NASW-NYS Survey Analysis – Behavioral Health Client Waiting Times

NASWNYS

NASW-NYS Survey Analysis – Behavioral Health Client Waiting Times

234 respondents

Level of Licensure

  • LCSW: 177 people out of 234 total, 75.64%
  • LMSW: 49 people out of 234 total, 20.94%
  • Other (LMFT, LMHC, MSW, CASAC, Psychologist): 8 people out of 234 total, 3.42%

Field of Practice

  • Nonprofit & Mental Health Outpatient: 44/234, 19%
  • Private practice: 137/234, 59%
  • State agencies: 41/234, 18%
  • Other (schools, hospitals): 4%

What is the average wait time for a new behavioral or mental health client to schedule an appointment with you?

The range of wait times is from 2-4 weeks to 12-14 months. Sixteen percent (16%) of social workers indicated that they are not accepting new clients at this time. Many social workers who are not accepting new clients are licensed clinical social workers working in private practice. This makes sense, as private practitioners have the autonomy to build their caseloads and accept clients as they choose.

The average wait time (49.79%) for a new behavioral or mental health client to schedule an appointment is a 2–4-week period. Licensed clinical social workers (LCSW) make up around 73% of the respondents for 2–4-week waiting period, with licensed master social workers (LMSW) making up just over 21% of respondents in the 2-4-week waiting period. From this group of LCSW’s, the majority, 83.5%, work in private practice, followed by 10% who work in state agencies, and 5.9% who work in a nonprofit or a mental health outpatient clinic. On the other hand, for the LMSW’s, most respondents (40%) within the 2-4-week period work in a state agency, followed by 32% who work in a nonprofit or mental health outpatient clinic, and 28% who work in a private practice.

The second most prevalent wait time is 4-6 weeks. Twelve percent (12.02%) of respondents indicated that 4-6 weeks was the average wait time for a new client to schedule an appointment with them. Similar to the results provided within the 2–4-week period, most respondents (85.71%) are licensed clinical social workers (LCSW’s), with just over ten percent (10.71%) being licensed master social workers (LMSW’s). Of the LCSW’s, 37.5% work in private practice, 33.33% work in nonprofits or mental health outpatient clinics, and 29.17% work in a state agency. Within this period, all of the LMSW’s work in a nonprofit or mental health outpatient clinic.

There were two social workers that indicated the wait period is 10-12 months. One LCSW who works in a nonprofit or mental health outpatient clinic, and one LMSW who works in a state agency. Additionally, one LMSW who works in a nonprofit or mental health outpatient clinic indicated the wait period was 12-14 months. State agencies and nonprofits or mental health outpatient clinics often receive the highest volume of clients. This high wait time may result in a life-or-death situation for individuals seeking mental health services. It is alarming that social workers are reporting this long waiting period for new behavioral health clients.

For additional insight on each time period, please see below.

  • 2-4 weeks- 49.79% (116 people)
    • LCSW- 85/116. 73.27%
      • Private Practice- 71/85, 83.5%
      • Nonprofit & Mental Health Outpatient- 5/85, 5.9%
      • State agencies- 9/85, 10.6%
    • LMSW- 25/116. 21.55%
      • Private Practice- 7/25, 28%
      • Nonprofit & Mental Health Outpatient- 8/25, 32%
      • State agencies- 10/25, 40%
    • 4-6 weeks- 12.02% (28 people)
      • LCSW- 24/28, 85.71%
        • Private Practice- 9/24, 37.5%
        • Nonprofit & Mental Health Outpatient- 8/24, 33.33%
        • State agencies- 7/24, 29.17%
      • LMSW- 3/28, 10.71%
        • Private Practice- 0/3, 0%
        • Nonprofit & Mental Health Outpatient- 3/3, 100%
        • State agencies- 0/3, 0%
      • 6-8 weeks- 5.58% (13 people)
        • LCSW- 8/13, 61.54%
          • Private Practice- 6/13, 46.15%
          • Nonprofit & Mental Health Outpatient- 0/13, 0%
          • State agencies- 2/13, 15.38%
        • LMSW- 3/13, 23.08%
          • Private Practice- 0/13, 0%
          • Nonprofit & Mental Health Outpatient- 1/13, 7.7%
          • State agencies- 2/13, 15.38%
        • 2-4 months- 7.3% (17 people)
          • LCSW- 12/17, 70.59%
            • Private Practice- 4/12, 33.33%
            • Nonprofit & Mental Health Outpatient- 5/12, 41.67%
            • State agencies- 1/12, 8.3%
            • Schools- 2/12, 16.67%
          • LMSW- 4/17, 23.53%
            • Private Practice- 0/4, 0%
            • Nonprofit & Mental Health Outpatient- 3/4, 75%
            • State agencies- 1/4, 25%
          • 4-6 months- 5.15% (12 people)
            • LCSW- 8/12, 66.67%
              • Private Practice- 4/8, 50%
              • Nonprofit & Mental Health Outpatient- 4/8, 50%
              • State agencies- 0/8, 0%
            • LMSW- 4/12, 33.33%
              • Private Practice- 1/4, 25%
              • Nonprofit & Mental Health Outpatient- 2/4, 50%
              • State agencies- 0/4, 0%
              • Schools- 1/4, 25%
            • 6-8 months- 2.58% (6 people)
              • LCSW- 5/6, 83.33%
                • Private Practice- 3/5, 60%
                • Nonprofit & Mental Health Outpatient- 1/5, 20%
                • State agencies- 1/5, 20%
              • LMSW- 1/6, 16.67%
                • Private Practice- 1/1, 100%
                • Nonprofit & Mental Health Outpatient- 0/1, 0%
                • State agencies- 0/1, 0%
              • 10-12 months- 0.86% (2 people)
                • LCSW- 1/2, 50%
                  • Private Practice- 0/1, 0%
                  • Nonprofit & Mental Health Outpatient, 1/1, 100%
                  • State agencies- 0/1, 0%
                • LMSW- 1/2, 50%
                  • Private Practice- 0/1, 0%
                  • Nonprofit & Mental Health Outpatient- 0/1, 0%
                  • State agencies- 1/1, 100%
                • 12-14 months- 0.43% (1 person)
                  • LCSW- 0/1, 0%
                    • Private Practice- 0/0, 0%
                    • Nonprofit & Mental Health Outpatient- 0/0, 0%
                    • State agencies- 0/0, 0%
                  • LMSW- 1/1, 100%
                    • Private Practice- 0/1, 0%
                    • Nonprofit & Mental Health Outpatient- 1/1, 100%
                    • State agencies- 0/1, 0%
                  • Not accepting new clients at this time- 16.31% (38 people)
                    • LCSW- 34/38, 89.95%
                      • Private Practice- 28/34, 82.35%
                      • Nonprofit & Mental Health Outpatient- 2/34, 5.89%
                      • State agencies- 3/34, 8.82%
                      • Schools- 1/34, 2.94%
                    • LMSW- 4/38, 10.53%
                      • Private Practice- 2/4, 50%
                      • Nonprofit & Mental Health Outpatient- 0/4, 0%
                      • State agencies- 2/4, 50%

How many clients are on your caseload?

The answers ranged from 1 to 350 clients per caseload, with a median of 30 clients per caseload. The average is around 40 clients on a caseload. 20 clients per caseload appears the most often. Of the top ten highest responses, 60% are LCSW’s and 20% are LMSW’s. Half of the LCSW’s who reported a higher caseload work in mental health outpatient clinics, while all the LMSW’s work in a state agency. This indicates that mental health outpatient clinics and state agencies tend to have higher caseloads at this point in time. Individuals seeking state agencies are amongst the most vulnerable in our state. This is concerning; as the number of individuals on a caseload increases, the less time a practitioner will have to thoroughly assess and diagnose each client throughout the week.

Additional data is below.

  • Mean (average): 40.57
  • Median: 30
  • Mode: 20
  • Range: 349
  • Ascending order: 1,3,3,4,5,5,6,6,6,6,6,6,6,6,7,7,7,8,8,8,9,9,9,10,10,10,10,10,10,10,10,10,11,12,12,12,12,13,13,14,14,14,14,15,15,15,15,15,16,17,17,18,18,18,18,19,19,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,21,21,21,23,24,24,24,24,24,24,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,26,26,26,28,28,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,31,32,32,32,32,32,33,34,35,35,35,35,35,35,35,35,35,35,35,36,36,40,40,40,40,40,40,40,40,40,40,40,40,40,40,43,44,45,45,45,45,45,45,46,47,48,48,50,50,50,50,50,50,50,50,50,53,55,55,55,55,55,56,60,60,60,60,60,60,60,60,60,60,60,60,65,65,65,65,68,68,68,70,70,70,70,70,70,71,75,75,75,75,80,80,80,80,80,84,84,85,90,100,100,100,100,102,110,112,113,115,115,120,140,140,150,160,180,350

On average, how many clients do you typically see for therapy during a one-week time period?

The answers ranged from 1 to 75 clients seen per week, with a median of 20 clients a week. The average number is around 23 clients seen per week.  30 clients per week appears the most in the data value. Of the top ten highest responses, 70% are LCSW’s and 20% are LMSW’s. One response was submitted by a Master social worker (MSW); they work in a mental health outpatient clinic and see 48 clients per week. The majority of the LCSW’s (57.14%) are private practitioners, followed by 28.57% who work in a state agency. This result is consistent within the group of LMSW’s who are seeing the largest number of clients per week.

Additional data is below.

  • Mean (average): 22.55
  • Median: 20
  • Mode: 30
  • Range: 74
  • Ascending order: 1,2,2,3,3,3,3,3,4,4,4,5,5,5,6,6,6,6,6,6,6,7,7,7,7,7,8,8,8,8,8,8,8,8,8,8,8,9,9,10,10,10,10,10,10,10,10,10,10,10,10,10,10,10,10,10,10,10,12,12,12,12,12,12,12,12,12,12,12,12,13,14,14,14,14,15,15,15,15,15,15,15,15,15,15,15,15,15,15,15,15,15,15,15,16,17,17,17,17,17,18,18,18,18,18,18,18,18,18,19,19,19,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,20,21,22,22,23,23,23,24,24,24,24,24,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,25,26,26,27,27,27,28,28,29,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,30,32,34,35,35,35,35,35,35,35,35,35,35,35,35,35,35,36,36,40,40,40,40,40,40,40,40,40,40,40,40,40,40,44,44,45,45,45,45,48,50,50,55,60,60,60,60,65,70,75

Additional feedback:

The last survey question prompted additional feedback from respondents. The three main themes are included below.

  • There is an increased volume of individuals seeking mental health services. Clinicians are overwhelmed with their caseloads and referrals.
  • Longer wait times are due to high staff turnover and burnout. Clinicians are leaving state agencies and outpatient clinics for private practice in hopes of better compensation for their work.
  • Due to low reimbursement rates, a lot of social workers are switching to fee for service and no longer accepting insurance.

One respondent shared that “there isn’t enough staff to support the caseload amounts and needs of the patients. Each clinician is doing the job of [two or three] people. Ideally, I should have 15 patients, but I have double that with an excessive amount of paperwork and demand from all angles. I can only do so much. The patients nor my paperwork are getting the quality of work I know I can deliver.” Additionally, social workers are concerned about their clients’ ability to maintain their progress; “due to my heavy caseload, I am very concerned about my clients’ inability to obtain appropriate and timely follow-up appointments. Weekly sessions are impossible and even biweekly sessions are not always feasible. This is a very serious issue.” Seasoned social workers have shared this is the highest caseload they’ve ever dealt with, and often must turn away new clients to obtain a work-life balance. Social workers across all fields of practice share this concern. Unfortunately, it seems that state agencies face these problems on a larger scale. A former state social work employee stated that “[the] clinic had incredibly high employee turnover due to low wages and very high caseloads. This contributed to longer wait times and less favorable outcomes for clients due to staff shortages or having to continuously start over with a new therapist.”

Overall, the responses from the survey, as well as the additional feedback received are a call to action for the future of the mental health landscape in New York state. Action must be taken to address social work burnout and the high waiting times for new behavioral health clients.

Amelia Lochner Malavé
Author: Amelia Lochner Malavé

NASW-NYS