Your state needs more mental health providers. Policymakers and professional organizations know this. But legislators are reluctant to take actions that would get more folks licensed. So what can they do instead? Scholarships! (Yes, you should say it this way.)
- In Tennessee, a new scholarship program for behavioral health professionals will pay up to $30,000 toward the costs of a qualifying master’s degree.
- In California, which already has several such programs, a proposed bill would create a new scholarship program (amounts TBD) specifically for those mental health professionals interested in supporting the state’s developing CARE Court system.
Many similar programs exist around the country, and legislators regularly propose new ones.
Sounds great! you might say. The financial burdens of graduate education are among the biggest barriers to entering the mental health work force. These programs and others like them can ease that burden.
Except there’s a catch. A big, gnarly catch.
A scholarship should not create a debt
These aren’t really scholarships in the traditional sense of the word. Typical scholarships are financial awards meant to cover some immediate part of the cost of education. While their use may be restricted — perhaps limiting their use to tuition and books rather than meals — they don’t usually create any future obligation for the student who receives them.
These mental health “scholarship” programs, on the other hand, require the student to commit to working for a certain length of future time in the state’s public mental health system. Some programs require recipients to meet that work commitment upon graduation, others upon licensure. If the therapist doesn’t fulfill the work requirement, the state can recoup the scholarship money.
In other words: One way or another, you’re paying that money back.
That Tennessee program mentioned above requires the recipient to work in public mental health for an amount of time equal to the time supported by the scholarship. Get a scholarship for a year, work in public mental health for a year. The California proposal would require a three-year commitment.
And that’s precisely what makes these programs and others like them a poor policy solution. States and counties should get more people to work in public mental health by making the jobs better. Better pay, more benefits, improved working conditions. That’s typically how public-sector jobs compete with private-sector jobs for employees.
Instead, programs like these allow state and county systems to skip all of that. Because they’ll have a future workforce mandated to work for them to pay off their scholarships.
What a strange phrase, even. Pay off their scholarships.
What happens later
Consider what could happen to a graduate student who receives one of these scholarships. They receive $30,000 to support their education, which is significant. Indeed, for some students it’s the difference between being able to afford a graduate degree and not. Faced with the choice between dropping out of a program (or not starting one) or taking the scholarship, they take the scholarship. In doing so, they agree to a 2-year future work commitment.
They graduate. A few years later, they get licensed, and the work requirement kicks in. A lot may have changed in the meantime.
Suppose family obligations, military deployment, or other good and normal reasons pull the clinician out of the state. They now have $30,000 in debt from the “scholarship” program to repay, in addition to the probably-significant student loan debt they’ve accrued. (Some programs waive repayment in the event of the therapist’s disability or death, but not if the therapist simply moved.)
Or instead, suppose that the student remained in the state where they received the scholarship. They make it through the gauntlet of underpaid, prelicensed work and get to licensure, deep in student loan debt. Once licensed, let’s say the group or private practice opportunities available to the clinician would pay $90,000 a year. But the kind of public mental health job that the therapist agreed to take as a condition of their scholarship pays $50,000 a year. That $30,000 “scholarship” is now going to cost them a whopping $80,000 in foregone wages over the required two years.
If you’re a state government, that’s one hell of a return on your investment. If you’re the therapist, you’re seeing what your friends are getting paid while you work to pay off your “scholarship.” You’re seething with resentment, and probably feeling more than a little exploited.
Who comes out ahead?
You might argue that in such an instance, the economically reasonable thing for the therapist to do is just take the private job and pay back the scholarship. Fair enough. That’s probably what I would do. But this only underscores the point that it’s the scholarship recipients who are bearing all of the financial risk with these programs.
States come out ahead when the recipient goes on to work in public mental health, because the scholarship brought in a public mental health worker at less cost than what they would have to pay in added salary to make the job desirable. And the state comes out even (perhaps less a few percentage points of real value due to inflation) when the recipient doesn’t go on to work in public mental health, because the money gets paid back. The only scenario in which the state potentially doesn’t come out ahead is one where the salary difference between public mental health and private work was already similar.
Of course, many of those who take these scholarships do so with their eyes open. They see the exchange as a fair one, and come out satisfied that both sides got something they wanted. It is ultimately the responsibility of the therapist to read all of the fine print that comes with any kind of award, by any name.
Furthermore, salary isn’t the only driver of where a therapist chooses to work. But a lot of the other motivators also line up against public mental health work for many therapists, so much so that even a scholarship that leaves the recipient economically ahead (hypothetically, a $30,000 scholarship in exchange for $20,000 in foregone salary) could still end up feeling like an exploitive trap.
What states should do instead
States shouldn’t have to use misdirection and debt obligations to make mental health care from qualified providers more readily available. They can use better solutions.
States using these programs would be more honest to call their awards forgivable loans rather than scholarships. That would better clarify the state’s interest in providing them, and the consequences for the borrower if they don’t comply with the loan’s terms.
But under any name, programs like these generally aren’t great policy solutions to the mental health provider shortage. They certainly don’t make a dent in the scale of the problem. They provide financial assistance to only a tiny sliver of those who could benefit from the assistance. And even when the work obligation is met, it takes years for a scholarship to actually benefit the public mental health system.
States can do better. They can offer a direct, targeted, and immediate economic incentive for public mental health work as student loan reimbursement on top of salary. (California has this kind of program as well.) These programs reward current public-sector work rather than binding someone to future work. They appear to improve retention, and can greatly reduce the risk that the award will need to be paid back.
And for states interested in bringing more therapists into licensure across all work settings, the solution is clear: Suspend or remove clinical exams.
Those exams have never demonstrated a correlation with actual future safety or effectiveness in clinical practice. But they do keep thousands of fully-qualified clinicians out of licensure, especially clinicians of color. Getting rid of them would work quickly and at scale. It’s the best and most immediate solution to the work force shortage.
And it would likely cost less than just one “scholarship.”