Children's mental health workforce in Massachusetts: Defining workforce capacity in a complex healthcare system

In 2009, the Blue Cross Blue Shield of Massachusetts Foundation commissioned the Lewin Group and DMA Health Strategies to survey licensed mental health practitioners to describe the state's children's mental health workforce capacity and analyze how well it matched the mental health needs of children and families. Prior mental health workforce studies have not addressed capacity to serve children. The study surveyed licensed mental health professionals in the state. The entire universe of prescribing providers (Psychiatrists and Clinical Nurse Specialists) was surveyed and a random sample of non-prescribers (Psychologists, Mental Health Counselors, Marriage and Family Therapists, and Social Workers) was regionally adjusted. A total of 735 respondents met the criteria of serving a case load of at least 10% children and adolescents (ages 0-21) for a child provider. In contrast to perceptions of limited access, many child providers reported one or more openings in their practices most of the time. However, the survey found that 37% to 51% of professionals do not participate on any public insurance panels, and 10% to 17% of prescribers do not participate on any panels. Administrative burden, lack of compensation for necessary collateral work, and low rates of payment were identified as disincentives for participating on insurance panels. Most significantly, more than half (54%) of children's mental health providers reported that they plan to leave the state or leave direct care in the next five years and the predicted entry of new licensees fall far short of the anticipated loss.