Workforce Recruitment and Retention

Simple Terms & Complex Issues

Workforce recruitment and retention have long been identified as significant challenges in the behavioral health field. While these are simple terms, the issues are quite complex. There is a need to attract and retain individuals in the field of behavioral health, in specific professions, and in specific specialties that focus on unique populations. There is the need to recruit and retain individuals in specific geographic locations, such as rural areas, and into critical faculty roles to educate the future workforce. At the provider level, there is the need to find and keep individuals for direct care, supervisory, managerial, and leadership positions. Across positions of all types, there is the need to increase the diversity of the workforce with respect to race, culture, and other key characteristics.

Recruitment Challenges

Research has identified a host of challenges in recruiting workers in behavioral health. The total supply of workers falls short of the estimated number required to meet to demand. Compensation in this field is often considered less than competitive with other sectors of the economy. Potential applicants may be concerned about the stigma associated with mental illness and substance use disorders; with the lack of opportunities for advancement; or the reputation of the organizations offering employment. Clinical managers have reported that many applicants lack the training, experience, certification or licensure, competencies, and interpersonal skills necessary for available jobs. In addition to some of the concerns outlined above, workers who left their jobs cited caseload size, paperwork burden, and the lack of mentoring and recognition as significant issues. 


There is little reliable data on the number of current vacancies in the behavioral health workforce. The U.S. Department of Labor does project a very high growth rate in the number of additional jobs that will be needed in this field over the next five years. This is separate from the number of workers that will be required to replace those who will retire or otherwise leave this workforce. 

Turnover rates reported in the literature vary greatly by position, by organization and by research study.

  • Formal studies have reported turnover rates as high as 70% per year.
  • Anecdotal reports of turnover among front-line, direct care workers are as high as 150% per year.

In assessing turnover rates, it is important to distinguish between voluntary turnover, in which an employee decides to leave the organization, involuntary turnover, in which an employee is terminated, and other separations, such as retirements. Research has shown that employee transfer within an organization, which is a different type of turnover, can be as high as 29% annually in behavioral health. The findings of this research have shown a negative effect on the fidelity to evidenced-based treatments among transferred workers.


There are a large number of recruitment and retention best practices that have been described in the published literature and online. Many strategies pertain directly to the behavioral health field, while others are drawn from the vast human resources literature and can be applied to behavioral health. There are a range of strategies specific to recruitment, and a pervasive belief that a major focus on workforce retention will strengthen any organization, making that organization much more successful in subsequent recruitment efforts. 


The largest behavioral health resource on this topic is the SAMHSA Recruitment & Retention Toolkit. Strategies are organized under the following categories: building a plan, recruitment, selection, orientation/onboarding, supervision, recognition, training, career development, and staff support. 

SAMHSA Recruitment & Retention Toolkit (Click here for the toolkit)

The following ATTC reports have a wealth of information about the recruitment and retention challenges, and what organizations are doing to overcome them. 

ATTC National Workforce Report 2017

ATTC Workforce Development Website

ATTC Vital Signs: Taking the Pulse of the Addiction Treatment Profession 2012

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