By Jeff Thomas, Jodi Daly and Tom Sebastian
If there were any remaining doubts that mental health is fundamental to health itself, the pandemic has erased them. Over the past year, we’ve all felt the intrinsic connection between physical and mental wellness. Decades of research bears this out, and even the most recent COVID-19 studies show that nearly one-third of virus survivors suffer from lingering neurological and psychiatric issues.
Now, as we collectively address and recover from the aftermath of daily stressors, social isolation and economic turmoil, it’s critical that we all recognize another fundamental truth: What is good for community behavioral health is good for our community.
Alarmingly, our community behavioral health system is in crisis. We cannot hire and retain enough mental health professionals to meet demand for our services, and it’s putting the health of our communities at risk.
State lawmakers must step up with changes to community behavioral health funding to ensure providers can continue to fill our vital roles. We act as a lifeline for the mental and physical health of our most vulnerable community members, ease strain on other community partners such as hospitals and law enforcement and serve as an economic stimulator by supporting productivity among those we serve and as large employers ourselves.
As leaders of three of the largest community behavioral health providers from Puget Sound to Spokane County, we and our peers provide an array of mental health and substance use treatment services to low-income and homeless adults and families who qualify for Medicaid benefits. We keep individuals and families in homes, and kids in school. Our work enables clients to achieve mental wellness and recovery, to raise families, excel at work and contribute to their communities.
In Spokane County alone, Frontier Behavioral Health cares for more than 7,000 adults and youth every month, with approximately 5,000 of those individuals served in outpatient programs.
Across Washington, pandemic-related increases in demand combined with reduced capacity is creating a perfect storm, thanks to longstanding workforce shortages which have only continued to worsen.
Statewide, the community behavioral health workforce is down by 11% over the past year and eight treatment facilities and clinics have been forced to close, according to a member survey by the Washington Council for Behavioral Health. Survey data indicates it takes an average of five months to fill certain critical positions and reflect general staff vacancy rates of 13%. Some agencies independently report vacancies as high as 26% for clinical staff positions.
The crux of the issue: chronic underfunding of community behavioral health prevents agencies from providing competitive compensation to mental health professionals. Community-based providers dedicate nearly 80 cents of every revenue dollar to salaries and benefits for clinicians and other team members, but we cannot compete with the salaries and benefits available through private practice, large hospital systems, state or federal government programs and even new telehealth-based providers serving clients out of state.
Fortunately, Frontier Behavioral Health has not had to shutter programs, but staff vacancies are placing tremendous additional stress on the dedicated team members who remain. Caseloads are swelling and workloads are higher, contributing to staff burnout and further increases in staff turnover.
When our most vulnerable community members cannot access behavioral health services, it leads to downstream effects across the system, including trips to the emergency department, hospitalizations and incarcerations. When we don’t operate at capacity, it strains the limited resources of our hospital and law enforcement partners and leads to more intensive and expensive care – with worse outcomes for those we serve.
There are solutions that will bolster our communities and encourage positive outcomes. First, we ask state lawmakers to support a proposed 7% increase in Medicaid reimbursement rates for community behavioral health services. While not enough to entirely close the gap, this would be a significant step toward attaining a level of payment parity that would support agencies in attracting and retaining mental health professionals and prevent threats to system capacity in the near term.
Looking ahead, there are a multitude of opportunities and models to strengthen community behavioral health. For example, when state leaders allot COVID federal relief funding in the coming weeks, equitable distribution to community behavioral health providers is one of the many solutions that could help us keep pace with needs as we look to implement long-term solutions.
A successful community behavioral health system supports the mental and physical health of our community members and alleviates burdens across our state and local systems of care. With sustainable funding, we can ensure the good of the community for years to come.
By Jeff Thomas, CEO, Frontier Behavioral Health; Jodi Daly, CEO, Comprehensive Healthcare; and Tom Sebastian, CEO, Compass Health – members of Fourfront Contributor, an advocacy and leadership collective of four of the largest community behavioral health agencies in Washington.
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