Advocacy in the Wake of Looming Mental Healthcare Workforce Shortages
Curt and Katie chat about the looming (and current) mental health workforce shortages. We talk about the exodus of mental health providers, legislation and proposed bills that seek to address these shortages, and what modern therapists can do to advocate for the needed changes. We also talk about inadequate or harmful strategies (like cheering, scholarships, and subway sandwiches) that are often implemented by agencies and legislatures. We provide individual and collective calls to action.
It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
Click here to scroll to the podcast transcript.
In this episode we talk about:
- Recent data that shows that there will be huge workforce shortages in coming years
- The difficulty for folks in accessing mental health services in all sectors
- The reasons that mental health workers are leaving the profession
- High caseloads, higher acuity
- Systemic burnout, jaded supervisors
- The inadequate “support” of mental health workers with subway sandwiches, cheering heroes
- Legislation that has gone through to support healthcare workers in receiving mental health
- Legislation that funds hiring more workers
- Bills addressing scholarships to increase folks going to school for mental health
- The problem with scholarship bills versus loan forgiveness bills
- Bills working to decrease wait times for those seeking services
- Creating and filling in mental health treatment needs with paraprofessionals, peer counselors
- Navigating funding and worker shortages with new treatment planning
- The challenge in “steeling our hearts” to make choices in how we work and who we work for
- Both individual and systemic action that we can take to address these issues
- A request for the National Guard to come in and staff residential treatment centers
- The importance of taking action now to get involved in legislative advocacy
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Who we are:
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
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Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano http://www.crystalmangano.com/
Curt Widhalm 00:00
This episode of modern therapist Survival Guide is brought to you by turning point
Katie Vernoy 00:03
Turning Point financial life planning helps therapists confidently navigate every aspect of their financial life from practice financials and personal budgeting to investing Tax Management and student loans. Visit Turning Point hq.com. To learn more and enter the promo code modern therapist for 30% off their quickstart coaching package.
Curt Widhalm 00:24
Listen at the end of the episode for more information.
You’re listening to the modern therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 00:43
Welcome back modern therapists. This is the modern therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast for therapists that looks at uncomfortable things in our profession. And this is another one of those episodes that does that. And we are talking about the already developed but looming and worsening mental health workforce shortage across America. And this actually, some of the stuff that we’re going to talk about today also has impact worldwide. So for our international listeners as well, we’re gonna talk about YouTube. But there’s been this little thing called COVID-19 pandemic. And those of us in the know, before the pandemic knew that Mental Health Access was not great in pretty much all parts of the world. And we follow along workforce issues and work with our legislature and the US government on some access issues in our advocacy efforts, and continue to have an interest in continue to provide advocacy on this. And as we’re looking at the next few years, it’s going to get worse, that we are seeing a exodus of workers from the mental health workforce, we are seeing a lot of reports from research organizations, we can talk about some things out of research group called Mercer and their reports that things are looking bad in the next five years as far as mental health workers that there is a exodus of workers here, Katie and I have talked before about how hard it is to become even eligible for some of these positions. And it’s going to get a whole lot worse,
Katie Vernoy 02:54
paired with what people were, colloquially calling a mental health pandemic. You know, the second, the second wave of pandemic is a mental health pandemic. And I think, for me, I’m actually seeing this in my own practice, I open for new clients, and I’m getting calls from folks who can’t find someone who takes their insurance, who are not getting calls back. I mean, there are already issues with folks being able to access mental health treatment when they want it. And we’ve also got this worker Exodus. And I think the the broad strokes of this, I think, are that there are, at least locally, you know, for me, I don’t know that many people that take insurance, you know, many people have gotten off insurance panels, I’m getting off insurance panels because of the, what they pay. And I think it’s something where people want to use their insurance, people also, at times need higher levels of care. And those beds are not there. I was reading an article out of Colorado where there there are folks who are staying in I think solitary confinement because they can’t get into mental health facilities when they’ve been determined that that’s the appropriate type of incarceration. Not that that’s kind of what we’re talking about today. But but there are so few mental health workers across the breadth and depth of our field, that people are not getting the services that they need. And there are big impacts on our community. So this is already happening. But it’s it’s something where we are also leaving the profession, and that’s pretty terrifying.
Curt Widhalm 04:34
And we’ve been talking about this for a while we had a episode earlier this year on why therapists quit. We had several follow up episodes to it. But in looking at the trends, and I’m looking at the Mercer report here, we are looking at some major mental health shortage of workers. The Mercer report talks About that they’re expecting 400,000 mental health workers will leave the occupation entirely over the next five years. And that’s going to be leaving mostly public mental health employers with a shortage of 510,000 spots us nationwide. Getting into the reasons why we’ve covered in a number of other episodes, super high case loads, you know, large case loads, the very quick return to business as normal in a lot of situations. And this is echoed, really largely at the time of this recording I’m seeing early reports of this is really impacting places like college counseling centers that are a month into the new year to two months into the new academic year by the time that this episode drops, and are seeing increases from last year’s already increased rates of seeking services by over 20% year over year. So they are facing increased calls for services with a drop in available workers to come in and provide services. The experience of these workers is also that the crises that are coming in are bigger and more severe than they have been in the past. So we’re getting this perfect storm of more need higher need and fewer people to do it. And most people in our profession, as caregivers tends to want to help out but it does lead to just this really systemic burnout problem. That is easier for a lot of people to go and not work in this profession. Because it is just so taxing at this point.
Katie Vernoy 06:57
Yeah, I think it’s something where, when I’ve had in the past, short staffing, you know, whether I was a mental health provider or, or a supervisor or manager, what we by and large do is take more cases, do more work, just try to keep going, you know, everybody needs us. We can’t say no, it’s it’s really hard. It’s all of those things. I was thinking I was picturing Adriana, you know, when she came and talked on our episode around the same thing happening for bilingual clinicians. But just this idea of I can’t say no, they need us and so that this these gigantic case loads that are both systemically problematic, but also personally problematic because there’s just no way to keep that pace up. And so folks burn out and leave really early. But even if they make it through I mean, we’ve we’ve had this this conversation and the burnout machine and you know, so we won’t go too far into this but it’s just it’s such a bad situation where not only are the clinicians, overworked burned out, usually not getting paid much more because oftentimes the cuts happen there. And their supervisors and managers have broken away from the day to day grind of seeing huge case loads, but are jaded and not necessarily the support that those clinicians need. And so they might as well have left the profession.
Curt Widhalm 08:24
And we specifically talked about this in our gaslighting therapists episode did at the beginning of the pandemic and there’s a part of me that really likes having been right but there’s also a part of me that is like, we knew this was coming and and so frustrated just in this was so predictable that yeah, this is just Ah,
Katie Vernoy 09:00
Curt Widhalm 09:02
Katie Vernoy 09:06
Oh, go ahead.
Curt Widhalm 09:07
But this is where we haven’t changed the way that we take care of the workers. I mean, maybe what we’ve changed is given them a second subway sandwich party each month and
Katie Vernoy 09:19
Or like cheering WOO HOOO! way to go thank you heroes
Curt Widhalm 09:23
some sort of banner that that promotes You are a hero. But But I mean, it’s it’s stuff like this and it’s stuff like, okay, we are seeing some of this response in legislation. There’s a bill was passed by both houses of the US government. Moving on, will link to it in the show notes, but as a bill written by Senator Tim Kaine to promote and look into interventions for preventing burnout. in mental health and healthcare workers, and this is widely celebrated is Alright, we’re going to be getting to the problem of why so many people are leaving the profession, how can we address this to keep people in. And these funding bills are continuing to miss the point in looking at this bill, my first response was, oh, we’re gonna blame the individual mental health practitioners and the healthcare workers. The bill is literally about promoting mental health care and looking for ways to promote resiliency. And I know that the $30 million that is being spent to investigate this is going to result in do more yoga and have thought about therapy. As mental health workers, we know that we need to go to therapy, it’s not dealing with all of the access issues, it’s not dealing with all of the giant caseload issues. It’s not being able to have good workplace practices. It’s no set Principal Skinner meme of like, is it that’s the problem? No, it’s the workers. They’re misinformed, that is just going to continue to reinforce this as a problem. And my big bold prediction is that in a couple of years, they’re gonna say, well, we spent $30 million on it, and it didn’t fix anything. So we probably don’t need to invest in mental health workforce issues for a while. Hmm.
Katie Vernoy 11:33
Yeah, I think one of my I’m going to put this on my to do list right now is figuring out if that does go through, is there a way for mental health providers to actually get on task forces and those types of things? Because I think there’s, there are possibilities, if there’s money going toward it, it has not been decided current, let me be a little Pollyanna for a second and then decided that’s not been decided. And maybe if our modern therapists across the country, go and try to get into these committees and at these tables and talk about what you were just saying, as well as different payment structures, and just like, just drop the RAND report right in front of them and say,
Curt Widhalm 12:11
That’s just it! They’re paying for more investigations to end up with things that are already in existence?
Katie Vernoy 12:20
Yeah, well, alright,
Curt Widhalm 12:23
we’ll have a call to action about what we can do with that next step with the way that grant money is going with Health and Human Services. Maybe not today, follow us on our social media, and we’ll figure it out, we’ll figure out exactly who needs to be called on that. Now, some of these other bills that I’m seeing, they do provide for money for hiring more workers, General Manager, those are good.
Katie Vernoy 12:49
Yeah, let’s hire more workers, give them some money, give them give them money and and autonomy, that’s probably not happening, but give them give them money.
Curt Widhalm 12:58
Now, there’s other bills to address behavioral healthcare work shortages. This also goes to other health care workers. They have their own podcast. We’re talking about behavioral healthcare workers here. There are other bills that are addressed towards scholarships for improving access in particularly like rural areas. But with telehealth, I’m seeing a lot of these just in general, like let’s get more people into school to be licensed for these positions. And these, in my opinion, are generally misguided and bad bills.
Katie Vernoy 13:33
And scholarships are bad
Curt Widhalm 13:35
Scholarships don’t address the problem and actually may end up increasing the problem.
Katie Vernoy 13:43
Because why did they increase the problems? My friend this is, it seems like a lot of a lot of people I know they got these scholarships, and to help them get through.
Curt Widhalm 13:53
scholarship money tends to increase the overall cost of tuition and expenses that universities charge free money that’s available for universities to take in, the more that it raises the cost for all students who don’t get the scholarships. Because if the tuition can go up, because it’s being covered by somebody else, this actually then ends up creating barriers for people who maybe, you know, not qualifying for the scholarships, still not able to pay for school, they end up taking out large loans. Now, what I’m saying is, this scholarship bills should be directed towards loan forgiveness, as opposed to paying for tuition, same dollar amounts. But if you are aware of anything, start talking with your legislators about how this money actually can impact the workforce as opposed to just filling some University’s endowment fund a little bit more or being able to get three Subway sandwiches in student appreciation. We’re just going to have an economy of Subway sandwiches. That’s that’s the way we’re talking about this.
Katie Vernoy 15:10
So so we can try to increase the workforce by either hiring people somehow making education cost less. There’s there’s another bill that I saw, and I think there’s one in California right now. But there’s a lot of them, I think, across the country that I’m sure are happening, but it’s working to decrease wait times for clients, patients seeking services. And on the face of it, this is potentially bad, because then there’s a legislative, potentially legal responsibility for mental health providers to take more clients more quickly. However, this is the part that I think is really interesting. And this is where I think there’s a challenge for us. If insurance panels cannot keep clinicians in their in their roles, and cannot keep up with these wait times. I’m wondering what happens if we don’t jump to this action here? Am I getting into cartel territory?
Curt Widhalm 16:14
No, I don’t think you are, because on one
Katie Vernoy 16:17
The Cardigan Cartel is taking this on!
Curt Widhalm 16:21
On one hand, the history of a lot of these insurance companies is whatever fines that they end up paying, are going to be probably cheaper than what they would have paid out in services anyway. And we’ve talked about this and things like the the episodes on the Kaiser Permanente strikes in the past, but these are billion dollar companies. fines to them are just, you know, shifting some numbers over from profit margins. It doesn’t. These things, these bills like this are really well intended, but they don’t address workforce shortages either. Yeah, and potentially even gives some of these insurance companies the opportunities for having a defense of, there’s no workers for us to actually hire to shorten these labor times. which then leads to what has also traditionally happened in the workforce, which is that, well, this seems like a great time for mental health professionals too heavy, really good impact on legislation. Traditionally, worker shortages have been addressed by creating or filling in with more paraprofessionals. Now that if the really high barrier to entry positions are going to need a longer pipeline, it’s being able to provide things like peer counseling services, peer support specialists, and, well, those are good, it’s not something that addresses the specific problems that we’re facing as licensees or for our pre licensed listeners on the pathway to being licensed. All the more reason for you to be involved with advocacy to address the specific issues. But my, you know, not Pollyanna, like, Debbie Downer piece of this hair is in unless you really take action right now, in all of the free time. And with all of that not burnt out energy that you have. History suggests that without really good action on this, we’re not going to get the very needed changes that we’ve identified 1015 years ago, that have all come to a head here and will likely come to a head at some other position again, in the future. We need the action now to continue to call legislators to be involved in the bill writing process. So that way, it can be better. Otherwise, it’s going to be filled in by paraprofessionals. And continuing to just replicate the same problems that we’re seeing in our workforce system.
Katie Vernoy 19:10
There’s there’s a few things that you’re saying that i i agree with, but I also think that they don’t have all the pieces to it. And so speaking to my experience with some of these public mental health contracts and those types of things, when there is a financial shortage, so they’re the funding goes away, because you know, and around near and around 2008, when, you know, the great recession began, there was a lot of funding that went away for mental health services. And so there were really creative ways that folks added some of these positions. So there was paraprofessionals case managers, there was different types of codes that could be used at or slightly lower rates. And there was also this huge push for evidence based practices to you know, kind of create these different funding streams and kind of pull money from here and There. And what I really saw is that there was this combination of how do we make this cost less? And how do we take care of people with a lower cost. And with, you know, there wasn’t a workforce shortage at that time, I don’t think I feel like there’s always a little bit of a workforce shortage and public mental health. But that’s a whole other conversation. But it’s one of those things where there was, there wasn’t money to pay people. And so they did create these positions. But since that time, and I think this, this is accounted for in the RAND report, as well, there’s been a real efficacy seen with these multidisciplinary teams. So I don’t want to say like, hey, let’s get out and make sure that we get to keep all the work, because I don’t know that that’s necessarily what we need to do, I think we need to make sure that the work that we’re doing, suits our expertise and suits, what is needed. But I think, at that time, there was creativity that was both kind of mercenary, as well as actually improving mental health care. So I don’t think it’s black or white, like, Hey, this is just because of a workforce shortage that we need to bring in people who have different qualifications. I also think, and this is very much aligned in what you were saying that there is a tendency to make do because it’s not a nameless, faceless mental health problem. It’s this client and that client and this group in that group. And I think, when we are looking to make a difference right now, I think there’s looking at how do I steal my heart against wanting to solve this systemic problem myself. And that is both in how we how we run our practices, but it also can be in where we get employment, when a when an agency gets a contract. So they get let’s say, they get a $500,000 contract, to provide services, if they cannot fulfill it, they they lose the money. And so for public mental health providers, they actually need to say stay staffed. And we can actually make a difference in who gets to keep their money by making sure we’re very diligent in where we go to get employed, and where we stay employed and where we do the work. And so there there’s there is I feel like there is an element of us choosing whether or not large app companies gets our employment, whether there’s, you know, public mental health organizations that don’t that do shady work, whether they get our employment, you know, like, we do have a value there beyond like insurance companies and their gigantic war chests being able to fight against some of these things. So maybe that was all over the place. But I think it’s something where I don’t want to say like, Hey, we can only do legislation, because unless we have power in and how we choose to do our work. I think there’s not going to be change anyway.
Curt Widhalm 23:19
You’re talking about individual issues here. While there’s also such big systemic issues that do need the focus, and well, I think that there’s a lot of individual efforts that we can make in our own practices, that it almost just kind of ignores the problem. I’m looking at an opinion piece in the Oregonian from September. And this was penned by Heather Jeffries, Executive Director of the Oregon Council on behavioral health. Cheryl Ramirez, Executive Director of the Association of Oregon mental health programs, and rice bowl and director of the Oregon Alliance. And their public call includes some things that very much speak to this kind of stuff, increasing funding to recruit and retain staff, reducing administrative burden. Those things are great, providing cash supports for organizations struggling with the financial impacts of increased costs and insufficient revenue. Fantastic. Publicly recognize and appreciate the workforce, throw more Subway sandwiches at them, maybe misses the point. Yeah, but the one that stands out to me is that they are asking the National Guard to be deployed to staff residential facilities. Hmm. We are in such a crisis, that the heads of behavioral workforce associations are coming together and saying we need people who Have nothing as far as training to be called in by the government to come and provide staffing here. And I point all of this out because we feel an individual responsibility to take some of these steps ourselves. There is only so much that each one of us can do that really needs to be able to address this, especially as a lot of these legislative waivers are ending and not, you know, being progressed things like, you know, telehealth supervision waivers that are, you know, going to be gone at the end of October in California where Katie and I practice but in this lurch where we talked about this in our in our most recent episode with Ben Caldwell is due to the legislative process, there is going to be systemic barriers, that rather than expanding some of this energy more for us to help the one or two or five more people on our caseload that we can take on to have a greater impact, spend those one or two or five hours where this can actually impact 1000s of people in a much better way. Even if it means looking more for long term changes in short term changes right now,
Katie Vernoy 26:32
I want to do a yes, and because I think it is hard, and we’ll do some of the legwork here. This is what we’ve been talking about with not focusing in on a conference this year, we will do some legwork. And we will try to help have some specific guidance on how we make some impacts here on legislation, policy, that kind of stuff. But I think we also need to be very conscious about the choices we make collectively and individually on where we get hired where we do our work, what we charge, because if there is a path to status quo, the legislative efforts won’t go through. Right. And so we have to push back against the status quo of poor insurance reimbursements ridiculous, or bureaucratic burdens on organizations, like we need to push back on those things, individually and collectively, or it doesn’t matter how many of us go in, there’s, you know, we’re a small workforce, kind of an in comparison to some of these gigantic, you know, other types of organ, you know, profession. So, all of us just saying, like, I’m going to take two or three fewer clients and going and fighting on the hill is not going to necessarily be sufficient, I think we need to do both.
Curt Widhalm 27:56
We do need to do both, right? It’s, it’s like the gaslighting episode where it’s like, this is stuff that is predictable that legislative changes are gonna be five, six years from now, where it’s like we, we told you, so stop, stop complaining about stuff five or six years from now, because the call for action is right now. Legislators know that mental health needs to be addressed. What they don’t know is what needs to be addressed in mental health. And that’s where that call to action is. And I know in some of my early online conversations, when I point these things out, the response is, well, this is at least addressing the short term thing that’s good enough. And right now, having been involved in advocacy for as long as we have addressing good enough for right now does not change the problems that are going to be way bigger five years from now. And I agree. And this is really where it’s giving up some of our short term action that, you know, still may not be kind of our perfect sort of answers to everything. I mean, we do have several more decades of podcasts that we need to make. But we do need to actually address some of our problems in in our systemic part of our profession, and get this stuff off the ground. We have been doing some of the legwork on we will organize some of this stuff. We encourage you to start looking at what bills are going to be written in your respective jurisdictions. Send them to us send them to me, email@example.com, c u r t at therapy reimagined.com. I’ll give you at least you know some ideas of things to start talking with your legislators about and if your legislators aren’t reading Mental Health stuff be calling their offices and saying, what are you doing to address mental health stuff in our profession, in our state in our in our country? Because the stuff that is being written is really what
Katie Vernoy 30:15
Curt Widhalm 30:16
it’s Subway sandwiches. So thank you for giving me something so we don’t have it explicit on this episode.
Katie Vernoy 30:25
I think we’re in agreement, I think both of us just have a different take on it and and what can be done more readily. You are very adept at the advocacy at the legislative level. And I think that is something where we need to, we all need to get better at it. And we need to be at some of these tables, we need to be talking to our legislators. I 100% agree. I think if we are working for places who are exploiting us, at the same time, we are undermining our efforts. So that’s all I’m saying.
Curt Widhalm 30:55
Okay, I agree with that.
Katie Vernoy 30:58
Overall, you know, kind of summarize in the call to action is really assess where you are in this in this time, in this really pivotal time. For our profession, are you working in a way that supports you and the work that you want to do? Have you created bandwidth so at the same time, you can advocate and make changes at the larger scale so that you’re both supporting yourself standing by your principles and how you are going to work and pushing for larger systemic change.
Curt Widhalm 31:42
Be in touch with us, follow our social media. Take those Subway sandwiches and tell your supervisors where to put them. And until next time, I’m Curt Widhalm with Katie Vernoy.
Katie Vernoy 31:55
Thanks again to our sponsor Turning Point
Curt Widhalm 31:58
we wanted to tell you a little bit more about our sponsor turning points. Turning Points is a financial planning firm that’s focused exclusively on serving mental health professionals to help you navigate all the important elements of your personal finances like budgeting, investing, selecting retirement plans, managing student loan debts and evaluating big purchases, like your first home. And because they specialize in serving therapists and private practice, so help you navigate the finances of your practice as well. They’ll help you navigate bookkeeping, analyze the financial implications of changes like hiring clinicians or diversifying your income sources. They’ll even help you consider strategies like S corp tax collection,
Katie Vernoy 32:35
And for listeners of MTSG you’ll receive 30% off the price of their quickstart coaching intensive just enter promo code modern therapist when signing up. And don’t forget to visit TurningPointhq.com to download your free finance quickstart guide for therapists.
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