Overwork you, high caseload, pressure to make a quota with face to face time with consumers that are highly dysfunctional, don't keep appointments with psychiatrists or with you, tons of paperwork, but the worst part is the people that they promote to be Program Managers. Program Managers tend to micromanage and don't have a clue about mental illness, aren't experienced in clinical skills, and some look and act like clients themselves. They don't promote a team environment due to pressures to turn in paperwork and make the quota with 3 hours face to face with each of your 25 clients per month. When clients attack you there's no one to talk to and management are critical and not helpful or supportive in any way. Managers also want to have constant meetings with you which also interfere with making your quota and completing paperwork on time. They also expect you to train new QMHP's on top of everything.