Talking about compensation can feel taboo with your closest colleagues—let alone on a public podcast. But with behavioral health budgets tighter than ever, avoiding the conversation altogether isn’t an option.
In the latest episode of No Notes, Dr. Denny Morrison sits down with Katie Weihe, VP of Human Services at Aurora Mental Health & Recovery, and Amanda Rankin, Customer Insights Lead at Eleos (and former COO of Trilogy), to break through the discomfort. Together, they explore the complex realities of staff pay, the unique limitations faced by community mental health orgs, and the creative strategies leaders are using to attract and retain top talent.
Missed the episode? Listen to the full conversation here.
Why There’s Pressure on Pay in Behavioral Health
Margins were already slim in behavioral health, but with added financial strain from the One Big Beautiful Bill Act (OBBBA) and its impending Medicaid cuts, budgets are shrinking even more. To keep pace with employee expectations, compete with employers offering higher pay and better perks, and frankly, stay in business, behavioral health organizations will have to get creative with their offerings.
COVID-19 Shifted Salary Standards
Even before recent regulatory shakeups, COVID-19 brought a lot of disruption to the healthcare labor market. During the “Great Resignation,” many providers left for non-clinical roles or opted for higher-paying travel assignments.
While nursing garnered much of the spotlight during those years, a collective realization of the importance of mental health emerged on the other side of the pandemic—putting increased pressure on behavioral health organizations to meet higher client demand and compensate clinicians fairly for their more widely recognized and vital work.
“I think that there’s some catching up that we’re doing, because this work is so important and thrust in the middle of America’s spotlight,” Weihe explained. “And so doing what we can to make sure that these providers are getting paid what they’re worth is huge.”
The Weight of Student Debt is Growing
Many newly minted clinicians graduate with significant debt—and entry-level salaries often fall short of covering loan payments and everyday expenses.
As Rankin pointed out, “Prior to the pandemic, the industry had been neglected for a long time as far as compensation was concerned.” Trying to pay down $100-200k in debt after getting a Master’s degree puts a lot of pressure on clinicians to seek out top-paying roles—most of which exist outside of community-based settings.
Pay Transparency Laws Are Changing the Landscape
Historically, many employers kept staff salaries under wraps. But now, states like Colorado—where Aurora is based—are flipping the script. With more pay transparency laws in place, many employers are required to disclose salary ranges in their job postings.
“We’re able to literally look up postings with our competitors, and we’re able to say, yep, this is what they’re paying—do we need to make any kind of changes? Because the market sometimes moves quickly,” said Weihe.
This not only guards against gender gaps but also forces organizations to keep pace with their peers in order to remain competitive.
Community Behavioral Health Faces Added Limitations
Pay and retention are especially difficult challenges in the community-based, not-for-profit sector. These organizations are limited in what they can offer staff due to their reliance on Medicaid and other state-funded programs.
“A licensed social worker going to work at a for-profit hospital or insurance company is often making more than what they might be able to make in community mental health,” Rankin explained.
Even small financial incentives from competitors can cause significant disruption—including up to a 40% annual churn rate, which drains time, resources, and continuity of care for clients.
This is exactly why retention strategies can’t depend on salaries alone. Community behavioral health organizations must find other ways to help staff feel valued and supported.
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Incentives That Actually Keep Staff Engaged
So, what kind of added benefits can your organization offer without breaking the budget? Here are a few ideas:
- Shift differentials to compensate for undesirable work hours like nights, weekends, or holidays
- Additional compensation for direct service time to encourage clinicians to focus on their caseload and client appointments
- Threshold-based bonuses for meeting certain levels of direct service on a monthly, quarterly, or annual basis
Of course, incentives only work when they’re transparent. If leaders can’t easily explain how they’re calculating bonuses or extra pay, staff may feel the system is confusing—or worse, unfair.
“I think it’s vital, as you’re building a compensation program, that it’s founded with data,” Weihe shared. “Then having it in a way that you can train to it [and] your philosophy is understood all the way down—because if it’s not done that way, that can create confusion.”
The most successful programs are rooted in real data, openly communicated, and governed by a clear system of checks and balances (like supervisor reviews or straightforward documentation standards), ensuring the process is fair for individual employees and the organization as a whole.
Alternatives to Productivity Standards
Another area to consider: “the dreaded P-word,” as Dr. Morrison put it.
Productivity often carries a negative connotation in behavioral health. Clinicians may interpret productivity standards—typically measured as billable hours compared to total work hours—as putting money over mission. Without careful communication, these expectations can feel at odds with the reason many providers entered the field.
One alternative route is to avoid calling it “productivity” altogether. Instead of tracking productivity rates, some organizations focus solely on direct service hours—staying aligned to their core mission of serving clients and rewarding clinicians for that important work.
“Now you are aligning the reasons that people are in the field,” Rankin said. “They’re here to help people. That’s why people come to work in community mental health.”
Growth Opportunities That Boost Retention
Not every clinician wants to manage—and that’s okay.
Career growth doesn’t always mean stepping into leadership. Many providers want advancement and higher pay without taking on responsibilities like supervising peers or managing budgets.
Offering alternative paths, such as clinical supervisor roles that let clinicians “dip their toe” into management or opportunities to earn specialty pay for added skills, can create new ways to grow without leaving client work behind.
And when promotions aren’t available, mentorship, skills training, and project-based assignments help staff expand their experience and prepare for leadership when the time is right.
“There’s no such thing as a perfect employee or a perfect job, but there can be a perfect match of job and employee, and that’s what you search for,” Dr. Morrison said.
Technology as an Employee Benefit
Documentation is one of the biggest pain points for clinicians—and one of the biggest drivers of burnout and turnover. By helping providers document faster and more easily, technology like ambient AI lightens that load and shifts more work time to client care.
Back when Rankin was still the COO of Trilogy, for example, she brought Eleos into the organization not to squeeze more productivity out of staff—but to remove barriers that were pushing them out the door.
Such an investment can quickly pay for itself. Replacing just one clinician can cost around 30% of their salary. So, preventing even a couple of departures each year through reduced burnout can offset the entire cost of an AI tool.
“Eleos has been such a great partnership because it saves time and [shows that] we see your pain points, and this is what we wanna do to try to help you,” Weihe said.
Behavioral health-specific AI tools like Eleos also capture services that often go undocumented—such as quick check-in calls with clients—so clinicians get credit for the work they’re already doing. That means more accurate billing, more goals met, and more bonuses earned without raising quotas.
In fact, one Eleos customer reported gains so significant that they were able to redirect those savings into higher staff salaries.
Practical Steps Behavioral Health Leaders Can Take Today
Even with budgets squeezed tighter than ever before, there’s plenty of opportunity for behavioral health employers to get creative with their retention strategies.
“We as leaders need to do everything we can to help our people do their best work in the best way possible,” Weihe emphasized.
The key is staying transparent—especially with so much uncertainty on the horizon (cough, cough OBBBA). Quarterly town halls, regular CEO updates, and open communication policies show that you’re invested in your team, even when you don’t have all the answers.
To prepare for the years to come, leaders should focus on what they can control. That means investing in staff development and easing the less-liked parts of the job (like documentation) as much as possible.
“Continuing to invest in how you alleviate burden for clinicians is always going to be a winning strategy, even when you don’t have control of the rest of the chaos that’s going on,” said Rankin.
At the end of the day, clinicians didn’t choose this field for compensation alone. Supporting them with incentives, growth opportunities, and tools that reduce administrative strain gives them the breathing room to focus on what brought them to behavioral health in the first place: helping people.
Want to see how Eleos can help reduce burnout and boost retention for your team? Book a personalized demo today.
