Senate lawmakers say low pay for mental health workers has led to a bottleneck in crisis care, and they’re trying to find funding to boost wages for more than 2,000 employees across the state.
Demand for mental health services in Vermont well exceeds capacity, and some patients languish for days in emergency rooms while they wait for space in open up in a psychiatric facility.
Lawmakers say a shortage of workers in the community mental health system is at the root of problem, and the officials who run the system say they have statistics to support that diagnosis.
“At Washington County [Mental Health Services], we have had 90 vacancies over the past several months. I’ve had 100 percent turnover in case managers,” says Mary Moulton, the executive director of the agency.
At Rutland Mental Health Services, according to CEO Dick Courcelle, “we have right now about a 23-, 24-percent turnover rate every year.”
“Right now,” Courcelle says, “we have 63 vacant positions across our agency.”
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George Karabakakis, the CEO at Health Care and Rehabilitation Services of Southeastern Vermont, says he’s carrying 48 vacancies.
“And it’s a challenge,” Karabakakis says.
"[The] system is on the verge of collapse unless we really address workforce stabilization." — Dick Courcelle, Rutland Mental Health Services CEO
The job vacancies and turnover rates at those three organizations are symptomatic of a broader problem across the community mental health system.
There are 11 so-called “Designated Agencies” scattered across Vermont. These are the community-based organizations that provide mental health services in a given region. And according to the trade association that represents designated agencies, statewide there are more than 400 unfilled positions at any given time.
“And we simply can’t keep up,” Moulton says. “We could do more work to help the crisis of getting people out of emergency rooms if we could stabilize our workforce.”
It’s a longstanding problem in the system, and one that Senate lawmakers say they’re committed to solving this year. Addison County Sen. Claire Ayer, the Democratic chairwoman of the Senate Committee on Health and Welfare, says her committee has spent the first part of this session scrutinizing the mental health shortage in Vermont.
“The single biggest issue is that the people in the community who are supposed to be providing these supports, doing these diagnoses, providing the crisis teams, are underpaid,” Ayer says.
"The people in the community who are supposed to be providing these supports, doing these diagnoses, providing the crisis teams, are underpaid." — Sen. Claire Ayer, Senate Committee on Health and Welfare chairwoman
Ayer’s committee passed a bill last week that would deliver pay raises to about 2,400 community mental health workers. The legislation calls for a $15 base wage for all mental health workers, as well a pay hike for more senior-level staffers who make less at designated agencies than they would in comparable jobs at hospitals or working for the state.
That wage gap can be severe. Pay for crisis clinicians at designated agencies, for example, is $14,000 below market rates.
“I think the idea is that these dollars can help support an investment in catching people before they fall over the precipice,” Karabakakis says.
And that’s the overriding principle behind the plan: By strengthening community-based interventions, lawmakers can lower the number of people requiring more intensive, hospital-based care.
Achieving the pay scales sought in the Senate bill won’t come cheaply, however. Preliminary estimates peg the payroll increase at more than $30 million a year, and lawmakers are now on the hunt for the money needed to fund it.
Senate President Pro Tem Tim Ashe says his chamber isn’t looking to new revenues to create the capacity.
“The question is whether there are dollars being paid in the system today that could be directed to what we view as a larger priority,” Ashe says.
"The question is whether there are dollars being paid in the system today that could be directed to what we view as a larger priority." — Senate President Pro Tem Tim Ashe
Among the funding sources under consideration is to divert money sent to hospitals to provide free care to uninsured patients.
Caledonia County Sen. Jane Kitchel, the Democratic chairwoman of the Senate Committee on Appropriations, says increased investments in community-based care might yield downstream savings in hospitals and correctional facilities. The question is whether lawmakers can preemptively book those savings to pay for the higher wages.
“We’re not at the point of having that finished. But that’s the work that’s currently underway by our fiscal staff,” Kitchel says.
Courcelle says the stakes are high, since the state’s entire mental health system is based on the effectiveness of designated agencies that employ more than 13,000 people across the state.
“That system is on the verge of collapse unless we really address workforce stabilization. First and foremost, that is what we must do,” Courcelle says.
Kitchel says her committee hopes to resolve some of the outstanding budget questions as early as this week.
This post was edited at 10:12 a.m. on 3/23/17 to correct the name of the executive director of Washington County Mental Health
