administrative personnel whose precious time is spent in pursuit of financial reimbursement essential to their operations.
The crisis that plagues the behavioral health workforce has become undeniable to key stakeholders, and measures to repair it are underway. For instance, the New York State (NYS) Office of Mental Health (OMH) is among several state agencies that have established career development pathways to incentivize aspiring professionals to enter the workforce. Emerging partnerships with institutions of higher education, the development of credentialing programs for existing and incoming paraprofessional personnel, and loan forgiveness programs promise to bolster a flagging workforce in coming years. The OMH has also established an Office of Diversity and Inclusion to promote diversity within the behavioral health workforce and to maximize recipients’ access to culturally competent care. In a similar vein, NYS has promoted the development and professionalization of Peer Specialists through the New York Peer Specialist Certification Board and corresponding credentialing and career pathways.
Additional opportunities to reinvigorate the behavioral health workforce hold considerable promise but have yet to materialize. An ambitious initiative undertaken in partnership between the state and federal governments is poised to deliver an enhanced array of support services to vulnerable Medicaid recipients heretofore unavailable to them. Eligible recipients may receive limited assistance in meeting select housing, transportation, and nutrition needs through Social Care Networks (SCNs) comprised of healthcare providers, community-based organizations, and other entities serving our state’s most vulnerable residents. To the extent these and similar initiatives are successful, they will address unmet needs and complement the actions of healthcare professionals, thereby easing the burden on them. Technological innovations, most notably those within the Artificial Intelligence (AI) realm, have enormous potential to support both clinical and administrative workloads and to enhance the efficiency and efficacy with which (human) providers approach their work. These technologies also entail innumerable risks that must be fully understood given the potential repercussions of their misuse. It is nevertheless incumbent on all stakeholders to the behavioral health and social welfare systems to explore increasingly innovative approaches if these systems are to finally meet a critical moment in public health.
The author may be reached at abrody@searchforchange.org or (914) 428-5600 (x9228).
References
Ballout, S. (2025). Trauma, mental health workforce shortages, and health equity: A crisis in public health. International Journal of Environmental Research and Public Health, 22(4), 620. https://pubmed.ncbi.nlm.nih.gov/40283844/
Frier Levitt (2025, April 28). Providers beware: The challenges of practicing behavioral health care. https://www.frierlevitt.com/articles/providers-beware-the-challenges-of-practicing-behavioral-health-care/
Georgetown University Center on Health Insurance Reforms. (2024). Understanding and mitigating behavioral health workforce shortages. https://behavioralhealth.chir.georgetown.edu/wp-content/uploads/bh-workforce-report.pdf
Kyere, E. & Fukui, S. (2023). Structural racism, workforce diversity, and mental health disparities: A critical review. Journal of Racial and Ethnic Health Disparities, 10, 1985-1996. https://pmc.ncbi.nlm.nih.gov/articles/PMC9361976/
Rabin, S., Kika, N., Lamb, D., Murphy, D., Stevelink, S., Williamson, V., Wessely, S., & Greenberg, N. (2023). Moral injuries in healthcare workers: What causes them and what to do about them? Journal of Healthcare Leadership, 15, 153-160. https://pmc.ncbi.nlm.nih.gov/articles/PMC10440078/
World Health Organization. (2022). World mental health report: Transforming mental health for all. https://www.who.int/publications/i/item/9789240049338
Zhao, Y., Gao, L., & Gao, J. (2025). The impact of emotional labor on mental health: A systematic review and meta-analysis of multi-occupational groups. Acta Psychologica, 261, 105905. https://www.sciencedirect.com/science/article/pii/S0001691825012181
