Lake County mental health providers battling staffing shortages linked to low wages, large caseloads and burnout [Lake County News-Sun, Gurnee, Ill.]

Dec. 6—Janelle Moravek, executive director for the Libertyville-based nonprofit Youth and Family Counseling, struggles to hire and retain certified therapists for her center, and it's not for lack of trying.

"It was a shortage before COVID, and now it's just downright desperation," she said.

Low wages, large caseloads and burnout are causing more mental health providers to leave the industry or go to private practice, said clinic directors, mental health professionals and advocates.

In the past two years, Moravek has raised her entry-level salary by $10,000, or nearly 25% of the original rate, but she said it's still below market rate and the clinic doesn't have the funds for more.

"As proud as I am that I'm paying more, it is not a living wage," she said. "For my single employees who have just graduated, $50,000 a year is not enough for them to get an apartment on their own."

The shortage of accessible mental health services is statewide, while demand for treatment is increasing, deeply affecting communities that already struggle with lack of financial and physical resources.

In Illinois, there are 13.8 behavioral health professionals for every 10,000 residents, according to the state's Department of Human Services. In Lake County, that translates to less than 1,000 behavioral health professionals to care for a population of just over 700,000.

The consequences of a shortage of accessible mental health services look different depending on where someone lives and what resources they have, said Venoncia Bate-Ambrus, executive director of the Healthcare Foundation of Northern Lake County.

"If you are dealing with a mental health condition, it affects pretty much all relationships across the board, from education to workplace to family and community social cohesion," Bate-Ambrus said.

Low wages also present a racial equity issue, Moravek added. In her experience, white women were more often able to stay in a lower paying position because of family or partner support.

"How do I build a staff that reflects the amazing diversity of our community? How do I build a staff when I can't pay a living wage?" Moravek said.

Her answer: money.

"You have to change laws. You have to change reimbursement policies. You have to change companies," Moravek said.

Fighting for increased reimbursement rates

Thresholds, a nonprofit mental health and substance abuse provider in Waukegan, was able to increase salaries and other employee benefits to attract and retain staff after a "historic" state investment in Medicaid reimbursements, according to Mark Ishaug, CEO of Thresholds.

In 2022, the Rebuild Illinois Mental Health Workforce Act added $170 million in Medicaid reimbursement rate increases for community mental health providers, legislation for which Thresholds helped advocate.

In the past year, Ishaug said staff salaries have increased by 25% to 30%, along with keeping health insurance rates consistent year after year.

"It was a great increase, but it's not enough," he said. "We still have to keep fighting for increased rates because as inflation goes up, the cost of living goes up. We just have to make sure that the public reimbursement for the lifesaving services we provide also goes up."

State reimbursements are a large source of funding for community mental health services, but reimbursement rates lag behind the consumer price index (CPI), and fail to cover the full cost of service, said Lauren Wright, executive director of Illinois Partners for Human Services.

"There is a structural and systemic inequity piece that connects directly to the way our society, and specifically in our experience the state of Illinois, values these kinds of services," Wright said.

Illinois pays some of the lowest rates in the country for Medicaid Managed Care reimbursement systems for mental health services, according to a 2021 reimbursement rate study by Illinois Partners for Human Services.

Of the mental health services assessed by the study, 90% would need reimbursement rate increases of between 10% and 20% to align with the 2021 consumer price index.

"When you think about building a road, which is a public good, the state contracts with some construction company to build the road," Wright said. "That construction company is not holding a bake sale to cover the remaining cost of what it takes for their workers to build that road. They get a fair contract that the state covers the actual cost of doing those services.

"If the state was valuing (mental health services) in that way, then they would have contracts that actually cover the full cost of delivering those services," she continued. "This is the perpetual bind that folks are in now."

Reimbursements from the state rarely cover the full cost of service, Wright said, and are not allowed to cover non-direct service costs, such as transportation, front and back office expenses, administrative costs associated with billing and more.

"Ultimately, in the end, having good wages and having good benefits requires substantial investment and flexibility from the state when it comes to valuing these services with community-based providers," Wright said.

Investment in employees

To support employee retention, Thresholds offers in-house training, professional development, wellness programs and other benefits, according to Ishaug.

Thresholds, which serves 90 people in Lake County in about one-third of the county's geography, is experiencing its lowest staff vacancy rates in the past five years and is able to take on new clients.

"We want to grow because the need is so great," Ishaug said.

Wright is working to address other recruitment and retention problems at the state level — advocating for loan repayment legislation for human service professionals, and compensation parity for state contracts with service providers.

In the short-term, Wright said telehealth provided flexibility for both employees and patients, helping to address workforce and accessibility issues that organizations are hoping to build on.

Investment in mental health services is more than just monetary, added Bate-Ambrus. It also needs to involve investment of time, knowledge and experience through mentorship and educational opportunities.

One barrier to service Bate-Ambrus noticed is a lack of therapists with shared cultural or linguistic knowledge for clients in northern Lake County, particularly in Black and Brown communities or the LGBTQ+ community.

"We need to develop pipelines from the community so that the providers in those communities mirror the communities that they're working in, so that they have a similar lived experience or similar cultural and linguistic background," Bate-Ambrus said.

The Healthcare Foundation of Northern Lake County funds a scholarship opportunity at College of Lake County for residents interested in addiction counseling, and a scholarship at Loyola University for supervisor training for current social workers.

"Lake County is a wonderful community to live, and work and recreate in. But we really do need to invest in our behavioral health workforce," Bate-Ambrus said. "It really takes a lot of investment across the board, not just finances but also people power, so that we can build our own qualified workforce here in Lake County."

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