Workforce woes at issue for mental health care Workforce woes at issue for mental health care

RICHMOND - A larger workforce is needed to improve outcomes for the growing scores of people seeking mental health care in Southwest Virginia and beyond, according to officials striving to expand those services.

In 2020, one out of five adults said they had received mental health treatment in the prior year, according to interview data from the National Center for Health Statistics. Demand for mental health services is higher now than ever before, said New River Valley Community Services Executive Director James Pritchett.

"As the stigma has decreased over the years, the demand has gone up," Pritchett said. "We've tried to meet the need by expanding programs and staffing."

New River Valley Community Services is one of 40 community service boards in Virginia, providing a "public safety net" for mental and behavioral health needs in Floyd, Pulaski, Giles and Montgomery counties, plus Radford, he said. Services range from psychiatric care to treatment for addiction, and the agency currently has at least 80 unstaffed jobs out of its 850 total positions, Pritchett said Friday.

"Even before the pandemic, there were workforce issues, finding enough people to hire appropriate, credentialed staff to fill those positions," Pritchett said. "The pandemic has made it worse, for many different reasons."

For one thing, community service boards like the New River Valley's are funded primarily through state and federal money, and usually serve people whose health insurance, if they have it, is covered by government subsidy, like Medicare, Medicaid and managed care organizations, which pay less to health providers than private insurance does.

"When you don't have an opportunity to generate as much from those insurance companies, it gets really difficult to be able to keep up with competitive salaries and wages," Pritchett said. "The most difficult positions to fill are psychiatrists, nursing, as well as licensed behavioral health therapists."

In Virginia, almost one in five people are enrolled in Medicare, according to government data as of 2020. Administrative costs have also increased for providers like New River Valley Community Services, as a result of so much paperwork required to satisfy those government-funded insurance providers.

"We are struggling with the different regulations and processes," Pritchett said. "And then their rates are lower than most other private insurance companies ... It just becomes really difficult."

The workforce and administrative challenges are what Pritchett is looking to the state government for help with, he said. All the while, other strides are also being made to improve regional mental health services, such as the opening of a new crisis center recently in Radford, Pritchett said.

On the side of state government is Sen. Creigh Deeds, D-Bath, who said mental and behavioral health providers are experiencing staffing shortages in every profession and in every area of the state.

"We need to focus on keeping people out of crisis," Deeds said. "We need to focus on making sure people are well in their communities. That's the goal."

Mental and behavioral health is a sector that has been underfunded and underworked for decades, he said.

"People with money, people with resources can get the services they need, but a whole lot of people don't have those resources, and don't have access to those services," Deeds said. "That's why we have to focus on building out the best public system we can."

Deeds said creating a comprehensive mental health system is urgent work, and he is frustrated that not everybody understands the urgency. He has campaigned for mental health care improvements since his son's suicide in 2013 exposed gaps in the state's system.

"There are huge losses across the board, affecting a lot of people," Deeds said. "Lives are slipping between the cracks because we're not providing for them."

Despite the frustrations associated with making changes to government, Deeds said the key is to keep working the process. Successful or not, he proposes legislation every session "to fill in the gaps" where statewide changes are needed, he said.

"We have a long way to go. We made a lot of progress, particularly in the period between 2014 and 2018," Deeds said. "We lost a lot of momentum, and then COVID was like a gut punch. It stretched resources as thin as could be across the state."

But momentum will return, he said. The state needs to focus on building its mental health workforce, in order to improve services provided, because west of Charlottesville, it gets difficult to find mental health care providers, he said.

"We've got some spots, say Blacksburg and Roanoke, where you've got some providers, but we have a real, real need in many of those communities," Deeds said. "If you can provide services in places like West Texas, or Montana or Alaska, by golly you can provide them in Southwest Virginia."

One recent state success listed by both Deeds and Pritchett is STEP-VA, a long-term initiative designed to improve the range and quality of mental health services available to Virginians. It's one of several programs to result from state commissions and studies initiated by Deeds since 2013.

"What we need to be thinking about is building a holistic structure that has goals of making sure people can live their best lives, and making sure that people, no matter where they are in Virginia, no matter what their resource level, have access to the services they need," Deeds said. "The work has to go on."

Improvement has come incrementally, and Deeds said stigma surrounding mental health has decreased as a result of educational outreach. But the short staffing in state-supported mental health agencies reflects one aspect of much work yet to be done in ensuring a complete continuum of care.

"People have a right to live the best life they can. We have to focus on making sure that people have the opportunity to do as well as they can," Deeds said. "It's a problem in every community, in every family, and it's one we have to deal with ... We can address this situation, and we will."