Financial boost keeps mental health workers on the job, caring for children

By Julie Riddle, MLive/Kalamazoo Gazette

Kaitlyn Berry knew helping people would come at a cost.

Still, the Western Michigan University grad student didn’t anticipate heading into a mental health counseling career with close to $100,000 in student loan debt hanging over her head.

“You just kind of accept that that’s the way it’s going to be,” Berry, 25, said of the financial stressors contributing to a critical shortage of mental health care providers in Michigan and elsewhere.

Earning less than their medical counterparts despite advanced degrees, many mental health professionals find themselves hard pressed to pay back oppressive student loan debt, especially in lower-paying public-sector jobs in rural and underserved areas.

Michiganders carry an average student loan debt of $36,116, according to the Education Data Initiative. Many mental health careers call for advanced degrees upping the possible loan debt, which workers must repay on salaries hovering around $50,000 per year for social workers and mental health counselors, according to the Bureau of Labor Statistics.

In Kalamazoo, three-quarters of WMU’s social work graduates head into the workforce shouldering loan debt averaging $47,000. That amount is likely much higher for students graduating from more expensive public or private universities, a school representative said.

Some, overwhelmed by financial burdens, take private practice jobs in hopes of higher pay. Others leave the field entirely, compounding a workforce shortage already strained by the flood of mental health needs that has overwhelmed providers’ caseloads in recent years.

With the introduction of MI Kids Now, a loan reimbursement program launched last year, the Michigan Department of Health and Human Services has set aside more than $7 million for in-the-field mental health workers. Program administrators hope to entice more people into mental health fields and convince them to stay in the underserved regions where that work is most needed.

In its 2022 cycle, the state awarded $4.4 million to 315 eligible mental health providers, who carry a whopping $107.4 million in total student loan debt — or an average of $341,000 in debt per provider, according to a state representative.

The state expected to hand out another $3 million after a second application window last month.

First, though, practitioners with loan debt need to know MI Kids Now and similar programs exist, experts and practitioners say.

Jennifer Harrison, director and professor at WMU’s School of Social Work and an authority in workforce retention, said the state needs to up its efforts to publicize programs that could keep mental health workers in a field that desperately needs them.

While some providers may not have heard of such programs, DHHS broadly advertises the program via email blasts to community mental health agencies, tribal organizations, public schools, and other organizations and through a press release sent to nearly 46,000 media, stakeholders, and residents who have signed up to receive DHHS news releases, Chelsea Wuth, DHHS associate public information officer, said in a written statement.

Still, such programs deserve every promotion effort possible, Harrison said. Failing to widely advertise such programs implies that student loan debt is “not that big of a deal” in the retention of mental health care workers, Harrison thinks.

“Which it is,” she said. “It’s a very big deal.”

LOAN HELP A POSSIBLE SOLUTION

Growing up in a low-income area of West Virginia, Berry, a first-generation college student, knew family and friends expected her to seek a well-paying job after graduation.

Instead, she followed her heart to pursue a graduate degree in counseling, picking up nearly $100,000 in loan debt in the process, with more tuition bills to come before she finishes her degree ― and, she says, little chance of earning a big paycheck after grad school to pay down the debt.

Berry wants to leave Michigan after graduation, but, if she can get access to MI Kids Now and other loan help programs, she plans to stay in the state and at a non-profit agency, at least for the term of the loan repayment program.

That’s the result the program’s creators say they hope to achieve.

MI Kids Now offers student loan repayment of up to $300,000 over 10 years. The program requires at least two years’ work at a Michigan public school or nonprofit clinic or organization, especially one serving children in an underserved area.

DHHS developed MI Kids Now after it in 2020 entered an interim settlement agreement related to a 2018 class-action lawsuit, K.B. vs. Lyon.

In that lawsuit, parents of children unable to access adequate mental health help accused the state of “staggering failures.” They said the state failed to respond when a 2016 DHHS workgroup called for immediate actions to fix Michigan’s “woefully understaffed” mental health workforce.

As part of the agreement, DHHS “is working to improve access to care when and where children need it” through MI Kids Now and other efforts, Wuth said in the DHHS statement.

Only three counties in the state — none of them in Southwest Michigan ― have an adequate supply of psychiatrists specializing in children’s mental health, according to the American Academy of Child and Adolescent Psychology, which tracks staffing nationwide. 

The Kalamazoo area has seven child psychiatrists to meet the needs of 113,700 children, according to AACAP data. Adequate care requires at least 47 child psychiatrists per 100,000 children, that organization says.

‘WE CAN HELP MORE KIDS”

Such shortages could impact community safety, said Victoria Orbe, children’s services director for Community Healing Centers in Kalamazoo.

Her understaffed agency provides in-home services for the most troubled kids ― those whose emotional struggles, unaddressed, can turn to violence, Orbe said.

Trying to compete with private practices snapping up loan-laden new grads at an unprecedented rate, her agency has increased starting salaries and offers sign-on bonuses, something previously rare in the nonprofit world.

Still, Orbe said, “We can’t fill a position for the life of us.”

An effective loan repayment program, especially one that encourages workers to stay in the public sector, “could be a game changer” for employers, Orbe said. She mentions such programs in her sales pitch to potential hires, telling them she’ll do what she can to help them jump through the hoops of getting financial help.

But loan programs don’t make hoop-jumping easy, Orbe said.

Last summer, she applied for MI Kids Now during the state’s 11-day application window. Eight months later, she learned via an email that she’d been turned down for the program because of a missing document.

“You have to get paperwork signed by your loan processor. Paperwork signed by I don’t even know who else. In 11 days,” Orbe said. “And that’s not even business days.”

That application period is consistent with the state’s other loan programs, said Wuth at DHHS.

The state modeled MI Kids Now on the decade-old Michigan Student Loan Repayment Program, or MSLRP, which also offered up to $300,000 in loan repayment for a more limited range of mental health specialties.

The older program offers an application window of nearly a month this year, increased from a shorter window in previous years.

Orbe said she might apply again, but her first attempt left her frustrated and discouraged. She needs others to find and tap into the program, though, because she needs to have someone to hire.

Every day, she turns away referred children in dire need of emotional help ― from toddlers sexually abused by their parents to kids charged with acts of extreme violence ― because she doesn’t have enough staff to care for them.

The biggest upside of loan repayment programs, if people can get to them, is simple, Orbe said: “We can help more kids.”

‘THE HOLE IS THAT BIG’

Danielle DeVine, a graduate student in her final year at WMU studying psychology and holistic health, said loan payback help would definitely push her toward work for a nonprofit.

Today’s students don’t trust loan repayment programs, though, DeVine said.

Young people have grown cautious about taking on loan debt not knowing if they can pay it back, and programs that make them jump through hoops to apply don’t help, she said.

“OK, this is cool,” students will think of the MI KIds Now program, DeVine said, “but how does this actually apply to me?”

If the state really wants to attract new talent with such programs, it needs to go out of its way to make them comprehensible and attainable, DeVine suggested.

Experts in the field know hazy requirements, complicated application processes and low acceptance rates limit loan repayment programs’ value as recruitment tools, said Bob Sheehan, chief executive officer for the Community Mental Health Association of Michigan.

Such programs do, however, convince people already in the field to remain at their jobs, he said.

In studies conducted in 2018 and 2019, about half of MSLRP recipients had stayed with their non-profit employer at least a year after the completion of their service commitment, according to the most recent data available on the state’s website.

By helping providers afford to stay at lower-paying jobs, the MI Kids Now program could improve a 20% to 40% vacancy rate among Michigan mental health care workers, especially those with the most trouble hiring, said Sheehan.

“Is it sufficient? No,” he said, ticking off other priorities his organization believes the state needs to pursue to fix the mental health care worker shortage. These include better pay, signing bonuses, a publicity campaign promoting behavioral health work, and student stipends.

The state should also increase the number of applicants accepted by MI Kids Now and allow a longer application window to get more providers crucial financial help, Sheehan believes.

DHHS may have intentionally made applying difficult, fearing an onslaught of thousands of applicants with only enough money to help a few hundred of them, Sheehan said.

“And I would say, right,” Sheehan said. “Exactly. The hole is that big and that deep.”

DHHS received more than 1,000 applications during the July 2022 application period, of which 315 met the program’s guidelines. Some rejected applications came from providers who were not eligible under program guidelines. The state screened out many other applications that were incomplete, Wuth said.

GUIDANCE FOR STUDENTS, ADVICE TO THE STATE

Kyle King, halfway through a clinical mental health counseling graduate program at Western Michigan University, thinks loan help programs might entice students to take on too much loan debt, believing they won’t have to pay it back.

The retirement fund King amassed in his former job in banking administration now pays tuition bills for a career in which he knows he may not earn much.

In the banking world, he saw how substantial student loan debt can have a far-reaching and detrimental impact, such as standing in the way of an applicant’s chance of securing a home loan.

Schools preparing mental health workers can help by steering students away from those loans in the first place, said Harrison, at WMU’s School of Social Work.

Schools statewide should make sure students know about and can access all loan programs available to them and counsel students to only take loans they really need, said Harrison, an authority in the field who has published numerous professional articles on workforce development in the mental health care sector.

Schools don’t bear sole responsibility for connecting loan help to people who need it. The state, if it truly wants to strengthen the mental health workforce, should do everything it can to make sure workers know they can get debt assistance, Harrison said, suggesting billboards placing the program before millions of eyes.

Meanwhile, on campus, she sends out email reminders and social media blasts, shares webinars, offers financial literacy classes, and pesters grad students about getting financial help upon graduation so they can focus on what they went to school to do ― helping people be better.

“What do you do to attract and retain the best folks?” Harrison mused. “You pay them good money. You offer them good benefits. You make sure the loan repayment and forgiveness programs are in place….And you’re a great employer that people want to stay with for years and years and years.”

WHO CAN HELP

Student loan debt assistance programs specific to mental health care practitioners, as shared by Western Michigan University’s School of Social Work.

* MI Kids Now loan repayment program (focused on behavioral health providers in underserved areas): michigan.gov/mdhhs/doing-business/providers/mkn-loan-repayment-program

* Michigan State Loan Repayment Program (partnership with employers in high need areas for all healthcare providers): michigan.gov/mdhhs/doing-business/providers/slrp

* National Health Service Corps (national program for rapid loan repayment for all healthcare providers): nhsc.hrsa.gov

* Public Service Loan Forgiveness (program for any student loans for employees working in public, non-profit, and governmental organizations and making payments for 10 years): studentaid.gov/pslf

Specific employers (federally qualified health clinics, some substance abuse providers, community mental health programs in some areas, etc.) may offer rapid loan forgiveness with years of service.

Source: Western Michigan University