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Content warning: This story describes a mental health crisis in an emergency setting.\u00a0<\/p>\n
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.\u00a0\u00a0<\/p>\n
\u201cSo now you want to put me in another cell,\u201d 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 \u201cBedlam<\/a>\u201d portrays crises unfolding daily in psychiatric ERs, street encampments and jails that warehouse people with mental illnesses.<\/p>\n After police handcuff and force Todd into the room, he yells, \u201cI come to a fucking hospital, man, and I\u2019m treated like I\u2019m back in fucking prison.\u201d 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<\/a>.\u00a0<\/p>\n Speaking to the camera, Dr. McGhee acknowledges Todd\u2019s trauma as a formerly incarcerated person. The film later reveals he has HIV and struggled to find housing for years. But \u201cit\u2019s hard sometimes to be compassionate \u2014 especially when, you know, they threaten to kill you,\u201d she says.<\/p>\n After playing the clip during a seminar last month, Associate Professor of Social Work Nev Jones prompted the students: \u201cWhat did you observe? What struck you about Dr. McGhee?\u201d<\/p>\n One student noticed how tired Dr. McGhee looked. Others pointed out that staff and police didn\u2019t make much of an effort to deescalate before using force. \u201cIt\u2019s so hard not to think everyone is against you,\u201d a student said, imagining how outnumbered Todd may have felt. Another said, \u201cI don\u2019t think anyone in that situation was like, \u2018OK, we hear what you need.\u2019\u201d<\/p>\n The scene from \u201cBedlam\u201d reflects what these master\u2019s 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\u2019s Youth Behavioral Health Workforce Fellowship<\/a> (YBHW), one of several initiatives to address the local mental health workforce crisis.\u00a0<\/p>\n Like other communities across the country, the Pittsburgh region has long faced a shortage of behavioral health professionals \u2014 particularly those willing to work public-sector jobs that serve the most vulnerable patients. Research shows<\/a> burnout, lower salaries, high student loan debt and lack of training opportunities, among other reasons, are driving shortages in Pennsylvania. It\u2019s a big part of why residents struggle to access behavioral health services, according to a 2024 Allegheny County report<\/a>. The downstream effects include disengagement from the system and more involuntary treatment<\/a>, Jones said.<\/p>\n The county designed the BH Fellows program<\/a>, a cohort-based training and student loan repayment initiative, to boost the local workforce. It partners<\/a> with the Jewish Healthcare Foundation<\/a>* to run the program. A spokesperson for the county\u2019s 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\u2019t have been possible without BH Fellows.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n Experts said local workforce development programs can help, but they won\u2019t bring about the kind of structural change that would make public-sector behavioral health care jobs viable for most.\u00a0<\/p>\n \u201cI don\u2019t think anything is really scaling right now,\u201d said Erica Maloney, an assistant professor of social work at Chatham University. \u201cThere\u2019s a lot of opportunity, but everything\u2019s just so disorganized and piecemeal.\u201d\u00a0<\/p>\n Public sector or private practice?\u00a0<\/p>\n During the seminar, Jones told students that scenes from \u201cBedlam,\u201d though shot in Los Angeles, could easily have taken place in their own backyard.\u00a0<\/p>\n \u201cYou drive down Second Avenue and it\u2019s like this literal microcosm of the revolving door between shelter, treatment facility and jail,\u201d she said, referring to the encampments that formed in recent years near institutions populated by people with serious mental illness. \u201cThe problems are not getting solved. The housing issues are still there. The poverty is still there.\u201d\u00a0<\/p>\n Social work students know they\u2019ll face disadvantages that are often unsustainable if they choose public-sector jobs that serve high-need populations, Jones said, including \u201cbrutal shift work, constantly encountering poverty and hardship and feeling overwhelmed by the magnitude of the problems in the public sector.\u201d\u00a0<\/p>\n It\u2019s why many want \u201ccushy\u201d private-practice psychotherapy jobs and \u201csee community mental health counseling or social work as the fastest routes,\u201d Jones added. The rise of teletherapy<\/a> 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\u2019s the only faculty member who\u2019s taught psychosis interventions as part of the Pitt School of Social Work\u2019s continuing education trainings<\/a>.\u00a0\u00a0<\/p>\n \t\t\t\t\tLoad more posts\t\t\t\t<\/p>\n \n\t\t\t\tSomething went wrong. Please refresh the page and\/or try again.\t\t\t<\/p>\n 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<\/a> from the federal Health Resources and Services Administration<\/a> (HRSA) to launch the program. Chatham University and Carlow University received HRSA grants to start similar programs<\/a>. They\u2019re working with Pitt to make training available across programs.\u00a0<\/p>\n Over the next four years, YBHW at Pitt will provide $25,000 annual stipends and specialized training \u2014 including the seminar taught by Jones and Ph.D. student Shannon Pagdon on strategies for \u201ctransformative change\u201d in public social work \u2014 to 14 second-year master\u2019s students. During the next seminar, they\u2019ll learn how to navigate Medicaid and Medicare systems \u2014 an essential skill in the public sector, Gartner said. Fellows also get hands-on experience through a practicum at a designated provider agency.\u00a0<\/p>\n When the grant closes out, 56 students will have received specialized training and stipends. But those perks aren\u2019t conditional \u2014 it\u2019s up to each fellow to decide if public-sector work is right for them. \u201cIt would be awesome if everyone kind of moved from this fellowship into a public social work space,\u201d said Gartner, but the program will train social workers to push for structural change \u201cwithin whatever type of practice space they\u2019re in.\u201d\u00a0<\/p>\n \u2018Talking to patients like they\u2019re people\u2019\u00a0<\/p>\n YBHW fellow Xio Fane, 25, finds public social work \u201ca little intimidating,\u201d but felt even more motivated to choose that path while watching how hospital staff treated Todd in \u201cBedlam.\u201d They immediately thought of ways to handle the situation differently.\u00a0<\/p>\n \u201cHe was very clear when he said, \u2018I don\u2019t want these police officers around me,\u2019\u201d they said. \u201cFor whatever reason, no one was like, \u2018OK, y\u2019all get out of here.\u2019\u201d\u00a0<\/p>\n Fane noted Todd self-medicates with drugs. \u201cAnd I\u2019m kind of curious as to why they didn\u2019t ask him, \u2018OK, what kind of drugs do you do and what do they do for you?\u2019 And then being like, \u2018There\u2019s this one medication \u2026 that will give the same effect. How do you feel about that?\u2019<\/p>\n \u201cSeeing how I felt and all the problem-solving I was doing just watching it \u2026 I\u2019m like, \u2018I\u2019m definitely in the right place,\u2019\u201d they said. \u201cAnd I think we need people who are capable of being more creative with their solutions and just talking to patients like they\u2019re people.\u201d<\/p>\n 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\u2019ll have to supplement a public-sector income by doing private-practice counseling on the side. \u201cWhich sucks,\u201d they said. \u201cI don\u2019t want to have to do that.\u201d\u00a0<\/p>\n 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\u2019t enough to prevent financial hardships, they said. They\u2019re considering applying to the BH Fellows program for further debt relief after graduation.\u00a0\u00a0<\/p>\n Lifting the burden of student debt<\/p>\n The county\u2019s BH Fellows program is a core part of its plan<\/a> to improve adult Medicaid patients\u2019 access to mental health services. It provides student loan debt repayment \u2014 up to $25,000 for a bachelor\u2019s degree and $45,000 for a master\u2019s degree \u2014 to behavioral health professionals in the county. (Research shows<\/a> some early-career mental health professionals can expect to spend between 16% and 30% of their pretax monthly income on paying back student debt.)<\/p>\n It also places fellows in full-time jobs at local provider agencies<\/a>, 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\u2019s Initiative<\/a>.\u00a0\u201cYou can tell they really put a lot of care into making sure that it\u2019s a well-versed and holistic training for everyone.\u201d <\/p>\n McCardle is the first in her family to attend college and worried her $60,000 in student debt would \u201cweigh [her] down\u201d for a long time. BH Fellows is \u201cwashing away that fear\u201d because she expects her debt to be reduced by 75% through the program. <\/p>\n The county Human Services spokesperson described the program\u2019s impact so far:\u00a0<\/p>\n Seven cohorts of about 25 fellows each have enrolled\u00a0\u00a0<\/p>\n 42 fellows have completed the program and 108 are serving in qualifying roles\u00a0<\/p>\n $4.8 million in student loan forgiveness was pledged, with nearly $1.5 million already paid\u00a0<\/p>\n Nearly 25% of fellows with eligible debt will graduate with all of it repaid\u00a0\u00a0<\/p>\n 43% will graduate with more than half of their debt repaid.\u00a0\u00a0<\/p>\n Behavioral health workforce data<\/p>\n Workforce shortage: The public mental health workforce is \u201cin really bad shape,\u201d said professor Nev Jones, noting the data needed for a full analysis \u201cprobably doesn\u2019t exist.\u201d<\/p>\n Decentralized system: Allegheny County officials agree. A Department of Human Services spokesperson said the decentralized nature of the behavioral health system limits data collection required for a comprehensive analysis.<\/p>\n Steps underway: The county contracts with Community Care Behavioral Health Organization (CCBH), a managed care organization that\u2019s part of the UPMC Insurance Services Division. The county is working toward \u201csystemwide, regularly refreshed data on census and capacity\u201d of the workforce that provides services centralized by CCBH.<\/p>\n UPMC response: UPMC Western Psychiatric Hospital reported its staff grew from 898 employees in 2020 to 1,080 in 2024, with overall turnover declining. It said career or industry changes are the top reason for departures. (The Allegheny Health Network didn\u2019t provide information by deadline.)<\/p>\n The goal is to drive recruitment and retention for \u201cchallenging jobs\u201d 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\u2019s why the program requires employers to meet a minimum salary threshold, which varies across a wide range of eligible jobs.\u00a0<\/p>\n Provider agencies were \u201csuper worried about that,\u201d said Amy Fenn, executive director of family preservation services at Pressley Ridge<\/a>, which is based in McCandless and operates in seven states. We thought that if \u201cwe got involved, then we would start to lose money, and we were already struggling,\u201d she said, describing how the pandemic decimated teams<\/a> that served families in their homes. But the county, which funds the program through Medicaid reinvestment dollars<\/a>, gave the agencies a rate increase.\u00a0<\/p>\n \u201cIt\u2019s 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,\u201d Fenn said. \u201cIn the Medicaid world, it doesn\u2019t usually work like that.\u201d<\/p>\n Maloney, the Chatham assistant professor, was less effusive. \u201cThose jobs are really, really hard,\u201d she said, pointing out that fellows can\u2019t leave for a non-eligible role offering better pay and work conditions for two years. \u201cI don\u2019t think this is super generous, but it is definitely better than nothing.\u201d\u00a0<\/p>\n 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\u2019s 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\u2019ll have less than $5,000 in debt. \u201cI\u2019m very excited about that,\u201d she said. If the program had existed when she was younger, pursuing graduate studies would have been \u201ca lot more realistic and achievable.\u201d\u00a0<\/p>\n 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. \u201cI really think this program has done wonders, and I would love to just see it continue and expand in some capacity.\u201d<\/p>\n Other Pennsylvania jurisdictions reached out to the county to learn from BH Fellows and some launched their own versions. But they can\u2019t replicate its unique Medicaid reinvestment funding model. \u201cSuch underspend no longer exists,\u201d 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.\u00a0<\/p>\n Venuri Siriwardane is the health and mental health reporter at Pittsburgh\u2019s Public Source. She can be reached at venuri@publicsource.org<\/a> or on Bluesky @venuri.bsky.social<\/a>.<\/p>\n * The Jewish Healthcare Foundation has contributed funding to Public Source\u2019s health care reporting.<\/p>\n This story was fact-checked by Ayla Saeed.<\/p>\n Your gift will keep stories like this coming.<\/p>\n Have you learned something new today? Consider supporting our work with a donation.<\/p>\n We take pride in serving our community by delivering accurate, timely, and impactful journalism without paywalls, but with rising costs for the resources needed to produce our top-quality journalism, every reader contribution matters. It takes a lot of resources to produce this work, from compensating our staff, to the technology that brings it to you, to fact-checking every line, and much more.<\/p>\n Your donation to our nonprofit newsroom helps ensure that everyone in Allegheny County can stay informed about the decisions and events that impact their lives. Thank you for your support!<\/p>\n Republish This Story<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/20251015-Youth-Behavioral-Health-Workforce-Fellowship-07.jpg\")
Associate Professor of Social Work Nev Jones, center, speaks to students during a seminar for the first cohort of the Youth Behavioral Health Workforce Fellowship on Sept. 24, at the University of Pittsburgh in Oakland. The seminar covered ways to create transformative change in public mental health services for those with serious mental illnesses. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/20251015-BH-Fellows-mental-health-staffing-02.jpg\")
BH fellow Michelle Bush, of Baldwin, participates in a behavioral health worker training at Pressley Ridge on Oct. 15, in Marshall-Shadeland. The fellows join together routinely over the two-year service term for professional development, networking and team-building experiences. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n<\/p>\n
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A person sits alone beside Second Avenue Commons as framed by the surrounding bridge and highway, on Sept. 8, 2023, in Uptown. The facility includes beds for people experiencing homelessness. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"People](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/20250226-NIH-funding-Pitt-CMU-Trump-01.jpg\")
The University of Pittsburgh School of Social Work in the Cathedral of Learning on Feb. 26, in Oakland. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/20250924-Behavioral-health-university-Pittsburgh-02.jpg\")
YBHW fellow Xio Fane, 25, listens during a seminar on strategies for \u201ctransformative change\u201d in public social work on Sept. 24, at the University of Pittsburgh in Oakland. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/20250924-Behavioral-health-university-Pittsburgh-03.jpg\")
YBHW fellow Xio Fane, far left, 25, listens with others in her cohort during Associate Professor of Social Work Nev Jones\u2019 seminar on \u201ctransformative change\u201d in public social work on Sept. 24. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/20251015-BH-Fellows-mental-health-staffing-04.jpg\")
Books on trauma, mental health and therapy line an office at Pressley Ridge\u2019s Marshall-Shadeland office on Oct. 15. Pressley Ridge is one of around 12 local behavioral health service agencies providing full-time employment for BH Fellows. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"Several](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/20251015-BH-Fellows-mental-health-staffing-03.jpg\")
From left, BH Fellows Donna Dobbs, of Penn Hills, Morgan Keys, of Lawrenceville, Jacob Nutter, of Downtown, listen during a social worker training at Pressley Ridge on Oct. 15, in Marshall-Shadeland. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n
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