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.

Following the launch of A5291/S5975, the Social Work Workforce Act, Social Workers for Justice New York applauded the vote of the National Association of Social Workers – NYS Chapter (NASW-NYS) to support the legislation and the repeal of the Licensed Master Social Worker (LMSW) exam requirement. The vote by the Board of Directors occurred on Thursday, October 19th. The National Association of Social Workers (national HQ) endorsed this in February of this year.

Shortly after the bill gained the support of NASW-NYS’ 6500 members, Assembly Committee on Mental Health Chair, Assemblywoman Aileen Gunther, co-sponsored the legislation. The bill is currently carried in the New York State Senate by Senator Samra Brouk who chairs the Senate Committee on Mental Health and Developmental Disabilities. It is also co-sponsored by two social workers in the Assembly, Chantel Jackson, LMSW and Manny De Los Santos, MSW.

Many social workers face challenges receiving their Licensed Master Social Worker (LMSW) certification due to the requirement of passing the Association of Social Work Board (ASWB) Exam. A 2022 ASWB Exam Pass Rate Analysis showed that from 2018 to 2021 only 51.9% of Black social workers and 71.2% of Latino social workers eventually pass the exam compared to 90.8% of white social workers. This standardized exam has resulted in fewer bilingual social workers, older social workers, and social workers of color entering the workforce to meet the service needs of New Yorkers. The exam has also been blocking older social workers from becoming licensed as well with the analysis finding that only 61.6% of social workers who are above the age of 50 eventually pass the exam compared to 85.7% of social workers who are between the ages of 18 and 29. Finally, the exam also found bias when examining the first language of social workers who were taking the exam. Sixty-three percent of social workers for whom their first language was another language other than English eventually passed the exam compared to 80% of social workers for whom their first language is English.

According to a survey by the National Deans and Directors of Social Work (NADD) there are now 18 states that are working on eliminating the entry level, or LMSW requirements (not including several states that do not have such a requirement such as California and Michigan) and 10 states working on a second pathway for the LCSW requirement. The professional association and legislators called for the swift passage of the legislation and highlighted that it would increase the workforce of mental health providers in the state at a critical time when a mental health epidemic is severely impacting New Yorkers.

Quotes: “Social Workers for Justice is pleased and grateful that NASW-NYS has joined the campaign to change the entry level licensure for social workers.  With their vote, they live our most important values to expand and diversify our workforce and serve the diverse communities of New York State.  We applaud their leadership for taking this crucial stand and we welcome the partnership,” said Jacqueline Mondros, Executive Director of Social Workers for Justice New York.  

“NASW NYS strongly supports the elimination of the entry level exam as a requirement for licensure.  We lose too many diverse and experienced social workers who are urgently needed on the front lines of homeless services, recovery, and mental health to an exam that has not a scintilla of evidence of its effectiveness.  We intend to bring the full force of our large state membership to challenge this unnecessary obstacle.”  Victoria Rizzo, President of the National Association of Social Workers – NYS Chapter  

“In a time when countless families across our state are struggling to access mental health care, we must take action to ensure that those who want to enter this workforce have the support they need to have successful careers. The Social Work Workforce Act will repeal the unnecessary requirement of the licensing exam, which has disproportionately barred Black, Brown, and older test takers from receiving their license—despite graduating from accredited Masters’ programs. By passing our bill, New York would be joining a number of other states who have already repealed this testing requirement, who then saw thousands of social workers enter their workforce and create immediate impact in their communities. I look forward to working with Assemblymember González-Rojas, and advocates across the state to ensure that New Yorkers can access the quality, culturally competent care they deserve,” said Senator Samra Brouk, Chair of the Senate Committee on Mental Health and prime sponsor of the Social Work Workforce Act. 

“New York State needs more Social Workers ready to take on the enormous challenge we face in providing residents with the mental health services they need and deserve. This legislation, when signed into law, will increase the number of Social Workers ready to take on this challenge, while also increasing the numbers of those who come from and represent underserved communities across our state,” said Assembly Member Aileen Gunther, Chair of the Assembly Committee on Mental Health. 

Join us in our advocacy efforts! Sign the petition to expand, include, and diversify the social work workforce to meet the current crises we face in homelessness, youth mental health, addiction, and immigration by passing the Social Work Workforce Act (House bill A05291 and Senate bill S5975). Click here to access the petition!

Press Contacts:
Olivia Knox, NASW-NYS Policy Coordinator, oknox.naswnys@socialworkers.org
Jacqueline Mondros, Interim Executive Director of SW4JNY, jackie@socialworkersforjustice.org