THERE IS NO question that the residential treatment facilities operated by The Home for Little Wanderers for teenagers with mental health problems are desperately needed. The current mental health crisis among even more fortunate children has been well-documented, and the Home for Little Wanderers deals primarily with children who have been removed from their homes.
And yet, the agency is not using 25 beds at its residential homes in Walpole and Plymouth.
“I can’t serve kids because I don’t have enough staff to serve them safely,” said Lesli Suggs, president and CEO of The Home for Little Wanderers.
Suggs has a waiting list for every service the organization provides.
Among workers in the human services field, which includes mental health but also those who work with people with disabilities, children, and the elderly, staffing is a massive problem. Staffing has always been a challenge in the low-paid field. But COVID exacerbated the crisis, as pandemic-related effects have taken a toll on the workforce overall, leaving many industries searching for employees.
Advocates say the crisis is particularly acute in human services because of the high stakes for people’s lives. “It’s different for you and I to have to wait longer to be served in a restaurant…than not having a person able to provide services to someone in need in one of our residential programs, where the risk to their safety is in question if there’s no staff there,” said Michael Weekes, president and CEO of the Providers’ Council, a trade association that advocates for human service agencies.
State policymakers have undertaken efforts to address the problem. The Senate, in its version of an American Rescue Plan Act spending bill, wants to create a $122 million loan repayment program to repay student loans for nearly 2,000 mental health clinicians. The bill is hung up in House-Senate negotiations. The House version includes a $100 million carveout for behavioral health workforce initiatives.
During the COVID pandemic, the Executive Office of Health and Human Services put $1.1 billion into stabilizing the health care industry. Some of this money went to temporarily increasing the rates paid for services like community-based treatment for children with behavioral health needs.
But advocates say the latest staffing crunch only highlights a decades-old problem, and the most important policy change will be to pay rates over the long term that are high enough to retain staff.
At the Home for Little Wanderers, for example, the agency operates through contracts with state agencies. For example, the Department of Children and Families pays a daily rate for each child placed there. (Some outpatient services are covered by insurance, though the state plays a role there too, since MassHealth, the state Medicaid program, is the primary insurer.)
Suggs said the agency’s budget is based on the state rates. Starting salaries are $45,000 to $48,000, depending on the position, for roles that require a master’s degree. Suggs said because the salary is so low, the agency ends up functioning as a training ground, where people come to get experience, then leave, since they cannot live in the Boston area on that salary while repaying student loans.
An added challenge is that schools have received an influx of federal money, and many of them are looking to hire mental health clinicians – with salaries that are $10,000 to $30,000 higher than what The Home for Little Wanderers can provide. Hospitals and state agencies also offer higher salaries.
Weekes said the problem is not new. A 2019 report by the University of Massachusetts Donahue Institute, commissioned for the Providers’ Council, found that the median wage for a human services worker was $27,000, compared to a $40,500 median wage for all other industries in Massachusetts.
State labor data confirms Suggs’s concerns that state agencies are able to outcompete private agencies. Data from the first quarter of 2021 on wages for individual and family services workers show that the approximately 1,100 workers who work for state government in this area earned an average of $1,274 a week. In contrast, the approximately 100,000 individuals who work for the private sector earned an average of only $548.
“It makes it more difficult to recruit and retain [workers],” Weekes said.
Weekes said using ARPA funds to bridge the gap temporarily would be helpful, but isn’t a long-term solution. “There’s no way to do this but to change the rates and make sure the rate system reflects what the market really is,” he said.
Lydia Conley, executive director of the Association for Behavioral Healthcare, a trade group, pointed to one program overseen by the Department of Mental Health, serving people with serious mental illness in the community, as an example of just how acute the staffing crisis is. Today, one in every three clinical positions is vacant. “Individuals are receiving services, but they’re not getting as robust services as we would hope,” Conley said. “And those vacancy rates are putting additional pressure on the remaining staff, creating a whirlpool effect where it drives staff out.”
According to data reported to the trade association by its members, 79 percent of outpatient providers reported waiting lists for services. Among psychiatrists who serve children, 32 percent reported waiting lists of one to three months, and 36 percent of psychiatrists for adults reported one-to-three month waits.
“It’s four decades of neglect coming home to roost,” Conley said. She said years of not taking mental health services seriously, and insurers reimbursing providers at too low a rate, resulted in a system that is inadequate to handle a burgeoning pandemic-related mental health crisis.
Conley said there are myriad reasons for the staffing challenges. Clinicians are burned out, the workforce is aging, and some are taking jobs in schools and medical clinics where wages are higher. Some are also starting solo practices where they can accept only commercial insurance or not take insurance. The association represents mental health clinics paid by insurance, primarily MassHealth. Data compiled by the association shows that a psychologist working for a behavioral health organization earns, on average, $78,603; in a community health center $89,315; and in a hospital $104,125.
Conley said the association supported a proposal made by Gov. Charlie Baker in 2019 – parts of which the governor is expected to reintroduce next year – which would have required that a larger percentage of health care spending in the state go toward primary and behavioral health care. Conley said improving the way behavioral health is paid for would “go a long way toward improved access, quality, and a pipeline of future workforce so we’re not having the same discussion in 10 years.”