As part of her education, Corredor-Purcifull must intern in a clinical setting for 24 hours a week. That’s on top of taking classes, working 25 hours a week as a massage therapist to stay afloat financially while paying off her student loans, and caring for her children, ages 8, 15, and 16.
At a time when people wait weeks or months for mental health treatment, when emergency rooms are filling with youngsters in psychiatric crises that might have been averted by outpatient care, when officials everywhere lament the rising tide of post-pandemic mental illness, the people training to be therapists confront one hurdle after another.
Corredor-Purcifull, who is 41 and lives in Revere, is in her final year of a three-year master’s program at the Boston College School of Social Work, and she feels under constant stress.
“My husband needed to work extra to support the family,” she said. “Food, mortgage, bills, expenses — it’s just too much. . . . There’s nothing worse than having that stress — that you don’t have enough money to provide for your family.”
Although psychiatrists and psychologists play critical roles, social workers and mental health counselors provide most of the one-on-one therapy. The coursework for each of those two latter professions differs somewhat, but the clinical training is similar. Both have to work hundreds of hours at internships, almost always unpaid, while attending school.
“It’s not that you’re working for free; you’re paying to be there,” said Kathleen Flinton, a BC social work professor. “They’re paying tuition that facilitates the field experience.”
After graduation, social workers and mental health counselors must also work two to three years under supervision, often in low-paying jobs, before they can practice independently.
“It’s akin to indentured servitude,” said Julianne Morse, a 27-year-old social worker who has earned her master’s degree and is accruing hours toward an independent license by working at a community mental health center. She’s earning $37 an hour, but only if the client shows up, and no-shows are common.
“If mental health is in such demand in our country,” she said, “then how come we aren’t recognizing this and supporting people financially to help them obtain the necessary training?”
Social workers’ salaries, always low, have changed little over the past 20 years, Flinton said. The pay varies but by most accounts, annual income is under $60,000, sometimes well under, for people emerging from years of training, often with substantial debt.
Graduates tend to find their first jobs at community mental health centers because those agencies, which primarily serve low-income people, often can provide the requisite supervision. But those who supervise new graduates don’t get paid for the extra work, another stress point in the system. A recent survey of community health agencies found that those clinicians are leaving the agencies faster than they can be replaced.
“We’re seeing the impact of the lack of investment in mental health infrastructure over time,” Flinton said.
Corredor-Purcifull fled violence in her native Colombia two decades ago, when she was 20. She knows many Latinos who have suffered lasting trauma from crossing the US border and understands the importance of having a therapist familiar with one’s culture and language.
She enrolled in BC’s master of social work program in 2019 and expects to graduate in May. As part of BC’s 9-year-old Latinx Leadership Initiative, she’s among 25 Latino students who form a supportive community and take most of their courses in Spanish, because that’s the language they’ll use when treating patients.
Recently, Corredor-Purcifull received a rare boost. She was among the few selected for a Mass General Brigham fellowship that provides a $15,000 stipend for her internship at the Lynn Community Health Center. But she’s funneling all that money into paying her student loans. (Total tuition for the three years at BC’s social work school comes to $83,000, but 95 percent of students receive financial aid.)
Melisa, who asked to be identified by her middle name because of the stigma of debt, said she feels burnt out even before her career has gotten off the ground. A 27-year-old social work student at Salem State University who aspires to serve the Latino community, she’s working 50 hours a week, half uncompensated, and she has mounting education debt.
“I love what I do for sure,” Melisa said. “I love the experience I’m gaining. I also need to make a living.”
Molly Hogan-Fowler, who oversees the social work internship programs at Salem State, sees inherent inequities. ”Being able to earn an advanced clinical degree is a privilege not everyone can afford,” she said. “We’ve seen students who end up leaving the program because finances became too tight. I suspect many folks don’t even get to us because they can’t figure out how to put the pieces together to make that kind of investment.”
Pamela Whynot, a 42-year-old social work student at Salem State, managed to put the pieces together, but it’s a tight fit.
She works three part-time jobs in addition to her internship, making for a packed schedule: 14 to 16 hours a week as an intern helping young people with a mental health diagnosis; four days a week at a job at a school for children with autism; Friday afternoons and some weekend hours working a a job teaching daily life skills to youngsters with intellectual disabilities; and six days a week, arising before dawn to work 4 to 6 a.m. as a personal care attendant for a disabled person.
And she’s in classes all day every Saturday.
On top of this, Whynot has five sons: three stepsons, and two biological sons, ranging in age from 10 to 23. Her 10-year-old has autism.
But Whynot considers herself lucky. A former tech company employee laid off during the pandemic, she had paid off her previous student loans just before starting social work school. Her internship is one of the rare ones that actually pays, although not much.
“I feel grateful that I have the energy and the resources and the family support to figure all this out,” Whynot said. “What about the folks who don’t? We’re never going to get the diversity we need if we don’t change some of these things.”
Change is certainly under discussion, and in some places underway.
In October, Mass General Brigham announced a $50 million investment in community health that includes a focus on boosting the mental health workforce. Among its efforts is the program with the Massachusetts League of Community Health Centers in which 12 students will receive a $15,000 stipend for doing an internship at a community health center.
The state government is also offering several grants and loan repayment programs, including $35 million in pandemic relief money to help pay the educational loans of master’s level mental health professionals. MassHealth, the state’s Medicaid program, has increased reimbursements for behavioral health care by 10 percent.
Governor Charlie Baker’s recently proposed legislation requiring insurers to devote more resources to mental health care might, if adopted, increase payments to social workers and mental health counselors.
All these measures will take time to make an impact, and it’s unclear whether they’re adequate to address longstanding inequities and underfunding.
Some say what’s really needed is a program offering free tuition in exchange for a commitment to work a certain number of years in a community agency serving the needy.
One thing is clear: Many people want to do the work. Academic leaders said they’ve seen no dropoff in interest in counseling careers, despite the challenges. “People are really hungry for meaningful lives and careers,” said Susan H. Gere, professor and cochair of Lesley University’s Department of Counseling and Psychology, which has seen an increase in applications.
The system, therapists say, exploits that passion to help others, counting on dedicated workers to persevere despite low pay.
“But that’s changing,” said Melinda Gushwa, director of the Simmons University School of Social Work. Today’s graduates are less willing to work themselves to the bone. And a new code of ethics for social workers lists self-care as one of their professional obligations. “In order for us to do our best work, we have to be well ourselves,” Gushwa said.
Amid a growing mental health crisis, said Salem State’s Hogan-Fowler, “We can’t keep relying on the goodness of people’s hearts.”