Felice J. Freyer’s article “Exodus of clinicians at mental health sites” (Page A1, Feb. 15) sheds light on a problem that has been obvious for years and has been exacerbated, of course, by the COVID-19 pandemic, which has illustrated the tremendous need for mental health services. While salaries are clearly an important factor, others are also significant and need attention.
Salaries follow insurance reimbursements, which are significantly lower for mental health than for other medical conditions. Medicaid reimbursements could set the bar high enough that private insurance would follow. Salaries could be improved and need to be competitive with the private practice sector. Other important factors include decreasing unnecessary documentation and forms and respecting clinician expertise to determine how patients should be seen in terms of frequency and modality of treatment.
As clinicians leave a system, remaining clinicians are expected to pick up the workload, further burning them out. This creates what is well documented in clinicians as a moral injury: not being respected and able to function with the expertise with which they are trained. As a result, many of their patients are made less stable and able to function.
For decades, little attention has been paid in a coherent manner to the development of the mental health workforce, including psychiatrists, psychologists, and social workers. Institutions providing mental health care must be supported financially as the need increases, and retention and recruitment of staff should be a primary concern.
Dr. Marshall Forstein
The writer is an associate professor of psychiatry, part time, at Harvard Medical School and former psychiatry residency director and vice chair for education at Cambridge Health Alliance. He has worked for almost four decades in public sector mental health.