Recruiting and Retaining Interns in the Field Post-Graduation: A Path to Decreasing Mental Health Workforce Shortages

Background: In 2015, 206 out of 254 (81.1%) Texas counties were designated as full or partial Mental Health, Health Professional Shortage Areas (HPSA). The Hogg Foundation’s 2016 report on Texas’ mental health workforce argues that Texas has a profound shortage of mental health workers, “Texas has not adequately invested in developing a strong mental health workforce and the consequences are increasingly evident.” The Hogg Foundation recommended Texas work to increase the number of intern sites across professions. It is unclear why the shortage is so great in Texas. This study seeks to gain greater insight into improving mental health worker retention and increasing the number of mental health workers in the educational pipeline by 1) understanding the experiences of interns and their supervisors in providing mental health-related services; and 2) based on that understanding, improving the experiences of interns and their supervisors. If more interns can be recruited and retained after graduation, improvement in the shortage should occur.

Methods: After IRB approval, project staff interviewed 24 mental health interns at the Bachelor and Masters levels in the fields of social work, licensed professional counseling, and psychiatric nursing. The sample also included 26 mental health professionals in the same fields serving as field instructors. All 50 participants were interviewed using semi-structured interviews with similar questions adapted to their role. The study took place in a large metropolitan area in the Southwest that has several universities coordinating internships for their students across the county. Participants were recruited from organizational members of a mental health coalition through direct appeals from the Coalition’s director and snowball sampling of supervisors and their interns. Study participants represent a diverse sample of mental health interns and professionals.

Questions were asked to identify internship structures, training and resource needs, and how to enhance post-graduation retention. Transcripts were analyzed by two researchers through open coding using Atlas.ti to develop a thematic understanding of the material. 

Results: Themes to explain recruitment and retention include a desire to help people, internal motivation and enthusiasm to succeed, intern preparedness and readiness, positive relationship with field instructor/student, the general agency environment, and overall agency support.

Several factors contributed to the lack of retention among interns. Lack of field instructor relationship, negative agency environment, and overall lack of support were often cited as the primary reasons for abandoning the mental health field. Interns’ enthusiasm contributed to retention but they felt intimidated by assigned duties and lacked the motivation for self-directed learning. Finally, interns’ feelings of unpreparedness and readiness influenced intern abandonment when their desire to help people was only moderate. Several factors, such as stipends, better structured agencies, and higher entry level salaries, were said to be important in any effort to increase retention of mental health interns. Themes were similar between interns and supervisors.

Conclusion: The study contributes to understanding how to increase recruitment of interns and their eventual retention in the field of mental health practice.