For Better Behavioral Health, Ohio Must Start by Building the Workforce

Just over a year ago, my organization released “Breaking Point”: an in-depth report spelling out how serious the workforce crisis in behavioral health services had become. A year later, I wish I could say things are better. They aren’t. More Ohioans than ever need help with mental illness or substance abuse, and there aren’t enough professionals to help them.

The reasons are many, but here are some of the most significant:

• Attrition: The work is stressful and can be emotionally draining, with high caseloads, irregular work hours and the need to be on-call. The added risk of exposure to COVID-19 in recent years further increased the rate at which people left the profession, often for service or manufacturing jobs with less stress and better pay.
• Low reimbursement rates: Providers find private insurance coverage does not include a full range of services or recognize all available professional licenses, and generally pays less than Medicaid. Meaning reimbursement rates, regardless of payer, do not allow providers to pay competitive market wages to attract or keep talented practitioners.
• Excessive licensing and education requirements: Many behavioral health positions are required to have master’s degrees, even though wages and earning potential remain low.

None of this means, however, that there is no hope. Here in Ohio, Gov. Mike DeWine has shown visionary leadership in his commitment to build on promises of the past by investing in a community-based system of care for mental health and substance use disorders that will support the health and well-being of our children, families and communities. I hope to see more progress toward such a system in the budget that state lawmakers will pass this summer.

Those who work in this field are grateful for the investments already made by the Governor and the General Assembly, including $90 million to support expanding the mental-health crisis infrastructure throughout the state. Another $85 million is to go to training, internships, scholarships and other programs to grow the number of community behavioral health providers.

The Breaking Point report makes clear the need for this and much more. We already knew, thanks to data from the Ohio Department of Mental Health and Addiction Services, that demand for behavioral health services in Ohio grew by 353% between 2013 and 2019. That was before the extraordinary stresses of the pandemic drove another sharp increase in demand between 2020 and 2021, and demand is expected to continue increasing through 2030.

When we asked behavioral health providers what they’re seeing on the ground, large majorities reported a growing need for youth and adult mental health services and for substance-abuse-disorder services for adults. But it’s harder than ever for them to provide those services. Nearly all — 98% of providers surveyed — said they’re having trouble hiring staff. More than 88% said they’re having trouble keeping the staff they do hire.

The inevitable result? Ohioans are facing longer wait times for those services, and that delay can have destructive consequences — an individual’s condition often worsens, requiring longer and more expensive treatment. In the meantime, people can lose jobs, lose their home, get into legal or financial trouble or face life-threatening circumstances because of their illnesses.

Gov. DeWine’s budget proposal includes many provisions that could help strengthen the behavioral health workforce. An important one calls for a historic 10% increase in rates paid to community behavioral health Medicaid providers. I recently testified before the House Finance HHS Subcommittee in support of those budget provisions and others that will improve mental health and substance use disorder services in Ohio. And, we are respectfully asking the Ohio General Assembly to double the Medicaid rate increase to 20% just so community providers can stay competitive with other health care sectors and can begin to meet more demand for care.

In the broader picture, The Ohio Council’s strategy for building the behavioral health workforce rests on four pillars:

• Relief: Providing short-term funding to enhance wages and other incentives for workers, plus help navigating educational funding programs and building public awareness of the need for more workers.
• Parity: Improving the enforcement of laws requiring insurance plans to cover behavioral-health services at the same level as primary care, plus encouragement for the plans to directly reimburse for professional licensure and certification of behavioral health professionals.
• Simplicity: Making it easier for professionals licensed in other states to become credentialed in Ohio and reducing documentation burdens.
• Administrative Reform: Modernizing state licensure and certification requirements to create opportunities for all education levels; while advocating for new, dedicated funding for home- and community-based services, in the meantime identifying targeted reimbursement adjustments to increase access to that type of care.

Ohio is fortunate to have leaders willing to make behavioral health a priority, but we can’t make progress until we fully embrace behavioral health as essential healthcare and attract more people to these meaningful and valued professions.