This story from Eye on Ohio, the nonprofit, unbiased Ohio Center for Journalism along with the Cleveland Observer. Join Eye on Ohio’s free mailing list as this helps to provide more public service reporting to the community.
COLUMBUS, Ohio — Unprecedented demand and a scarce worker pipeline add stress to Ohio’s already strained behavioral health system.
According to data from the Ohio Department of Mental Health and Addiction Services, demand for behavioral health services increased by 353% statewide from 2013 to 2019. Demand picked up again in 2021, with providers reporting an increase in the need for adult and youth mental health care by 70% and the need for substance abuse treatment by 60%.
“Demand has definitely increased,” said Eric Morse, CEO of The Centers in Cleveland, a nonprofit that offers a range of services, including case management, counseling, psychiatric services, and substance abuse treatment. “It was high for COVID, I think. COVID has only made it worse.”
There are many reasons for the shortage, mental health professionals said.
Employees and clients have become accustomed to telehealth appointments, and it’s difficult to get employees to want to return to private homes where much of the mental health care takes place, Morse said.
Low wages also discourage new people from entering the profession, and existing employees burn out as the caseload increases and are more likely to change careers or retire.
Justin Larson, who oversees support programs for Thrive, a peer recovery service for people with mental illness or substance use disorders, said the pandemic hampered his ability to find new employees.
“Sometimes it was hard to find fellow recoverers who really want to work in a hospital,” he said, especially during Covid peaks. “It was quite difficult to get people to want to work in an environment where people came in who could be positive for Covid-19.”
Higher demand and a lean workforce mean longer wait times for services, which can be dangerous for patients.
“I can’t even imagine. That could be a possible death,” said Kelitha Bivens-Hammond, a peer supervisor at Thrive. “Honestly, if we had to turn someone down, they could go back and overdose. That’s my first thought. This is a life or death situation.”
Bivens-Hammond knows firsthand how dangerous addiction and mental health problems can be. Before becoming a peer recovery counselor, she struggled with addiction. She started using alcohol at the age of 9. At the age of 21, she started trying treatment centers. After 27 attempts at sobriety for about 20 years, she got help from Thrive.
“I know I would have died. I’m sure of that,” she said. “That’s where I went. I was already institutionalized. I had already been in prison. There was nothing left for me but to die.”
Bivens-Hammonds helps up to 10 people a day at Thrive’s site at St. Vincent Charity Medical Center in Cleveland. Thrive also has locations in MetroHealth, University Hospitals, the Cleveland Clinic, and elsewhere in the state.
A lack of behavioral health services could put pressure on other systems, said the Center’s Morse. People may need to go to the hospital or visit an emergency room to receive services. If an incident occurs, the police can be called in, leading to criminal charges or further damage to a person’s mental health.
“We know statistically that suicide and overdose rates are getting worse,” he said. “I would say that if we had a better capacity to help people, that number – I hope so – would drop. That would ultimately be what I would hope. If we had good access to health, there would be fewer deaths.”
Recruitment and retention are the main barriers to meeting demand, say mental health providers.
“The number of providers looking to enter the behavioral health space of the community is still a challenge,” Morse said. “The labor market is of course very employee-friendly at the moment. While we’ve raised our wages quite a bit over the past two years, we’re still competing in jobs that are certainly a lot less stressful than working here. Especially among case managers, where we typically hire people with a bachelor’s degree in psychology, sociology or social work. People with those degrees can get better paying jobs that are less stressful.”
Morse employs 28 case managers. He has a budget of 40, and he says he can use 60 to 80 because the demand is so high. Each case worker serves approximately 100 people. The median salary is $40,000 per year.
“This is another reason why we have turnover,” he said. “The work is really very hard. The caseload should be around 40 to 50 because these are people who need a lot of attention. Due to the staff shortage, with a caseload of 100, the work is really changing. It changes your ability to respond to the needs of everyone you serve.”
Luke Church, a team leader for Thrive at MetroHealth Hospital, says the system definitely needs more people. “I don’t think it’s because of a lack of trying,” he said. The difficulty lies in finding the right people with the right background, qualifications, temperament and passion.
“It’s kind of a niche job market,” Church says. “With a shortage of employment on top of all those variables, I think it’s hard to find people. There just aren’t enough agencies that can even apply.”
Five peer counselors report to the church. “Two more people would make it more comfortable,” he said.
Paul Bolino, CEO of the nonprofit Community Counseling Center in Ashtabula County, is seeking 11 positions within his agency, representing a 10% staff shortage.
“We’re understaffed in multiple programs,” he said. “A lot has happened during the pandemic. As the stress increased, people made different choices and made some changes. We were not immune to the big reshuffle.”
Exhaustion is also a factor, he said.
“We also have a number of private practitioners in the area who are retiring,” he said. “They’re leaving the workforce, and it’s hard because when you’re dealing with commercial insurance that requires a higher license – an independent license – and years of experience, we’re not filling those positions fast enough. So when those providers leave the networks, leave the area or leave the workforce, the younger clinicians don’t have time to make up for that.
“We need to build up the skilled workforce,” he said.
To this end, his organization has started an internship program. He also points to a planned new social work program at Kent State regional campuses, including in Ashtabula.
“We said, ‘Let’s bring in people who are new to the field, that’s students, whether they’re traditional or non-traditional students. Let’s bring them in as interns, develop them into our system, and then we hope that through our involvement with them during that time they can stay and be part of our organization for the longer term,” he said.
Morse tries a similar tactic.
“We are looking at how we can be more present in the schools. To really promote this as a good career,” he said. “You can start as a case manager, then get your master’s degree and progress to a therapist. Then move on to management. It can be a good career for someone, not just a job We want to promote that.”
Even if the pipeline issues are resolved, salary will likely remain an issue.
“Of course there’s a point where if we could get the salaries high enough, I think it would be a more attractive job and we might have fewer vacancies,” Morse said.
“We need to continue the process of making these jobs attractive and paying them enough with solid benefits so that you can have a career in that position,” Bolino said. “There are just so many things at work. But if we don’t, we’ll serve fewer people, and I don’t think we can afford to do that with how heavy it is now.”
Ohio lawmakers also see the need. In May, Governor Mike DeWine announced that the state will commit $85 million to strengthen the behavioral health system. The money will be used to create scholarships and paid internships to attract new hires into the field.
“More options to pursue careers in behavioral health means more new clinicians to help patients in need,” said Teresa Lampi, CEO of the Ohio Council of Behavioral Health & Family Services Providers, during the announcement.
That’s welcome news across the state.
“It takes more than a village,” said Bolino. “It will take a state and more to deal with this.”
This story is part of the Northeast Ohio Solutions Journalism Collaborative‘s Making Ends Meet project. NEO SoJo consists of more than 18 news outlets in Northeastern Ohio, including: Eye on Ohioencompassing the entire state.