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Opinion | Alabama faces critical staff shortages in community mental health care

Without mental health professionals and direct care staff, we can’t do our jobs. It’s as simple as that.

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If you or a loved one is receiving mental health services in Alabama, chances are this vital care could be delivered by a community mental health provider.

Community-based mental health providers serve the overwhelming majority of Alabamians who receive state care for mental illness, addiction, and intellectual disabilities.

It’s critically important that we continue to offer these services in community settings that are most affordable and accessible to the people who need it. But as the leader of an organization that represents 20 of these providers, I can tell you that our important work is in jeopardy.

If the state doesn’t make necessary investments that will allow our mental health system to keep up with rising costs and, specifically, the rising costs to recruit and retain staff, the services we offer our communities will be affected. Without mental health professionals and direct care staff, we can’t do our jobs. It’s as simple as that.

Recognizing this reality, the Alabama Department of Mental Health asked for $30.6 million in additional funding from the state’s next budget to address these workforce needs. Our community mental health providers urge the Alabama Legislature to fully fund this request – for the sake of the individuals and communities we serve.

Our providers offer a wide range of services for people across the lifespan — everything from outpatient mental health counseling to inpatient care; from day programs to group homes for people with developmental disabilities; and from court-ordered drug monitoring to residential substance abuse programs. These are needs that, when not met, have serious repercussions for our families and our communities.

But as it stands, the state funding we receive does not allow us to pay competitive salaries in today’s hyper-competitive healthcare workforce environment. Our direct care workers on average start at $12 an hour – less than many chain stores and fast-food restaurants are paying. On average, our master’s level mental health professionals make less than a bachelor’s level teacher. It’s easy for our workers to leave us for comparable jobs and increase their annual salary by $10,000 to $20,000 or more.

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Even though the state has made important investments in specific areas of mental health services in recent years, the basic workforce issues faced by community mental health providers have grown even worse. It’s the same story for mental health providers stretching from the Shoals to the Wiregrass, Mentone to Mobile and all points in between.

Almost one in five of our providers’ jobs is vacant right now.  Vacant positions have increased by more than 50 percent since late 2020.  Without the people who are the heart and hands and feet of our mission, we cannot continue to sustain current services.

Most Alabamians know all too well why this matters.

The federal Substance Abuse and Mental Health Services Administration reports that an astounding 41 percent of Alabama adults sought treatment for a mental health issue between 2017 and 2019.

Yet, according to 2023 data from Mental Health America, Alabama ranks near the bottom for access to mental health care.  Only Texas ranked worse than us on this list. This is based on a number of factors, including unmet needs, uninsured population and, importantly, workforce availability.

On the workforce availability front, we ranked dead last. Our state’s residents compared to the number of mental health practitioners was 850 to 1. Nationally, the ratio is 350 to 1. This represents a huge gap between the needs and our ability to meet those needs.

If we don’t address this issue, we will have to make difficult choices about consolidating or cutting services so that we can pay competitive wages to attract and keep our teams intact.

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Job shortages have already had an impact in recent years. Caseloads for mental health clinicians continue to increase because the need far outweighs the system’s capacity to serve, and people sometimes have to wait months for appointments. Forty-two agencies that operated 140 settings and served 1,012 individuals with intellectual disabilities and developmental disabilities have closed due to workforce issues.  As you can see, our services are in jeopardy when mental health providers have such a critical shortage of workers.

To be sure, this $30.6 million of new investment is only part of the solution. We must also create a better pipeline of people who are trained to meet the mental health needs of Alabamians. But it doesn’t matter how many people we train if our mental health providers don’t have enough money to hire them.

We urge Alabama lawmakers to help us keep mental health working – by making sure community mental health providers can pay competitive salaries and maintain the necessary staff to serve our communities’ needs.

Holly Caraway McCorkle is executive director of the Alabama Council for Behavioral Healthcare, which is made up of 20 community mental health providers that currently employ 5,200 people, provide services across Alabama, and meet the needs of more than 115,000 individuals with mental illness, substance use disorders and lifetime developmental disabilities that require ongoing supports.

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