The state needs 33,000 new behavioral health workers by 2028. It’s training fewer every year — and can’t afford the fix.
By Michael Phillips | MDBayNews
Maryland has roughly half the behavioral health workers it needs right now. Nine counties carry a whole-county federal mental health shortage designation, and the workforce gap touches every corner of the state. Meanwhile, the pipeline meant to produce the next generation of therapists, counselors, and psychiatrists is shrinking, not growing.
That’s the picture emerging from a 2024 report commissioned by the Maryland Health Care Commission (MHCC), which found the state employed an estimated 34,613 behavioral health professionals in 2023 — about 18,000 workers short of what is needed today, before accounting for the additional 14,565 who are expected to retire, leave Maryland, or exit the field entirely by 2028.
The math is stark: Maryland will need to recruit and train roughly 32,786 new behavioral health workers within the next four years — nearly the same number currently employed — just to keep up with rising demand.
Where the Shortage Hits Hardest
Federal shortage designations from the Health Resources and Services Administration (HRSA), updated January 2026, show nine Maryland counties carrying a whole-county geographic Mental Health Professional Shortage Area (MHPSA) designation: Calvert, Cecil, Charles, Harford, Kent, Queen Anne’s, St. Mary’s, Talbot, and Washington. Prince George’s County — Maryland’s most populous majority-Black jurisdiction — carries a partial designation. The remaining counties, including Baltimore City, Montgomery, and Anne Arundel, do not hold a geographic designation, though that does not mean access is adequate.
Health Professional Shortage Areas: Mental Health, Geographic, by County, January 2026 – Maryland
Geographic HPSA designations measure whether an area as a whole falls below a minimum provider-to-population threshold. They do not capture population-based shortages — meaning low-income residents and Medicaid patients in non-designated counties can still face severe access barriers even when the county’s overall provider count looks adequate on paper. The MHCC’s statewide workforce analysis, which accounts for actual unmet need rather than geographic boundaries, found Maryland short by 18,000 workers regardless of how federal designations carve up the map.
The MHCC report found that Baltimore City employs significantly more behavioral health workers per capita than any Maryland county — one reason it holds no geographic shortage designation. But the counties with the fewest providers per resident span the state’s full demographic and geographic range, from midsize suburban counties like Charles and Calvert to rural jurisdictions on the Eastern Shore.
Somerset County, on the lower Eastern Shore, has no practicing psychiatrists at all, according to the Maryland Department of Health — yet it carries no geographic HPSA designation under the federal system. Worcester County averages fewer than two psychiatrists per 100,000 residents, also without a whole-county designation. The gap between federal shortage maps and on-the-ground reality is itself part of the story.
The racial dimensions of the shortage are also documented in the MHCC report. Hispanic and Latino residents make up 12 percent of Maryland’s population but are underrepresented in the behavioral health workforce in every county except Calvert. Black and African American workers are concentrated disproportionately in lower-paying paraprofessional roles — peer support specialists, outreach workers, case aides, and psychiatric technicians — and underrepresented among psychiatrists, psychologists, and nurse practitioners.
The Jobs That Can’t Be Filled
The MHCC report breaks down the shortage by occupation. The largest single gap is in counseling and therapy: Maryland will need 9,532 new counselors and therapists by 2028, including 5,784 to meet rising demand and 3,748 to replace workers leaving the field. Social and human services assistants — a broad category that includes peer recovery specialists, outreach workers, and unlicensed case managers — are second, with 8,029 new workers needed.
Social workers in behavioral health settings need 2,675 new hires. Community health workers need 2,622. Occupational therapists need 1,840. Psychiatric aides and technicians need 1,740.
Even at the psychiatrist level — the top of the clinical hierarchy — the state needs 269 new psychiatrists by 2028, against a current base of just 1,196. That figure includes 164 replacement hires for those expected to leave, as well as 105 net new positions to meet growing demand.
“When you have those vacancies, it basically translates into your capacity to provide treatment to people is substantially lower,” Shannon Hall, executive director of the Community Behavioral Health Association of Maryland, told Maryland Matters in December 2024. “They’re picking up the slack, so it just creates a lot more stress across the entire system.”
The Pipeline Is Shrinking
The MHCC’s analysis of Maryland’s college and university graduation data reveals a troubling trend: the education system is producing fewer clinicians now than it was before COVID-19, even as demand accelerates.
Since the onset of the pandemic, degree completions from Maryland master’s programs that lead to clinical licensure have all declined from their 2019 peaks. Graduates in clinical and counseling psychology are down 30 percent. Counseling and therapy programs are down 10 percent. Social work is down 9 percent.
Maryland ranked 37th out of 50 states in psychiatry residency matches per capita in 2024 — meaning the state is producing new psychiatrists at a below-average rate relative to its population, even before accounting for how many of those residents leave the state after training.
And a significant portion of those who do graduate aren’t entering the field. The MHCC found that 70 percent of Master of Social Work and clinical and counseling psychology graduates from Maryland universities since 2014 were either working in other industries, employed out of state, or not working at all one year after completing their degree.
Addiction studies programs are similarly strained: certificate and associate degree completions from community colleges remain well below the average annual job openings for alcohol and drug counselors statewide.
The Budget Collision
The MHCC’s report recommends a $148.5 million investment over five years to address the workforce shortage — through wage increases, improved Medicaid reimbursement rates for providers, tuition assistance, streamlined licensing, and expanded training programs.
Maryland is unlikely to make that investment anytime soon. The state is grappling with a projected $1.6 billion budget deficit heading into fiscal year 2026, and behavioral health is part of the problem: higher-than-anticipated Medicaid spending on behavioral health services was flagged by the Department of Legislative Services as one of the key drivers of the shortfall.
The dynamic is self-reinforcing. A workforce too small to meet demand means longer waits, more crises going untreated, and ultimately more expensive interventions — emergency room visits, law enforcement responses, and inpatient hospitalizations — all of which draw on state resources. Advocates warned during the 2026 legislative session that proposed cuts to 988 crisis line funding and school-based behavioral health programs would accelerate that cycle.
“If this falls by the wayside because of budget shortfalls,” Hall told Maryland Matters, “it’s not just behavioral health that’s going to pay for that. It’s the schools, it’s the hospitals, it’s the criminal justice system, and ultimately it’s vulnerable people in Maryland.”
A Mandate Without a Workforce
The timing of the workforce crisis carries an added dimension that has received little public attention. Maryland is required by law to implement Assisted Outpatient Treatment (AOT) — a program allowing courts to order individuals with serious mental illness into outpatient treatment — statewide by July 1, 2026.
The program, authorized by 2024 legislation backed by the Moore administration, began in five pilot jurisdictions in 2025. Full statewide rollout is now three months away. It will require community mental health providers across all 24 Maryland jurisdictions to accept and serve court-ordered patients — at the exact moment the state has the fewest providers per capita in recent memory to deliver that care.
Whether the AOT mandate can be meaningfully implemented against a backdrop of this scale of workforce shortage remains an open question the state has not yet publicly addressed.
Methodology
This article draws on the Maryland Health Care Commission’s October 2024 report “Investing in Maryland’s Behavioral Health Talent,” commissioned under Senate Bill 283 (2023) and prepared by Trailhead Strategies. Additional data sources include the federal Health Resources and Services Administration’s shortage area designations (updated April 2026), the Maryland Department of Legislative Services’ fiscal year 2026 budget analysis, and reporting by Maryland Matters, WYPR, and Capital News Service.
The MHCC report is publicly available at mhcc.maryland.gov. HRSA shortage area data can be queried at data.hrsa.gov/tools/shortage-area/hpsa-find.
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