Perspectives on Turnover and Workforce Shortages in Community Behavioral Health: Implications for Policy and Research

There is a high rate of worker turnover in public mental health settings, contributing to a critical provider shortage with serious implications for mental healthcare access, particularly for low-income and underserved populations. These challenges unfold within strained public mental health systems characterized by chronic underfunding, high caseloads, and administrative demands, all of which exacerbate workforce instability. The primary objective of this study was to qualitatively examine public mental health workers' perspectives on factors influencing turnover and experiences of ongoing workforce shortages. Semistructured interviews were conducted between September and October 2024 with mental health workers (N = 20) from 12 agencies within the public mental health system in Philadelphia. Thematic analysis identified four key themes: (1) identification of financial and occupational stressors that contribute to turnover, (2) profound dedication and commitment to serving acute community mental health populations, (3) reactions and implications of staffing shortages, and (4) factors important to staying at work in the public mental health system. A notable secondary finding highlighted disparities in access to care for Spanish-speaking clients with participants describing shortages of Spanish-speaking clinicians and interpreters across the public mental health system that may negatively impact therapeutic rapport and timely access to services. Findings highlight the value of frontline provider perspectives in informing policy and research efforts aimed at strengthening and sustaining the public mental health workforce while promoting equitable and linguistically responsive access to behavioral health services.