Thursday, May 22, 2008

Article on MH Workforce from Asheville Citizens Times

May 22, 2008
Mental health staffing suffers acute shortage

Leslie Boyd

The already inadequate work force in state’s mental health system will not grow fast enough to meet the needs of the population it serves, a state task force predicts in a new report.
The shortage of workers in mental health, developmental disabilities and substance abuse services is national, but because of North Carolina’s tumultuous reform effort, the problem is particularly acute here.“It’s actually a crisis,” said Dr. Marvin Swartz, head of the Division of Social and Community Psychiatry at Duke University Medical Center. “And unless the population of this state stops growing, it’s only going to get worse.”Swartz also was on the state task force that issued the report, “Workforce Development Initiative,” last month. The report offered recommendations to recruit and retain mental health workers.

None of the recommendations will lead to a quick fix, Swartz said.“I’m afraid we’ve become too enamored of market solutions for complex social problems,” he said. “My personal view is that privatization has not worked.”People still are leaving the system faster than they can be replaced, said Jane Ferguson, CEO of Appalachian Counseling. “They burn out, and they leave,” she said. “We’re losing these really great people because they’re just tired.”The turnover rate among service providers across the state is at 78 percent a year, and it’s not just among the lowest-paid workers, said John Tote, director of the N.C. Mental Health Association. One of Appalachian’s top employees, Ken McAbee, the director of child and family services, just resigned to take a job with Transylvania County Department of Social Services as a child protection worker.“There’s just too much change, too much instability, and none of it makes things better for the people we serve,” he said.McAbee said he had a case last fall where the person needed a lot of supervision, so he requested 25 hours of one-on-one services a week. The request was denied, and the person was approved for 25 hours over 90 days.“We appealed it, and it took four months for the appeal to be heard,” McAbee said. “When we got the approval, it was for more hours than we had requested in the first place. How much time and money was spent on that?”McAbee also said the new crisis beds in the system are all but inaccessible in a real emergency.“You have to do six hours of paperwork,” he said. “Approval can take two days.”Blair Clark, co-founder of Parkway Behavioral Health Services, said the system is improving, but at too slow a pace.“The constant changes have slowed down a little,” he said. “But some people are still falling through the cracks.”When mental health reform privatized the delivery of services, the safety net was shredded, said Mike Hopping, a psychiatrist who left the system five years ago, early in the state’s mental health reform. He says he left because of the immorality of a system that puts more stock in regulations than it does in the people serves. When he quit, he was the medical director at Blue Ridge Area Program, which later spun off its services to New Vistas Behavioral Health and became Western Highlands Network, the management agency for eight counties in Western North Carolina.When mental health reform forced the area programs to stop offering mental health services and treatment, social workers, psychologists and psychiatrists were laid off, and they no longer were eligible for state benefits in the new privatized system. Many jumped ship before they could be laid off, going to other state jobs where they would be able to keep their pensions and health benefits.Fewer workers were available in the system, Hopping said, and paperwork increased. Ferguson said providers average two or more hours of paperwork for each hour of services they provide, and much of the time is taken up putting the same information on a half-dozen different forms.Hopping believes state and federal regulators made compliance more difficult during the 1990s to save money. “What government did was to choke the system with paperwork and regulations,” Hopping said.

“The budget went through the roof because everybody had to hire more staff, and when times were lean and (government) funds were cut, the paperwork wasn’t. So you had to keep your business office intact. The only place to cut was services.”Swartz said mental health workers — especially those who work one-on-one with patients — are paid poorly, and many are hired as part-time workers with no benefits.“The state system could hire people and pay their benefits, but a small company can’t necessarily do that,” Swartz said.One solution, he said, would be to let small companies to buy into the state’s benefits system.Tote supports that idea.“If you’re a private provider contracting with the state, you ought to be able to opt into the state insurance plan,” he said.

Joe Ferrara, CEO of Meridian Behavioral Health Services, said his company has started training and hiring peer-support workers — people who have a mental illness or are recovering from an addiction — to work with clients.“We hire them full time with benefits and pay $10 an hour,” he said. “We have good workers and less turnover, and we have the added benefit of putting people to work who often have a hard time finding jobs. It’s win-win for us and for them.”

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