The median annual salary of a direct-care worker in a 24-hour residential treatment center is $23,000, compared with $25,600 for an assistant manager at Burger King, according to data from the 2011 Behavioral Health Salary Survey by the National Council for Community Behavioral Healthcare. In addition, the survey provides evidence of “second-class status” within the health care industry of mental health and addictions treatment professionals. A licensed professional social worker earns $45,300 in a mental health care agency and $50,500 in a general medical facility. For registered nurses, working in an addictions treatment facility means taking a pay cut; their average salary is $52,000, or nearly $15,000 less that the national average of $66,500 for all nurses.

The survey found the same patterns at the executive level. Chief medical officers at behavioral health organizations earn salaries ranging from $101,000 to $150,000 (mean of $114,200). At all other types of health care organization, the salary range for chief medical officers is $184,000 to $292,400.

“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 healthcare community,” said Linda Rosenberg, National Council president and chief executive officer, when the survey report was released in April.

The survey, conducted in partnership with the National Association of Addiction Treatment Professionals, includes salary data for executives, administrators, clinicians, and direct care and support staff in public and private behavioral health care organizations. A total of 860 such organizations in 46 states, Puerto Rico, and the District of Columbia completed the survey in November 2010, reporting data for the period between July 1, 2009, and June 30, 2010.

More than three-quarters of the organizations (77%) were private, not-for-profit agencies, 12% were state or local government agencies, and 4% were private for-profit organizations (7% did not report a category). About half (53%) had operating budgets of $14 million or less; only 4% had budgets exceeding $50 million. The vast majority of financial support for respondent organizations was provided by state and county funds for indigent care (43%) and Medicaid (37%), with small percentages from private health insurance (6%), self-pay (6%), and Medicare (4%). Philanthropic donations and grants accounted for the remaining funding (4%).

In the past decade, the salaries of behavioral health workers in several areas, including management and support staff, have kept pace with or exceeded the rate of inflation, according to the report. However, for some positions, such as case managers and administrative support staff, salary growth has failed to offset the inflation rate, despite the historic drop in the consumer price index in 2008–2009.

In the report's introduction Ms. Rosenberg notes “glimmers of hope,” such as the 2010 expansion of the National Health Service Corps loan repayment program. Yet, as she observed, “Trained employees are jumping from job to job in search of a modest raise, which creates crippling staff turnover, incapacitating the patient-centered care systems we want but have yet to adequately support. We must bring employment “parity” to behavioral health, ending the second-class status of employees working in mental health and addiction organizations.”

The full report is available for purchase at www.thenationalcouncil.org.