Last year, public health officials warned that the coronavirus pandemic would likely lead to a spike in demand for mental health services. New data in Vermont shows that prediction is bearing out.
But that uptick in need comes as mental health agencies contend with an unprecedented workforce shortage.
Some experts say Vermont’s community mental health system is on the verge of a “catastrophe.”
Champlain Community Services sits in an old brick building at Fort Ethan Allen in Colchester.
The organization was founded in 1967, as part of a movement to de-institutionalize people with intellectual disabilities.
"I’m not exaggerating to make a point. This is close to catastrophe, I think, statewide, potentially, for the frontline service delivery.”Beth Sightler, executive director, Champlain Community Services
Until as recently as 2002, Vermonters with disabilities would go there to do manufacturing work, in what were known as “sheltered workshops.”
Beth Sightler is the organization's executive director.
“It was this site, downstairs … [where] people did, like, piecemeal work, and were paid by the piece, and were paid not a lot of money,” Sightler said, on a recent visit. “But it was safe and it was comfortable.”
The organization has evolved its mission since then. And now, Champlain Community Services helps its clients get – and keep – more meaningful jobs out in the real world:
“For the people in services to have opportunities to really engage in the community and, like, be truly participating, not, like, [a] token, but to truly participate and belong …” she said.
Over the course of her career in the human services field, Sightler has learned to make do with limited resources. But she says the current staffing shortage at CCS is threatening its ability to fulfill its mission.
Of 40 frontline direct support positions at CCS, half are vacant.
“You know, I don’t want to be … I’m not exaggerating to make a point,” she said. “This is close to catastrophe, I think, statewide, potentially, for the frontline service delivery.”
Vermont’s well-documented worker shortage is cramping operations at businesses of all types right now.
But the staffing shortage is especially problematic for the 16 community-based agencies that were created to provide mental health services and substance abuse treatment in Vermont.
Julie Tessler is the executive director of the organization Vermont Care Partners.
“Can you imagine being a child in psychiatric crisis, stuck in an emergency department with those bright lights?” she asked. “It’s just not a place you want for anyone to be: in psychiatric crisis, waiting in an emergency room.”
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According to Tessler, that exact scenario is playing out across Vermont, as a result of the staffing shortage at community mental health agencies.
A decade ago, Vermont decided to reduce the number of inpatient psych beds in the state, and funnel more money into the community mental health system.
The idea was that the state could curb the need for inpatient admissions by treating patients before their conditions deteriorated to the point of needing hospitalization.
The system needs staff to provide those supports though. And of the 5,000 positions across the system, Tessler says more than 800 are vacant.
“So, it’s really affecting people’s lives, when we don’t have the staff to provide the service and when staff turn over quickly,” she said.
Those staffing vacancies mean that hundreds of Vermonters in need of mental health services are stuck on waiting lists. And lack of access to care means lots of them end up in emergency rooms, where they wait for days or even weeks in some cases for an inpatient bed to open up.
“The highest waitlist I can recall in my 30 years at Washington County Mental Health has been 60 people waiting on a waitlist for outpatient therapy services, and it’s at about 120 right now."Mary Moulton, executive director, Washington County Mental Health
This is not a new problem, but health care providers say it’s gotten worse in recent months.
Tessler says the staffing shortage has had an especially detrimental effect on children’s services.
“[For] children in particular, this has been a really rough year – being isolated, not being able to go to school in the normal ways …” she said. “So, for us to not be able to fully staff our school-based services and children- and youth-based services is having a really negative impact on the children and youth we serve.”
At Washington County Mental Health, executive director Mary Moulton says she’s short 80 positions right now. And Moulton says the situation is deteriorating rapidly.
“The highest waitlist I can recall in my 30 years at Washington County Mental Health has been 60 people waiting on a waitlist for outpatient therapy services, and it’s at about 120 right now,” Moulton said.
Moulton said there are lots of reasons agencies are having trouble finding workers, including lack of childcare and affordable housing. But she says pay is likely at the top of the list.
New mental health workers start out at a little under $15 an hour.
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Community mental health agencies, which rely largely on Medicaid reimbursement rates that are set by the state, got a 3% cost of living increase in the state budget this year.
But that’s a far cry, Moulton says from what they’d need to compete pay-wise with private mental health institutions, for example, or even the Department for Children and Families.
“In fact, some of our analysis has shown that that’s a 25%-plus increase,” she said.
And if Vermont wants to solve the staffing crisis, Moulton says, it’s going to have to fundamentally reconsider how it pays for mental health.
“So Vermont’s got to be bold,” she said. “If it’s serious about this — getting upstream and making the workforce strong … it’s got to get serious about shifting the dollars.”
The Vermont Agency of Human Services says the situation is every bit as dire as the community mental health agencies say it is.
And about a month ago, Cheryle Wilcox, planning director at the agency, created a new taskforce to address the problem.
"Vermont’s got to be bold. If it’s serious about this -- getting upstream and making the workforce strong … it’s got to get serious about shifting the dollars.”Mary Moulton, executive director, Washington County Mental Health
“And so, we’re looking at things like how do we support programs like tuition reimbursement and loan repayment – those are huge issues for folks that work at the mental health agencies,” Wilcox said.
Alison Krompf, the incoming deputy commissioner at the Department of Mental Health, says Vermont is also in the midst of a broader health care reform initiative that will ultimately reconfigure how providers are reimbursed for providing care.
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“And they do it at a low cost, in comparison to other health care organizations," she said. "And so how do we capture that value and then make sure we are valuing it appropriately?”
Krompf says that process will include a reevaluation of how much money community mental health agencies get for the work they do.
Have questions, comments or tips? Send us a message or get in touch with reporter Peter Hirschfeld @PeteHirschfeld.
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