Commentary: The workforce problem is a mental health problem

February 28, 2022 5:48 am
A woman shown in profile in a dark room

The community mental health centers of New Hampshire provide supports and services to 50,000 individuals and families each year. (Getty Images)

During the winter months I do most of my running on a treadmill with a screen and access to a training platform. Coaches prompt me to go faster than I might on my own. You will have to be of a certain age to get this reference, but at times I find I have accelerated to the point that I feel I might “George Jetson” off the back of the tread. The workforce challenges we are facing in the world of community mental health are feeling similar to this phenomenon.

The NH Community Behavioral Health Association (CBHA) began collecting data on the aggregate vacancies of the 10 community mental health centers in December 2015. The number of vacancies reported in January 2016 was 147 across the 10 centers. CBHA saw that number as highly concerning for our system of care and worried that staffing challenges were impacting timely access to services. Little did we know that 2016 would represent the lowest number of openings across the system. As you can see from the chart below, the number of vacancies crept up in 2017 and 2018, but started to inch downward in 2019 and 2020. And then the pandemic hit in March of 2020 and our world was turned upside down.

A graphic of the mental health workforce shortage In the past two years we have seen community mental health center vacancies skyrocket at the same time that demand for services has increased higher than we have ever seen. As of Jan. 31, 2022, we hit a high of 400 vacancies.  

New Hampshire’s community mental health providers have been on the frontlines of the pandemic since it began. We have not closed. We have not stopped providing services. In fact, we have added new services such as statewide Rapid Response Mobile Crisis to try to meet the needs of New Hampshire residents living with mental illness, serious emotional disturbance or substance misuse disorders. We have done this while our staff were experiencing the same pandemic challenges as every other person living through this pandemic.  

Our state has maintained a focus on mental health services. Efforts have included expansion of inpatient beds, working with centers and other providers to add residential capacity and implementing the statewide Access Point for 24/7 statewide access to crisis care. We need all these services, and more. Coverage of telehealth services has been a welcome opportunity to increase access to care, but our work still requires people. Positions need to be filled with qualified staff. Caseloads must be of a manageable size. We need to do more to be able to attract and retain a strong CMHC workforce. 

There have certainly been positive supports that were put in place during the pandemic: Payroll Protection Loans, stipends for front line providers, flexible leave for those exposed to or diagnosed with COVID, salary adjustments and sign-on/retention bonuses. But as we can see from the sharp increase in vacant positions, it is not enough. We are a system of care that has been overwhelmed by demand, by administrative burdens, by competition with other providers who are not required to accept Medicaid, Medicare, and the uninsured and can therefore pay higher salaries. We feel  pressure and guilt when we are not able to meet the needs of our communities. 

So, what do we do? We need to recognize the community mental health staff as frontline health care heroes. We need to ensure adequate, stable, and sustainable funding to offer competitive salary and benefit packages to our staff. We need an increase in the State’s Medicaid rates. The State Loan Repayment Program (SLRP) is a wonderful resource, but we are only able to have a few staff at a time approved and this does not include Bachelor level staff. We must address the overwhelming burdens imposed by state administrative rules that lead many to leave the CMHC system for private practice as soon as they are licensed. 

The community mental health centers of New Hampshire provide supports and services to 50,000 individuals and families each year. These are our neighbors, our family, our friends. The same is true of our staff, who are giving their all. We need to find more ways to help them feel supported in their work, to find time to practice good self-care and recharge so they can be their best selves as treatment providers.  

We must find ways to implement meaningful and sustainable changes that resolve our workforce challenges. The treadmill is going faster. We must find solutions before we can no longer manage to hold on.

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Jay Couture
Jay Couture

Jay Couture is President and CEO of Seacoast Mental Health Center in Portsmouth. She lives in Rye.