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ideastream Focus on Mental Health: Are the Bases Covered? Staffing in Community Mental Health

Wednesday, April 30, 2003 at 3:13 PM

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As Cuyahoga County's Health and Human Services levy draws near, people who work in mental health have a lot on their minds. Funding for their field is in shaky condition. Many are concerned about whether staffing levels are adequate to meet demand. ideastream's April Baer reports.

A study by the Ohio Council of Behavioral Healthcare Providers finds that the average caseworker with a B.A. was making $26,000 per year. in 2002. Mental health work is not the kind of job people take for the money. People who DO choose the profession say there’s a lot more to it.

This is the city’s psychiatric emergency room at St Vincent Charity Hospital. Carrie Bohm, the manager of psychiatric services is having a busy day. Over the course of a few hours, the police make repeated visits, bringing in people who’ve been exhibiting dangerous symptoms in public. Not every case is a hair-raiser, but Carrie and her staff have to be ready for anything.

At one point, a woman being checked in begins raising her voice. Someone else is triaging the patient. But Carrie drops what she’s doing, and makes herself available, standing just a few feet away, ready to step in if she’s needed. When things calm down, she’s away to another patient, trying to coax the sleeping woman to get out of bed for a minute.

Carrie says things could be worse. The other day a patient attempted to leave by riding his bicycle around the ward. Josephine Jones is the director of Emergency and Ambulatory services at the psych E.R. Over the years, she says, trends in mental health have changed, but one thing remains a constant.

Josephine Jones: Behavioral health generally is less well paid than other health care providers. I think if you are a social worker or a nurse that goes into behavioral health, particularly if you’re working in a county program or working at a center, you’re going to make several dollars an hour less than a nurse, who’s providing the same important care in a med surg (sic) facility.

Jones notes there was a time when mental health work was accomplished primarily through unpaid labor - nuns and other volunteers. Now that’s changed, but she says the pay has not quite caught up with the rest of the medical industry. She also believes that some people shy away from mental health work, simply because they’re afraid of the illness itself.

Concerns have been raised about other professions as well. Dr. Robert Ronis is vice-chair for Education and Director of Public Psychology at Case Western Reserve University’s School of Medicine. He says the days of government subsidies for psychiatric residencies are over.

Robert Ronis: Probably the last two decades and certainly the last decade, the emphasis has really been on primary care and psychiatry lost the battle to be considered one of the primary care specialties. So additional funding went to some universities and so some programs to support residency training in family medicine, internal medicine, OB/GYN and pediatrics, but psychiatry residencies and some other areas that are considered sub-specialties are not as well supported.

The shortage is felt keenly in rural areas and especially in big cities. Ronis helped found a Public Academic Liason or PAL program, to encourage more psychiatrists to choose community mental health.

Robert Ronis: Some of the things that discourage trainees from public sector careers are: feeling burned out, feeling overwhelmed by numbers, by severity of the illnesses they’re exposed to and feeling isolated. So we work very hard right from the beginning to make sure that this was an experience where residents had support of the supervision but were also getting a sense of what it was like to work as part of a multi-disciplinary team. That they are not alone. They are working with case managers, social workers, psychologists, nurses.

In child psychiatry, Ronis says, the pickings are even slimmer. According to the American Academy of Child and Adolescent Psychiatry, more than 20% of child and adolescent psychiatry residency positions were unfilled in 1999. Dr. Ronis says officials should be very concerned about how high turnover and staffing shortages in all mental health professions.

Robert Ronis: There’s a tremendous amount of evidence that assertive community treatment, which is working with very small case loads perhaps 12 clients to a case manager, are extremely effective in keeping people out of the hospital, but there’s no evidence that having a caseload of 50-60 clients a case manager provides anything of any effectiveness. But that’s what we put our money into because we have the sense that somehow we can afford that, but we can’t afford the other.

Observers have suggested staffing in mental health may be a problem requiring multiple solutions. Community-based agencies are always looking for more revenue to bolster their hiring and retention. University Hospitals Health System has started a program recently to attract more residents to child psychiatry. Some unions say that to raise pay and improve benefits, more workers must be organized. The Service Employees International Union local 1199, already represents workers in several parts of town, and wants to organize more. The union has been involved in heated negotiations with nine mental health agencies, seeking a pledge of non-interference for organizing efforts. The dispute was deemed so important that the union has taken a stand against the County’s upcoming Health and Human Services levy. In Cleveland, I’m April Baer, 90.3.

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