By Cora Smith | Community News Service

Nearly one in five positions sits empty within Washington County’s state-designated mental health provider. That’s a slight improvement from the vacancy rate over the last 18 months, said Mary Moulton, executive director of Washington County Mental Health Services, but it’s too soon to tell if the trend will continue.

“Since the pandemic, we experienced the same exodus — in particular some of our programs — as other businesses throughout the state and country,” said Moulton. “And for us, it gravely impacts our ability to provide services that people are expressing they need right now.”

Hundreds of Vermonters are seeking mental health support that isn’t there. In October 2021, mental health agencies across the state faced 20% vacancy rates, with some agency departments seeing rates as high as 50%, those in the field say. It’s a crisis, and mental health services leaders say lawmakers need to address it, demanding higher Medicaid reimbursement rates.

For Rutland County Mental Health Services, that county’s designated provider, vacancy rates have been high since the beginning of the pandemic in March 2020.

“We have a number of vacancies and a number of positions ranging from residential care staff to licensed mental health clinicians,” said Dick Courcelle, the nonprofit’s chief executive officer. “So this impacts pretty much all areas of the agency, and it certainly has become more acute this past year in particular.”

Staffing shortages make it difficult to keep up. Moulton said Washington County has 140 people on a waiting list to receive support. People in crisis can get help fairly quickly, she said, but folks who need long-term therapy often have to wait.

And the demand for services is growing.

“COVID has led to higher levels of anxiety, depression, suicide, drug overdose and overall stress,” said Julie Tessler, executive director of Vermont Care Partners, a network of more than a dozen mental health and social services agencies. “So people’s needs have increased over the last three years, and at the same time our workforce has decreased.”

Nearly 1,000 Vermonters are waiting for mental health services across the state, Tessler said. Waiting for those services can worsen mental health problems, creating even more dire scenarios.

“When we can’t provide the level of support that people need in our community, we can’t provide all the residential and crisis beds that people need,” Tessler said. “And that’s one reason some people end up in emergency departments.”

The staffing crisis and its impact especially poses a problem for Vermonters with developmental disabilities.

In Washington County, Moulton said her agency has 45 vacancies in its developmental disabilities department, leaving clients without the daily support they need to thrive.

Lamoille County is in the same boat.

“Some of the services that we do, nobody else does,” said Michael Hartman, executive director of Lamoille County Mental Health Services, another designated agency. “So that’s another challenge to it, is that there are some folks with very specialized needs because of their disability.”

Without the staff to fill these roles, Hartman said, these needs aren’t being met. Why is this happening? When it really comes down to it, the main culprit is money.

Vermont’s mental health agencies are largely funded by Medicaid, so they get a low reimbursement rate from the federal government.

“In the last 15 years or so, our funding rates have lagged inflation by 15%,” said Tessler at Vermont Care Partners. “And even though we did get an 8% Medicaid rate increase last year, inflation was back.”

Leaders at state-designated agencies say they also can’t afford to pay staff competitive wages.

Many mental health workers make $20 or less, Tessler said, making it difficult to retain staff. If you can make more working in fast food and need to make ends meet, she figures, the choice to leave seems inevitable.

The rise of telehealth and private companies has also fueled this staff exodus.

“What we’re seeing is the explosion in telehealth services, certainly over the course of the pandemic, has resulted in some clinicians choosing to go do telehealth exclusively for one of these large online portals, so that they have greater flexibility in terms of their work,” said Courcelle in Rutland County.

Hartman, with the Lamoille County agency, said licensed counselors and social workers are hard to keep because they can find higher salaries in private practices or on their own.

Moulton said: “We’re offering flexibilities, we’re offering sign on bonuses. We’re trying to pay a more fair wage. We’re just trying to do everything we can to get people to want to come and do really good work.”

But agencies are reaching their limit. Their leaders say continued support from the Statehouse is crucial.

“We are hoping the Legislature will really evaluate the level of crisis we’re in and the people we’re serving are in,” said Tessler. “And we hope that they will appropriate a 10% Medicaid rate increase, and we’ll be advocating for that along with our partners.”

Despite the challenges, Moulton is grateful that Vermonters are still seeking mental health support and trying to advocate for themselves.

“I often say the pandemic was the great equalizer in that it made everybody realize that mental health is health,” Moulton said. “So the good news in this is that people are coming in who might not have sought mental health help because they didn’t think they should, or there was a stigma.”

The Community News Service is part of the Reporting and Documentary Storytelling Program at the University of Vermont.