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COLUMBUS, Ohio – Unprecedented demand and a lean employee pipeline 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 increased 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 is definitely increasing,” said Eric Morse, CEO of The Centers in Cleveland, a non-profit organization that offers a range of services, including case management, counseling, psychiatric services and substance abuse treatment. “It was high before COVID, I think. COVID has just made it even worse.”
There are many reasons for the shortage, mental health professionals said.
Workers and clients got used to telehealth appointments, and it’s hard to get workers to want to return to private homes, where much of the mental health care takes place, Morse said.
Low pay also discourages new people from entering the profession, and existing employees burn out as caseloads increase and are more likely to change careers or retire.
Justin Larson, who oversees support programs for Thrive, a peer recovery service for those suffering from mental health or substance abuse, said the pandemic hindered his ability to find new workers.
“Sometimes it’s been difficult to find peer recovery supporters who actually want to work in a hospital,” especially during Covid peaks, he said. “It was a bit difficult to get people to want to work in an environment where people came in, which can be positive for Covid-19.”
Greater demand and a lean staff mean longer waiting times for services, which can be dangerous for patients.
“I can’t even imagine. It could be a potential death,” said Kelitha Bivens-Hammond, a peer supervisor at Thrive. “Honestly, if we were to turn someone away, they could go back and use 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 21, she started trying treatment centers. After 27 attempts at sobriety over about 20 years, she got help from Thrive.
“I know I would be dead. I know that,” she said. “That’s where I was going. I had already been institutionalized. I had already been to prison. There was nothing left for me but to die.”
Bivens-Hammonds helps up to 10 people a day at Thrive’s location in St. Vincent Charity Medical Center in Cleveland. Thrive also has locations at MetroHealth, University Hospitals, the Cleveland Clinic and elsewhere in the state.
Lack of behavioral health services can put pressure on 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 further damage to a person’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 better capacity to help people, those numbers – I hope – would go down. Ultimately that would be what I would hope. If we had good access to health, there would be fewer death.”
Recruitment and retention are the biggest obstacles to meeting demand, mental health care providers say.
“The number of providers who want to enter the community behavioral health space is still a challenge,” Morse said. “The labor market is of course very employee-friendly right now. Even though we’ve increased our pay pretty significantly over the last two years, we’re still competing with jobs that are definitely a lot less stressful than doing the work here. Especially among case managers, where we typically employ people with a bachelor’s degree in psychology, sociology or social work. People with these degrees can get higher paying jobs that are less stressful.”
Morse employs 28 caseworkers. He has budgeted for 40, and he says he can use 60 to 80 because the demand is so great. Each case manager serves around 100 people. The median salary is $40,000 annually.
“This is another reason we have turnover,” he said. “The task is really, really tough. The caseload should be around 40 to 50 because these are people who need a lot of attention. Because of the lack of staff, when the caseload is 100, it really changes the work. It changes your ability to respond to the needs of all 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 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 lack of employment on top of all those variables, I think it’s hard to find people. There’s just not enough bodies that are necessarily able to apply.”
Five peer advisors report to the Church. “Two more people would make it more comfortable,” he said.
Paul Bolino, executive director of the non-profit Community Counseling Center of Ashtabula County, is looking to fill 11 positions across his agency, representing a 10% workforce shortage.
“We are short staffed in several programs,” he said. “A lot happened during the pandemic. As the stress arose, people made different choices and made some changes. We were not immune to the big adjustment.”
Attrition 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 difficult 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 these providers leave the networks, leaves the field or leaves the workforce, the younger clinicians don’t have time to figure it out.
“We need to build the educated workforce,” he said.
To that end, his organization has started an internship program. He also points to a planned new social work program at Kent State’s regional campuses, including in Ashtabula.
“We said, ‘let’s bring in people who are new to the field, meaning students, whether they’re traditional or non-traditional students. Let’s bring them in as interns, develop them in our system, and then hopefully through our engagement with them during that time makes them stick around and be a part of our organization for the long term,” he said.
Morse tries a similar tactic.
“We are looking at how we can be more present at the schools. To really hype this as a good career,” he said. “You can start as a case manager, then get your master’s degree and then progress to being a therapist. Then enter management. It can be a good career for someone, not just a job. We would like to promote that.”
Even if the pipeline issues are resolved, wages are likely to remain an issue.
“Obviously there’s a point where if we could get the wages high enough, I think it would be a more appealing job and maybe we’d have fewer vacancies,” Morse said.
“We need to continue the process of making these jobs attractive and making them pay enough with solid benefits so you can have a career in that position,” Bolino said. “There are just so many things at work. But if we don’t, we’re going to serve fewer people, and I don’t think we can afford that with how heavy things are right now.”
Ohio lawmakers also see the need. In May, Gov. Mike DeWine announced that the state will commit $85 million to strengthen the behavioral health system. The money will be used to set up grants and paid internships to lure new employees into the field.
“More opportunities to enter a career in behavioral health will mean more new clinicians to help patients in need,” said Teresa Lampi, CEO of the Ohio Council of Behavioral Health & Family service providers, during the announcement.
This is welcome news around the state.
“It’s going to take more than a village,” Bolino said. “It’s going to take a state and more to fix this.”
This story is part of the Northeast Ohio Solutions Journalism Collaborative’s Making Ends Meet project. NEO SoJo is composed of 18-plus Northeast Ohio news outlets, including Eye on Ohio, which covers the entire state.
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