Addicted and Mentally Ill Patients: Just As We Stigmatize Them, We Undervalue Those Who Try to Help Them

A licensed social worker with a master’s degree earns less than a manager of a fast-food restaurant, according to the 2011 Behavioral Health Salary Survey just released by the National Council for Community Behavioral Healthcare. The survey finds that the nation’s mental health and addictions treatment professionals are paid far less than their counterparts in other health care sectors.
“Just as people with mental illnesses and substance-use disorders are routinely stigmatized, it appears those working in the behavioral health sector are also treated differently—even within the health care community,” says Linda Rosenberg, National Council president and CEO.

Why the stigma? A few reasons come to mind.

Some people believe that it isn’t worth spending much on caring for and counseling the mentally ill because “they’ll never  be able to make much of a contribution to society.” (I recall an attorney who was defending a city that refused to follow state laws about educating and mainstreaming handicapped children explaining to me that:  “These kids will never get good jobs and pay enough in taxes to return on the investment the city would be making in their education.” )

Others blame those addicted to drugs or other substances, refusing to understand that addiction is a disease, and that once hooked, will-power alone is rarely enough to break a serious addiction. Patients need counseling; medication can help. And programs for addicts can work. I personally know a musician who was addicted to heroin for five years, finally hit bottom, and went into rehab. He was lucky enough to connect with a very good counselor, and with the counselor’s help, went through the extremely painful process of “getting clean.”  That was close to twenty years ago. He is now a computer specialist, married and has a delightful child.

Finally, in our society, we tend to look down on “do-gooders.”  We respect people who work with money: packaging it (Wall Street professionals who create a wide array of financial products); lending it (bankers who make reckless loans and then foreclose on our mortgages); gambling with it (hedge fund operators) or just raking it in (CEOs). People who work with people (teachers, social workers, the day- care workers who care for our children) command far less respect.

Below, the results from the survey of more than 850 mental health and addictions treatment organizations:

•    A direct care worker in a 24-hour residential treatment center earns a lower median salary ($23,000 a year) than an assistant manager at Burger King ($25,589).
•    The annual salary range for a chief medical officer at a behavioral health organization is $101,000–$150,000, compared to the national average of $183,947–$292,395 for the same position in any other type of health care organization.
•    A social worker with a master’s degree in a mental health-addictions treatment organization earns less ($45,344) than a social worker in a general health care agency ($50,470).
•    A registered nurse working in a behavioral health organization earns $52,987 compared to the national average for nurses of $66,530.

“The survey underscores the need to end the second class status of employees working in mental health and addictions organizations” says Rosenberg, who cites the recent economic crisis and state budget cuts as contributing to the problem. “Until we achieve equity with the rest of the public healthcare safety net, we will continue to struggle to recruit and retain the number and caliber of professionals needed for more efficient and effective mental health and addictions services.”

The survey, conducted in partnership with the National Association of Addiction Treatment Professionals, includes salary data for executives, administrators, clinicians, direct care and support staff in public and private behavioral health care organizations from July 1 2009 to June 30 2010.  Completed in November 2010, survey findings are based on salaries reported by 860 respondents from 46 states. The full report is available at

5 thoughts on “Addicted and Mentally Ill Patients: Just As We Stigmatize Them, We Undervalue Those Who Try to Help Them

  1. Thanks Maggie-
    We hear about mental health parity all the time.
    But realistically it will never become fully realized either for patients or their providers.
    Mental ill health is still stigmatized by our US puritanical hertiage of it being a matter of moral weakness or even sin. Mainstream bio-medicine also still resists (the rigorously documented over decades) mind-body connection. To name just a few of the impediments to genuine parity.
    Someday we might grow up? Not in my lifetime.
    Dr. Rick Lippin

  2. Dr. Rick,
    I agree.
    But I’m hoping that eventually, we will over come our fear of mental illness and our lack of compassion for those who are addicted to alchohol and drugs (usually because they are suffering from depression and othor mental illnesses associated with poverty. See my next post.)
    I’m not at all sure that attitudes will change in my lifetime, but I’m hopeful that things will change during my childrens’ lives,
    They’re now 29 and 32m and and my sense is that many members of their generation are quite different from those who came of age (turned 21) in the late 70s, 80s, and early 90s.
    My children and their friends (who live in N.Y., North Carolina, California, and many other parts of the country) tend to be in careers where they are helping people (public school teachers, working in half-way houses, getting degrees in neruology (focusing on alcholism and obesity) ) psychology (focusing on chidren suffering from autism)
    And by and large, these are kids who grew up in upper-middle-class or upper-class homes where their parents earned a pretty good income. They have chosen careers that, in most caes, won’t bring huge financial rewards, but will bring emotional rewards.
    I’m not claiming that most kids in this next generation have different values, but I am seeing a change– much like the change we saw in the late 1960s (when very few kids wanted to become lawyers,many more wanted become family physicians. )
    So, I’m hopeful.

  3. The lack of parity in the treatment venues is also related to the worldview that people are not a valued group. It also is increased due to the divisions and lack of collaboration in the healthcare field. There is much dialogue yet little true application. It is clear that until the various disciplines come together and truly become collaborative, reduce barriers and begin to see people as people not as a comodity we will continue to have inequality and the lack of parity. I agree with Dr. Lippin, not in my lifetime.
    Marc Baisden
    Vanouver, WA

  4. Marc–
    Welcome to HealthBeat and thanks much for your ocmment.
    You write: “It is clear that until the various disciplines come together and truly become collaborative, reduce barriers and begin to see people as people not as a comodity we will continue to have inequality and the lack of parity.”
    I agree that viewing patients as commodities is a huge problemin our heath care system.
    If health care reform goes
    forward, rewardig providers for outcomes, not volume, this could change–though not quickly. As I said to Rick, in my children’s lifetime, but probably not in mine.
    But at this moment, the political fate of the country is unclear. , , ,