The nation’s behavioral health care workforce shortage has been well documented for years and is only expected to worsen over the next decade. Now, the shortfall has become even more pronounced amid COVID-19.
Prior to the pandemic, 56% of Americans were seeking behavioral health assistance for themselves or loved ones, according to research co-conducted by the National Council for Behavioral Health. That number has already started to grow in light of the crisis and the stress that comes with it, with mental health apps in especially high demand.
The increase means behavioral health supply and demand are becoming even further mismatched. Many providers are rising to the challenge by implementing creative solutions such as turning to non-licensed coaches and former clinicians, in addition to leveraging telehealth.
Take, for instance, Parkview Behavioral Health in Fort Wayne, Indiana.
With more than 13,000 employees serving residents in northeast Indiana and northwest Ohio, Parkview is one of the region’s largest behavioral health providers.
The hospital was already grappling with workforce shortages before the pandemic, with its rural location contributing to the problem.
“We may be facing more [of a] shortage, just because in the large urban [areas], there’s obviously additional staff that are available,” Connie Kerrigan, a registered nurse and director of outreach at Parkview, told Behavioral Health Business. “As we reach into the rural communities, it does become more of an issue.”
Now, COVID-19 has thrown another wrench in things.
“It’s a very fluid state,” Kerrigan told BHB. ”We’re just trying to think of different ways that we can reach people.”
Meanwhile, Rogers Behavioral Health, located in rural Wisconsin, is facing similar challenges, Chief Clinical Officer Brad Riemann told BHB.
“You just don’t have enough people to draw from,” Riemann said to BHB. “We’re this huge behavioral health provider in southeastern Wisconsin with a fairly small population. We actually have less trouble hiring key personnel in some of our regional sites [in urban areas].”
Rogers also operates facilities in 17 other locations across the country, most of which are located in major metropolitan areas. Hiring is less challenging in those locales, Riemann said.
But COVID-19 complicates matters, given that the encouraged practice of social distancing may make it hard for some patients to meet with clinicians face-to-face.
“I think it’s impacting every organization just about in every way,” Riemann said. “Our patients’ safety and our staff’s safety are our top priorities.”
For Riemann, it’s a challenge of unique proportions that he’s working daily to meet. One way he’s doing that is by pulling out-of-practice clinicians back into the behavioral health business.
The Rogers facility in Oconomowoc has between 2,400 and 2,500 employees total, by Riemann’s estimation. Many of those workers used to directly provide mental health services to patients but are now working in various administrative capacities.
“[We’re] trying to deploy people [who] maybe were master’s license level [professionals and] just haven’t been practicing for a while,” Riemann said, counting himself among those training to get back to providing services to patients during the current time.
Riemann says the hospital has approached some of those employees about the possibility of working with patients again and is encouraged by the response.
“I haven’t been involved in patient care for quite a few years,” Riemann said. “But [we’ve got to] get back in the game … because you’ve got people who are going to [need help].”
Rogers also currently provides some teletherapy services, and Riemann feels the hospital is in a stronger position to deliver remote assitance going forward in a post-COVID-19 world.
“I’ve been extremely impressed with how nimble our organization has been and how people have just come in and said, ‘What can we do to help?” versus … people kind of running and hiding,” Riemann said.
Meanwhile, other behavioral health providers have been leaning heavily into telehealth from the start, with more and more companies relying solely on virtual offerings for everything from mental health to substance use disorder (SUD).
One such telehealth company is San Francisco-based Ginger, which provides coaching, psychiatry and therapy services to individuals by video and text.
However, Ginger executives don’t think telehealth is the only answer to fixing the behavioral workforce shortage. Instead, the CEO claims the solution lies in another aspect of the company’s business model: behavioral health coaches, who do not require the intensive training that licensed therapists must go through.
“I think that behavioral health coaches [are] going to be an increasingly important part of how we manage mental health in this country [as well as] globally,” Ginger CEO Russ Glass told BHB. “I do think … it’s going to be an up-and-coming career.”
Behavioral health coaches provide lower levels of care and concentrate on equipping people with strategies to achieve emotional wellness and meet other personal goals. Coaches are not licensed to diagnose behavioral disorders or prescribe medications.
Glass asserts that even after COVID-19 passes, companies like Ginger are in an advantageous position because they aren’t bound by the constraints of location. Thus, they can more easily hire new clinicians from anywhere in the country.
“I expect that [COVID-19] will accelerate adoption of solutions like Ginger telehealth … [and other] virtual care solutions,” Glass added. “It is going to move [the way in which] consumers think about getting health care forever.”
But Glass acknowledged virtual delivery of services alone will not close the workforce gap, which leaves room for traditional, brick-and-mortar providers to continue contributing unique ideas of their own.
For example, Rogers is taking steps to address the workforce shortage by partnering with universities in states where they operate.
The provider offers students studying behavioral-related subjects the opportunity to do on-site shadowing. Additionally, the company is planning to help develop a psychiatric nursing curriculum for a university in Wisconsin, though he said he could not disclose at which institution.
Then there’s Parkview. Like Glass, Kerrigan believes coaches can play a substantial role in shoring up the behavioral health care workforce. Parkview uses peer support coaches specifically.
From a legislative point of view, she believes incentives like student loan payoffs and forgiveness can entice more professionals to enter the behavioral health field, where competitive wages can often be an issue.
“From a financial perspective, [behavioral health] may not be as attractive to some people initially going through school because they may not think they’ll see the rewards that they might see in another career,” Kerrigan said. “So how can we help people … be successful and not feel like they’re going to come out with a lot of debt? I think that’s going to be crucial.”
Ultimately, when it comes to figuring out how best to tackle the ongoing workforce shortage at a time when it is compounded by a pandemic, the stakes have never been higher.
“I think we have to really be creative and think outside the box,” Kerrigan said.