Guest Opinion: To pivot from community behavioral health crisis, state leaders must act

By Jeff Thomas, Jodi Daly and Tom Sebastian

Over the past three years, we’ve all faced COVID-related challenges that have caused serious disruption to our daily life and wellbeing. And across our communities, the impact is becoming increasingly evident.

More adults and children are suffering from anxiety, depression and other behavioral health disorders than ever before, and other concerns, such as homelessness, have evolved into crises.

As community behavioral health providers, we’re working tirelessly to address these concerns and connect those in need to care, but unfortunately, we’re also facing an entirely separate crisis that we cannot solve alone.

Community behavioral health is experiencing an unprecedented workforce shortage that has been building for years due to chronic underfunding. As demand for our services continues to increase, we’re unable to attract and retain enough mental health providers to keep pace with our communities’ needs.

It is a crisis that threatens the very health of our clients, our local economies and our partners across the social safety net.

Community behavioral health agencies serve low-income adults and youth who qualify for Medicaid benefits as well as provide crisis and inpatient services for all those in our communities. We address and de-escalate mental health crises and connect individuals to sustained supports, preventing trips to the emergency department or jail and supporting more efficient use of our law enforcement and hospital partners’ limited resources. Our services and programs help alleviate homelessness, support healthy families and assist individuals in living independently and gaining employment.

As needs have continued to rise, we’ve been resourceful in identifying opportunities to maintain access to care. However, the systemic challenges we’re confronting require more than innovation to overcome. We need the help of lawmakers.

Chronically low Medicaid reimbursement rates for community behavioral health services have left us unable to offer competitive compensation compared to large hospital systems, public sector entities and private practices, among others. We dedicate around $0.80 of every revenue dollar to salaries and benefits, and still, many behavioral health providers opt for higher pay elsewhere.

As a result, according to a member survey by the Washington Council on Behavioral Health, providers are recording a 19% vacancy rate across departments, with rates reaching 29% for master’s-level clinicians. On average, it is taking over eight months to fill critical staff positions.

These workforce shortages are directly impacting access to care. Statewide, an unprecedented 74% of providers either reduced access to services or closed programs altogether in 2022.

As providers, we’re doing everything we can to ensure our doors remain open. In Spokane, Frontier Behavioral Health recently launched our CARE Model, a redesigned, team-based approach to outpatient services that improves client access and maximizes staff capacity by opening new professional pathways for bachelor’s-level graduates who aspire to work in community behavioral health. But provider-led solutions like this are simply not enough.

We’re calling on Gov. Inslee and the Washington State Senate to join their colleagues in the Washington state House in supporting a 15% increase in Medicaid and non-Medicaid reimbursement rates for community behavioral health services. This stopgap measure will allow providers to take immediate action to address the workforce shortage and prevent complete erosion of our system.

It will also lay a foundation for longer-term solutions that better reflect the value that community behavioral health provides to our communities, such as the Certified Community Behavioral Health Clinic (CCBHC) model. Based on demonstrated success in more than a dozen states, we believe this innovative funding model is the key to a sustainable behavioral health system, but a multi-year process to implementation remains ahead of us.

We can all agree that it is paramount that we prioritize the mental health and wellbeing of our communities now – and fortunately, state lawmakers have a meaningful opportunity to take immediate action to make this a reality.

Jeff Thomas is the CEO of Frontier Behavioral Health based in Spokane; Jodi Daly is the CEO of Comprehensive Healthcare based in Yakima; and Tom Sebastian is CEO of Compass Health based in Everett.