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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Do You Want Fries with That Prescription?

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The last time I took my grandson through the drive-through at Burger King, I found myself wondering whether the young woman who took our order might prefer working in our field. We are always looking to bolster our workforce, which is shrinking and rapidly aging. But I quickly realized there was one very good reason for her to remain with the fast food chain. In a word, money.

According to our 2011 Salary Survey, an assistant manager at Burger King earned nearly $3,000 more a year than a direct care worker in a 24-hour residential treatment center helping some of the most ill and vulnerable among us. And the situation hasn’t improved. In 2017, food service managers made a mean hourly wage of $27.52, $5 more an hour than a substance abuse or mental health counselor. Registered nurses working in an addictions treatment facility earn, on average, nearly $15,000 less than the national average for all nurses.

When we say it’s important for our workforce to understand the daily struggles of the people we serve, we don’t mean they literally should be struggling to put food on the table and a roof over their heads. It’s no wonder that the best and the brightest are looking elsewhere to make ends meet.

A report by the Health Resources and Services Administration confirms what we already know – the behavioral health workforce is not sufficient to meet current demands. We have only about a third the number of psychiatrists we need. Nearly three-quarters of all National Council members lose money on psychiatric services, and more than half of all practicing psychiatrists only accept cash.

Money matters. Without funds, community providers can’t hire skilled staff. Low reimbursement rates lead to low salaries, resulting in limited and lackluster care.

The Elephant in the Room

We can’t hope to make a difference in the lives of the people we serve unless we address the elephant in the room. Our nonprofit member specialty behavioral health centers haven’t seen a rate increase in years. They have no way to cover the costs of improving services or paying salaries adequate to recruit and retain skilled staff. Unlike our member health centers, behavioral health centers are not made whole when insurance companies routinely pay far less than cost.

For years, we have been saying that when community clinics are adequately compensated for providing access to evidence-based treatment, they can transform access to care. Now we have evidence to support this.

The 2014 Excellence in Mental Health Act we successfully championed established Certified Community Behavioral Health Clinics (CCBHCs) in eight states. CCBHCs provide evidence-based mental health and substance use services integrated with primary care. In return, they receive cost-based reimbursement that supports the infrastructure, staff and skilled supervision to deliver care that works. And they are doing just that.

Six months into the two-year demonstration, CCBHCs had hired 1,160 new staff, and that number is far higher now. They are hiring psychiatrists and addiction specialists, ensuring their patients expanded access to psychiatric care and addiction services – including medication-assisted treatment for opioid use disorder. “CCBHC status has transformed chronically underfunded organizations’ ability to recruit and hire, especially in rural areas of the country,” notes Rebecca Farley David, National Council vice president of policy and advocacy.

In Oklahoma alone, the state’s three CCBHCs have collectively hired 639 new staff. North Care, a CCBHC in Oklahoma City, has increased its staff by 25 percent over the past year because it is able to offer higher salaries and additional benefits, according to CEO Randy Tate. Becoming a CCBHC has allowed the Grand Lake Mental Health Center in the northeast part of the state to hire wellness coaches, dieticians, recovery support specialists and peers.

But this is about more than numbers – this is about people. This is about our ability to engage the community college student experiencing his first episode of psychosis … to connect the divorced, single mom addicted to pain pills with treatment … to serve the elderly widower who is isolated and alone.

Come Join Us

The need is great and will only continue to grow, so we must make our voices heard. We will continue to champion any and all efforts to grow and expand the behavioral health workforce, including the Excellence in Mental Health and Addiction Treatment Expansion Act. This bipartisan legislation would extend CCBHC operations by an additional year in the current eight states and allow 11 new states to participate.

We also support several bills pending in Congress that would add addiction treatment sites to the National Health Service Corps (NHSC) and expand NHSC mental health services settings. Together, these efforts will expand the behavioral health workforce and improve access to desperately needed mental health and addiction services for millions of Americans.

The next time I encounter a young person looking for a rewarding career, I want to be able to say to them, “Come join us. You will be fairly compensated for doing some of the most important work you will ever love.”

Tell me what you are doing to address the workforce shortage in behavioral health. The people we serve are counting on us.