Tight Budgetary Measures Impact Care in Public Mental Health Clinics

Many public agencies switch from salaried therapists to cheaper independent contractors to manage within the budgetary constraints of mental health clinics. But these contractors tend to have less knowledge about the latest evidence-based therapies.

Community mental health clinics, where most specialty mental health treatment is delivered, have been relying more on independent contractors to treat patients. Many clinics have simultaneously been moving toward the greater use of evidence-based psychosocial practices (EBPs), meaning talk therapies that are informed by rigorous research as well as clinician expertise and patient preferences. A new study, however, has found that these contractors tend to have less knowledge about the latest evidence-based therapies and they are also less willing to adopt them.

The study, from the Perelman School of Medicine at the University of Pennsylvania, sought to understand the potential impact of using independent contractors on mental health services delivery. The findings are published in Psychiatric Services.

“The independent contractor therapists we surveyed turned out to have less positive attitudes towards evidence-based talk therapies for youth such as cognitive-behavioral therapy (CBT) and less knowledge about them, compared with salaried employee therapists,” Rinad S. Beidas, PhD, the lead author of the study and assistant professor of Psychology at Penn Medicine, said in a statement.

Methods and Results

The study obtained quantitative data from 130 therapists in 23 organizations. Qualitative data were collected from executive administrators in nine of the 16 organizations participating in EBP initiatives sponsored by the City of Philadelphia.

The researchers then used regression with random effects to estimate the associations between worker status and clinician attitudes toward EBPs, knowledge of EBPs, and organizational culture and climate. The qualitative data was used to understand the impact of relying on independent contractors on organizational participation in EBP initiatives.

Nearly 60% of the therapists were independent contractors; the rest were salaried employees. Compared with their salaried counterparts, contractors reported they would be less willing to adopt EBPs even if they found them appealing. Contractors also showed significantly less knowledge of EBPs for children with psychiatric disorders.

It is likely that these staff did not have access to the professional development opportunities available to salaried staff. Agencies tend to hire such contractors because they don’t need to invest much in their training, hence allowing them to stay within their increasingly tight budgets.

Relying on Contractors Impacts Quality of Care

A growing number of community mental health clinics rely on independent contractors. The research analyses the consequences of this shift.

Many public agencies switch from salaried therapists to cheaper independent contractors to manage within the budgetary constraints of mental health clinics. But these contractors tend to have less knowledge about, and are less willing to adopt, the latest evidence-based therapies. Agencies also may be less willing to invest in training contractors on new treatments. All of this combined has a direct impact on the quality of care.

“The agencies seemed less willing to invest in the professional development of their independent contractor therapists, because they perceived them as more likely to leave once they found a more permanent position,” Beidas said.