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Loan-forgiveness program encourages mental health professionals to work in underserved areas

Rural Minnesota
Mental health workers, who are usually required to complete college and graduate degrees, are often underpaid, especially in rural areas of the state.

In parts of rural and urban Minnesota, trained mental health professionals — including psychologists, social workers, marriage and family therapists, and licensed clinical counselors — are few and far between. Patients seeking assistance for mental health needs sometimes must wait months or travel hundreds of miles for an appointment.

A new state-sponsored option aims to slowly chip away at this shortage. Beginning this year, mental health professionals have been added to the Minnesota Loan Forgiveness Program, which was developed to ease the debt burden of health-care workers and encourage them to work in an underserved area of the state. This means that a cohort of recent mental health graduates willing to work for three to four years in one of the state’s designated Health Professional Shortage Areas will receive funding to pay off an average of 60 percent of their college and graduate-school loans.

Applicants had to apply for this new program, and some 15 recipients — from a mix of mental health professions — will be chosen for fiscal year 2016. 

“Over the last couple of years there’s been a lot of reporting on the looming health-professional shortage,” said Will Wilson, supervisor of the Minnesota Department of Health’s Primary Care Financial and Technical Assistance Unit of the Office of Rural Health and Primary Care. “Basically we have more patients and fewer practitioners. A number of people,” at the State Legislature and at workforce and education task force meetings, “have been thinking about strategies to address these shortages.”

Loan forgiveness was one of the more popular strategies that was raised at these meetings, Wilson said. Mental health workers, who are usually required to complete college and graduate degrees, are often underpaid, especially in rural areas of the state.

“The mental health worker shortage in those areas is especially significant,” Wilson said. When you combine lower pay with higher educational requirements, it makes it hard to attract workers. “That’s why mental health workers were added to the program this year.”

Legislative focus on mental health

Before mental health professionals were added, Wilson said that the Minnesota Loan Forgiveness Program budget was just $740,000 per year: “It wasn’t very much at all. We only had 15 or 16 recipients total for all professions.” But in the 2015 legislative session, after state lawmakers made significant increases in mental health funding, the budget swelled. “It was a big year in the legislature for mental health initiatives,” Wilson said, “Now we’ve been budgeted for $3.25 million per year for all professions in the program.”

With relatively short notice of the expanded funds, Wilson and his colleagues scrambled to let people know about the new program.

“We tried to blanket all of the schools that graduate people in mental health programs,” Wilson said, adding that the program is staffed by himself just two other colleagues. “We also reached out to the associations, the boards, everybody who has a stake in it and could help us get the world out. We told as many people as we could, using our tiny little bullhorn. We got a pretty good response, about 20 applications. So it will be competitive. It was more than we expected for the first go-around. It shows the demand is there.” 

Applications for 2016 are being reviewed now and awards will be announced in the next couple of weeks. Applications for fiscal year 2017 are being accepted until Jan. 4, 2016.

First talk, and now action

At the Legislature, there’s been talk of trying to increase the number of mental health workers in shortage areas for years, said Sue Abderholden, NAMI Minnesota's executive director:  “We’ve been working on this issue since 2013. Basically we never had a real plan before. People would talk about it, but nothing was ever done.” 

Adding mental health graduates to the loan forgiveness program is a good first step toward increasing access to mental health services across the state, Abderholden said: “If you want to build a mental health system, you need people to run it. So this is an important piece.”

State Sen. Greg Clausen
State Sen. Greg Clausen

Sen. Greg Clausen, DFL-Apple Valley, was an advocate for the program. “I was a principal at Rosemount High School,” he said “I saw far too many cases where a student needed mental health counseling and they were unable to get an appointment in a timely matter.”

The shortage of mental health workers in urban and outstate areas, Clausen said, “is pretty dramatic. This is a real problem that we need to address. We need to bolster the work force.” 

And loan-forgiveness program recipients tend to stay in the community, Clausen said. “From the studies we’ve seen, it looks like almost 80 percent will stay. That’s a good number.”

One element of the program that Abderholden wants to make sure doesn’t get pushed to the side in coming years is an initiative focused on attracting diverse applicants to the loan-forgiveness program. It is key — in rural and urban areas — that patients see health-care professionals who reflect their cultural experiences and backgrounds.

“Our original hope was there would be separate set-aside money to work on diversity,” Abderholden said. “It ended up being folded in. We’re OK with that, but we just want to make sure that our outreach efforts into communities of color and immigrant communities continue to be strong.” 

How the program works

To be approved for the Minnesota Loan Forgiveness Program, Wilson said that applicants must be graduates of mental health training programs. And, most importantly, he added: “they need to have debt. Otherwise the incentive doesn’t work. They need to be licensed already or be recent graduates. We give preference to recent graduates because often they are usually younger and looking for a community to practice in. There is a better chance with somebody who’s just starting out that they’ll move somewhere and make a life for themselves in the community.”

The central feature of the program involves an agreement that award recipients will work in an underserved community for a minimum of three years. A fourth year of service is optional, Wilson said. The hope is that after their years of service, they will stay, because they have a made a home for themselves in the community.

Total awards vary, depending on profession and debt size. Wilson explained that the average award for psychologists, who face a higher debt burden post graduation, is $12,000 per year, to be used to pay off educational debt. The average award for licensed social workers and marriage and family therapists is $7,000 a year, he said.

Payments go directly to the award recipient. “We give the professional the award, they work in an underserved community and at the end of the year they give us their bank statements to show that they used the money to pay back their loans,” Wilson said. “After four years on average the loan recipient will have 60 percent of their loans paid off.” 

If an award recipient moves away from an underserved area, he or she is no longer eligible for the program.

“If they leave for any reason, there is a penalty,” Wilson said. “They have to pay all the money back plus interest. But it is rare for someone to leave because we select the best people, people who are committed to serving the underserved.”

Life in the field

Working as a mental health professional in an underserved community is not for everyone. There are reasons communities like these are underserved, including lower pay for workers, community poverty, rural isolation and complicated social problems in communities. For medical professionals, it takes a true commitment to service to look beyond “easier,” sometimes higher-paying work and head to where the need is greater.

“It takes a certain type of person to want to go out and work in a rural area,” Wilson said. “The same can be said for some communities in the metro area.”

In underserved urban areas, mental health professionals may be working with “people with more acute needs,” Wilson said. “That can be very challenging.” 

That said, the new program has proved popular among recent graduates.  “We’ve already had more applications than we can fund,” Wilson said.

As word of the program has spread, the next round of applications has attracted even more interest. 

Sue Abderholden
Courtesy of NAMI-MN
Sue Abderholden

“We might get 40 applications this cycle,” Wilson said. He and his colleagues will use the same standards to review applicants for the next fiscal year. With such a significant sum at stake, the bar has been set high.

“We are looking for people who are committed to helping the underserved. This means that they have demonstrated that commitment through their academic history. We want people to show how they are culturally competent and are the best of the best.”

With each year, as more and more recipients are added to the pool, the number of available mental health professionals practicing in shortage areas will increase.

Award recipients won’t have a hard time finding a job. “If they are going into an underserved area, they’ll have people stumbling over themselves to hire them,” Wilson said. “The demand is so great.”  

Abderholden cautions that while she believes programs like this one are a good first step, there is still much more work to be done if we want to make sure that all Minnesotans have access to high-quality mental health care.

“Every new person in these fields is a new person,” she said. “And that’s good. Clearly they are needed. Part of our work is to make sure that mental-health graduates know that this program exists for them. If they do, we think it will continue to grow. It is a good thing. But it’s not going to fix everything in the next year or two. We have to look at this as a long-term strategy.” 

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