Comment: Community mental health services are in acute need

By Tom Sebastian, Jeff Thomas and Jodi Daly / For The Herald

Community behavioral health is key to the health and wellbeing in Washington state. In the aftermath of the covid-19 pandemic, this couldn’t be more apparent.

As a mental health crisis looms, we, as community behavioral health care providers, are on the front lines, working to address some of the most critical challenges that face our region; from anxiety and depression to addiction and homelessness.

At the same time, we as behavioral health care providers are experiencing our own state of emergency. Chronic underfunding has led to an unprecedented workforce shortage; and left us unable to hire enough qualified staff to keep pace with demand. To cope, we’re making adjustments, which for many providers has meant reducing capacity for services, and ultimately, turning away those in need.

As community behavioral health providers, we are privileged to serve low-income individuals and families who qualify for Medicaid benefits; often the most vulnerable members of our communities, and many at risk for life-altering crises without tools to cope.

Every day, our teams deliver services that help kids thrive, families remain intact, and adults achieve mental wellness and recovery. Our work reduces homelessness and supports employment and self-sufficiency. We prevent mental health needs from becoming crises, reducing reliance on our law enforcement and emergency services partners, diverting trips to the hospital, and connecting community members to the most appropriate care options.

The covid-19 pandemic has exacerbated the need for these services, but the truth is, the current workforce shortage that plagues community behavioral health has been building for decades. Chronically low Medicaid reimbursement rates have left us unable to offer competitive compensation to recruit and retain the talent needed to keep pace with demand for services.

We are doing everything we can to fill the pipeline, but reality conspires against us. Although we dedicate around 80 cents of every $1 in revenue to salaries and benefits, many mental health professionals opt for higher pay in private practices and large hospital systems.

This is why we need help.

Across our state, community behavioral health providers are seeing a 30 percent to 40 percent increase in demand for services, according to a member survey by the Washington Council on Behavioral Health. However, data shows that staff vacancy rates have risen to 19 percent. On average, it is taking providers more than eight months to fill critical staff positions.

Open positions and high turnover significantly impact local communities. Last year, Compass Health had to intermittently stop accepting new clients across outpatient programs so that team members could focus on serving existing clients; leaving gaps in the safety net for vulnerable individuals and families needing mental health support. And Compass Health is not alone; in fact, an unprecedented 74 percent of providers surveyed by the Washington Council had to limit or close admissions to outpatient services in 2022.

As providers, we’re innovating to ensure our doors remain open. From partnering with schools to directly serve youth and families to utilizing certified peer counselors to support service delivery, we’re leading several approaches to meet growing needs; but it’s not enough.

We’re calling on state lawmakers to act now to stabilize community behavioral health in Washington. Washington state House leaders are supporting a 15 percent increase in Medicaid and non-Medicaid reimbursement rates for our services; and it is critical for the state Senate and Gov. Jay Inslee to do the same. While the step won’t fix our staffing shortages, it will give us a chance to address immediate problems.

As a long-term solution, we’re advocating for lawmakers’ continued support of statewide adoption of the Certified Community Behavioral Health Clinic model. Based on demonstrated success in more than a dozen states around the country, we believe this evidence-based model is the answer for a more sustainable behavioral health system, but it will take time to plan and implement.

Ultimately, solutions and funding must match the scale of these issues. The state has a critical opportunity to act now and invest in community behavioral health, relieving some of the unsustainable pressures, and helping to ensure the system remains intact.

Tom Sebastian is CEO of Compass Health. Jeff Thomas, CEO of Frontier Behavioral Health. Jodi Daly is CEO of Comprehensive Healthcare; all are members of Fourfront Contributor, an advocacy and leadership collective of large community behavioral health agencies in Washington state.