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Maryland needs to increase the number of behavior health care workers by about 50% to meet current demands, a “significant problem” that only gets worse in coming years unless the state finds ways to boost the workforce.
Those were the findings of a report, “Investing in Maryland’s Behavioral Health Talent,” presented recently to the Maryland Medicaid Advisory Board. Chair Nicole McCann said officials have been aware of the issue for some time, but that the report helps shed light on what can be done about the workforce shortage.
The report said that in 2023, Maryland had 34,613 people working in various areas of the behavioral health field, but it said that number was 18,222 workers shy of what is currently needed. And that doesn’t take into account the additional 14,565 workers who are expected to be needed by 2028 to meet the growing need for behavioral health care, it said.
Shannon Hall, executive director of Community Behavioral Health Association of Maryland, called the shortage of behavioral health workers a significant problem.
“When you have those vacancies, it basically translates into your capacity to provide treatment to people is substantially lower,” Hall said in a recent interview. “You end up with waitlists. You end up with vacant rooms if you can’t meet the minimum staffing requirements.
“It just really creates a backlog that disrupts the entire system,” she said.
The report, commissioned by the Maryland Health Care Commission, is a result of 2023 legislation that created a fund to reimburse local governments or health departments for costs associated with education and recruiting behavioral health workers and to improve the shortage.
Maryland’s behavioral health workforce shortage is due to “historical underinvestment in the behavioral health system, increasing rates of mental illness and substance use and high rates of burnout and attrition has led to a national shortage of peer recovery specialists,” the report says.
The state will need to invest about $148.5 million over the next five years to help fix the workforce shortage, it says. Those funds could go toward raising wages for staff and reimbursement rates for providers, the report says. They could also go toward tuition assistance for those looking to enter the field.
In terms of policy, the report said the state could work to expedite the licensing process, so new workers can start sooner, and to increase awareness of behavioral health occupations through programs such as the Blueprint for Maryland’s Future.
Behavioral health covers a wide range of care, including mental health services, addiction and rehabilitation resources, trauma counseling and more. But without adequate staffing levels, people may sit on waiting lists, and staff providing those services might burnout and leave the field entirely.
“Based on current trends, 45% of BH (behavioral health) professionals working today are expected to retire, leave Maryland, or leave the field of their occupation over the next five years,” according to the report. “If this attrition rate persists, Maryland will need to attract 30,000 new BH workers to meet unmet need and replace workers leaving the field, roughly the same number currently employed.”
Cathie Eaton, executive director of the Maryland Counseling Association, said that not having enough behavioral health staff means that people in need of those services may sit on waiting lists.
“I have friends who have had waitlists for years, and they just can’t get new clients in because they don’t have the capacity,” Eaton said. “It leaves a lot of folks who need behavioral health services without.”
But from her perspective, the wages are not high enough to get people interested in the field.
“In general, it’s a high-stress field,” Eaton said. “It’s a very fulfilling field, but we understand that a lot of people don’t want to go into the field because of the pay scale.”
The behavioral health positions facing the greatest workforce shortage numbers include both licensed professionals as well as unlicensed paraprofessionals and assistants.
The “Investing in Maryland’s Behavioral Health Talent shows that many occupations in the field face a current workforce shortage that could worsen in coming years. Courtesy of Trailhead Strategies.
For example, 9,532 new counselors and therapists will be needed by 2028 to keep up with projected demand by that year. That includes 3,748 new workers needed to replace workers leaving the field by 2028, as well as 5,784 workers to keep up with rising demand.
Social and human services assistants — a broad category that includes outreach workers, unlicensed case managers and other paraprofessionals — is the second highest shortage in this field, with 8,029 more people needed to meet 2028 demand. That would be 4,000 new paraprofessionals to replace outgoing workers and 4,029 to to keep up with rising demand.
Adding all the other behavioral health positions facing workforce shortages, an estimated 32,786 new workers will be needed by 2028.
Hall said that the lack of personnel exacerbates burnout, as current staff need to take on a higher workload to account for the vacancies and care for patients.
“It makes people who carry extra responsibilities and a lot more stress. It’s harder for them to take time off,” Hall said. “They’re picking up the slack, so it just creates a lot more stress across the entire system.”
She said the report points to a need to “champion behavioral health as an investment, even amid a challenging budget year.”
“If this falls by the wayside because of budget shortfalls … behavioral health is not going to win that game. And it’s not just behavioral health that’s going to pay for that,” Hall said. “It’s the schools, it’s the hospitals, it’s the criminal justice system and ultimately it’s vulnerable people in Maryland. So this is an area where … either you invest in it upfront, or you pay for it in more expensive settings.”
