What came first, the increase in children’s mental health issues or the shortage in staff to help them?
According to the Centers for Disease Control (CDC), anxiety, depression, ADHD, and behavioral health problems are the most common mental disorders in children. Many states, including Massachusetts, Connecticut, and Vermont, were lauded for their access to healthcare in a recent Mental Health America tally.
Those states, along with Rhode Island, were similarly recognized as providing better access for children according to a Soliant Health report.
In Connecticut, The Child Health and Development Institute (CDHI), based in Farmington, recently published a report presenting a strategic plan that promotes changes. It noted that a review found more than 40 different initiatives across 14 states and several national organizations are attempting to tackle rising behavioral health needs and staff shortages.
Aleece Kelly, MPP, senior associate at CHDI, said both behavioral health issues and staff shortages were occurring before the pandemic but significantly worsened during it.
“We are in this cycle of more kids with needs which leads to higher caseloads leading to staff burnout and turnover which brings on staff shortages and delays in care,” she said. “It’s just a cycle that keeps going around and around.”
The plan, developed by CHDI along with the Children’s Behavioral Health Plan Implementation Advisory Board with funding from the Connecticut Department of Children and Families, pinpoints eight recommendations for system and policy changes.
According to that report, the state needs to increase reimbursement rates; make significant investments in workforce recruitment and retention; develop a behavioral health center that can track trends in supply and demand; diversify the workforce pipeline; remove administrative barriers to workforce entry and retention; expand the youth and family peer support workforce; and expand the role and capacity of community-based organizations in prevention and early intervention.
Not only is recruitment a priority, but retention of qualified workers is as well.
“A recent survey of Connecticut non-profit providers found more than one in five positions were vacant, and there was a 39% rate of staff turnover in the last year,” according to the report.
Contributing to the problem is insurance reimbursement rates and grant funding have not kept pace with the rate of inflation. Also, the increased need for mental health care during the pandemic precipitated a change in delivery of care, namely telehealth.
That pulled many healthcare workers away from more community-based services, particularly in more under-served areas, and the higher level of mental healthcare needs led to burnout.
Jason Lang, Ph.D., CHDI’s chief program officer, agreed that lower levels of staffing create a huge problem. “I think the pay issue—lack of reimbursement and low pay—are additional barriers making the career less appealing,” he explained. “Clinicians have been leaving for higher paying jobs, retiring, or leaving the profession altogether, which leaves underserved areas behind. How do we build a pathway for clinicians when the salary and caseloads are so challenging?”
Kelly and Lang emphasized the importance of implementing the CHDI’s recommendations in Connecticut.
Kelly said, “There are other challenges in the system, but I think the eight recommendations made in the report go a long way to address the issues. Like setting reimbursement rates… I think that would address the underlying needs of financial support.”
Lang said although the recommendations would be a step forward, he added they are not an instant solution.
“This is a long-term plan,” he said. “It certainly would go a long way in setting the state on the right path, but it will take years to see it come to fruition.”
Some surveys have shown, like the data provided by the National Council for Mental Wellbeing this past April, more than 80% of the nation’s behavioral health workforce believes that without public policy changes, providers will not be able to meet the demand for mental healthcare.