Staff Turnover among Behavioral Health Professionals

Webster’s dictionary defines employee turnover as “the ratio of the number of workers that had to be replaced in a given time period to the average number of workers.” The Bureau of Labor Statistics conducts a monthly survey designed to gather data on job openings, hires, and terminations named the Job Openings and Labor Turnover Survey (JOLTS).  The “data serve as demand-side indicators of labor shortages at the national level.” The survey does collect information on turnover among “Health Care and Social Assistance” providers but it does not break the data down into the subcategory of behavioral health care provider. The JOLTS information would suggest that national turnover across all industries is approximately twenty-three percent annually and within the category of health care it is approximately nineteen percent annually.

According to the February 2013 minutes of the Indiana Council of Community Mental Health Care (ICCMHC) Human Resources Committee meeting, the combined turnover rate among the Indiana CMHC’s is higher than the national JOLTS data, with the lowest reported agency turnover rate at twenty-three percent and most agencies reporting much higher annual turnover rates that were above thirty percent. Nationally, within rural settings, turnover among behavioral health care providers has reached as high as ninety percent (Jobs to Careers 2013).

Why is turnover in behavioral health so much higher than other types of health care agency? Pay is notably lower among social workers and the job can be very stressful. highlighted social work in their 2013 article “Stressful jobs that pay badly” stating that “high stress and a meager paycheck are just another day at the office.” While portrayed social work as poorly paid stressful jobs, they also highlighted the dedication of the social workers and how important the services they provide are for the community (, 2013).

Performance and motivation are multifaceted subjects that are impacted by many variables. A quick literature review demonstrates that many studies have been conducted on employee motivation and compensation plans. Those studies, in general, “assume that higher performance requires greater effort” or that higher performance requires inconvenience on the part of workers. In order to provide incentives, these models predict the existence of reward systems that structure compensation so that a worker’s inconvenience is incentivized. These incentives or “rewards” can be both monetary and non-monetary so they may take on many different methods.  In general, almost everyone is motivated by monetary compensation to some degree, many to a moderate degree, and most to a great degree when compensation is properly designed (Baker, Jensen and Murphy, 1987).

In his paper titled Compensation and Incentives: Practice vs. Theory, Baker summarizes his literature review by stating “Evidence, from research on compensation plans indicates that explicit financial rewards in the form of transitory performance-based bonuses seldom account for an important part of a worker’s compensation.” Baker cites separate studies on pay and performance, and finds that “their evidence indicates that pay is not very closely related to performance in many organizations that claim to have merit increase salary systems”.

A firm’s compensation method can be split into three subcategories labeled-“the level, the functional form, and the composition.” The level of compensation is the total cost of the pay package to the employer. The level of compensation governs the quality and quantity of workers an organization can entice (Baker, Jensen and Murphy, 1987).

According to Jobs to Careers, the community mental health industry is operating in a dynamic business environment in which a number of related industries are competing for behavioral health care providers. Those competing entities include school corporations, hospitals and even primary care settings. At the same time fewer individuals are entering the profession and a national health care shortage is being projected. Those agencies that are able to provide quality behavioral health care staff will be the companies that can compete more effectively. Currently, the demand for qualified staff has never been greater (Jobs to Careers, 2013).

Most corporations understand that turnover can be very costly to organizations when both the direct and indirect cost of recruiting, orienting, and training of replacement employees is fully recognized.  Lost productivity is also a real cost that is no less important than any expense that is paid with cash (Bliss, 2007).  With demand for behavioral health increasing and supply limited, any and all efforts should be directed at increasing efficiencies within the system.  Addressing the high turnover rate appears to be a logical opportunity.

About the Author

Jerry Landers is the Vice President of Business Development for Aspire Indiana. While the beliefs and opinions expressed in this blog are solely those of Mr. Landers you can learn more about community mental health and how it intersects with business and media at


Leedy, P. D., & Ormrod, J. E. (2010). Practical research:  planning and design (9th ed.). Upper Saddle River, New Jersey: Pearson Education, Inc., publishing as Merrill.

Zahorsky, D. (nd) Fighting Employee Turnover Costs. Small Business Information. Online About: Small Business Information. Retrieved July 2013

Bliss, William G. (2007) Cost of Employee Turnover – The Advisor. Retrieved July 2013

Bureau of Labor Statistics (2013), Job Openings and Labor Turnover Survey, Retrieved July 2013

Jobs to Careers (2013), Behavioral Health, Retrieved July 2013 (2013) Stressful jobs that pay badly, Retrieved July 2013,

Lawler, Edward E., (1987), The Design of Effective Reward Systems, Englewood Cliffs, NJ, Prentice Hall.

Mobley, William H., (1982), Employee Turnover: Causes, Consequences, and Control, Reading, MA., Addison–Wesley.

Steers, Richard, M., & Porter, Lyman, (1991) Motivation and Work Behavior, New York, McGraw Hill. (2013), US Health Care Budget, Retrieved July 2013,

About jerrylanders

Executive Director for Aspire Indiana Health and Vice President for Aspire Indiana. Doctorial Student at Columbia Southern University studying business. Married and father of three children. I blog about mental health, business, social media and how all three intersect.
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