Two states, same problem: Staffing shortages plague industry

By Eileen Weber
July 1st, 2023
David Matteodo, MPH
David Matteodo, MPH, is the executive director of the Massachusetts Association of Behavioral Systems.

Mass. and RI weigh in on nationwide dilemma

The mental health field has been hit hard with the nationwide staffing shortage that has impacted physicians, dentists, nurses and more.

According to the U.S. Substance Abuse and Mental Health Service Administration, there will be a deficit of an estimated 58,000 psychologists by 2025. In addition, the shortfall for other mental health professionals (psychiatrists, mental health counselors, social workers, school counselors, etc.) is estimated at close to 180,000.

“The two biggest holes are nurses and mental health professionals. That’s been our biggest problem,” said David Matteodo, MPH, executive director of the Massachusetts Association of Behavioral Systems. “We haven’t been able to fill the beds. We’ve got about 600 people boarding in the ERs per day. Ironically, we have about the same number of beds. But we can’t put a patient in a bed if we don’t have the staff.”

A survey run by Matteodo’s organization and the Massachusetts Health & Hospital Association found that 19.9 percent of those beds were “offline due to staffing shortages.” This was a nine percent increase from the previous year.

“We haven’t been able to fill the beds. We’ve got about 600 people boarding in the ERs per day. Ironically, we have about the same number of beds. But we can’t put a patient in a bed if we don’t have the staff.” --David Matteodo, MPH, executive director, Massachusetts Association of Behavioral Systems.

Joseph J. Trunzo, Ph.D., a practicing clinical psychologist in Rhode Island, agreed with Matteodo’s assessment. Trunzo is president elect of the Rhode Island Psychological Association.

In an Op-Ed he wrote in March for a local publication, Trunzo relayed that his practice is carrying an unprecedented wait list of more than 100 people. Prior to the current situation, he was able to see people within a week or two of initial contact.

Trunzo is chair of the psychology department at Bryant University and associate director of the School of Health & Behavioral Sciences.

“I have never seen the need for services and access to providers as intense as it is right now,” he wrote, noting he has spoken with other practitioners all in the same situation.

In addition, Trunzo noted, two-thirds of psychologists have reported an increase in the severity of symptoms among patients experiencing anxiety and depression, trauma, stressor-related disorders, and substance use disorders in 2022.

The shortage is attributed to a combination of factors including not enough people to replace retirees; increased worker burnout, and dissatisfaction with pay scale and reimbursement rates.

According to the Association of American Medical Colleges, more than 150 million people live in federally designated mental health professional shortage areas, and more than half of U.S. counties lack a single psychiatrist.

Based on a 2021 survey from the Mental Health Association of Rhode Island (MHARI), the biggest hit is to children and adolescents. Data from the Rhode Island Kids Count Factbook, indicated “36 percent of children aged three to 17 who needed behavioral health counseling were unable to obtain care, with wait times for youth psychiatric inpatient admission more than doubling between 2018 and 2019.”

For adults, MHARI highlighted SAMHSA’s reporting that only 47.5 percent with a mental illness in Rhode Island receive any treatment.

Staff shortages were a problem before the pandemic, but COVID exacerbated the issue.

Matteodo said patient acuity increased, specifically more patients displaying aggression.
When acuity rises, more staff is required for safety reasons.

“The pandemic made things worse,” he said. “We lost staff to things like patient acuity increasing. That’s been a challenge. We lost nurses to other opportunities. And we lost a lot of social workers to telemedicine because they can work remotely. In Massachusetts, telemedicine is mandated for behavioral health. Coverage and pay are the same as in-person.”

Matteodo also referred to an inadequate pool of applicants. Although efforts have been made to encourage and incentivize more people into the behavioral health care field, pay and the challenges of the job can be deterrents.

This past spring, the Boston Public Health Commission announced its “Behavioral Health Workforce Pathway,” initiative, with an eye toward recruiting individuals from communities to ensure cultural, racial, ethnic, linguistic, and other key aspects of diversity in the behavioral health workforce in Boston.

American Rescue Act funds will also be used to try to encourage more students into the profession.

In Rhode Island, the Executive Office of Health and Human Services, Office of the Postsecondary Commissioner and Department of Labor and Training convened a Healthcare Workforce Summit to identify current and future solutions to workforce challenges.

That meeting resulted in three groups focusing on different aspects of the problem: general pipeline development, the mental health workforce and compiling accurate data.

Another effort is the state’s first biennial comprehensive review of all social and human service programs in the departments of Human Services; Children, Youth and Families; Behavioral Healthcare, Developmental Disabilities and Hospitals; Health; and the Medicaid program, including reimbursement rates to providers.

The longstanding problem of boarding patients in emergency departments prompted the American College of Emergency Physicians and 34 other organization to write a collective letter to President Biden saying this issue is coming to a tipping point.

In the letter, the organizations highlighted the major current issues: patients experiencing preventable harm as a result of boarding in the ED; patients severe enough to require admission being treated in the waiting room without ever getting to the ED; the rise in pediatric patients; disproportionate impacts to patients with mental health emergencies; physician and nurse burnout; staffing shortages, particularly with nurses; and the healthcare system incentivizing hospitals to prioritize staff and bed space for more lucrative elective surgeries instead of other admissions.

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