Jeff Thomas discusses Washington’s behavioral health crisis system, labor shortages and improving the behavioral health system – State of Reform
jeff thomas is managing director of borderline behavioral health. Frontier Behavioral Health is a not-for-profit organization that works with community partners to provide behavioral health and related services to individuals of all ages. They are also one of the regional operators for Washington’s Behavioral Health Crisis System.
In this Q&A, Thomas discusses Washington’s behavioral health crisis regime, the labor shortage in the behavioral health industry, and what is being done to address those shortages.
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Matt Beuschlein: Can you tell me about Washington’s behavioral health crisis system and how it is statewide?
jeff thomas: “First of all, we don’t have a state behavioral crisis system, we have nine regions, each with different crisis systems.
That’s an important thing to be aware of… There are certain similarities because there are certain laws that dictate what services look like, especially the laws in the area IT [Involuntary Treatment ACT] evaluations, and then there are contractual requirements to have a regional behavioral health crisis line. So these two things are present in every region, although they look very, very different in every region.
In Spokane, for example, we operate the regional crisis hotline for all six counties in that region. But we only do the ITA assessments for Spokane County. What ITA assessments of ours look like in Spokane County is very different than Pend Oreille County or Stevens County where you basically have a doctor who has to bring the phone home at night and make calls in the middle of the night. They don’t have a whole department doing that. So even if articles of incorporation and contracts can look the same, it can basically look very different.
I think it would be very difficult to say that every system will be identical in every region and county. Because there are just such big differences from very, very rural to very, very urban.”
MB: What is the behavioral health staffing shortage and what impact are we seeing as a result of this shortage?
JT: “The shortage of skilled workers is a challenge throughout the state and nationwide. One that is felt more in rural areas. Many behavioral health agencies have up to 30% vacancies for their clinical staff. I know a rural provider that has a vacancy rate of 55%.
Unfortunately, many agencies have to restrict and cap the number of new clients they accept. This means that people are not coming into care as quickly as we would like. But case numbers can only swell to a certain point before we don’t do anyone a favor to put them in care because we can’t provide them with the level of care they need.”
MB: Speaking of labor shortages, how is Frontier Behavioral Health working to address the shortage? What is being done outside of your organization to address these bottlenecks?
JT: “Frontier Behavioral Health and others are looking to hire more undergraduate-level staff. The greatest shortage currently exists among clinicians at the master’s level. So there are ways we can hire staff at the undergraduate level to provide additional support. It won’t be the only solution, but that’s one of the things we’re looking at.
We’re certainly doing everything we can to be creative in terms of recruitment and retention. But if someone can go somewhere else and make 30% more, you’re going to have a hard time keeping them.
But the bottom line is that there are significantly more people being served by their insurance company, which is great. But the pipeline of people entering the field and the current workforce just aren’t getting close to keeping up with the increased caseload. So we keep losing ground on that front. We always have employees making their way to those higher-paying jobs.”
MB: What are some of the key priorities for improving the behavioral health system? Are there critical points that need to be addressed?
JT: “It’s a challenge not to be too ambitious, which could be when we have such a labor shortage. This is the most basic problem of recruiting and retaining to have manpower to do the work that is available.
There are definitely ways that coordination with integrated and managed care can be improved.
I’ll give you an example: Frontier Behavioral Health has nearly a dozen care navigators, all funded by grants or research grants, that connect individuals to the care they need.
If you’ve ever had to seek specialized medical care for yourself or a family member, that’s a whole maze in itself. And if you’re someone who’s already impoverished or struggling with mental health issues, if you’re trying to get from A to B and then B to C, then go to a lab draw, then go back to the specialists… It is difficult .
So we have care liaisons to help with everything from opioid addiction to oral health to working with our physical health partners, but all of that is currently funded by grants or research money. We need mechanisms by which these low-cost, unaccredited workers can recognize and report their services. So these services are counted when people look at what the costs are. So that’s an example of a path that I think would be important going forward in life.”
MB: How has COVID impacted both demand for behavioral health services and system responsiveness?
JT: “Since last March, for a period of time, and I believe many, I believe, there has been a slight decrease in access to services in our organization. It was different, all done remotely, and that was new to everyone. But people found out, and as we peaked late last year, the number of people trying to access services increased. And it has continued at a high level ever since.
There is a higher prevalence of anxiety and depression, and social isolation doesn’t help with these things. Teens who can’t do the normal things would [normally] go out and play or be on a sports team or at school. So, in absolute terms, we are seeing an increase in demand coupled with ever-increasing vacancy rates due to labor shortages. So it certainly doesn’t help that those two things coincide.”