Vermont's mental health agencies worry staffing shortages are reaching 'point of no return'
A “mass exodus” of frontline workers at community mental health agencies across Vermont has curtailed access to services and intensified concerns about the health care system’s capacity to provide timely treatment for psychiatric conditions.
Of the 5,000 positions at Vermont’s 16 nonprofit, publicly-funded community mental health organizations, 970 are now vacant, according to officials tracking the issue.
Beth Sightler, executive director at Champlain Community Services in Colchester, told VPR in July that staff vacancies at her organization were threatening its mission to support people with developmental disabilities.
“I’m not exaggerating to make a point: This is close to catastrophe I think statewide for the frontline service delivery,” Sightler said in July.
In a follow-up interview in November, Sightler said the situation is more dire now than it was in the summer.
“What’s happened over the past couple of months … is almost spooky, you know?” Sightler said. “It’s kind of a mass exodus.”
"What I don’t know is, if we’ve passed the point of no return."Beth Sightler, Champlain Community Services
At Champlain Community Services, the vacancy rate among frontline workers has now exceeded 50%, and Sightler said she has 17 workers trying to support about 85 clients.
“You don’t want to admit that maybe things aren’t going to be OK,” Sightler said. “But the reality is, is that it’s a really critical point, and I have concerns about people’s safety that I haven’t had before.”
The staffing problem is not unique to CCS. And Sightler, as well as directors of other mental health agencies in Vermont, say the state is on the cusp of irreversible damage to its mental health infrastructure.
“I said [in July] that it could be a catastrophe, and I think we’re probably there,” Sightler said. “What I don’t know is, if we’ve passed the point of no return.”
The problem has become so acute that mental health organizations formally asked the Scott administration to mobilize the Vermont National Guard to fill direct-support positions at the hardest hit mental health agencies.
Commissioner of Mental Health Alison Krompf told VPR that the agency denied that request, in part to avoid exacerbating workforce challenges at organizations that employ Guard members.
“When you deploy the National Guard … you may be pulling from say the emergency department, specifically physicians from the emergency department, or I know at our own state hospital we have National Guard members," Krompf said. "So we’re pulling those folks from say an inpatient psychiatric facility, to then go work elsewhere, and it can end up destabilizing other mental health programming."
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Last month, Human Services Secretary Mike Smith allocated $2 million in emergency funds to “stop the bleeding” at mental health agencies, Kromp said, by offering retention bonuses and other financial incentives to community mental health workers.
Julie Tessler, executive director of Vermont Care Partners, said mental health agencies are grateful for the aid.
Tessler, however, said meaningfully addressing the staffing “crisis” will require more substantial investment in the system of designated agencies and social services agencies that form the backbone of Vermont’s community mental health system.
“And we honestly believe we need something like $80 million — it’s a $500 million system of care — to bring our rates to the level that we could provide the compensation that would truly recruit and allow us to retain staff,” Tessler said.
"I have staff members who are receiving food subsidies and fuel subsidies, so it’s increasingly hard to recruit people into a really important and meaningful line of work."Rachel Cummings, Counseling Service of Addison County
At Counseling Service of Addison County, executive director Rachel Cummings said low pay for frontline workers is the biggest hurdle to hiring and retention.
She said many of her employees live in a local subsidized housing complex.
“I have staff members who are receiving food subsidies and fuel subsidies, so it’s increasingly hard to recruit people into a really important and meaningful line of work just because we can’t keep up with what it takes to be middle class and make a living in this state,” Cummings said.
Cummings said she’s managing a 15% vacancy rate across the agency.
She said some departments, however, are more pinched than others. The agency’s 24/7 emergency service program, for example, is staffed by a total of six people, four of whom are mothers with young children.
“I really worry that this work isn’t valued. I worry that … mental health and mental wellbeing isn’t a priority and a value, and that we’re still … chasing illness versus really supporting people to live active and engaged and connected lives in the community,” Cumming said.
Tessler said wait lists for mental health counseling have can destabilizing effects on the broader health care system.
“We don’t have fully-staffed emergency service teams and mobile crisis response, so we’re not there meeting people’s needs in crisis to the extent that we should be,” Tessler said. “And … what that means is that then people end up in the emergency room.”
Officials at the University of Vermont Medical Center recently cited the “mental health crisis” as one major reason for inpatient capacity shortages at the state’s largest hospital.
Krompf said the concerns raised by Sightler, Cummings, Tessler and others are valid.
“Wait lists for ongoing services for adults and for children have been increasing,” she said.
Krompf said her agency is examining ways to boost financial support for community mental health agencies, but said the administration hasn’t landed yet on a final budget package. And while pay increases for frontline workers are likely an essential component of any workforce solution, she said the state also needs to be wary of unintended consequences.
“Unfortunately, if you stabilize in one area or incentivize recruitment in one area, you end up shifting the same workforce away from one thing and into another,” she said. “And so we need to be really careful about how we’re applying these incentive programs, so that we don’t end up disincentivizing other staffing, because staffing’s an issue across the entire state.”