Mental health workforce faces challenges

FINDLAY — As mental health needs have increased in Hancock County and nationwide, so have the challenges in recruiting and retaining the workforce to address these needs. From 2013 to 2019, Ohio saw a 353% increase in the demand for services, said Ginny Williams, chief culture and transformation officer for Family Resource Center. The stresses of the COVID-19 pandemic added to this. Williams said social media likely plays a role in the increase, but also the realities most families are facing are "so much more complex" these days. As the demands have increased, the Medicaid reimbursement rate has stayed the same, she said, and FRC cannot increase its staff without more funding. But more and more people need their services. FRC is part of what is referred to as the community mental health system. Unlike, say, a private therapy practice, its purpose is to serve those with the highest acuity need and the least amount of resources, Williams said. She said some view community mental health as a "training grounds," where mental health professionals encounter a wide range of diagnoses and conditions. After getting that experience, many move on to a hospital or private practice, where the demand may not be as great. Healthcare providers who leave for private practice often also not only are paid better but find there is less red tape, Williams said. About 70% of FRC's clients are insured through Medicaid, and the organization must deal with the administrative burden related to that. Williams said an Ohio survey found that 70% of community behavioral health providers said they were "overwhelmed" with more clients than they had capacity for, and 98% said recruitment was very difficult. "So we're not alone in that," she said. Williams said many states have moved to a model of care that offers a higher reimbursement rate for care at a certified community behavioral health clinic (a designation FRC has earned). Ohio has not, although Williams said state officials are moving in that direction. She described it as a potential "game changer". Staff turnover and insurance challenges affect those needing care, as well. "Somebody walking through the doors and saying, 'I need help' is the hardest part," Williams said. If they then start talking to a therapist they come to trust, and that person leaves, the transition is difficult and clients may be reluctant to tell their story all over again to someone new. Also, more and more insurance companies are putting restrictions on what type of provider a person can see, Williams said. Sometimes people are put on a wait list, and "that can be as much driven by their insurance as our capacity," she said. She said FRC staff are working to troubleshoot these issues daily. She said some insurance companies require patients to see a medical provider before they can see a counselor, even if they do not want or need medication. She said clients are often frustrated as this process goes on. FRC tries to connect them with peer support or a case manager in the meantime. Someone struggling with their mental health often doesn't know who to call or what questions to ask in the first place, said Zach Thomas, director of wellness and education for the Hancock County Board of Alcohol, Drug Addiction and Mental Health Services. "We should not expect that burden to be on the person in the middle of crisis," he said. He used the analogy of a car accident. If you're in a fender bender, police will take a report, and then you call your insurance agent — and the insurance agent takes it from there. "I think one of the best things we can do is to continue to promote, and to bring really strong awareness to, 988 (the suicide and crisis lifeline). Because when you call 988, you're not expected to know exactly what you need," he said. "It is the role of the people on the receiving end of that call to be able to direct you appropriately." He hopes that, as this message continues to get out there, people will eventually know that they should call 988 in a mental health crisis, just as they know they should call their insurance company in a car crash. Dave Crosser, community relations lead for FRC, pointed out that most of us have been told to call 911 in an emergency since kindergarten, so that's what people do by default. But calling 911 tends to lead to a police or ambulance response, which may not be what's needed in a mental health crisis. He, too, encouraged people to be aware of 988. While community mental health may face higher turnover rates, there is a shortage of mental health professionals across the board. There is a nationwide shortage of psychiatrists, medical doctors who specialize in mental health. "Psychiatrists are the ones that can prescribe medications," Thomas said. "And the ratio of prescribers to client needs is often really askew." "In 2021, 76% of Ohio counties were designated by the Health Resources Services Administration (HRSA) as Mental Health Professional Shortage Areas (MHPSA), or regions where, due to provider shortages, residents struggle to access mental health care," states a report from the Ohio Council of Behavioral Health and Family Services Providers. "Despite ongoing statewide efforts to grow the (behavioral health) workforce, today Ohioans face even greater hardship accessing mental healthcare, as 85.2% of the state is now designated as a MHPSA, constituting a 10% increase in MHPSAs across the State of Ohio in only three years." While the need for mental health professionals is increasing, "the pay is not necessarily commensurate to what they're being expected to do," Thomas said. He said some people are drawn to this field simply because they want to help and make a difference. Others are attracted to it because they themselves have lived experience with mental health, and have now gotten to a place of recovery where they want to help others who are struggling. He said Northwest Ohio has strong social work and counseling programs. Some people who may want to use their lived experience to help others might find four years of school a time and financial barrier, however, he said. So, the health and human services collaborative led by ADAMHS has been working with Millstream Career Center, which offers a mental health component in its health professions curriculum. Students who complete this program can work as a mental health technician at a place like The Steady Path, FRC's residential center. The ADAMHS board is encouraging young people to seek careers in the field. But Thomas said they also want to be realistic about the paperwork and insurance issues involved. "It's more than just 'I really want to help you,'" which is what motivates people, he said. "It's the minutiae and the tediousness of those positions that sometimes people don't see." Williams said this profession has a high level of burnout due to secondary trauma or "compassion fatigue." She said FRC has tried to promote self-care and offer resources to help. But she said the pandemic increased the demand, along with the "intensity" of clients' needs. Several people who left the organization have told her at exit interviews, "It's just taking too much of a toll on my own mental health." And, while some left to work in mental health care elsewhere, others made a total career change. "In general, the applicant pool is very small," Williams said. FRC has tried to attract people through recruitment or retention bonuses. Some staff may qualify for a program that helps with student loan repayment. Williams said they also find grants for professional development and training for existing staff, with the goal of encouraging them to stay while also offering more opportunities for clients. Thomas said what keeps many people going despite the stresses is knowing that they are making a difference. "It's those little gems that show that glimmer of hope, right?" he said.