A pipeline for Pittsburgh’s mental health workforce?

Content warning: This story describes a mental health crisis in an emergency setting. 

An unhoused man grows agitated as an emergency room psychiatrist presses him to take an antipsychotic and a benzodiazepine and stay in a locked seclusion room.  

“So now you want to put me in another cell,” says the 47-year-old man, Todd, as 14 University of Pittsburgh Social Work students watch the disturbing scene on a screen. The 2020 documentary “Bedlam” portrays crises unfolding daily in psychiatric ERs, street encampments and jails that warehouse the mentally ill.

After police handcuff and force Todd into the room, he yells, “I come to a fucking hospital, man, and I’m treated like I’m back in fucking prison.” The psychiatrist, Dr. McGhee, throws her head back in frustration. She says she must keep him and others safe, but he resists confinement and repeatedly threatens her. He screams as officers and staff strap his wrists and ankles to a bed. 

Speaking to the camera, Dr. McGhee acknowledges Todd’s trauma as a formerly incarcerated person. The film later reveals he has HIV and struggled to find housing for years. But “it’s hard sometimes to be compassionate — especially when, you know, they threaten to kill you,” she says.

After playing the clip during a seminar last month, Associate Professor of Social Work Nev Jones prompted the students: “What did you observe? What struck you about Dr. McGhee?”

One student noticed how tired Dr. McGhee looked. Others pointed out that staff and police didn’t make much of an effort to deescalate before using force. “It’s so hard not to think everyone is against you,” a student said, imagining how outnumbered Todd may have felt. Another said, “I don’t think anyone in that situation was like, ‘OK, we hear what you need.’”

The scene from “Bedlam” reflects what these master’s students could face if they choose to work in the public mental health system. All are enrolled in a program designed to prepare them for that route: Pitt’s Youth Behavioral Health Workforce Fellowship (YBHW), one of several initiatives to address the local mental health workforce crisis. 

Like other communities across the country, the Pittsburgh region has long faced a shortage of behavioral health professionals — particularly those willing to work public-sector jobs that serve the most vulnerable patients. Research shows burnout, lower salaries, high student loan debt and lack of training opportunities, among other reasons, are driving shortages in Pennsylvania. It’s a big part of why residents struggle to access behavioral health services, according to a 2024 Allegheny County report. The downstream effects include disengagement from the system and more involuntary treatment, Jones said.

The county designed the BH Fellows program, a cohort-based training and student loan repayment initiative, to boost the local workforce. It partners with the Jewish Healthcare Foundation* to run the program. A spokesperson for the county’s Department of Human Services said in a statement that this model is getting results where previous models have failed: More than 1,400 people received uninterrupted care which wouldn’t have been possible without BH Fellows.      

Experts said local workforce development programs can help, but they won’t bring about the kind of structural change that would make public-sector behavioral health care jobs viable for most. 

“I don’t think anything is really scaling right now,” said Erica Maloney, an assistant professor of social work at Chatham University. “There’s a lot of opportunity, but everything’s just so disorganized and piecemeal.” 

Public sector or private practice? 

During the seminar, Jones told students that scenes from “Bedlam,” though shot in Los Angeles, could easily have taken place in their own backyard. 

“You drive down Second Avenue and it’s like this literal microcosm of the revolving door between shelter, treatment facility and jail,” she said, referring to the encampments that formed in recent years near institutions populated by people with serious mental illness. “The problems are not getting solved. The housing issues are still there. The poverty is still there.” 

Social work students know they’ll face disadvantages that are often unsustainable if they choose public-sector jobs that serve high-need populations, Jones said, including “brutal shift work, constantly encountering poverty and hardship and feeling overwhelmed by the magnitude of the problems in the public sector.” 

It’s why many want “cushy” private-practice psychotherapy jobs and “see community mental health counseling or social work as the fastest routes,” Jones added. The rise of teletherapy during the COVID-19 pandemic, which made it easier to set up a practice from home, compounded the problem. More social work curricula are catering to this demand and deprioritizing the kind of specialized training required to serve people with serious mental illnesses. Jones said she’s the only faculty member who’s taught psychosis interventions as part of the Pitt School of Social Work’s continuing education trainings.  

Assistant Professor of Social Work Rachel Gartner hopes the YBHW Fellowship will incentivize Pitt students to choose careers that support the most vulnerable children and youth. She received a $2.3 million grant from the federal Health Resources and Services Administration (HRSA) to launch the program. Chatham University and Carlow University received HRSA grants to start similar programs. They’re working with Pitt to make training available across programs. 

Over the next four years, YBHW at Pitt will provide $25,000 annual stipends and specialized training — including the seminar taught by Jones and Ph.D. student Shannon Pagdon on strategies for “transformative change” in public social work — to 14 second-year master’s students. During the next seminar, they’ll learn how to navigate Medicaid and Medicare systems — an essential skill in the public sector, Gartner said. Fellows also get hands-on experience through a practicum at a designated provider agency. 

When the grant closes out, 56 students will have received specialized training and stipends. But those perks aren’t conditional — it’s up to each fellow to decide if public-sector work is right for them. “It would be awesome if everyone kind of moved from this fellowship into a public social work space,” said Gartner, but the program will train social workers to push for structural change “within whatever type of practice space they’re in.” 

‘Talking to patients like they’re people’ 

YBHW fellow Xio Fane, 25, finds public social work “a little intimidating,” but felt even more motivated to choose that path while watching how hospital staff treated Todd in “Bedlam.” They immediately thought of ways to handle the situation differently. 

“He was very clear when he said, ‘I don’t want these police officers around me,’” they said. “For whatever reason, no one was like, ‘OK, y’all get out of here.’” 

Fane noted Todd self-medicates with drugs. “And I’m kind of curious as to why they didn’t ask him, ‘OK, what kind of drugs do you do and what do they do for you?’ And then being like, ‘There’s this one medication … that will give the same effect. How do you feel about that?’

“Seeing how I felt and all the problem-solving I was doing just watching it … I’m like, ‘I’m definitely in the right place,’” they said. “And I think we need people who are capable of being more creative with their solutions and just talking to patients like they’re people.”

Fane hopes to work with young people who have intersecting identities, including teens and kids who are queer, neurodivergent or have disabilities. But they expect they’ll have to supplement a public-sector income by doing private-practice counseling on the side. “Which sucks,” they said. “I don’t want to have to do that.” 

Money is tight, which is why Fane is grateful for the $25,000 stipend. It allows them to focus on school instead of working part-time to cover rent, groceries and taking care of their cat. But after Pitt deducts a portion to pay toward their student loans, the amount isn’t enough to prevent financial hardships, they said. They’re considering applying to the BH Fellows program for further debt relief after graduation.  

Lifting the burden of student debt

The county’s BH Fellows program is a core part of its plan to improve adult Medicaid patients’ access to mental health services. It provides student loan debt repayment — up to $25,000 for a bachelor’s degree and $45,000 for a master’s degree — to behavioral health professionals in the county. (Research shows some early-career mental health professionals can expect to spend between 16% and 30% of their pretax monthly income on paying back student debt.)

It also places fellows in full-time jobs at local provider agencies, where they work throughout the two-year program. And it provides them with 14 days of training. Topics covered include grief, safety, supervision and cultural humility, said Megan McCardle, 30, a fellow and the supervisor of family-based mental health services at Allegheny Children’s Initiative. “You can tell they really put a lot of care into making sure that it’s a well-versed and holistic training for everyone.”

McCardle is the first in her family to attend college and worried her $60,000 in student debt would “weigh [her] down” for a long time. BH Fellows is “washing away that fear” because she expects her debt to be reduced by 75% through the program.

The county Human Services spokesperson described the program’s impact so far: 

• Seven cohorts of about 25 fellows each have enrolled  
• 42 fellows have completed the program and 108 are serving in qualifying roles 
• $4.8 million in student loan forgiveness was pledged, with nearly $1.5 million already paid 
• Nearly 25% of fellows with eligible debt will graduate with all of it repaid  
• 43% will graduate with more than half of their debt repaid.  

The goal is to drive recruitment and retention for “challenging jobs” with high vacancy rates, said Scotland Huber, the chief communications officer at the Jewish Healthcare Foundation, which partners with the county to recruit, train and support fellows. It’s why the program requires employers to meet a minimum salary threshold, which varies across a wide range of eligible jobs. 

Provider agencies were “super worried about that,” said Amy Fenn, executive director of family preservation services at Pressley Ridge, which is based in McCandless and operates in seven states. We thought that if “we got involved, then we would start to lose money, and we were already struggling,” she said, describing how the pandemic decimated teams that served families in their homes. But the county, which funds the program through Medicaid reinvestment dollars, gave the agencies a rate increase. 

“It’s a win-win because the employees got a reasonable, nice salary that we could not pay before and we had a rate that would cover it,” Fenn said. “In the Medicaid world, it doesn’t usually work like that.”

Maloney, the Chatham assistant professor, was less effusive. “Those jobs are really, really hard,” she said, pointing out that fellows can’t leave for a non-eligible role offering better pay and work conditions for two years. “I don’t think this is super generous, but it is definitely better than nothing.” 

Meghan Labiaux, 43, is a fellow who supervises a team of service coordinators at UPMC Western Psychiatric Hospital. They help unhoused people find housing and meet other basic needs. It’s rewarding work, she said, recalling how she felt when her first client got the keys to an apartment. But some of her coworkers have to work second jobs. And after 15 years of service, she still has nearly $30,000 in student debt. By the time she graduates from BH Fellows, she’ll have less than $5,000 in debt. “I’m very excited about that,” she said. If the program had existed when she was younger, pursuing graduate studies would have been “a lot more realistic and achievable.” 

Labiaux noticed more high-quality candidates applying for open positions on her team and a higher rate of applications overall, which she attributes to BH Fellows. “I really think this program has done wonders, and I would love to just see it continue and expand in some capacity.”

Other Pennsylvania jurisdictions reached out to the county to learn from BH Fellows and some launched their own versions. But they can’t replicate its unique Medicaid reinvestment funding model. “Such underspend no longer exists,” wrote the county Human Services spokesperson. Huber said the program will recruit fellows through 2026 and run through 2028. Its future beyond that is unclear. 

Venuri Siriwardane is the health and mental health reporter at Pittsburgh’s Public Source. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.

* The Jewish Healthcare Foundation has contributed funding to Public Source’s health care reporting.

This story was fact-checked by Ayla Saeed.