Yale psychiatry prof: Behavioral health workforce in Connecticut and nationwide is facing an ‘emergency’

A psychiatry professor at the Yale University School of Medicine painted a sobering portrait of the behavioral health workforce in Connecticut and across America during a meeting last week of the Behavioral Health Partnership Oversight Council.

“I no longer call it a crisis; I really call it an emergency across our nation,” Michael Hoge, who is also the director of Yale Behavioral Health, told the council, a body made up of legislators, health care providers and advocates that advises state agencies on behavioral health issues.


The deep issues faced by Connecticut’s behavioral health workforce have drawn attention in recent months, amid what has been described as an “overwhelming” crisis in pediatric mental health care. As state lawmakers, providers and advocates have looked toward solutions, many have emphasized widespread workforce issues within mental health care. Providers often describe high rates of turnover and struggles to fill open positions, largely due to inadequate compensation and burnout among staff.

As the state legislature mounts a campaign to address a wide range of issues within behavioral health care, the importance of workforce development has been front and center. One proposal, House Bill 5001, would provide licensure reciprocity for out-of-state mental health professionals, offer loan forgiveness and otherwise support recruitment and retention efforts.


Hoge, who has studied and advised on mental health workforce issues for decades, said that America has long contended with shortages in its mental health workforce. But in recent years, a combination of social and economic forces have created a “perfect storm” that has elevated the issue to “catastrophic” proportions, he said.

Even before the pandemic, America has struggled against a labor imbalance, Hoge noted. In 2018, the U.S. Department of Labor reported more job openings than unemployed people for the first time in nearly two decades — a situation further exacerbated by the so-called current “Great Resignation.” Meanwhile, the deepening opioid epidemic, the COVID-19 pandemic, and the ensuing mental health crisis, have created an even bleaker situation.

Hoge emphasized that behavioral health workforce issues run deeper than merely a lack of workers. They also reflect the “gutting” of publicly-funded, community-based behavioral health agencies, he said, as employees are attracted away by federally-qualified health centers and hospital systems or into private practices, where salaries tend to be higher.

During the meeting, Dr. Chuck Herrick, a Nuvance Health psychiatrist, noted that even hospital systems struggle to stem the flow of providers who leave for private practice.

“What’s happening, particularly with COVID-19, is that people are tired of working, hospitals are very stressful, volumes are up and their salaries are low, and they can go into private practice and they can accept cash,” he said.

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Other members of the council discussed various solutions to the workforce crisis, including an idea promoted by state lawmakers to provide loan forgiveness to those who enter mental health fields.

Hoge noted that while loan repayment programs have been “very influential” in attracting workers, they may not work similarly well at retaining them. However, he stressed, the workforce crisis calls for creative, immediate solutions.

“We’re desperate now, so finding somebody who is committed for three years is a very, very important thing to do,” he said.


Broadly, Hoge recommended widening and strengthening the workforce, including by creating expanded roles such as “peer specialist” positions within recovery programs, making training more accessible and financing systems that enable competitive compensation.

He also noted successful efforts in states across the country, including the Behavioral Health Education Center of Nebraska, which has bolstered the state’s mental health workforce and a trust in Alaska that funds mental health programs through the proceeds of managing more than 1 million acres of land.

“Where we are now is a dire, dire need for action to move forward to stop talking about all the workforce issues and have better, concerted plans in our state and across the nation in order to address this issue,” he said.

Eliza Fawcett can be reached at