Massachusetts addiction treatment workforce breaking down, trade group reports

By Chris Lisinski

JUNE 1, 2023…..Potent worker shortages are putting critical treatment services out of reach for Bay Staters struggling with substance use disorder, particularly those relying on safety net benefits, a new report warns.

While overdoses in Massachusetts continue to kill more than 2,000 people each year, nearly a quarter of jobs in the substance use disorder treatment system are unfilled and the average wait for admission to some longer-term residential recovery programs is more than a month, the Association for Behavioral Healthcare said.

The industry group surveyed dozens of its members, who reported a shortage of employed clinicians, counselors, nurses and other personnel who play major roles in the state’s opioid epidemic response.

“Historically low rates and the difficulty filling jobs serving complex populations has resulted in high vacancy rates, frequent turnover, long waitlists and the permanent closure of certain programs,” authors wrote in the 14-page report.

Altogether, survey respondents reported a 24 percent vacancy rate for positions across the spectrum of substance use disorder treatment services, ABH said.

Some industry subsets are facing even tighter conditions. ABH said 46 percent of staff departed acute treatment service settings in the 12 months before its survey, while four in five nurses in opioid treatment programs left in the past year, “a critical workforce shortage that impacts OTP operations and the ability to dose methadone.”

Fifty-three of 55 respondents said they have one or more empty client-facing position, and 44 percent of the time, it took longer than six months to fill an open job, ABH wrote.

The trend continues to head in the wrong direction for some sectors, too. The report said that for every 10 master’s-level clinicians or counselors who left their jobs, only 9.2 were hired, deepening the gap.

Warning of a “hidden safety net access crisis” for 24/7 treatment services, ABH said the number of beds available to patients on public benefits has fallen while the number available to those using private insurance or paying out of pocket has increased.

The group counted nearly 190 “safety net” acute treatment and crisis stabilization services beds that went offline between February and May alone, and said more than 260 clients were on wait lists for long-term residential recovery slots at the time of its survey.

“Respondents with a waitlist reported that the average wait for admission was 34 days. A quarter report that clients wait for 60 days or more, with some waiting as long as 135 days,” the group wrote.

ABH published the report Tuesday, but the data it cited is from a member survey conducted in April 2022. However, authors said responses were “supplemented and updated with publicly available data to give additional context to the issues facing the substance use disorder treatment care continuum.”

Workforce shortages continue to plague most of the health care sector, including hospitals and long-term care facilities.

Lawmakers and former Gov. Charlie Baker agreed last year on a mental health access reform law that required commercial insurers to cover emergency services, gave regulators more tools to enforce payment parity for mental health care, and eliminated a prior authorization requirement for mental health acutement treatment.

The law also sought to mitigate a crisis of emergency department “boarding,” when patients who need specialized mental health care beds wait for days or weeks to get placed, by expediting review of younger patients in those situations and standing up an advisory council.

ABH urged lawmakers to take additional action this session to ensure state and federal parity requirements are more frequently enforced.

The group also wants policymakers to focus on improving pay and reimbursement rates in the industry, saying that many workers depart because of lackluster compensation, and to eliminate copays and other cost-sharing for substance use disorder interventions.

“As Massachusetts continues to see unacceptably high rates of fatal overdose, we must do more to support and expand the workforce of behavioral healthcare providers who can make a difference in the lives of people with substance use disorder,” ABH President and CEO Lydia Conley said in a statement alongside the report. “We also have more work to do to hold both public and private insurance payers accountable to ensure that behavioral health treatment parity becomes a reality.”