Key Takeaways
- NewVista has avoided agency staffing for four years: Neicole Knott, Vice President of Operations at NewVista Behavioral Health, said the company has not used agency staffing post-pandemic across its more than twenty facilities in Ohio and Indiana.
- Behavioral health turnover runs well above the general labor market: A 2022 Open Minds survey of behavioral health facilities put the national average turnover rate at 31%, with mental health workers and psychiatric aides averaging over 37%, according to Open Minds’ behavioral health turnover analysis.
- Replacement costs compound the damage: Gallup research estimates that replacing an individual employee costs between one-half and twice their annual salary, depending on role and seniority, which amplifies the operational hit of every behavioral health departure.
- Relationship continuity is the clinical argument against agency staff: Knott argued that most of what behavioral health providers do is based on relationships and trust, and that patients who do not trust their clinician will not come to care or benefit from it when they do.
- Retention strategy centers on internal development: NewVista offers tuition reimbursement after six months of employment, letting technicians work toward nursing credentials and building an internal feeder pipeline rather than importing staff at premium rates.
- Ongoing competency evaluation reinforces the pipeline: The company runs 30-day reviews for new hires and continuing competency assessments for existing staff, treating training as sustained development rather than onboarding.
- Capping census is the alternative to temporary labor: Federal regulations dictate one-to-ten staff-to-patient ratios for partial hospitalization and one-to-twelve for intensive outpatient programs. When staffing falls short, NewVista suspends groups rather than bringing in unfamiliar agency workers.
- The workforce warning from inside the field is stark: A 2023 National Council for Mental Wellbeing / Harris Poll survey found that 83% of behavioral health workers believe provider organizations cannot meet demand without public policy changes, reframing retention-focused strategies as a survival necessity rather than a competitive advantage.
The behavioral health industry confronts a workforce crisis that has become, by now, thoroughly documented. There are not enough psychiatrists. There are not enough licensed clinical social workers. There are not enough psychiatric nurses with specialized training. The shortages push many providers toward a familiar solution: staffing agencies that can supply temporary workers to fill the gaps, at premium rates, with minimal commitment on either side.
NewVista Behavioral Health has taken a different path.
“In my four years of being here, we haven’t used agency staffing post-pandemic,” said Neicole Knott, Vice President of Operations at the company, which operates more than twenty behavioral health facilities across Ohio and Indiana.
The claim stands out in an industry where temporary staffing has become standard operating procedure. Recent studies put the average turnover rate in behavioral health at thirty-one percent nationally; in some states and some roles, it climbs as high as thirty-seven percent, according to Open Minds’ 2022 survey of behavioral health facility executives. One in three employees leaves each year. The cost of replacing each departure ranges from half to twice their annual salary, according to Gallup, depending on the position and the market. The math favors a relentless churn.
The Case Against Agency Staffing in Behavioral Health Treatment
Knott argued that behavioral health care is fundamentally relationship-based, which makes that churn particularly damaging. “Most of what we do is all based on relationships and trust,” she said. “If your patients aren’t trusting their service provider, they’re not going to come to care, or they’re not going to get a benefit out of care.”
The therapeutic relationship is not an abstraction. It is the medium through which treatment works. A patient who has begun to open up to a clinician (sharing trauma, acknowledging struggles, building the trust that makes vulnerability possible) may shut down entirely when faced with an unfamiliar face. Progress evaporates, and the work starts over. Sometimes it never restarts at all.
Research supports the connection between staff continuity and patient outcomes. The length of time a team remains intact matters more than the raw turnover numbers suggest. Stability creates conditions for the kind of sustained engagement that behavioral health treatment requires.
NewVista’s Retention Strategy: Internal Development Over External Recruitment
NewVista’s approach centers on internal development rather than external recruitment. The company offers tuition reimbursement for employees who want to advance. A technician aspiring to become a nurse, for instance, can access educational support after six months of employment. The idea is to build a pipeline from within, developing people who already understand the organization’s culture and mission rather than importing strangers at premium rates. Operators weighing similar investments are also leaning on resources such as the new nonprofit behavioral health financial benchmarking scorecard, which is putting harder numbers behind the workforce tradeoffs providers have traditionally navigated by instinct.
“We really try to do internal feeders to those right levels of care,” Knott said, “so that we can make sure that moving forward we have the right people driven by the right mission of our organization to serve the patients that are seeking care.”
The company also invests in ongoing competency evaluations (thirty-day reviews for new hires, continuing assessments thereafter) to ensure that staff can perform their roles effectively. Training becomes not merely onboarding but sustained development.
Managing Behavioral Health Capacity Without Temporary Staffing
The strategy requires trade-offs. When staffing falls short despite these efforts, NewVista adjusts capacity rather than bringing in temporary workers. “If we don’t have the right licensed staff, then we don’t offer that group, unfortunately,” Knott said. Federal regulations dictate staff-to-patient ratios for programs serving Medicare and Medicaid patients: one-to-ten for partial hospitalization, one-to-twelve for intensive outpatient. Without adequate staff, the arithmetic simply does not work.
Capping census means turning away patients who need care. It is not a comfortable position. But Knott suggested that the alternative (relying on unfamiliar agency staff to maintain volume) undermines the therapeutic relationship that makes behavioral health treatment work in the first place. You can fill the schedule without filling the need.
A Replicable Behavioral Health Workforce Model, or a Survival Necessity?
Whether this approach can be replicated elsewhere depends on factors that vary by organization, such as market conditions, leadership priorities, and the willingness to view labor as a long-term investment rather than a variable cost to be minimized. Not every provider operates in the same environment or faces the same constraints.
“Employees are your greatest asset,” Knott said. “And our thought process is investing in those folks so that they can really live out the mission of what we’re trying to do.”
In an industry where eighty-three percent of workers believe provider organizations cannot meet demand without policy changes, and where burnout threatens a potential exodus of the workforce that remains, retention-focused strategies may be less a competitive advantage than a survival necessity. The question is whether the industry can afford to keep people, or whether it can afford not to.
Frequently Asked Questions
How bad is the behavioral health workforce turnover problem?
A 2022 survey of behavioral health facility executives conducted by Open Minds put the national average turnover rate at 31.3%, with variation by role: 17% for supervisors, about 23% for clinical professionals, 26% for licensed practical nurses, 29% for registered nurses, and over 37% for mental health workers and psychiatric aides. That means one in three employees at an average behavioral health facility leaves each year, and the rate climbs higher for the frontline paraprofessional roles that patients often interact with most.
Why do behavioral health providers rely so heavily on staffing agencies?
The combination of persistent clinician shortages, federal staff-to-patient ratio requirements for Medicare and Medicaid programs, and the operational pressure to keep groups running has driven many providers to use temporary staffing as a stopgap. Agencies provide licensed coverage on short notice, but at premium rates, and typically with minimal long-term commitment. The agency model offers flexibility to the operator, but it can fracture the continuity that behavioral health treatment depends on, particularly in programs where the same patient may see several different clinicians in a short period.
What does the evidence say about staff continuity and patient outcomes?
Behavioral health outcomes are closely tied to the strength and stability of the clinician-patient relationship. Research has shown that team continuity matters beyond the raw turnover number, because it is the length of time a care team remains intact that supports sustained engagement. High turnover disrupts that engagement and can force patients to re-establish rapport with new providers mid-treatment. For complex cases (trauma, severe depression, substance use) the cost of that disruption can be measured in missed sessions, deteriorating symptoms, and treatment dropout.
What federal staff-to-patient ratios apply to behavioral health programs?
For programs serving Medicare and Medicaid patients, federal regulations establish minimum staff-to-patient ratios of one-to-ten for partial hospitalization and one-to-twelve for intensive outpatient. When staffing falls below those thresholds, programs cannot legally operate at full census, forcing providers either to pay for temporary coverage or to reduce program capacity. Workforce advocacy efforts across behavioral health, including CASP’s 2026 Capitol Hill push for Direct Support Professional recognition and reimbursement, have argued that paraprofessional roles need dedicated federal infrastructure if provider organizations are going to meet demand within staffing-ratio constraints.
What does it cost when a behavioral health employee leaves?
The replacement cost depends on role and seniority, but Gallup estimates that replacing an individual employee ranges from one-half to twice their annual salary when recruiting, onboarding, training, and productivity loss are all counted. For a clinical role paid in the $70,000 to $100,000 range, that translates to a $35,000 to $200,000 hit per departure. At industry-average turnover, the aggregate cost to a mid-sized behavioral health operator runs into the millions annually, which is a meaningful slice of margin in a sector already navigating tight reimbursement.
Can technology ease the workforce shortage while retention strategies take hold?
Technology is playing a growing role at the edges of the workforce challenge. Workflow automation, documentation support, and routing tools can free clinician time for patient-facing work, while earlier detection can shift demand upstream. Coverage of AI arriving at the front door of behavioral health points to where augmentation is practical today. Technology does not replace the therapeutic relationship, however, and operators who over-index on tooling without addressing retention tend to find the underlying workforce math unchanged. Adjacent funding pressures, visible in the Massachusetts school mental health funding cliff arriving in June 2026, reinforce the point: workforce stability ultimately depends on whether payment structures support sustained investment in people.
