It’s not news to people in Okanogan County that the demand for behavioral healthcare services is rising. What’s less commonly known is that the ability to serve that demand is decreasing.
According the Washington Council for Behavioral Health, the number of contacts for behavioral health crisis response statewide were three times higher in July of 2021 than they were in March of 2020. The demand for ongoing behavioral health treatment increased by 34 percent between October of 2020 and July of 2021, while the vacancy rate for Masters-level service providers (counselors) is at 26 percent.
Locally, Okanogan Behavioral HealthCare (OBHC), the County’s largest behavioral health care provider, is feeling the impacts as well. Over the 18-month period from January 2020 to July 2021, OBHC provided 26,919 Mental Health Outpatient services to 2,210 unique individuals. Its Substance Use Disorder program assisted 631 unique individuals with 10,552 services. That averages more than 2000 services per month.
Covid-19 stressors are just part of the reason for the imbalance between the demand and the ability to serve. Okanogan County has been a federally-recognized Behavioral Health Care Provider Shortage Area for years before Covid. When the state requirement for vaccination of healthcare workers took effect, behavioral healthcare organizations in Washington lost up to 50 percent of their workforce; OBHC lost 30 percent. As of October 2021, fifteen behavioral health care organizations in the state had closed. And while OBHC was able to continue providing 24-7 crisis response, its ability to continue previous levels of ongoing care and actively enroll new clients was markedly diminished.
The reasons providers gave for leaving their positions echoed throughout the state. Some left due to strongly held religious or personal beliefs regarding the vaccination requirement for health care organizations. Parents of children whose schools closed often had no choice but to stay home because childcare was not available or affordable. Some providers who were close to retirement age took that as their cue to make the transition. Behavioral health care workers who were exposed had to isolate; some got sick, or stayed home to care for family members who were ill. Many providers were recruited away from their positions by other behavioral healthcare organizations that were able to pay higher salaries and hefty sign-on bonuses. Some were able to continue providing telehealth services by video or telephone, but those are not optimal solutions, especially in rural counties like ours, where internet and cell-phone access is unavailable or unreliable in many areas. The increased workload and less than ideal conditions took a further toll in a field that already has a high rate of burnout.
As of October 2021, the turnover rate among Washington State Council for Behavioral Health members is 29 percent, so replacing those providers is a major challenge. It’s not uncommon to take five months to fill a single Masters-level position under ordinary conditions - OBHC has had an ongoing recruitment posted for years. There aren’t a lot of “home-grown” providers here. It’s particularly difficult to recruit employees from outside the area to a remote rural community where the amenities of larger communities are an hour and a half to three hours away, especially when they can earn a significantly higher income in those areas, and it’s easier to find housing.
Because community behavioral health providers like OBHC get 85 to 90 percent of their funding from Medicaid reimbursements, starting salaries for Masters-level providers are typically about $20,000 per year lower than other employers like the Department of Corrections, Western State Hospital, Eastern State Hospital, the Department of Children, Youth and Families, or providers on the west side of the state.
One of the ways OBHC hopes to improve its ability to pay competitive salaries and recruit qualified providers is by joining in the statewide efforts by the members of the Washington State Council for Behavioral Health to improve the chronically low Medicaid reimbursement rates. Currently the Governor is proposing a 4.5 percent increase that would go into effect in January of 2023. But the need is actually about 7 percent, and it’s needed now, not 11 months from now.
Improving Medicaid reimbursement rates is just one of the many ways OBHC is working to improve its ability to hire qualified staff and meet the demand for services. The organization also hopes to improve awareness of behavioral health care as an option when students first begin learning about the career choices they might want to make.
Over the past year or so, OBHC has also been making steady improvements to its operations, including updating technology to improve efficiency and provide cost savings, cross-training employees to help fill temporary gaps, and re-examining programs, policies and procedures to ensure they support achievement of the organization’s mission. So, while the current situation is not yet in balance between demand and service provision, there is plenty to find encouraging in the question of how to meet the ongoing demand for high quality and effective behavioral health services now, and beyond Covid.
