State of the HHS
Workforce 2026
Turnover, burnout, shortages, compensation, and regulatory shifts reshaping behavioral health, IDD, and community health organizations.
The HHS workforce isn’t just short-staffed. It is structurally failing. Ninety-three percent of behavioral health workers report burnout. Nearly half of direct support professionals turn over every year. And the federal government projects a shortage of 202,000 behavioral health practitioners by 2037. This is the landscape every HHS operator is hiring into—and most are doing it without a workforce strategy.
This report synthesizes data from SAMHSA, HRSA, BLS, KFF, NASHP, and direct field intelligence from The Wilkinson Firm’s work with 150+ HHS organizations across 12 states. It is structured for operators—not academics. Every section connects to a decision you can make this quarter.
Contents
- The Burnout Crisis: 93% and Climbing
- Turnover by Role: Where the Bleeding Is Worst
- Shortage Projections: The Numbers Nobody Wants to Say Out Loud
- Compensation Reality: What HHS Actually Pays
- Medicaid Reimbursement: The Rate Squeeze
- Regulatory Shifts: 30 States Moving at Once
- Technology Adoption: Still Behind, Starting to Move
- What Operators Can Do Now: A TWF Framework
The Burnout Crisis: 93% and Climbing
The National Council’s 2025 workforce study put the number at 93%. Not “some degree of burnout.” Ninety-three percent of behavioral health workers have experienced burnout, with 62% rating it 8–10 on a 10-point severity scale.
Eighty percent report burnout has negatively impacted their personal lives. Thirty-seven percent say it has worsened their own mental health. The workforce that treats mental illness is itself in crisis—and most organizations are addressing it with pizza parties and wellness apps instead of structural change.
In our work with 150+ HHS organizations, we see three consistent burnout accelerators: (1) no documented role boundaries between clinical and administrative work, (2) no structured onboarding past day one, and (3) supervisor-to-staff ratios above 1:15. Fix those three, and severity scores drop measurably within 90 days.
Turnover by Role: Where the Bleeding Is Worst
Not all turnover is equal. Direct support professionals (DSPs) turn over at 44% nationally—the highest sustained rate in HHS. But clinical roles are accelerating: 48% of behavioral health workers are considering leaving for other employment, and the pipeline to replace them is shrinking.
The DSP crisis is especially acute: more than half receive government-funded assistance for housing, food, energy, or healthcare. They are earning less than retail and warehouse workers while being asked to provide complex person-centered care. New York alone reports 20,000 unfilled DSP positions across nonprofit providers.
The cost of each departure compounds. National Opinion Research Center data shows each recovering worker who leaves costs employers roughly $16,500 in combined attendance decline and replacement costs. Multiply that across a 50-person behavioral health organization with 40% turnover, and you are looking at $330,000 in annual workforce waste—before you count service disruption, client disengagement, or payer audit exposure.
Organizations that implement structured 90-day onboarding, role-specific career ladders, and quarterly stay interviews consistently reduce turnover 15–25 percentage points within two retention cycles. The fix is structural, not motivational.
Shortage Projections: The Numbers Nobody Wants to Say Out Loud
SAMHSA projects a shortage of approximately 31,000 full-time equivalent mental health practitioners as of 2025. That is the near-term floor. HRSA’s long-range model is worse: 88,000 shortage of mental health counselors and 114,000 shortage of addiction counselors by 2037.
BLS projects 17% employment growth for mental health counselors and 22% for substance abuse counselors through 2034—both classified “much faster than average.” Demand is not the problem. The pipeline is.
Community health workers (11% growth, 7,800 annual openings) and rehabilitation counselors (10% growth) add volume to the deficit. Marriage and family therapists are projected at 16% growth. Every one of these roles feeds the same strained labor pool, and the education pipeline has not scaled to match.
You cannot hire your way out of a structural shortage. Organizations that win in 2026 will be the ones that retain who they have, upskill internal talent, and build employer brands that attract from adjacent industries. Posting and praying is no longer a strategy—it is a liability.
Compensation Reality: What HHS Actually Pays
The compensation landscape in HHS is defined by a painful gap: the work demands clinical skill, regulatory compliance, and emotional resilience, but the pay often fails to reflect it.
| Role | Median Annual | 25th–75th Percentile | Source |
|---|---|---|---|
| Behavioral Health Counselor | $57,425–$70,025 | $57,762–$85,620 | PayScale/Glassdoor 2026 |
| BH Case Manager | $52,473–$55,955 | $47,618–$66,031 | Salary.com/Glassdoor 2026 |
| Community Health Worker | $51,030 | $43,263–$62,822 | BLS/Glassdoor 2026 |
| Direct Support Professional | ~$30,160 ($14.50/hr) | Varies by state | ANCOR 2023 |
| Case Mgmt Manager (Supervisor) | $76,911–$90,871 | — | Salary.com 2026 |
The DSP pay floor is the single most urgent data point in this report. At $14.50 per hour, direct support professionals earn less than the national average for retail associates ($15.35) and warehouse workers ($17.80). These are the people providing daily living support, medication administration, and crisis intervention for individuals with intellectual and developmental disabilities.
Entry-level licensed counselors start near $49,000—after completing a master’s degree and supervised clinical hours. The debt-to-earnings ratio makes HHS roles structurally uncompetitive against private practice, tech sector wellness programs, and hospital systems with signing bonuses.
Compensation alone does not drive retention. But compensation below market eliminates retention as a possibility. In our engagements, organizations that bring DSP wages to $16.50+ and add structured career ladders see 90-day retention improve by 18–30% without increasing total labor cost—because turnover-driven overtime and temp agency spend drops faster than the wage increase costs.
Medicaid Reimbursement: The Rate Squeeze
Medicaid typically reimburses at 70–80% of Medicare rates for behavioral health services. In 2025, Medicare cut its conversion factor to $32.35—a roughly 14% drop for mental health services. Medicaid rates, pegged to that baseline, followed.
The KFF Medicaid Budget Survey shows momentum is slowing: 34 states raised behavioral health rates in FY 2024, but only 26 planned increases for FY 2025, and just 14 are planning increases for FY 2026. The window of rate relief is closing.
Notable state actions: Michigan raised non-physician behavioral health rates from 75% to 90% of physician rates in FY 2025. Iowa implemented roughly 10.6% across-the-board increases. Alaska pushed a 12.1% autism service rate increase. These are the exceptions. Most states are holding or declining.
One positive development: LMFTs and LMHCs can now bill Medicare independently at 75% of psychologist rates, effective 2024. This opens revenue capacity—but only for organizations that have credentialed their clinical staff properly and built the billing infrastructure to capture it.
If your workforce strategy depends on rate increases to fund retention initiatives, you are building on sand. The operators who survive the rate squeeze will be the ones who reduce waste (turnover cost, temp agency dependency, overtime) and reinvest those savings into competitive compensation and infrastructure. That is exactly what The Workup™ is designed to sequence.
Regulatory Shifts: 30 States Moving at Once
The legislative velocity around HHS workforce is unprecedented. In 2025 alone, 29 states enacted 75 bills addressing coverage mandates, parity enforcement, workforce development, crisis response, and school-based initiatives.
Three structural shifts stand out:
Licensure compacts are scaling. Thirty states have adopted Social Work Licensure Compact legislation as of 2026. The Compact Commission is working toward operational multistate licensure—meaning a licensed social worker in Georgia could practice in Tennessee without re-credentialing. For HHS organizations operating across state lines, this is a labor pool expansion.
New provider types are being created. Washington State added Behavioral Health Support Specialist and Psychological Associate as billable provider types effective 2026. This creates new roles that can absorb clinical demand without requiring full licensure—a direct response to the shortage projections.
Loan repayment is expanding. Texas now offers up to $180,000 in loan repayment for psychiatrists with rural incentives. Federal bills S.3486 (Expand the Behavioral Health Workforce Now Act) and S.683 (More Behavioral Health Providers Act) are targeting education, training, and rural capacity specifically.
Mental health parity enforcement is tightening: Georgia, Alaska, Oklahoma, and Washington passed new parity enforcement measures in 2025. At least 13 states considered mobile crisis legislation, with 6 enacting measures. The regulatory floor is rising, and organizations without compliance infrastructure will feel it.
Multi-state HHS operators are most exposed. Every new compact, provider type, and parity mandate creates a compliance obligation. Organizations running without a current employee handbook, state-specific policy sets, and a compliance audit cadence are accumulating regulatory risk faster than they realize. This is what Multi-State Mastery™ was built to solve.
Technology Adoption: Still Behind, Starting to Move
HHS remains one of the least digitized sectors in healthcare. Fewer than 25% of behavioral health facilities report exclusive EHR use. The rest are running on a mix of paper, spreadsheets, and partially implemented systems that create documentation gaps and compliance exposure.
The telehealth signal is strong: 62.3% of patients with a telehealth claim in February 2025 had a mental health diagnosis. Seventy-three percent of employers now offer access to virtual mental health care. For HHS organizations, integrated telehealth is no longer an innovation play—it is table stakes for clinical recruitment.
AI-based triage and intake systems are moving from experimental to embedded. Job titles are increasingly failing to reflect actual work as telehealth, team-based care, and AI-assisted tools reshape daily responsibilities. This creates a classification and compliance problem that most organizations are not tracking.
Technology adoption in HHS is a workforce strategy decision, not an IT decision. The organizations that integrate HRIS, telehealth scheduling, and documentation systems reduce administrative burden on clinical staff—the single largest burnout accelerator we measure. If you are asking clinicians to toggle between four systems to document a single session, you are manufacturing turnover.
What Operators Can Do Now
This data tells a story that most HHS leaders already feel: the system is under more pressure than ever, and the old approach—post jobs, hope for applicants, react to turnover—has stopped working.
Based on our work with 150+ HHS organizations across 12 states, here is what we see separating operators who are stabilizing from those who are still in crisis mode:
1. Audit before you act. Most organizations do not know their real turnover cost, their actual time-to-fill by role, or their compliance gap count. Without a baseline, every intervention is a guess. This is why every TWF engagement starts with The Workup™—a diagnostic that maps workforce health before prescribing a fix.
2. Fix the foundation before you recruit. Handbooks, job descriptions, onboarding sequences, and compliance policies are not overhead—they are infrastructure. Organizations that skip this step hire into chaos and wonder why nobody stays. Foundation First™ exists because we saw this pattern repeat hundreds of times.
3. Build retention systems, not retention campaigns. Stay interviews, career ladders, structured supervision, and compensation benchmarking are systems. Appreciation weeks and bonuses are campaigns. Systems compound. Campaigns expire.
4. Treat compliance as a competitive advantage. As 30 states raise the regulatory floor simultaneously, organizations with clean audit trails, current handbooks, and documented training become the employers of choice. Clinicians want to work at organizations that run properly.
5. Build your employer brand intentionally. In a shortage market, your reputation as an employer is a strategic asset. Talent Magnet™ was designed to help HHS organizations build sourcing pipelines and employer brands that attract before they post.
Know Where You Stand
Every data point in this report maps to a decision you can make this quarter. Start with a diagnostic conversation—no pitch, no pressure, just a clear picture of where your workforce stands.
Book a Discovery CallSources & Methodology
This report synthesizes data from federal agencies, industry bodies, and TWF field observations. All statistics are cited at the point of use. Federal data sources include SAMHSA, HRSA, BLS, HHS ASPE, and CMS. Industry sources include The National Council, ANCOR, NADSP, KFF, and NASHP. Compensation data is sourced from BLS, PayScale, Glassdoor, Salary.com, and ZipRecruiter (2025–2026 data). TWF field observations are drawn from direct engagement with 150+ HHS organizations across 12 states as of April 2026.
Key sources:
HRSA State of the Behavioral Health Workforce, 2025 · The National Council Help Wanted Survey, 2025 · HHS Surgeon General Health Worker Burnout Report, 2025 · ANCOR Report on the Direct Support Workforce Crisis, 2023 · BLS Occupational Outlook Handbook, 2024–2034 · KFF Medicaid Budget Survey FY 2025–2026 · NASHP State Behavioral Health Workforce Strategies · HHS ASPE Health IT Adoption in Behavioral Health Settings
Disclosure: The Wilkinson Firm provides HR consulting services to HHS organizations referenced in this report’s aggregated observations. This report is published for educational purposes. TWF field observations reflect aggregated patterns, not individual client data. No client-identifiable information is included. TWF follows the editorial standards described in our Editorial Policy.