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COLUMBUS, Ohio — Record demand and employee shortages are adding stress to Ohio’s already strained behavioral health system.
From 2013 to 2019, the demand for behavioral health services increased 353% statewide, according to data from the Ohio Department of Mental Health and Addiction Services. Demand spiked again in 2021, with providers reporting a 70% increase in need for adult and youth mental health services and a 60% increase in need for addiction services.
“Demand has definitely increased,” said Eric Morse, executive director of The Centers in Cleveland, a nonprofit organization that offers a variety of services including case management, counseling, psychiatric services and substance abuse treatment. “I was high before COVID, I think. COVID has made it even worse.”
There are many reasons for the shortage, mental health professionals said.
Workers and clients have gotten used to telehealth appointments, and it’s hard to get workers to want to return to private homes where much mental health care takes place, Morse said.
Low wages also discourage new people from entering the profession, and existing workers burn out as caseloads rise and are more likely to change careers or retire.
Justin Larson, who oversees support programs for Thrive, a peer-to-peer recovery service for those suffering from mental health or substance abuse disorders, said the pandemic hampered his ability to find new workers.
“Sometimes it’s been hard to find recovery partners who really want to work in a hospital,” especially during Covid spikes, he said. “It was a little difficult to get people to want to work in an environment where people who could be positive for Covid-19 were coming in.”
Higher demand and understaffing mean longer waits for services, which could be dangerous for patients.
“I can’t even imagine. That could be a potential death,” said Kelitha Bivens-Hammond, peer supervisor at Thrive. “Honestly, if we had to turn someone down, they could come back and use and overdose. That’s my first thought. This is a life or death situation.”
Bivens-Hammond knows firsthand how dangerous addictions and mental health issues can be. Before becoming a peer recovery counselor, she struggled with addiction. She started consuming alcohol at the age of 9. At 21, she began trying out treatment centers. After 27 attempts at sobriety over some 20 years, she received help from Thrive.
“I know that I would have died. I know that for a fact,” she said. “That’s where he was leading me. I had already been institutionalized. He had already been in jail. I had nothing left but to die.”
Bivens-Hammonds helps up to 10 people a day at Thrive’s location at St. Vincent Charity Medical Center in Cleveland. Thrive also has locations at MetroHealth, University Hospitals, the Cleveland Clinic, and other locations around the state.
The shortage of behavioral health services could add pressure to other systems, the Center’s Morse said. People may need to go to the hospital or visit an emergency room to receive services. If an incident occurs, the police may be called, leading to criminal charges or additional damage to someone’s mental health.
“We know statistically that the suicide rate and the overdose rate continue to get worse,” he said. “I would say that if we had a better ability to help people, those numbers would, I hope, go down. That would ultimately be what I hope for. If we had good access to healthcare, there would be fewer deaths.”
Recruitment and retention are the biggest hurdles to meeting demand, mental health care providers say.
“The number of providers wanting to get into the community behavioral health space continues to be a challenge,” Morse said. “The labor market is obviously very favorable for employees right now. Even though we have increased our salaries substantially over the last two years, we are still competing with jobs that are much less stressful than doing the work here. Particularly 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 that he can use 60 to 80 because the demand is so high. Each social worker cares for about 100 people. The median salary is $40,000 a year.
“This is another reason we have rotation,” he said. “The work is very, very difficult. The number of cases should be around 40 to 50 because these are people who need a lot of care. Due to staff shortages, the number of cases is 100, it really changes the job. It changes your ability to respond to the needs of everyone you serve.”
Luke Church, Thrive team leader at MetroHealth hospital, says the system definitely needs more people. “I don’t think it’s for lack of trying,” he said. The difficulty lies in finding the right people with the right background, credentials, temperament, and passion.
“It’s kind of a niche job market,” Church said. “With a job shortage on top of all those variables, I think it’s hard to find people. There just aren’t necessarily enough agencies that can even apply.”
Five fellow counselors report to the Church. “Two more people would make it more comfortable,” he said.
Paul Bolino, executive director of the nonprofit Community Counseling Center in Ashtabula County, is looking to fill 11 positions at his agency, representing a 10% labor shortage.
“We are short-staffed in several programs,” he said. “A lot of things happened during the pandemic. As the stress increased, people made different decisions and made some changes. We were not immune to the big shakeup.”
Wear and tear is also a factor, he said.
“We also have several private doctors in the area who are retiring,” he said. “They’re leaving the workforce, and that’s tough because when it comes to 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, younger doctors don’t have time to make up for that.
“We need to build the skilled workforce,” he said.
To that end, his organization has started an internship program. He also points to a new social work program planned at Kent State’s regional campuses, including Ashtabula.
“We said, ‘let’s bring in people who are new to the field, who are students, whether they are traditional students or non-traditional students. Let’s bring them in as interns, let’s develop them in our system, then hopefully through our engagement with them during that time we’ll get them to stay and be a part of our organization for the long term,’” he said.
Morse is trying a similar tactic.
“We are looking at how we can be more present in schools. Really market this as a good career,” she said. “You can start as a case manager, then get your master’s degree, then go on to be a therapist. Then go 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 is likely to remain an issue.
“Obviously, there is a point where if we could get the salaries high enough, I think it would be a more attractive job and maybe we would have fewer openings,” Morse said.
“We have to continue the process of making these jobs attractive and making them pay enough with solid benefits that you can have a career in that position,” Bolino said. “There are 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 things are right now.”
Ohio lawmakers also see a 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 employees to the field.
“More options to enter behavioral health careers will mean more new doctors to help patients in need,” said Teresa Lampi, executive director of the Ohio Council of Behavioral Health and Family Service Providers, during the announcement.
That’s good news statewide.
“It will take more than a town,” Bolino said. “It will take a state and beyond to address this.”
This story is part of Northeast Ohio Solutions Journalism CollaborativeThe project Make ends meet of . NEO SoJo is comprised of more than 18 Northeast Ohio news outlets, including Eye on Ohiothat covers the entire state.