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Ohio's mental health system 'in crisis' due to worker shortage

Counselor and patient
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Those seeking behavioral health support in Northeast Ohio may face increased wait times because of a worker shortage. Industry leaders say they're working to fix that.

Ohio’s behavioral health system is in dire need of more counselors, psychologists and other behavioral health workers to meet the surge in demand for mental health and addiction services and relieve wait times that have lengthened in recent months, industry leaders say.

The state’s behavioral health system is struggling to deal with a sharp increase in demand for services at the same time it has been struck with a worker shortage that is affecting industries across the country.

“We’re in crisis,” said Lori Criss, the director of Ohio’s Department of Mental Health and Addiction Services (OhioMHAS). “The increased demand for mental health and addiction services is far outpacing the available supply of the professionals and paraprofessionals who deliver those services.”

Lori Criss, the director of Ohio’s Department of Mental Health and Addiction Services (OhioMHAS)
Lori Criss, the director of Ohio’s Department of Mental Health and Addiction Services (OhioMHAS)

The gap between supply and demand is causing lengthy wait-times to see a provider, a shortage in supervised crisis beds across the state and an inability to maintain partnerships between key collaborators that help connect Ohioans in crisis to the help they need.

OhioMHAS study showed that even before the pandemic, the industry struggled to meet demand.

  • Between 2013 and 2019, more than one in five Ohioans lived with a mental health or substance use disorder.
  • Over the same period, demand for behavioral health services increased 353% while the workforce only grew 174%.
  • Nearly 2.4 million Ohioans lived in communities without enough behavioral health professionals.

These striking figures, published in 2021, don’t factor in the effects of the pandemic, which began in 2020. Experts say COVID-19 made an already dismal situation exponentially worse.
“The behavioral health system has never really had as much workforce as needed but the extreme disparity after the pandemic is beyond anything I’ve seen,” said Criss.

To address the shortage, agencies and providers across Ohio are embracing investment, innovation and creativity in the hopes of providing Ohioans with the care they need when they need it.

Governor DeWine’s $85 million plan

In May, Ohio Gov. Mike DeWine announced a $85-million-dollar partnership between OhioMHAS and various institutions of higher education across the state.

The plan seeks to increase the number of future behavioral healthcare workers in the pipeline by supporting paid internships and scholarships for students working to attain behavioral health certifications and degrees, according to amedia release.

“When we first approached higher ed [leaders], we were met with such enthusiasm for this proposal that it really was inspiring,” Criss said.

The plan also will help remove financial barriers to obtaining the licenses, certifications and exams that are required for employment in mental health fields, the release said. The funding will be used to establish an Ohio Technical Assistance Center to help students navigate the state and federal funding opportunities available to them and help them plan and budget to repay their loans, according to Criss.

The tricky part is convincing prospective students to pursue a career in behavioral care. That means getting into high schools and middle schools to help younger people understand that mental health and addiction care has positive aspects that don’t often get highlighted, said Criss.

“We need to really focus on the opportunity to help others and how behavioral healthcare support people pursuing living their best lives,” Criss said.

Staffing the Beds

Scott Osiecki, the chief executive officer for the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County, agrees it’s important to attract new behavioral health workers, but he said it is equally important address some of the reasons people leave the field.

Scott Osiecki, the chief executive officer for the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County
Scott Osiecki, the chief executive officer for the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County

Osiecki said he has heard directly from many professionals who report that the training and pay they are receiving are not adequate in the face of the stress and trauma they shoulder in the field.

“People are coming out of college with a huge amount of debt and making less than they could at a supermarket where they would experience far less stress,” Osiecki said. “It isn’t surprising that there is an exodus in the field.”

That contributes to the worker shortage and longer wait times, Osiecki said, pointing to the crisis beds in their facilities at Applewood, Bellefaire JCB and OhioGuidestone.

Throughout the past few years, there have been waitlists for youth ages 8 through 17 to access these highly supervised spaces for intensive, individualized and short-term therapeutic services.

In 2019 and 2020, the vast majority of people on the waitlists – 70% and 85% respectively – were waiting because of difficulties finding the appropriate facility for the age and gender of the youth in crisis. Less than a third of patients were put on the waitlist were there due to an inability to staff the crisis beds.

By 2021, however, the problem was staffing. Nearly two-thirds of those on the waitlist were unable to get a bed because there weren’t enough people to staff the facilities.

“These agencies just can’t run at full capacity because of the shortage,” Osiecki said.

Although he stresses that there isn’t a quick fix, Osiecki said the ADAMHS Board has begun addressing the financial pressures on those entering or already working in the field. This includes increasing salaries, providing signing bonuses and analyzing various methods of paying people an overall higher wage, he said.

Like OhioMHAS, the ADAMHS Board is also looking at the pipeline, creating videos for grade-school and high-school students to highlight the vast range of positions available in behavioral healthcare. Providers have joined forces to create a taskforce to help provide paid internships for students.

Hopefully, these efforts bear fruit, Osieki said, because demand is not expected to let up.

“Calls for crisis support are only going to increase,” he said. “We have to get more staff in the door to better meet the needs of our community.”

When demand is a good thing

Although the increase in demand for mental health services has strained the system, some providers say the demand itself is a positive development in the field in behavioral healthcare.

“We have really expanded the acceptance of mental healthcare, particularly within stigmatized communities,” said Allyse Hawkins, clinical director of Oriana House.

Oriana House provides community corrections services for individuals who have been involved in the criminal justice system. This includes mental health and substance use counseling, cognitive skills training and other wraparound services for individuals in halfway houses, community-based correctional facilities, drug courts or any other environment in which clients are not incarcerated.

Hawkins explained that many of Oriana House’s clients have experienced negative side effects of Ohio’s shortage of behavioral healthcare workers.

“The shortage has affected everything from how quickly we can complete an assessment, to when people can get started in treatment, to how long they have to wait to get into a group,” Hawkins said.

To help clients access services more quickly, Oriana House has had to think outside the box to present their services in a different way, she said.

Previously, group classes — like substance use, anger management, grief or trauma groups — were closed, which meant that the cohort with whom you started the group was the same cohort you ended with a few months later. If individuals relapsed or couldn’t make a session, they were generally not able to stay in the group.

Now those rules have changed.

“We’ve opened up all of our groups to keep a steady flow of people coming in,” Hawkins said. “This also means that one provider can see eight people an hour, instead of only one.”

Oriana House has also embraced telehealth as a counseling option. Although no-shows are a regular and expected occurrence for behavioral health appointments, the current system cannot spare a provider with an hour free because it was reserved for someone who didn’t show up. Now, when individuals reach out to say they can’t make an appointment, they are quickly sent a link to connect them virtually to a counselor.

“The key for us is getting creative without ever sacrificing the level of quality that our clients so desperately need from their providers,” Hawkins said.

Immediate Support

Clients facing long waits have been forced to embrace creative solutions to weather the time gap before they are able to find professional support.

Archie Green, a Cleveland-based mental health advocate and “Neighborhood Cope Dealer,” wants Ohioans to know there are a ton of tools at their disposal to navigate those in-between times.

Archie Green, a Cleveland-based mental health advocate and “Neighborhood Cope Dealer,” wants Ohioans to know there are a ton of tools at their disposal to manage the wait for behavioral health services.
Archie Green
Archie Green, a Cleveland-based mental health advocate, says there are tools that can help manage the wait for behavioral health services.

“Free guided meditations online, physical activity to get your endorphins up and watching what you put into your body are all things that you can do every day,” he said.

A talented hip-hop artist, Green also highlights the power of music as a powerful coping strategy for those experiencing crisis.

“I put together playlists to speak to how I feel, whether that’s angry, happy, sad or celebrating,” Green said. “Those playlists can help people tap into their emotions or express themselves.”

Although some are experiencing wait times, those in acute distress can call Ohio Care Line, which individuals can access by dialing 800-720-9616 or texting “4hope” to 741741. Those in crisis will immediately be able to connect to a professional who can help connect them to resources in their area.

“Sometimes just that conversation alone can be helpful and reassuring,” said OhioMHAS’ Lori Criss.

Criss said she is hopeful that Ohio’s behavioral health staffing crisis will ease as a result of state and local initiatives. There is widespread understanding of the state’s needs and support for the work ahead, she said. That puts Ohio in a good place to increase the supply of workers to meet demand.

“This is hard work, and it’s going to take a while for us to really stabilize the system and build what Ohioans want and need,” said Criss. “But we are off to a great start.”